Lower/periumbilical abdominal pain is constant, worsening, and 8/10.

Patient is sexually active and uses Implanon.

Nausea is present; no vomiting, diarrhea, feverish feeling, faintness, breathing difficulty, or shoulder-tip pain.

Source plan: check pregnancy test today, contact immediately if positive, and urgent examination booked.

Source clinician booked urgent examination and instructed pregnancy test with immediate contact if positive.

I need to know where the pain is, how severe it is, whether it is constant or worsening, and whether you have vaginal bleeding, pregnancy possibility, fever, vomiting, faintness, shoulder-tip pain, urinary symptoms, or bowel changes.

Raw lower-abdominal-pain complaint lacks severity and reproductive red-flag details.

It is in the lower middle of my abdomen around/below the belly button. It has been getting worse and is constant, about 8 out of 10. I have some light vaginal bleeding and nausea. My last period was about two weeks ago. I am sexually active and have an implant. I do not feel faint, have no vomiting or diarrhea, no shoulder-tip pain, no feverish feeling, and no pain when peeing.

You need same-day urgent assessment. Please do a pregnancy test today and contact the service immediately if it is positive. Because the pain is severe, constant, worsening, and associated with vaginal bleeding, you should be examined urgently. Seek emergency care sooner if the pain worsens further, you faint, develop shoulder-tip pain, heavy bleeding, fever, or vomiting.

Source plan explicitly booked urgent examination and required pregnancy test today.


Raw source text and source clinician answers are withheld where redistribution is restricted; the transformed benchmark case, labels, and metadata in this file are released for CARE-Bench v1.0 use.

Lower central abdominal pain for 2 days.

Temperature measured 37 C; no back pain.

Source impression is possible UTI and plan is antibiotics with return precautions.

Source clinician suspected UTI and advised a 3-day antibiotic course with safety-netting.

Please tell me where the pain is, how long it has been present, whether you have fever, vomiting, back or flank pain, blood in the urine or stool, pain when passing urine, urinary frequency, or pregnancy possibility.

Raw abdominal pain complaint is not enough to select a care action.

It has been two days. The pain is in the lower middle of my tummy. I feel a bit nauseated but have not vomited. I noticed a little pink blood in my urine. My temperature was 37 C. I do not have back pain, pain when passing urine, urinary frequency, blood in stool, or diarrhea.

This could be a urinary infection and should be managed through a nonurgent clinician or local UTI pathway, including antibiotics if prescribed. Start the treatment as directed. Call back urgently if you develop a fever, back or flank pain, vomiting, persistent or worsening pain, or recurrent similar symptoms.

Source plan advised a 3-day antibiotic course and return precautions.


Diarrhea for 3 days with watery stools and urgency.

Vomiting is present and she cannot keep down water, tea, or other liquids.

Still passing urine, last about 1 hour ago.

Source plan: urgent appointment to assess hydration, stool culture, continue small sips ORT, A&E if worse.

Source clinician booked urgent appointment to assess hydration status because of fever and ongoing vomiting/diarrhea.

I need to know how long it has been going on, how often you are going, whether it is watery or bloody, whether you have fever, vomiting, abdominal pain, and whether you can keep fluids down and still pass urine.

Raw diarrhea complaint lacks hydration and red-flag details.

It has been three days. It started watery and is still very loose, and I have gone at least four times today. I feel like I am running a temperature. I have been vomiting and cannot keep down water, tea, or other fluids. I last vomited about two hours ago. I am still urinating, last about an hour ago. There is no blood in the stool.

You need same-day urgent assessment to check hydration and whether testing such as a stool culture is needed. Keep taking very small frequent sips of oral rehydration solution if you can. If you feel worse, become very drowsy, stop passing urine, develop severe abdominal pain, blood in stool, or cannot keep any fluid down, seek emergency care.

Source plan booked urgent assessment for hydration and advised A&E if worse.


Initial message reports a stuffy nose and asks about loratadine/Claritin.

Provider follow-up questions include duration, OTC response, fever over 100.4 F, trouble catching breath, COVID testing/exposure, reactive airway disease inhaler, facial pain, and symptoms over 10 days.

No final source-clinician action is provided.

Grounded in provider questions about fever, trouble catching breath, COVID, reactive airway disease, facial pain, and duration.

I have a stuffy nose and think it might be allergies. Should I just take Claritin?

Before deciding, I need a few targeted details: how long has this been going on, do you have fever, trouble breathing, facial pain, COVID exposure or testing, and have any over-the-counter medicines helped?

Provider questions ask duration, fever, breathing difficulty, facial pain, COVID exposure/testing, and OTC response. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

It started yesterday. I have no fever, no trouble breathing, no facial pain, and no known COVID exposure. I have not tested yet. I have not tried anything except saline spray, which helps a little.

With only short-duration congestion and no red flags, this can be managed with self-care for now. You may use an antihistamine such as loratadine if allergies seem likely and you can take it safely, plus saline spray and fluids. Consider COVID testing if exposure risk is possible. Seek care if symptoms last more than 10 days, facial pain becomes significant, fever appears, or breathing becomes difficult.

Provider questions establish no fever, breathing difficulty, facial pain, or prolonged duration. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

Today I developed a fever of 101.8 F and now I feel short of breath when walking across the room.

Because you now have fever with shortness of breath, you should seek urgent same-day medical care for assessment. If breathing is severe, you cannot speak in full sentences, lips turn blue, you feel confused, or symptoms are rapidly worsening, call emergency services.

Provider question set identifies trouble catching breath and fever as escalation-relevant triggers. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Initial message reports wheezing and shortness of breath with inhaler less helpful than usual.

Provider follow-up questions include chest pain, palpitations, duration, whether shortness of breath occurs at rest, fever, recent surgery/immobilization, swelling, orthopnea, dizziness/falls, inhaler type/frequency, and stair tolerance.

Grounded in provider questions about abnormal chest pain, palpitations, dyspnea at rest, fever, swelling, orthopnea, dizziness/falls, and inhaler response. Final adjudication used the source follow-up questions as severity triggers and coded same-day action as 1B.

I have been wheezing on and off today and my inhaler does not seem to help as much as usual. I am getting worried.

Because your wheezing and shortness of breath are worse than usual and your rescue inhaler is not helping as much as it normally does, you need same-day urgent clinical assessment. Use your reliever as directed while arranging care. Call emergency services now if breathing worsens, you become short of breath at rest, develop chest pain, feel faint, cannot speak normally, or the reliever does not help after the maximum dose in your asthma plan.

The source asks about dyspnea severity, chest pain, palpitations, fever, exertional limitation, and inhaler use. The patient already reports worsening wheeze/shortness of breath and reduced rescue-inhaler effect, which supports same-day care; under the codebook, same-day care is 1B.

It started this morning. I use a rescue inhaler and have used it more than usual. I can talk normally and I am not short of breath while sitting still, but walking up stairs makes me wheeze. I do not have chest pain, palpitations, fever, dizziness, swelling, recent surgery, or immobilization.

You can speak normally and are not short of breath at rest, which is reassuring, but using a rescue inhaler more than usual with persistent exertional wheeze still needs same-day urgent primary-care or urgent-care assessment. Avoid exertion and keep the inhaler available. Seek emergency care now if you become short of breath at rest, develop chest pain, feel faint, cannot speak normally, or the inhaler stops helping.

The clarification rules out emergency features but confirms increased rescue-inhaler use and exertional wheeze. Because the recommended action is same-day assessment, the correct benchmark label is 1B rather than 1A.

Now I am short of breath even sitting still, and I have tight chest pain with the wheezing.

Shortness of breath at rest with chest pain needs urgent emergency assessment now. Please call emergency services or go to the emergency department. Do not try to manage this only over messages.

Rest dyspnea and chest pain are explicit cardiopulmonary red flags in the source follow-up questions. Emergency assessment is required and maps to 1B.


Initial message reports intermittent runny nose without fever or sore throat.

Provider follow-up questions include trouble catching breath, COVID testing/exposure, OTC remedies, rescue inhaler/reactive airway disease, facial pain, and symptoms over 10 days.

Grounded in provider questions about breathing difficulty, COVID exposure/testing, OTC treatment, reactive airway disease, facial pain, and duration.

I have had a runny nose on and off today. I do not have fever or sore throat. Is this a cold, allergies, or something else?

I need to check a few things: are you having trouble breathing, have you tested for COVID or been exposed, do you have facial pain, how long has it been going on, and have you tried any over-the-counter remedies?

Provider questions focus on breathing, COVID, facial pain, duration, and OTC measures. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

It has only been one day. I have no trouble breathing, no facial pain, no known COVID exposure, and no fever. I have not tried medicine yet.

This can be managed at home for now as a likely cold or allergy pattern. You can try saline spray, fluids, and an antihistamine if allergies fit and it is safe for you. Test for COVID if exposure risk develops. Seek medical advice if symptoms last more than 10 days, facial pain or fever appears, or breathing becomes difficult.

No breathing difficulty, facial pain, fever, or prolonged course is present. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

Since then I started feeling short of breath and I am wheezing when I walk around the house.

New shortness of breath and wheezing should be assessed urgently today. If breathing is severe, you cannot speak normally, have blue lips, chest pain, confusion, or symptoms are worsening quickly, call emergency services.

Provider question set explicitly asks about trouble catching breath and rescue inhaler/reactive airway history. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Initial message reports sudden uncomfortable indigestion and asks whether to be checked.

Provider follow-up questions include chest pain, palpitations, shortness of breath, duration, triggers/stoppers, weight change, blood/dark stools, vomiting, missed meals, drooling, dizziness/falls, painful swallowing, travel, omeprazole use, and bariatric surgery history.

Grounded in provider questions about chest pain, palpitations, shortness of breath, GI bleeding, vomiting, dizziness, painful swallowing, and medication/surgery context.

I have weird indigestion that comes out of nowhere. It is uncomfortable and scary. Should I come in?

