Diverticular disease is characterised by intermittent abdominal pain in the left lower quadrant of the abdomen associated with constipation or diarrhoea. It can be difficult to differentiate from other conditions such as colitis, irritable bowel syndrome and colorectal cancer. Acute diverticulitis typically presents with severe constant left lower quadrant pain associated with signs of systemic upset such as fever. The patient may also have a change in bowel habit or rectal bleeding. On examination there is tenderness in the left lower quadrant. Acute diverticulitis may be complicated by perforation, abscess, fistula formation, bleeding or a stricture.

Heavy menstrual bleeding has been defined as ‘excessive menstrual blood loss which interferes with a woman’s physical, social, emotional, and/or material quality of life’. Heavy menstrual bleeding affects 25% of women of reproductive age and is estimated to be the fourth most common reason for gynaecological referrals. Women should be asked about pelvic pain which might suggest endometriosis and pressure symptoms which might suggest significant fibroids. Examination is appropriate if there is intermenstrual or postcoital bleeding and, if the woman is actively bleeding, may identify the source of the bleeding.

Impetigo is a common contagious bacterial infection of the skin. The causative organisms are either Staphylococcus aureus or, less commonly, Streptococcus pyogenes. The infection can occur at any age, but it is particularly common in children, especially the pre-school and early school age years, and tends to be more frequent during the summer months. It may arise on previously normal skin or complicate a pre-existing dermatosis. The diagnosis is essentially a clinical one, but if in doubt a swab should be taken for bacteriological culture.

Anxiety disorders are common, highly treatable conditions, with a strong evidence base for cognitive behaviour therapy. In a recent population sample of the under 12s, only 65% of those who met criteria for a diagnosis of an anxiety disorder had sought professional help and only 3.4% had received an evidence-based treatment. Assessment should include an exploration of neurodevelopmental conditions, drug and alcohol misuse, and speech and language problems.

Delirium is associated with an increased risk of subsequent cognitive decline and there is evidence to suggest that the association is causal, a systematic review and meta-analysis has found. Every study found that those with delirium experienced greater cognitive decline than controls and the combined odds for a given cognitive decline were more than doubled in patients with delirium; OR 2.30. Subgroup analyses provided evidence that delirium is a causative factor rather than a marker of vulnerability to dementia.

Nausea during the first few weeks of varenicline therapy may reduce adherence, a study from North America has found. The authors analysed data on 870 adults receiving varenicline in two smoking cessation trials conducted at multiple sites in Canada and the USA.

Reassurance is a mighty tricky skill. Get it right, and your patient will be happy, and unnecessary investigations and prescriptions will be avoided. Get it wrong, and the consequences can be profound. Over my career I developed a very simple rule. It’s fine to reassure a patient once. Be very cautious about giving reassurance twice. Never, ever, give reassurance three times.