Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes, affecting an estimated 0.1-0.2% of patients with diabetes in the UK. Affected women pass the condition on to both daughters and sons. However, affected men cannot pass the condition on to any of their offspring. It has high penetrance, with more than 85% of carriers developing diabetes during their lifetime. Bilateral sensorineural hearing loss occurs in most cases. The hearing loss typically develops in early adulthood and often precedes the onset of diabetes.

In general practice palpitations are reported in around 8 per 1,000 persons per year. The differential diagnosis includes cardiac and psychiatric causes, as well as numerous others e.g. anaemia, hyperthyroidism, prescribed medication, caffeine and recreational drugs. Factors that point towards a cardiac aetiology are male sex, irregular heartbeat, history of heart disease, event duration > 5 minutes, frequent palpitations, and palpitations that occur at work or disturb sleep.

There has been a marked increase in the availability and use of ECG machines in general practice. In 2008, Day and colleagues reported that 85% of GPs who responded to their survey had an ECG machine and that 91% of them used it at least once a week.  We report a case in which artefact was misinterpreted as torsades de pointes, often referred to simply as torsades. Our patient did not suffer any harm and did not have any unnecessary investigations, yet inappropriate treatment was administered making the potential for harm a real possibility. We describe the ECG features which differentiate artefact from torsades and review common sources of ECG artefact, in both hospital and general practice.

The close proximity of contraceptive implant placement to the course of the ulnar nerve can result in injury. Several factors have been implicated in this complication including: low BMI, erroneous placement of the implant, implantation over the brachial groove, and migration of the implant from its original insertion. Clinicians should familiarise themselves with the vulnerable neurovascular structures in the area and refer promptly to a specialist if any neurological symptoms develop during placement or removal of these devices.

A 30-year-old lady presented to the gynaecologist with persistent vaginal bleeding following insertion of an IUD. A transvaginal ultrasound showed a normal uterus, normal ovaries and no adnexal masses or free fluid. It was assumed that the IUD had fallen out. Around the same time she presented to her GP with a short history of dysuria, intermittent visible haematuria and recurrent UTI. Eventually, she was referred to the urology department for further investigation and underwent flexible cystoscopy, which showed the presence of an IUD within the bladder.

It is important to be vigilant for retained foreign bodies as a cause of recalcitrant bacterial conjunctivitis, even in the absence of foreign body sensation. A relapsing-remitting history should prompt referral to an ophthalmology department. All patients presenting with a red eye should be asked specifically about contact lens wear, and causes of conjunctivitis other than those bacterial in nature — such as viral and chlamydial infections or allergy — should be borne in mind.

Bell’s palsy has a typical presentation of sudden onset, mild otalgia, altered facial sensation and/or taste, with no obvious prodrome. It represents over half of hemifacial weakness cases in primary care. However, as a diagnosis of exclusion, there are a number of key clinical features of more sinister diagnoses that must be considered.

Lyme disease, also known as Lyme borreliosis, is caused by infection with Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) complex, a Gram-negative spirochaete bacterium. Infection in humans takes place through tick bites. The work-up of Lyme arthritis should include a careful history including residence in, or time spent visiting, an endemic region, previous history of tick bite(s), and erythema migrans.

Ramsay Hunt syndrome is a lower motor neurone weakness of the seventh (facial)cranial nerve caused by reactivation of the herpes zoster virus.