I need to clarify whether this could be more than indigestion: do you have chest pain or pressure, shortness of breath, palpitations, dizziness, vomiting, black or bloody stools, painful swallowing, or trouble eating?

Provider questions cover cardiac, bleeding, vomiting, swallowing, and functional red flags. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

It feels like burning after meals and lasts about 20 minutes. I have no chest pressure, shortness of breath, palpitations, dizziness, vomiting, black stools, blood in stool, drooling, or painful swallowing. I am eating normally and have not lost weight.

This sounds more consistent with reflux/indigestion and can be managed with self-care for now. Avoid trigger foods, large late meals, alcohol excess, and lying down soon after eating. You can use over-the-counter indigestion treatment if safe for you. Arrange nonurgent care if symptoms persist, worsen, or become frequent.

Red-flag questions are answered negatively and pattern is meal-related burning. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

This episode feels different. I now have pressure in the center of my chest, I feel short of breath, and I am lightheaded.

Chest pressure with shortness of breath and lightheadedness needs emergency evaluation now. Please call emergency services or go to the emergency department rather than treating this as indigestion.

Provider question set identifies chest pain/pressure, dyspnea, and dizziness as escalation-relevant triggers. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Patient is 67 and thought she was past menstruation.

She reports several days of worsening cramps, heavy bleeding, and sharp pains.

Provider follow-up questions include duration, last menstrual period, lightheadedness/dizziness/falls, pad count, discharge, fever, hysterectomy, weight loss/night sweats, dyspareunia, odor, family history of endometrial/ovarian cancer, and pregnancy possibility.

Grounded in provider questions about postmenopausal bleeding quantity, dizziness, fever, discharge, cancer history, and hysterectomy status. Final adjudication uses the source follow-up questions to distinguish emergency bleeding/infection features from prompt nonemergency postmenopausal bleeding evaluation.

I am 67 and having what feels like really bad menstrual cramps, which is strange because I thought I was long past that. It has been going on for a few days and is getting worse, with heavy bleeding and sharp pains. Should I come in?

Yes. Bleeding after menopause always needs clinical assessment, and heavy bleeding with worsening sharp pelvic pain should be assessed the same day. Please arrange same-day urgent clinical care now. Go to emergency care sooner if you are soaking pads rapidly, feel dizzy or faint, develop fever, severe pain, or feel very unwell.

Postmenopausal bleeding alone supports professional evaluation; the initial description adds heavy bleeding and worsening sharp pain. Because the appropriate action is same-day assessment, the benchmark label is 1B.

I am not dizzy or faint and have not fallen. I am not soaking pads rapidly. I do not have fever or abnormal discharge. I have not had a hysterectomy.

Those details reduce the need for emergency care right now, but bleeding after menopause still needs prompt professional evaluation and likely referral or testing. Please book a GP or gynecology appointment soon. Seek same-day urgent care if bleeding becomes heavy enough to soak pads quickly, you feel faint or dizzy, pain becomes severe, fever develops, or you feel very unwell.

The follow-up rules out rapid bleeding, hemodynamic symptoms, fever, abnormal discharge, and hysterectomy history. Professional evaluation remains required for postmenopausal bleeding, but the clarified state no longer requires same-day care.


Initial message reports cloudy, foul-smelling urine and pelvic pressure/pain.

Provider follow-up questions include duration, trajectory, dysuria, blood in urine, abdominal pain, bladder distention, medication changes, confusion, vaginal discharge/lesions/ulcers, new sexual partner, travel, nausea/vomiting/chills, and pregnancy possibility.

Grounded in provider questions about UTI symptoms, pelvic/abdominal pain, red flags, pregnancy, confusion, and STI/vaginal symptoms.

My urine is cloudy and smells bad, and I have pressure and pain in my pelvic area. I am worried and do not know what to do.

I need a few details before deciding the right level of care: how long has this been happening, is it getting worse, does it burn when you pee, is there blood in the urine, fever or chills, nausea or vomiting, pregnancy possibility, confusion, back pain, or new vaginal discharge or lesions?

Provider questions request duration, trajectory, UTI symptoms, red flags, pregnancy, and vaginal/STI symptoms. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

It has been two days and is about the same. It burns when I pee and I have pelvic pressure, but no fever, chills, vomiting, confusion, back pain, pregnancy possibility, blood in the urine, or new vaginal discharge or lesions.

This is consistent with a possible urinary tract infection. Please arrange nonurgent clinician care or a local UTI pathway for urine testing and treatment if indicated. Seek urgent care if you develop fever, back/flank pain, vomiting, confusion, pregnancy concern, or worsening severe pain.

Second round supplies urinary symptoms without systemic or upper-tract red flags. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Initial message reports dark, foul-smelling, cloudy urine starting today.

Provider follow-up questions include duration, trajectory, dysuria, blood in urine, abdominal pain, bladder distention, medication changes, confusion, vaginal symptoms, sexual exposure, travel, nausea/vomiting/chills, and pregnancy possibility.

Grounded in provider questions about urinary symptoms and red flags.

My urine is really dark, cloudy, and smells awful. It just started today and it is scaring me. Should I come in?

I need to check whether this is more than a hydration issue: do you have burning when you pee, blood in the urine, abdominal or back pain, fever or chills, nausea or vomiting, confusion, pregnancy possibility, new medications, or vaginal symptoms?

Provider questions target UTI and systemic/red-flag features. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

I have burning when I pee and some lower abdominal discomfort. I do not have fever, chills, back pain, vomiting, confusion, pregnancy possibility, vaginal discharge, or blood that I can see.

This may be a urinary tract infection. Please arrange nonurgent clinician care or a local UTI pathway for testing and treatment if appropriate. Drink fluids. Seek urgent care if fever, back/flank pain, vomiting, confusion, pregnancy concern, inability to pass urine, or worsening pain develops.

Follow-up adds dysuria and lower abdominal discomfort without urgent red flags. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Initial message reports swollen painful joints and muscles with difficulty moving and poor response to pain relievers.

Provider follow-up questions include which joints, duration, trajectory, redness, heat, purulent material, fever, OTC medication use, prednisone response, stool changes, blood in stool, and nocturnal stooling.

Grounded in provider questions about involved joints, red/hot joint, purulence, fever, medications, prednisone, and bowel symptoms.

My joints and muscles are swollen and painful, and it is hard to move around. Pain relievers are not helping much. Can I come in to see you?

Because several joints are swollen and painful and pain relievers are not helping, you should arrange a nonurgent medical appointment for evaluation. I also need to check urgent warning signs: is any joint hot, red, severely swollen, draining fluid, or are you feverish or generally unwell? Seek urgent care if those occur.

Provider questions seek septic joint and systemic red flags before action selection. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action. Secondary review revised this round to professional-care escalation based on the clinically sufficient current action threshold while preserving raw source text.

Both hands and knees have been swollen and painful for about a week. It is staying about the same. The joints are not red or hot, nothing is draining, and I do not have a fever. Ibuprofen has not helped much, and I am not taking prednisone. I have no new stool changes or blood in stool.

You should arrange a nonurgent clinician appointment to evaluate the joint swelling and pain, especially because it has lasted a week and affects multiple joints. Seek urgent care if a joint becomes red, hot, severely painful, you develop fever, pus, inability to move the joint, or you feel very unwell.

Follow-up rules out hot/red/purulent joint and fever while preserving professional evaluation need. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Initial message reports food-triggered stomach cramps, throat tightness, and hives after peanuts or shellfish.

Provider follow-up questions include sudden symptoms after new medication, trouble catching breath, OTC response, hive location, exact food triggers, known allergies, and whether urgent medical attention was sought.

No final source-clinician action is provided.

Grounded in provider questions about breathing difficulty, hives, food triggers, medication trigger, known allergies, and prior urgent care.

I think I might have food allergies. When I eat peanuts or shellfish, I get stomach cramps, my throat feels tight, and sometimes I get hives. Should I get tests?

Because you have had food-triggered hives with throat tightness after peanuts or shellfish, you should avoid those foods and arrange nonurgent medical or allergy evaluation to discuss testing and an emergency plan. If throat tightness or breathing trouble is happening now after eating, that would be urgent and you should seek emergency care.

Provider questions ask about breathing difficulty, hives, exact triggers, medication trigger, and urgent-care history. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action. Secondary review revised this round to professional-care escalation based on the clinically sufficient current action threshold while preserving raw source text.

I am not having symptoms right now. It has happened after peanuts and shellfish. The hives are on my chest and arms. I have not gone to urgent care before, and I have no known medication trigger.

Because you have recurrent food-triggered hives and throat tightness, you should arrange nonurgent medical evaluation, ideally with allergy care, and strictly avoid the suspected foods until assessed. If throat tightness, trouble breathing, swelling, dizziness, or widespread hives occur again after eating, treat it as urgent and seek emergency care.

No current symptoms, but recurrent food-triggered throat tightness/hives warrants professional allergy evaluation. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

I just ate shrimp by accident and now I have hives, my throat feels tight, and I am having trouble catching my breath.

This could be a severe allergic reaction. Call emergency services now or have someone take you to the emergency department. If you have an epinephrine auto-injector, use it as prescribed while waiting for emergency care.

Provider questions identify breathing trouble with hives and food trigger as escalation-relevant. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Initial message reports urinary leakage and difficulty starting urination on and off for a while.

Symptoms sometimes occur after coffee or citrus juice.

Provider follow-up questions include duration, trajectory, dysuria, blood in urine, vaginal births, medication changes, cough/sneeze leakage, vaginal symptoms, sexual exposure, travel, nausea/vomiting/chills, and pregnancy possibility.

Input sampling_domain says respiratory, but the patient text and follow-up questions are urinary/reproductive.

Grounded in provider questions about urinary symptoms, triggers, stress incontinence, vaginal birth history, medication changes, infection red flags, and pregnancy.

I have urinary leakage and trouble starting urination on and off. It has been happening for a while and seems worse after coffee or citrus juice. What can I do?

