A sore throat needs observations, ear and neck checks, and antibiotic scoring before throat appearance drives prescribing.
Tonsillar exudate alone should not drive antibiotic prescribing.
The most useful place to begin is acute tonsillitis, because sore throat is common and the prescribing choice often happens quickly. Use the review to slow that moment down: check observations, look beyond tonsillar exudate, examine ears and neck, then apply Centor or FeverPAIN before choosing supportive care, delayed antibiotics or immediate treatment. The same discipline helps with travellers’ diarrhoea, where hydration comes first and testing or antibiotics depend on severity, duration, blood, fever, pregnancy and persistence after return.
The next acute topic is critical care: prehospital trauma transfusion, post-ICU rehabilitation, severe respiratory infection and possible hantavirus exposure all show why protocols need local logistics and bedside physiology. For ward, clinic or revision time, diagnostic error brings continuity, safety-netting and planned follow-up into persistent unexplained symptoms. Idiopathic normal pressure hydrocephalus adds a concrete older-adult falls question: gait change, cognition, urinary symptoms, imaging and response to temporary CSF drainage need to be considered together. Classical homocystinuria is more specialist, but memorable when lens dislocation, developmental delay or young-onset thrombosis should trigger total homocysteine testing.
A sore throat can look straightforward, but antibiotic choices need more than tonsillar exudate. The review links fever, swallowing pain, oral intake, ear and neck examination, Centor or FeverPAIN scoring, and safety-netting for complications such as quinsy or airway concern.
Post-travel diarrhoea is usually clinical, not laboratory-led. This review separates mild self-limiting illness from moderate, severe, bloody or persistent symptoms, with clear attention to hydration, loperamide limits, selective azithromycin use, resistance, and protozoal causes after return.
Critical care teams get a broad update on neutral trials, trauma haemorrhage resuscitation, post-ICU rehabilitation, severe respiratory infection and possible hantavirus exposure. The most practical point is how protocols set a baseline while local logistics and patient physiology still shape escalation.
Persistent symptoms without a clear label need a plan, not another disconnected consultation. This conversation focuses on wrong, delayed and missed diagnoses, with practical habits around documenting uncertainty, safety-netting, follow-up, examination and team review when symptoms cross specialties.
Older adults with gait decline, cognitive change and urinary symptoms need more than a remembered triad. The shunting review explains how imaging, temporary CSF drainage response and objective gait measures help frame referral, consent and the real risks of haematoma or low-pressure headache.
Progressive myopia, lens dislocation, developmental delay or young-onset thrombosis can point to classical homocystinuria. The round-up is specialist but clinically memorable: total homocysteine testing matters, newborn screening can miss cases, and lifelong biochemical control protects against thrombotic harm.
When a child or young adult presents with sore throat, do not let exudate alone drive antibiotics. Check observations, ears and neck, use Centor or FeverPAIN consistently, and give clear safety-netting for poor oral intake, persistent fever, airway concern or quinsy. The tonsillitis review gives a cleaner prescribing structure.
What should be checked before antibiotics for acute sore throat?
Use Centor or FeverPAIN consistently, but do not stop at the throat. Check observations, inspect the ears and palpate the neck for cervical lymphadenopathy.
What should safety-netting cover in suspected tonsillitis?
Ask the patient to seek reassessment if symptoms fail to improve after 3 days, fever develops above 38.3°C, or there are concerns about quinsy, airway obstruction, otitis media or scarlet fever.
When does post-travel diarrhoea need more than hydration?
Testing or antibiotics become more relevant when illness is severe, persistent, bloody, febrile, complicated by pregnancy or dehydration, or when results will alter antimicrobial management.
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