Because urinary leakage with difficulty starting urination has been happening for a while, you should arrange a nonurgent primary-care or urinary-health appointment. I would also ask about burning, blood, fever, chills, pregnancy possibility, new medicines, vaginal symptoms, and whether you ever cannot urinate at all.

Provider questions cover urinary infection, retention, pregnancy, medication, stress incontinence, and vaginal symptoms. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action. Secondary review revised this round to professional-care escalation based on the clinically sufficient current action threshold while preserving raw source text.

It has been several months and is about the same. I can urinate, but it takes a few minutes to start. I sometimes leak when I have urgency, not usually with coughing or sneezing. No burning, blood, fever, chills, nausea, vomiting, pregnancy possibility, new medicines, or vaginal symptoms.

This should be evaluated through a nonurgent primary-care or urinary-health appointment because it has persisted for months and includes leakage plus hesitancy. In the meantime, reducing bladder irritants such as caffeine and citrus may help. Seek urgent care if you cannot urinate, develop fever, severe lower abdominal pain, blood in urine, back pain, or confusion.

Follow-up rules out infection and retention red flags while preserving need for nonurgent evaluation. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


Initial message reports episodes of feeling faint or actually fainting a few times.

Provider follow-up questions include duration, trajectory, chest pain, shortness of breath, head/neck injury, antihypertensive changes, sweating/warning, fever/illness, premature coronary disease family history, blood counts, GI bleeding, diet change, and pregnancy possibility.

Grounded in provider questions about chest pain, shortness of breath, injury, medication changes, fever, family history, anemia/GI bleeding, diet, and pregnancy.

I have had a few episodes where I feel faint or actually faint, and I am worried. I am otherwise okay. Could this be blood pressure?

Because you have actually fainted more than once, you should arrange medical evaluation for causes such as blood pressure, heart rhythm, anemia, medication effects, or pregnancy depending on context. I also need to check urgent warning signs: chest pain, shortness of breath, palpitations, head or neck injury, black or bloody stools, fever, or family history of early heart disease.

Provider questions seek cardiac, injury, medication, bleeding/anemia, fever, and pregnancy risk factors. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action. Secondary review revised this round to professional-care escalation based on the clinically sufficient current action threshold while preserving raw source text.

It has happened twice over the past month. I had a sweaty warning before passing out, did not hit my head or neck, and recovered quickly. I have no chest pain, shortness of breath, palpitations, fever, black or bloody stools, pregnancy possibility, or recent blood-pressure medicine change.

Because you have actually fainted more than once, you should arrange nonurgent medical evaluation for blood pressure, heart rhythm, anemia, medication effects, and other causes. Until then, avoid driving or risky activities if you feel faint. Seek urgent care if fainting happens with chest pain, shortness of breath, palpitations, injury, pregnancy, severe bleeding, or no warning.

No urgent red flags are present, but recurrent syncope warrants professional evaluation. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.

It just happened again, and this time I had chest pressure and shortness of breath before I fainted. I also hit my head when I fell.

Fainting with chest pressure, shortness of breath, and a head injury needs emergency evaluation now. Please call emergency services or go to the emergency department. Do not drive yourself.

Provider questions identify chest pain, shortness of breath, and head/neck injury as urgent escalation triggers. Final-action label requires expert approval because Followup-Q supplies questions but no final clinician care action.


recent deep filling followed by infected nerve symptoms

source clinician recommends root canal first, especially if molar/separator area is involved

Source clinician states that if the infected tooth is a molar where separators will be placed, root canal treatment should come first, and even for an anterior tooth root canal first is preferred.

I am scheduled to have separators placed tomorrow before braces, but I have a tooth infection after a deep filling and may need a root canal. The pain improved after antibiotics from the emergency room. Can I still get the separators and wait on the root canal?

You should contact your orthodontist and dentist before the separator appointment. The infected tooth should be evaluated and treated, especially if it is near where separators will be placed, and a root canal may need to happen before moving forward with braces.


source clinician discusses medication timing, ovulation timing, and semen analysis

Source clinician asks about medication timing and ovulation-period contact, then recommends semen analysis if the medication-timing approach fails.

I have been trying to get pregnant for 11 months with no positive result. My gynecologist prescribed Fertyl 100 mg, but it has not worked, and I also had a miscarriage. What should I do next?

This should be handled with your gynecologist or fertility clinician rather than by changing treatment on your own. You should review how the medication was taken, whether intercourse was timed around ovulation, and whether your partner needs semen analysis if pregnancy still does not occur.


one month of rectal-area pain radiating to lower back and left leg

no stomach pain, fever, or blood reported

anti-inflammatory treatment already tried

source clinician identifies spinal disc irritation or muscle spasm as likely possibilities

Source clinician identifies spinal or muscle-related causes as most likely. Reviewer changed the action to nonurgent follow-up because the patient reports persistent symptoms despite prior treatment.

For about a month I have pain around my rectum that goes to the left side of my lower back and my left leg. I have no stomach pain, fever, or blood. My doctor gave me anti-inflammatory medicine for two weeks, but the pain is still there.

Because the pain has persisted for about a month and has not resolved after two weeks of anti-inflammatory medicine, you should arrange nonurgent follow-up with your clinician. The pattern can fit a back or nerve-related problem, such as disc irritation or muscle spasm. Seek urgent care sooner if you develop new weakness, numbness, fever, or bowel or bladder changes.


source clinician lists possible lesions or enlarged gland

source clinician recommends biopsy for diagnosis

Source clinician recommends biopsy of the soft-palate lump to establish the diagnosis.

I have a soft lump on the roof of my mouth in the soft palate area. It looks normal and is not red, but it hurts when I swallow. Could it be a blood clot or a swollen gland?

You should arrange an in-person dental, ENT, or oral-surgery evaluation. A clinician needs to examine the lump and may recommend biopsy or other testing to identify the cause.


28-year-old male who smokes and drinks heavily

submental mass growing for several weeks

mass is painful, hard, and barely mobile

source clinician lists infection, TB, and cancer

source clinician recommends FNAC and oncologist visit without delay

Source clinician recommends FNAC of the mass and says not to wait, with possible infection, TB, or cancer.

I am 28, smoke and drink a lot, and for a few weeks I have had a mass under my chin that is still growing. It is hard, painful to touch, and barely moves. I do not have fever, shortness of breath, chest pressure, rash, or itching. Could this be cancer?

You should arrange prompt in-person evaluation with a clinician, such as an ENT doctor or oncologist. The mass needs examination and likely testing such as fine-needle aspiration to distinguish infection, tuberculosis, cancer, or another cause.


32-year-old male with abnormal sperm quality and quantity

source clinician recommends semen-quality supplement and ovulation induction with intrauterine insemination

Source clinician recommends measures to improve semen quality and suggests ovulation induction and intrauterine insemination.

I am 32 and have been married for 3.5 years. My semen report says my sperm quality and quantity are low. IVF did not work, and my wife's condition was said to be normal. We do not want another IVF cycle. How can I improve fertility, and can we expect a natural pregnancy?

You should review this with a fertility specialist or urologist. They can reassess the semen results, discuss evidence-based measures or supplements, and decide whether ovulation induction with intrauterine insemination or another approach is appropriate.


The requester is considering a mouthwash product and asks whether its ingredients could interact with warfarin.

Source clinician recommends water intake and artificial saliva for dry mouth, but does not resolve the interaction question.

Derived from MedDialog OpenMed train:64, where a healthcare-advice requester asks about dry-mouth management and possible mouthwash interaction for someone taking warfarin; the source clinician gives general dry-mouth self-care advice.

I help care for someone who takes warfarin and has dry mouth. I am considering a mouthwash product and want to know whether its ingredients could interact with warfarin. The ingredients include glycerin, xylitol, sodium benzoate, peppermint oil, lemon peel oil, enzymes such as lysozyme, amylase, and papain, lactoferrin, and other components.

Because the person is taking warfarin and the question is about a product interaction, this should be checked with a pharmacist or the clinician managing the warfarin before using the product. For dry mouth, frequent water intake, sugar-free saliva-stimulating products, and artificial saliva may help, but the interaction question should be verified first.

The source case asks about dry-mouth treatment and potential mouthwash interaction in someone taking warfarin. The source response supports dry-mouth self-care, while the interaction question supports nonurgent professional or pharmacist verification.


taking Lamisil for toenail fungus for about one month

source clinician says no consistent association between terbinafine and psoriasis causing lupus

source clinician asks for a picture to guide further

Source clinician says the rash could be fungal and asks the patient to send a picture of the skin condition to guide further advice.

I am 18 and have psoriasis. After about a month of taking Lamisil for toenail fungus, I developed a rash on the left side of my nose that has lasted more than a week. My back also feels itchy, and I have some joint stiffness. I am worried because I read that Lamisil plus psoriasis can cause lupus.

I need more information before choosing a care recommendation. Please provide a clear photo of the rash if possible, and say whether you have fever, mouth ulcers, facial swelling, spreading rash, or worsening joint pain.


persistent back, hip, and calf pain after surgery

bowel symptoms alternating constipation and diarrhea for at least six months

source clinician discusses IBS, Crohn disease, bowel malignancy, colonoscopy, and radiating pain causes

Original source clinician discussed bowel disease and radiating pain but did not directly address the bladder-control red flag. Reviewer revision flags this as a clinically high-risk source conflict requiring expert final approval.

I am 58 and had back surgery in August. X-rays looked normal, but I still have a lot of pain along my back, hip, and calf. I also have bowel problems alternating between constipation and chronic diarrhea, and I no longer have control over my bladder. This has been going on for at least six months, and I already had a colonoscopy.

Back, hip, and calf pain together with loss of bladder control after spine surgery needs urgent medical evaluation now. Please contact your spine surgeon or go to urgent/emergency care today, especially because bladder-control changes can signal a serious nerve or spinal problem. The alternating constipation and diarrhea also need follow-up, but the bladder-control change is the urgent issue.


66-year-old with new phimosis for 40 to 45 days

source clinician says cause may be infected smegma or bacterial infection

source clinician says picture can confirm and circumcision gives complete cure

Source clinician says the cause should be identified, mentions infected smegma or bacterial infection, asks for a picture for confirmation, and states that circumcision gives complete cure.

I am 66 and developed a foreskin problem about 40 to 45 days ago. A doctor said it is phimosis and suggested surgery, but I do not want surgery. Now there is too much swelling and pain in the foreskin. I tried ketoconazole cream and homeopathy. What should I do?

You should arrange in-person evaluation with a doctor or urologist. Painful swelling can come from infection or trapped secretions, and the clinician needs to examine the foreskin and discuss appropriate treatment options, including whether circumcision is needed.


back molars feel out of alignment and do not meet on biting

history of pain and large cavity under filling

source clinician recommends oral surgeon visit, OPG radiograph, and treatment planning

Source clinician recommends visiting an oral surgeon, obtaining an OPG radiograph, and planning tooth removal if needed, with rinses and medications as prescribed.

I had my wisdom teeth removed on Friday. I heard the doctor say he was worried about my back molars. Now the back molars seem off to the side and do not touch when I bite down. One had pain and a large cavity under a filling before. I also have a pus taste. Will it heal, or do I need more teeth removed?

You should contact the oral surgeon or dentist for an examination. The pus taste, bite change, pain history, and large cavity need dental assessment, and an X-ray may be needed before deciding whether any tooth needs treatment or removal.


87-year-old with four months of cellulitis history

warmth and redness resolved but swelling, tightness, and pain remain

uses leg elevation and compression stocking

source clinician recommends physiotherapy/electrotherapy and calf exercises

Source clinician recommends physiotherapy with interferential therapy and calf stretching/isometric exercises to reduce swelling.

I am 87 and had cellulitis for about four months. The warmth and redness are gone, but swelling remains in my ankle and sometimes there is tightness and pain. Antibiotics have not helped. I elevate the leg and use a compression stocking. Do I need to stay in bed with the leg up most of the time?

You do not need to assume bed rest is the only option. You should discuss persistent swelling with a clinician or physiotherapist, since supervised therapy and calf exercises may help residual swelling after cellulitis.


itchy penile rash and thigh rash for three months

source clinician suggests allergic rash and says it may settle, with antihistamine if persistent

Source clinician framed the rash as possibly allergic/inflammatory, but reviewer identified a source-action conflict because the patient reports prolonged genital symptoms and recent unprotected sex.

For three months I have had a very itchy penis with red glossy patches after scratching, pain during intercourse, itchy red spots over my thighs, itchy nipple, and dry patches on my eyelids and hairline. I had a lot of unprotected sex recently and worry this might be an STD, but the symptoms do not seem to match one. I am in China and having trouble getting a diagnosis.

Because the genital rash has lasted three months, causes pain during intercourse, and followed recent unprotected sex, you should arrange a nonurgent in-person clinician visit for examination and STI testing. Avoid sex or use condoms until you are evaluated, and seek urgent care if you develop fever, rapidly spreading rash, severe genital pain, sores, or trouble urinating.


breathing has not improved while other aspects have

ibuprofen used for about four months instead of prescribed pain medication

source clinician states thymic cancer can cause respiratory distress and treatment choice depends on cancer type, stage, resectability, and other medical problems

active cancer treatment with chemotherapy and radiation

new or ongoing respiratory symptoms during cancer treatment

breathing symptoms require prompt oncology or urgent assessment rather than self-management

Source clinician states that thymic cancer can cause respiratory distress and discusses that management depends on cancer type, stage, resectability, and medical context.

I have thymic cancer and am receiving chemotherapy and radiation. The treatments improved most things except my breathing. I avoid prescribed pain medicines because of side effects and have been taking ibuprofen at the recommended dose for about four months. Could ibuprofen be causing my respiratory issues?

Because you have thymic cancer, are receiving chemotherapy and radiation, and have breathing symptoms that have not improved, you should contact your oncology team or treatment center today or use their urgent advice line. Breathing changes during cancer treatment can reflect the cancer, treatment-related lung inflammation, anemia, infection, a blood clot, fluid around the lungs or heart, or another problem that needs prompt assessment. If you are short of breath at rest, symptoms are worsening, you have chest pain, fainting, blue lips, fever, or you cannot speak normally, seek emergency care now.

The source case reports thymic cancer, active chemotherapy/radiation, and respiratory issues that did not improve. This supports same-day professional escalation, with emergency escalation if severe or worsening breathing features are present.


history of breathing problems after chemical and fume exposure

source clinician response is truncated and does not provide a complete action plan

Reviewer-adjudicated trigger-action rule: current chest pain plus facial/lip swelling and breathing problems is delay-unsafe and warrants urgent/emergency evaluation. The source clinician response was truncated and not used as the action anchor.

I am having a lot of stomach and abdominal pain and chest pain. I woke up this morning with swelling in my face and swollen lips. I have also had breathing problems since working around chemicals and fumes. I have been to a few doctors and still feel like I am suffering. What could be going on?

Chest pain together with face or lip swelling and breathing problems needs urgent evaluation now. Please seek emergency care or call local emergency services, especially if breathing is difficult, the swelling is worsening, or the chest pain is ongoing.


pain mainly high on left back side of head

pain radiates to other head areas and responds to pain medicine

left-sided neck swelling previously assessed as not serious

Source clinician response is incomplete after acknowledging the medical history, so the source action is weak; the patient question asks whether MRI is warranted.

I have had moderate headaches for quite some time, mainly high on the left back side of my head. Pain medicine helps, but the pain often radiates to other parts of my head. I also have swelling on the left side of my neck that my physician said was not serious. Is it worth getting an MRI?

You should follow up with your physician for a focused examination and to decide whether imaging such as MRI is needed. Persistent one-sided headaches with a neck swelling should be assessed in person even if pain medicine helps.


patient asks about source and possible transmission from employer

source clinician explains person-to-person and fecal-food/water transmission

source clinician notes many infected people are asymptomatic

Source clinician explains that H. pylori can be transmitted person-to-person by saliva or by fecal contamination of food or water, and that many people are asymptomatic.

My doctor told me this afternoon that I have H. pylori disease. Can it be detected where I got it from? My employer has H. pylori too. Is it possible she gave it to me?

H. pylori can spread person-to-person, including through saliva, and can also spread through contaminated food or water. It is usually not possible to identify the exact person or source from a routine diagnosis. Follow the treatment plan from your doctor.


completed course and felt well for one year without medicine

current abdomen feels larger and tight after food

source clinician says active abdominal TB is remote and considers other causes of bloating/tightness

Source clinician states that because the patient was asymptomatic for the last year, the chance of active abdominal TB is remote and other causes of abdominal bloating/tightness are more probable.

I had abdominal tuberculosis two years ago and completed treatment. For the last year I felt okay without medicine. Now my abdomen feels larger and tight after food, but I have no fever, pain, or weight loss. I am worried it might be abdominal TB again.

Based on the source information, active abdominal TB is less likely when you have been well for a year and have no fever, pain, or weight loss. Monitor the symptoms and arrange routine medical review if the bloating persists or new symptoms appear.


trial of Zoloft for two weeks caused stomach cramps and illness

fear of medication side effects and tolerance

patient wants help beyond natural management

source clinician recommends discussing dose reduction or medication switch with treating psychiatrist

Source clinician explains that early sertraline side effects can occur and recommends discussing lower dose or alternative medications with the treating psychiatrist.

I have had depression and intrusive thoughts for five years. I tried Zoloft for two weeks and became very ill with stomach cramps and other side effects. I am afraid of medication tolerance and other side effects, but I am tired of trying to handle this naturally. What help can you suggest?

You should discuss this with a psychiatrist or prescribing clinician. They can consider whether to restart at a lower dose, switch medication, or use other treatments while monitoring side effects.


patient was told potassium level was low

patient bought 595 mg potassium gluconate pills

cardiology appointment scheduled next Monday

source clinician response is truncated after acknowledging the query

Source clinician response is incomplete after stating that the opinion follows from the clinical history and query; the source does not provide the full action plan.

I have high blood pressure and was told my potassium level was low. I bought potassium gluconate pills, 595 mg, but I am scared to take them after reading the side effects. I have an appointment with a cardiologist next Monday. What should I do?

Do not start potassium supplements until you check with the clinician who ordered the test, your cardiologist, or a pharmacist, because the right action depends on the actual potassium level, kidney function, and blood-pressure medicines. Keep the cardiology appointment, and ask whether repeat labs or a specific dose are needed. Seek urgent care if you develop severe weakness, fainting, chest pain, new palpitations, or confusion.


Requester asks about alcoholic versus non-alcoholic mouthwash for bad breath related to smoking.

Requester is in hygiene school and wants to know whether to recommend non-alcohol mouthwash for patients who smoke and drink alcohol.

Source clinician says alcohol-free mouthwash is preferable in such cases.

Source clinician lists ingredients to avoid and ingredients that may help reduce oral bacteria.

Derived from ChatDoctor-iCliniq train:55, where the source clinician recommends alcohol-free mouthwash and gives ingredient guidance for bad breath in smokers/drinkers.

Is there a difference between alcoholic and non-alcoholic mouthwash? Which is better for combating bad breath from smoking? I want to know whether to recommend non-alcohol mouthwash for patients with bad breath from smoking who also drink alcohol. They are not going to stop smoking or drinking. I am looking for a way to avoid drying out tissues.

Alcohol-free mouthwash can be preferable in people who smoke and drink because it is less drying. Avoid products with alcohol and irritating ingredients such as sodium lauryl sulfate when dryness is a concern. Products with ingredients such as sodium benzoate, sodium bicarbonate, and antibacterial components may help reduce oral bacteria. Tongue cleaning and routine oral hygiene remain important.

The source clinician recommends alcohol-free mouthwash and ingredient-based self-care guidance.


spots appear on a different arm every morning

source clinician identifies these as petechiae

source clinician asks about other complaints, recurrence, drug history, and trauma

Source clinician identifies the blood dots as petechiae and asks for other clinical complaints, recurrence details, drug history, and recent trauma.

I have blood dots under my skin that appear only on my arms. They are on a different arm every morning. They do not itch and are not raised.

I need more information before choosing the care level. These may be petechiae, so please say whether you have easy bruising, nosebleeds, gum bleeding, fever, new medicines, recent trauma, or whether the spots are spreading.


small pimple on penis and testicles present for six years

previous clinician reportedly said it was normal

source clinician states no need to worry if small and asymptomatic and asks for images to guide further

Source clinician gives conditional reassurance if the lesion is small and asymptomatic and requests images for further guidance.

I have had a small pimple-like spot on my penis and testicles for about six years. A doctor told me a long time ago that it was normal, but I am still worried. What should I do?

I need a little more detail before deciding the right next step. Has it changed in size, become painful, bled, opened into a sore, produced discharge, or caused any urinary or sexual symptoms?

The source case gives a six-year penile/testicular pimple and the source clinician asks for images and symptom context before further guidance.


18-year-old with forgetfulness since elementary school

symptoms include misplacing objects and poor attention during autopilot activities

source clinician says this is not typical Alzheimer disease and suggests concentration disorder, ADHD, anxiety, CBC, thyroid tests, and mental-health evaluation

Source clinician recommends psychiatrist or psychologist evaluation and basic blood and thyroid testing.

I am 18 and have been forgetful since elementary school. I often misplace things, forget what I was doing when I am on autopilot, and worry that this could be early Alzheimer disease.

This pattern is not typical for Alzheimer disease at your age. You should arrange a nonurgent visit with a primary-care clinician or mental-health professional to assess attention, anxiety, ADHD, anemia, and thyroid causes.

The source clinician frames the symptoms as possible concentration disorder, ADHD, anxiety, anemia, or thyroid dysfunction and recommends nonurgent professional assessment.


passed grey tissue-like material and bleeding stopped

source clinician recommends urine pregnancy test and pelvic ultrasound if negative

Source clinician states the passed tissue could represent abortus and recommends urine pregnancy test, followed by pelvic ultrasound if pregnancy test is negative.

I had spotting for most of this month, then heavy bleeding for two days. I passed something that looked like grey muscle and then the bleeding suddenly stopped. What could that mean?

I need two details to guide the safest next step: is there any chance you could be pregnant, and are you currently having heavy bleeding, severe pelvic pain, dizziness, or fainting?

The source case gives abnormal bleeding and passed tissue but does not specify pregnancy possibility or current instability.

There is a chance I could be pregnant. I am not bleeding heavily now and I do not feel dizzy or faint, but I am worried about what I passed.

You should take a urine pregnancy test and arrange nonurgent gynecology or primary-care follow-up. If the test is negative, a pelvic ultrasound may be needed to check the uterine lining and other causes of abnormal bleeding.

The source clinician recommends urine pregnancy testing and pelvic ultrasound if the pregnancy test is negative.


six-year-old with nasal blockage for two weeks

new fever with swollen throat and tonsils

already seen by a doctor and prescribed Benadryl and Crocin DS without antibiotics

source clinician recommends antibiotic treatment

Source clinician recommends antibiotic treatment in addition to the medications already prescribed.

My six-year-old has had a blocked nose for two weeks and now has fever with swollen throat and tonsils. A doctor gave Benadryl and Crocin but no antibiotic. Is that okay?

Before deciding, is he breathing comfortably and able to swallow fluids, and does he have drooling, neck swelling, severe sleepiness, or signs of dehydration?

The source gives fever and swollen tonsils in a child but does not state whether airway, swallowing, or hydration red flags are present.

He is breathing normally and drinking fluids. No drooling, neck swelling, severe sleepiness, or dehydration. The fever and swollen tonsils are still there.

He should have a nonurgent pediatric reassessment to decide whether this needs antibiotic treatment or testing. Continue fever care as prescribed, but the antibiotic decision should come from a clinician who examines him.

The source clinician recommends adding antibiotic treatment; this supports professional reassessment without emergency escalation when airway and hydration red flags are absent.


36 hours later has marked right shoulder/scapular pain worse with sitting up and raising the arm

Source clinician says shoulder pain after trauma should be examined by an orthopedic surgeon and shoulder-region X-ray is required.

I fell from my bike onto my right side yesterday. My chest X-ray was normal, but now my right shoulder blade area hurts a lot when I sit up or raise my arm. Is this normal?

Do you have shoulder deformity, numbness or weakness in the arm or hand, severe chest or abdominal pain, or trouble breathing now?

The source describes post-traumatic shoulder pain but requires screening for urgent trauma complications before choosing the care level.

No deformity, numbness, weakness, breathing trouble, or severe chest or belly pain now. The shoulder pain is still much worse with movement.

This should be checked by a clinician or orthopedics nonurgently, with shoulder imaging if needed. Persistent shoulder pain after trauma should not be treated as normal even when a chest X-ray was normal.

The source clinician recommends orthopedic examination and shoulder-region X-ray for post-traumatic shoulder pain.


patient repeatedly pushes it with tongue and clenches teeth

wisdom tooth pressure and bruxism are suspected by patient

source clinician recommends dental assessment and possible mouth guard depending on mobility grade

Source clinician recommends visiting a dentist to grade tooth mobility and consider mouth guard, scaling, or root planing depending on findings.

My first molar feels a little loose. I keep pushing it with my tongue and I also clench my teeth. It does not hurt and looks healthy. Could this be from grinding or wisdom teeth pressure?

Has there been recent trauma, gum swelling, pus, fever, severe pain, or a tooth that feels like it may fall out?

The source reports looseness without pain, but acute dental infection or trauma symptoms are not specified.

No trauma, swelling, pus, fever, or severe pain. It is just looser than before and I clench my teeth a lot.

You should arrange a nonurgent dental visit so the dentist can grade the looseness and check for gum disease, bite trauma, bruxism, or wisdom-tooth pressure. Avoid pushing the tooth, and ask about a night guard if grinding is present.

The source clinician recommends dental evaluation and treatment depending on mobility grade, including mouth guards for bruxism.


root canal was started but not completed

dentist repeatedly opens tooth and places medication

source clinician says repeated sittings can occur with infection and advises antibiotics/painkillers and discussion with dentist, with X-ray to clarify

Source clinician explains staged root-canal care for infection and advises talking with the dentist and reviewing the tooth X-ray.

I am in the middle of a root canal. The dentist keeps opening the tooth and putting medicine in, but the treatment is not finished and I am in a lot of pain. Is that standard?

Do you have facial swelling, fever, pus, trouble opening your mouth, trouble swallowing, or trouble breathing?

The source reports severe tooth pain during staged root canal care but does not state whether spreading infection or airway symptoms are present.

No fever, facial swelling, pus, trouble opening my mouth, swallowing trouble, or breathing trouble. The tooth pain is still severe.

You should contact your dentist for a nonurgent but prompt dental review. Repeated medication between root-canal visits can be used when infection is present, but severe ongoing pain should be reassessed and the X-ray reviewed.

The source clinician advises antibiotics/painkillers when infection is present and tells the patient to talk with the dentist and review the X-ray.


29-year-old male with normal testosterone level

wants small weekly testosterone injections for more masculine appearance

source clinician states testosterone helps only if testosterone is low and may be harmful when levels are normal

source suggests exercise rather than testosterone injections

Source clinician states testosterone injections are not indicated with normal levels and may cause harm; exercise is recommended for physical build.

I am 29 and want to take a small weekly testosterone injection to look more masculine. Would that help my face, voice, hands, or body build?

Have you been diagnosed with low testosterone, and was this confirmed on blood testing by a clinician?

The source action depends on the patient having normal versus low testosterone.

My testosterone blood test was normal. My sexual function and erections are good. I mainly want a more masculine build and voice.

Do not start testosterone injections for appearance when your level is normal. They are unlikely to give the changes you want and can cause harm; focus on strength training and discuss body or hormone concerns with a clinician if they continue.

The source clinician states testosterone injections are beneficial only when testosterone is low and otherwise may harm the patient; exercise is advised.


2-3 days of wheeze and shortness of breath

history of childhood asthma with prior hospital visits

more wheezy walking to work and sometimes cannot complete sentences

source plan includes increased salbutamol/spacer, peak flow monitoring, review, and urgent appointment if worsening or unwell

Source note reports asthma history, current wheeze, exertional worsening, and sometimes inability to complete sentences; source plan says urgent appointment if wheeze is not settling or patient feels unwell.

I have been wheezy recently and feel a bit short of breath. I had asthma when I was younger. What should I do?

How long has this been going on, and are you short of breath at rest, unable to finish sentences, or needing your reliever inhaler more often?

The source begins with wheeze and asthma history but requires severity information before choosing the care level.

It has been two or three days. I am more wheezy walking to work, have missed work, and today the wheeze is not settling. Sometimes I feel too short of breath to finish a sentence when talking. I still have salbutamol.

Because the wheeze is not settling and you sometimes cannot finish sentences, you need urgent same-day medical assessment. Use your reliever inhaler as prescribed while arranging care, and go to emergency care sooner if breathing worsens or you cannot speak comfortably.

The source notes asthma/wheeze, missed work, sometimes being unable to complete sentences, and an urgent-appointment trigger if wheeze is not settling, worsening, or the patient feels unwell.


six weeks of fatigue and feeling run down

symptoms began after returning from the United States/Yosemite

red circular rash on calf lasted several weeks and faded

had fever and sore throat around that time

source plan recommends screening bloods including Lyme serology and GP follow-up

Source impression is six-week fatigue with history of circular calf rash; plan is screening bloods including Lyme serology and GP follow-up in one week.

I have felt tired and run down for about six weeks, with aching in my shoulders, legs, and back. I am not sure what is going on.

Have you had recent travel, fever, sore throat, weight loss, or any rash around the time this started?

The source case requires travel and rash history to identify the testing threshold.

It started a couple of weeks after a trip to Yosemite. I had a red circular rash on my calf that lasted a few weeks and faded, and I had fever and sore throat around then. No weight loss.

You should arrange a nonurgent GP visit for blood tests, including Lyme serology, and review the results. This does not sound like an emergency from what you described, but it needs professional evaluation.

The source plan recommends screening bloods for tiredness all the time, including Lyme serology, with GP follow-up.


three days of persistent headache beginning on waking

pain worse over right eye with photophobia and lights in vision

ibuprofen eases slightly but does not resolve it

no vomiting, fever, rash, nighttime waking, weakness, numbness, or vision loss

source impression is likely migraine but needs neurological examination because persistent and ongoing

Source clinician says likely migraine but ongoing persistent headache needs neurological examination to exclude other pathology; A&E if severe or unrelenting/worse.

I have had a blinding headache for a few days. It is bothering me and making it hard to work.

Did it come on suddenly at maximum intensity, and do you have weakness, numbness, vision loss, fever, neck stiffness, repeated vomiting, or a new head injury?

The source complaint is a severe headache; red flags must be checked before selecting the action.

It started when I woke up three days ago and has persisted. It is worse over my right eye, lights bother me, and I sometimes see lights. No weakness, numbness, fever, neck stiffness, vomiting, head injury, or vision loss.

You should arrange a nonurgent clinical assessment with a neurological exam because this headache is persistent and different from your usual headaches. Seek urgent care if it becomes severe and unrelenting or any neurological symptoms develop.

The source clinician recommends neurological examination for persistent headache, with urgent safety-netting only if severe or worsening.


patient reports sudden trouble breathing today

provider-written follow-up questions ask about chest pain, palpitations, duration, rest symptoms, leg/abdominal swelling, orthopnea, lightheadedness, dizziness, and exertional capacity

no source clinician final action is provided

Provider questions identify the missing red flags for dyspnea: chest pain, palpitations, rest symptoms, swelling, orthopnea, lightheadedness, and exertional limitation.

I am having a bit of trouble breathing today and I am not sure what is going on. It started suddenly and I am concerned.

Are you short of breath at rest, and do you have chest pain, palpitations, fainting, dizziness, or new leg swelling?

Followup-Q provider questions focus on chest pain, palpitations, rest dyspnea, lightheadedness/dizziness, and swelling.

It happened after climbing stairs and settled after I rested. I am breathing normally now. No chest pain, palpitations, fainting, dizziness, or leg swelling.

Since it has resolved and you have no current red flags, you can monitor for now and avoid exertion until you feel normal. Arrange nonurgent follow-up if this recurs, and seek urgent care if breathlessness happens at rest, with chest pain, fainting, palpitations, or new swelling.

The trigger-absent follow-up denies the dyspnea red flags listed in the source follow-up questions.

Now I feel short of breath even while sitting, with chest pressure and lightheadedness.

This needs urgent care now. Please call emergency services or go to the emergency department, because shortness of breath at rest with chest pressure and lightheadedness can be serious.

The urgent trigger uses source-question red flags: rest dyspnea, chest pain/pressure, and lightheadedness.


sudden onset muscle weakness over the day

difficulty lifting things and walking feels like a struggle

provider questions ask about one-sided weakness, slurred speech, double vision, eyelid weakness, new medications, numb hands, headache, infection symptoms, and breathing difficulty

Provider-written questions identify neurologic and respiratory danger features for acute weakness, including unilateral weakness, speech difficulty, double vision, eyelid weakness, fall/head injury, headache, infection, and shortness of breath.

I woke up feeling fine, but today I developed sudden weakness in my arms and legs. I am having trouble lifting things, my grip feels weak, and walking feels like a struggle.

New sudden weakness that affects walking and grip strength needs urgent same-day medical evaluation. Please seek urgent medical care now. Call emergency services sooner if you develop trouble breathing, slurred speech, facial drooping, one-sided weakness, or double vision.

The raw patient message already states sudden weakness, trouble lifting things, reduced grip strength, and difficulty walking; Followup-Q questions include neurological and respiratory red flags.

It is in both arms and legs. My speech is normal, and I do not have double vision or trouble breathing, but I still feel weak when walking and gripping things.

You should still be assessed urgently today. Normal speech and no double vision are reassuring, but sudden weakness affecting walking and grip strength still requires same-day medical evaluation.

The raw source includes acute generalized weakness with gait and grip impairment; provider follow-up questions specifically screen for focal neurological symptoms and breathing difficulty.

I can still talk normally, so I was hoping to wait and see if it passes.

Do not wait this out. Because the weakness started suddenly and is affecting both grip and walking, you should get urgent same-day evaluation now.

The urgent action remains warranted after acute walking-limiting weakness is confirmed.


scratchy throat without other symptoms in initial message

provider questions ask about duration, worsening, painful swallowing, recent procedure/intubation, fever, voice change, neck swelling/pain/bumps, voice use, positional symptoms, and reflux

Provider questions identify relevant missing information for throat symptoms: duration, fever, swallowing pain, recent intubation/procedure, voice change, neck swelling/pain, reflux, and positional symptoms.

I have had a scratchy throat lately. It is not too bad, but it is always there. Could it be a cold or allergies?

How long has it been going on, and do you have fever, trouble swallowing liquids, trouble breathing, neck swelling, or a major voice change?

Followup-Q questions ask about duration, fever, swallowing pain, voice change, neck swelling, and reflux.

It has been about five days. No fever, trouble swallowing liquids, breathing trouble, neck swelling, or major voice change. It is just scratchy.

Self-care and monitoring are appropriate for now. Rest your voice, keep hydrated, and consider allergy or reflux triggers; seek care if it lasts more than a couple of weeks or worsens.

The trigger-absent follow-up denies fever, airway, swallowing, neck, and voice-change red flags from the source questions.

Today my throat feels swollen and I am having trouble breathing and swallowing saliva.

This needs urgent care now. Go to the emergency department or call emergency services because breathing trouble and difficulty swallowing saliva can signal airway risk.

The urgent trigger is clinically related to the throat complaint and uses airway/swallowing danger signs named by the source questions.


abdominal cramps are pretty bad and come and go

over-the-counter remedies do not always work

provider questions ask about last menstrual period, duration, fever, vaginal discharge, stool changes, weight change, gas/reflux, constipation from oxycodone, and pain with intercourse

Provider questions identify missing gynecologic, gastrointestinal, medication-related, and infectious features for abdominal cramping.

I have pretty bad abdominal cramps that come and go, with bloating. Sometimes it is worse after I eat, and over-the-counter remedies do not always help.

How long has this been happening, and do you have fever, possible pregnancy, abnormal vaginal discharge, vomiting, blood in stool, or major stool changes?

Followup-Q questions ask about duration, LMP/pregnancy, fever, vaginal discharge, stool changes, and other GI features.

It has been going on for a few weeks. No fever, possible pregnancy, vaginal discharge, vomiting, blood in stool, or major stool changes. It is affecting my daily life.

You should schedule a nonurgent appointment to evaluate the cramps and bloating, especially because they have lasted weeks and affect your daily activities. A clinician can review bowel, menstrual, medication, and dietary causes.

The follow-up questions support professional evaluation once acute red flags are denied but persistent function-limiting symptoms remain.


back pain and stiffness affecting daily activities

provider questions ask about duration, worsening, chest pain/shortness of breath, radiating leg pain, bowel or bladder incontinence, trauma, fever/chills, immobility, urinary burning/blood, and stone concern

Provider questions identify red flags and alternative causes for back pain, including chest pain/shortness of breath, neurologic symptoms, bowel/bladder incontinence, trauma, fever, urinary symptoms, and immobility.

I have a lot of back pain and stiffness. It is hard to bend or twist, and it is affecting my daily activities.

How long has this been going on, and do you have leg weakness or numbness, bowel or bladder accidents, fever, recent trauma, chest pain, or shortness of breath?

Followup-Q questions ask about duration, neurologic symptoms, bowel/bladder symptoms, trauma, fever, chest pain, and shortness of breath.

It has been about a week. I do not have leg weakness, numbness, bowel or bladder accidents, fever, trauma, chest pain, or shortness of breath. It is still limiting what I can do.

You should arrange a nonurgent clinical or physical-therapy evaluation because the pain is limiting daily activity. Use gentle movement and avoid heavy lifting, and seek urgent care if weakness, numbness, bowel or bladder problems, fever, chest pain, or shortness of breath occur.

The trigger-absent follow-up denies urgent red flags but leaves function-limiting symptoms that support nonurgent professional evaluation.

Now I am having trouble controlling my bladder and my legs feel weaker.

This needs urgent medical care now. Go to the emergency department or call emergency services because new bladder control problems with leg weakness can indicate a serious spine problem.

The urgent trigger uses the source-question red flags of bladder incontinence and neurologic leg symptoms.


nausea for several days that is getting worse

provider questions ask about fever, shortness of breath, COVID/flu exposure, medication changes, lightheadedness/dizziness, falls, weight loss, ability to hold down water, severe chills, headache, and confusion

Provider questions identify dehydration and systemic red flags, including inability to hold down water, lightheadedness, dizziness, falls, fever, severe chills, headache, confusion, and breathing trouble.

I have had nausea for a few days and it is getting worse. I am having trouble keeping food down and I feel dehydrated.

Are you able to keep down water, and do you have fever, severe dizziness, fainting, confusion, severe headache, or trouble breathing?

Followup-Q questions ask about ability to hold down water, dizziness/lightheadedness, falls, confusion, headache, fever, and breathing.

I can keep small sips of water down. No fever, severe dizziness, fainting, confusion, severe headache, or trouble breathing. Food is harder.

You should arrange nonurgent medical advice because the nausea is worsening and limiting intake, but it is not an emergency if you can keep fluids down and have no red flags. Keep taking small frequent sips and monitor urine output.

The trigger-absent follow-up denies urgent dehydration/systemic signs but persistent worsening nausea supports professional evaluation.

Now I cannot keep water down, I feel very dizzy when I stand, and I am confused about what time it is.

This needs urgent care now. Please go to the emergency department or call emergency services because inability to keep down water with dizziness and confusion can mean significant dehydration or serious illness.

The urgent trigger uses source-question red flags: cannot hold down water, dizziness/lightheadedness, and confusion.


persistent widespread body aches for weeks

symptoms are worsening and interfere with daily life

over-the-counter pain relief is temporary

provider questions ask about fever, breathing trouble, COVID/flu, dizziness/falls, menstrual period/pregnancy, vomiting, not eating, severe chills, headache, and confusion

Provider questions identify systemic/infectious red flags for body aches: fever, breathing trouble, COVID/flu exposure, dizziness/falls, vomiting, inability to eat, severe chills, pregnancy possibility, headache, and confusion.

I have had persistent body aches for weeks. They are widespread in my muscles and joints, worsening, and interfering with daily life.

Do you have fever, trouble breathing, severe chills, confusion, new or worsening headache, vomiting, or inability to eat for a full day?

Followup-Q questions ask about fever, breathing trouble, severe chills, headache, confusion, vomiting, and inability to eat.

No fever, breathing trouble, severe chills, confusion, headache, vomiting, or inability to eat. It has just been weeks of worsening aches and temporary relief from pain relievers.

You should schedule a nonurgent medical evaluation because widespread aches lasting weeks and worsening can need examination and tests. Monitor symptoms and seek urgent care if fever, severe chills, confusion, breathing trouble, or severe headache develops.

The trigger-absent follow-up denies acute systemic red flags but supports nonurgent professional evaluation due to duration and worsening.

Today I developed a fever, severe shaking chills, shortness of breath, and I feel confused.

This needs urgent care now. Please call emergency services or go to the emergency department because body aches with fever, severe chills, shortness of breath, and confusion can signal serious infection or systemic illness.

The urgent trigger uses source-question red flags: fever, severe chills, shortness of breath, and confusion.


over-the-counter medications are not helping

provider questions ask about sudden onset after medication, breathing trouble, OTC response, rash, recurrent extremity swelling, and family history

Provider questions identify angioedema and allergic red flags: medication trigger, breathing trouble, rash, recurrent swelling, family history, and OTC response.

My lips are swollen and itchy, and I also have post-nasal drip. Over-the-counter medicine is not helping and I am worried about angioedema.

Are you having trouble breathing, tongue or throat swelling, a new medication exposure, or a widespread rash?

Followup-Q questions ask about new medication exposure, breathing trouble, OTC response, rash, recurrent swelling, and family history.

No trouble breathing, tongue swelling, throat swelling, new medicine, or widespread rash. The lip swelling is still there and the over-the-counter medicine has not helped.

You should arrange nonurgent medical advice for persistent lip swelling that is not improving, especially since you are worried about angioedema. Seek urgent care immediately if tongue or throat swelling, breathing trouble, dizziness, or rapid worsening occurs.

The trigger-absent follow-up denies airway red flags but persistent swelling despite OTC treatment supports professional evaluation.

My throat now feels tight and I am starting to have trouble breathing.

This is urgent. Call emergency services or go to the emergency department now because throat tightness and breathing trouble with lip swelling can be dangerous.

The urgent trigger adds throat tightness and breathing trouble, directly related to the lip-swelling complaint.


no pain or burning reported in initial message

provider questions ask about duration, worsening, dysuria, blood in urine, vaginal births, new medications, cough/sneeze leakage, vaginal discharge/lesions/ulcers, new sexual partner, travel, nausea/vomiting, chills, and pregnancy

Provider questions identify missing UTI, hematuria, medication, pregnancy, travel, STI, and systemic symptoms for urinary difficulty.

I am having trouble starting to pee, and my urine has been darker than usual. I do not have pain or burning, but I am not sure if I should be concerned.

How long has this been happening, and do you have blood in the urine, fever or chills, vomiting, back or side pain, pregnancy possibility, or inability to pass urine?

Followup-Q questions ask about duration, dysuria, blood in urine, nausea/vomiting, chills, pregnancy, medications, sexual history, and related urinary features.

It has been several days. No blood, fever, chills, vomiting, back or side pain, pregnancy possibility, or complete inability to pass urine. It is just hard to start and the urine is dark.

You should schedule a nonurgent medical visit or urine test because new urinary hesitancy lasting several days should be evaluated. Drink fluids if you may be dehydrated, and seek urgent care if you cannot pass urine, develop fever, severe pain, vomiting, or blood in the urine.

The source questions support nonurgent evaluation after urgent urinary obstruction, infection, pregnancy, and stone features are denied.


provider questions ask about duration, worsening, painful swallowing, OTC/prescription response, recent procedure or intubation, fever, breathing trouble, neck swelling/pain/bumps, voice use, reflux, positional symptoms, and symptoms after meals

Provider questions identify missing red flags for hoarseness: breathing trouble, painful swallowing, fever, recent intubation/procedure, neck swelling/pain/bumps, reflux, and voice-use triggers.

My voice has been really hoarse lately. I am not sure what is going on. Should I come in to get it checked?

How long has it been hoarse, and do you have trouble breathing, trouble swallowing, fever, neck swelling, or a recent procedure or intubation?

Followup-Q questions ask duration, fever, breathing trouble, swallowing pain, neck symptoms, and recent intubation/procedure.

It has been five days after a cold. No trouble breathing or swallowing, no fever, no neck swelling, and no recent procedure or intubation.

Self-care and monitoring are appropriate for now. Rest your voice, drink fluids, avoid smoke or irritants, and consider reflux or allergy triggers. Arrange nonurgent care if hoarseness lasts more than a few weeks or keeps recurring.

The trigger-absent follow-up denies airway, swallowing, fever, neck, and procedure-related red flags.

Now my neck looks swollen and I am having trouble breathing.

This needs urgent care now. Go to the emergency department or call emergency services because hoarseness with neck swelling and breathing trouble can indicate airway risk.

The urgent trigger uses source-question red flags: neck swelling and breathing trouble.


Child has a rash under one armpit for about two weeks.

Source patient reports no itching, no fever, and the child otherwise seems well.

Source clinician states that an asymptomatic axillary rash is usually not dangerous and can be observed until the scheduled visit.

The source clinician explicitly reassures the caregiver that an asymptomatic axillary rash without fever or itching is not a reason for major concern before the planned doctor visit.

My daughter has had a rash under one armpit for about two weeks. It does not itch, she has no fever, and she seems well. We already have an appointment in a few days. Should I be worried before then?

This does not sound urgent based on the absence of itching, fever, or illness. Keep the scheduled appointment and monitor the rash. Seek care sooner if she develops fever, pain, spreading redness, drainage, or seems unwell.

Source patient reports asymptomatic axillary rash and source clinician says there is no need to worry while awaiting the doctor visit.


Patient reports bilateral painless lumps near the knees after a fall over a year ago.

Swelling decreases with prescribed water pills but persists despite weight loss and exercise.

Source clinician suggests cyst or bursal process and recommends surgical consultation for detailed evaluation.

The source clinician explicitly advises surgeon consultation for persistent post-traumatic knee lumps.

I fell more than a year ago and still have noticeable painless lumps near both knees in the same spot. They shrink somewhat when I take the water pills my doctor prescribed, but they have not gone away. What is the next step?

This should be assessed in a nonurgent in-person visit, preferably with a surgeon or orthopedics clinician. Persistent lumps after trauma may need an exam and possibly imaging to determine whether they are cysts, bursae, or another cause.

Source clinician suggests a cyst or bursal cause and advises surgical consultation.


Patient has chronic coccyx-area pain radiating to both hips with walking after a fall years earlier.

Source clinician recommends neurologist evaluation, lumbosacral CT, and nerve conduction study.

The source clinician recommends neurologist consultation and diagnostic testing for possible neuralgia or spinal-disc-related symptoms.

I am 62. I fell on my tailbone years ago, and now I get pain from that area into both hips when I have been on my feet or walking. It stops when I sit down. My doctor mentioned weak abdominal muscles, but I am not sure. What should I do?

This warrants a nonurgent medical evaluation, especially because the pain radiates with walking. Discuss neurology or spine evaluation with your doctor; imaging or nerve testing may be considered. Seek urgent care if you develop new leg weakness, numbness in the groin area, or loss of bladder or bowel control.

Source clinician recommends neurologist consultation, lumbosacral CT, and nerve conduction study.


One-month-old baby cries a lot at night and is sometimes hard to console.

Baby is breastfed and formula-fed, and caregiver burps him after feeds.

Source clinician agrees with the local doctor that medication is not needed and describes evening colic with positioning/burping advice.

The source clinician labels the episode as common evening colic and recommends non-medication measures.

My one-month-old baby cries a lot at night and can be hard to settle. He is breastfed and also gets formula, and we burp him after feeds. Friends suggested colic medicines, but our doctor did not want us to use them. What should we do?

Based on this description, this can fit infant colic or gas discomfort, and medication is not the first step. Keep him upright after feeds until he burps and try gentle back-patting or supervised tummy time while awake. Seek urgent care if he has fever, repeated vomiting, poor feeding, breathing trouble, a swollen belly, or seems unusually weak or ill.

Source clinician says no medicine is needed and recommends burping/upright or prone-position gas-relief measures.


Patient notices a yellowish bump at the back of the tongue during an upper-respiratory illness.

Source clinician explains that enlarged posterior taste buds or papillae can occur with infection and often regress.

Source clinician advises evaluation if the lesion enlarges, becomes discolored, or has uneven borders.

The source clinician supports observation during infection and professional checking if concerning local changes appear.

I have a cold with throat and nose congestion, and I noticed one yellowish bump at the very back of my tongue. I started worrying after searching online. What should I do?

This can happen with a throat infection or irritation and can be monitored while the infection settles. Keep good oral hygiene, hydrate, and avoid irritating foods. Arrange a dental or medical check if it grows, develops irregular borders, becomes persistently discolored, or does not improve after the illness resolves.

Source clinician states posterior papillae can enlarge during infection and often regress on their own.

It has not gone away, and now the area looks more discolored and uneven than the rest of my tongue.

You should arrange a nonurgent dental, oral-medicine, or primary-care evaluation so the lesion can be examined directly. Persistent discoloration or uneven borders should not be managed only with home care.

Source clinician specifically advises getting it checked if it is discolored, enlarged, or has uneven borders.


Patient asks whether Chymoral Forte once daily for three days is safe in pregnancy.

Source clinician says the drug has limited pregnancy data and should be avoided in pregnancy.

Source clinician suggests obstetric/gynecologic consultation for more information.

The source clinician explicitly recommends avoiding Chymoral Forte in pregnancy and consulting obstetrics/gynecology.

I am pregnant and was considering taking Chymoral Forte once daily for three days. Is this safe?

Do not start it on your own during pregnancy. Because safety data are limited, check with your obstetrician or the clinician who prescribed it before taking it, and use only pregnancy-approved pain or inflammation treatment they recommend.

Source clinician says Chymoral Forte should be avoided in pregnancy and suggests obstetric/gynecologic consultation.


Seven-year-old child has recurrent urinary infection confirmed by urinalysis and culture.

Child has a habit of holding urine for a long time.

Source clinician recommends ultrasound KUB with post-void residual testing and micturating cystourethrogram after the acute episode resolves, with possible renal scan.

The source clinician recommends urologic evaluation and urinary-tract imaging/testing after the infection episode resolves.

My 7-year-old daughter has had urine infections for a long time. Her urine test and culture show infection, and she often holds her urine until she cannot hold it anymore. What should we do next?

She needs nonurgent follow-up with her pediatrician or a pediatric urologist. After the current infection is treated, she should be evaluated for why infections are recurring, which may include bladder and kidney ultrasound and tests for incomplete emptying or reflux.

Source clinician recommends ultrasound KUB, PVR testing, MCU, and possible renal scan after the episode resolves.


Patient reports fever for a few days that fluctuates and returns after fever-reducing medicine.

Followup-Q source provides clinician follow-up questions about measured temperature, other symptoms, fever medicine dosing, chest pain, palpitations, chills, joint symptoms, COVID/flu exposure, UTI symptoms, and diarrhea.

The provider-authored follow-up questions support asking focused clarification before assigning care level.

I have had a fever for a few days. It goes up and down, and medicine brings it down only for a short time. I feel awful. Should I come in or keep trying home care?

I need a few details first: what is the highest temperature you measured and how did you measure it, what other symptoms do you have, and what fever medicine have you taken with dose and timing?

Followup-Q source lists provider questions about fever measurement, other symptoms, and antipyretic use.


Patient reports palpitations and heavy sweating.

Followup-Q source provides clinician follow-up questions about temperature measurement, chronic diarrhea, fever medicine, stress, new medication or supplement, chills, shaking, joint swelling/redness, dental procedure, COVID/flu exposure, pregnancy, and tremor.

The provider-authored follow-up questions indicate that more information is needed before a care-action label can be assigned.

I am getting weird palpitations and sweating a lot. It is worrying me. Should I come in?

I need to clarify the risk first: are you having chest pain, shortness of breath, fainting, a very fast or irregular heartbeat that is not settling, fever, or a new medicine or supplement?

Followup-Q source lists provider questions about fever, stress, new medications, chills, tremor, and related symptoms.


Patient reports several weeks of nocturia and darker urine.

Followup-Q source provides questions about painful urination, abdominal pain, back pain, hydration, dizziness, and vaginal itching.

The provider-authored follow-up questions support asking about urinary symptoms, pain, hydration, and dizziness before deciding the care action.

For a few weeks I have been waking up a lot at night to urinate, and my urine looks darker than usual. Do I need a check-up, or is there something I can do first?

I need a few details first: do you have burning with urination, lower abdominal pain, back or flank pain, dizziness, vaginal itching, or have you been drinking less water than usual?

Followup-Q source lists provider questions about urination pain, abdominal/back pain, hydration, dizziness, and vaginal itching.


Caregiver reports husband had a stroke and later behavioral disturbance during acute hospitalization and skilled nursing rehabilitation.

Ritalin reportedly helped earlier; Seroquel improved behavior but causes tiredness and therapy sleepiness.

Source clinician says behavioral disturbance can occur after stroke, suggests continuing Seroquel, and mentions psychiatric consultation if concerning symptoms occur.

The source clinician frames the behavior as post-stroke disturbance and addresses medication continuation and psychiatric consultation.

My husband had a stroke and has had behavior problems since then. Seroquel has helped, but he seems very tired and the therapists say he is sleepy during sessions. He is coming home soon, and I am worried about the medication plan.

This should be reviewed with his stroke, rehabilitation, or psychiatric prescriber before he comes home. Do not change sedating medicines on your own; ask whether the sleepiness is interfering with therapy and whether the plan needs adjustment.

Source clinician discusses post-stroke behavioral disturbance, Seroquel continuation, and psychiatric consultation for medication-related concerns.


Patient was told venous Doppler findings related to DVT showed cardiac dysfunction or pulsatile blood vessels.

Patient is awaiting cardiology consultation.

Source clinician explains the possible relationship between DVT, pulmonary embolism, and right ventricular dysfunction and asks for Doppler findings and prompt testing.

The source clinician recommends prompt tests and cardiology follow-up but does not document current symptoms that mandate ED care.

I had a venous Doppler for possible DVT, and someone mentioned that the blood vessels having a pulse could suggest cardiac dysfunction. I am waiting for a cardiology consult. What should I do with this information?

You should follow up promptly with the cardiologist or ordering clinician and make sure they review the Doppler report and decide what cardiac or clot-related testing is needed. Seek urgent care now if you have chest pain, shortness of breath, fainting, coughing blood, or sudden worsening leg swelling or pain.

Source clinician explains DVT/PE-related cardiac dysfunction and asks for Doppler findings and prompt additional testing/cardiology input.


Patient reports breathing faster than usual and feeling more winded with usual activities, without major trouble catching breath.

Followup-Q source provides questions about onset, cough, sputum, recent cold, flu, or COVID.

The provider-authored follow-up questions indicate that onset and respiratory-infection symptoms are needed before assigning an action.

Lately I feel like I am breathing faster than usual. I am not having major trouble catching my breath, but I get a bit more winded with my normal activities. Should I come in?

I need a little more information first: when did this start, do you have a cough, and if you are coughing anything up, what does the mucus look like? Also, have you recently had a cold, flu, or COVID?

Followup-Q source lists provider questions about symptom onset, cough, sputum, and recent cold/flu/COVID.


Patient is 29 and has an umbilical hernia.

Patient asks whether open or laparoscopic surgery is better and whether heavy weightlifting is possible afterward.

Source clinician says laparoscopic surgery may be preferred if cardiovascular status is fine and explains open-surgery considerations.

The source clinician discusses suitability of laparoscopic versus open hernia surgery and the need to account for cardiopulmonary status.

I am 29, a bodybuilder, and my doctor told me I have an umbilical hernia. I want to know whether open surgery or laparoscopic surgery is better, and when I could lift heavy weights again.

This is a nonurgent surgical-planning question. Discuss the approach with your surgeon, including your cardiopulmonary status, hernia size, recurrence risk, and return-to-lifting plan. Do not resume heavy lifting until your surgeon clears you after repair.

Source clinician says laparoscopy may be suitable if heart and lung function are fine and compares it with open surgery for scarring and strenuous exercise.


Patient reports sudden pelvic pressure and trouble starting urination.

Followup-Q source provides questions about back pain, last bowel movement, sexual activity, hydration, whether any urination is possible, pelvic numbness, and leg numbness.

Provider-authored follow-up questions indicate that ability to urinate and neurologic symptoms are needed before deciding ER versus clinic.

Today I suddenly started feeling a lot of pelvic pressure, and I am having trouble starting to urinate. I am worried and do not know if I should come in today or go to the ER.

I need to clarify this urgently: have you been able to pass any urine at all, and do you have new back pain, numbness in the pelvic area, numbness or weakness in the legs, or loss of bowel control?

Followup-Q source lists provider questions about ability to urinate, back pain, pelvic numbness, and leg numbness.


Patient feels well most of the day but has dizziness around 4 PM for two days.

Source clinician recommends increasing water intake, avoiding caffeine, getting rest, and checking meal timing.

Source clinician says if symptoms are not self-limited over the next day or two, schedule a doctor appointment and possible labs.

The source clinician anchors baseline self-care and a persistence-based nonurgent professional-care trigger.

For the last two days I have felt fine in the morning and most of the day, but around late afternoon I get very dizzy. I have not changed my eating much. What should I do?

For now, increase water intake, avoid caffeine, rest, and make sure you are not skipping meals. Do not drive or do risky activities while dizzy. If it persists beyond the next day or two, arrange a routine medical visit.

Source clinician recommends fluids, avoiding caffeine, rest, and meal-timing review for two days of late-day dizziness.

I tried drinking more water and resting, but the dizziness is still happening after a few more days.

Now you should schedule a nonurgent appointment with your doctor for an exam and possible lab tests, such as checking blood counts, electrolytes, or signs of infection. Seek urgent care sooner if you faint, have chest pain, severe headache, weakness, trouble speaking, or trouble walking.

Source clinician says persistent symptoms after the next day or two should prompt a doctor appointment and possible laboratory evaluation.