Patient’s father had angioplasty one month earlier.

He has shortness of breath and hand numbness only while walking; otherwise normal.

He takes Concor, Ascard, Lipiget, and Brilanta/Ticagrelor.

Source clinician said Brilinta can cause breathlessness but should not be stopped, and asked about foot swelling, orthopnea, and cough to assess heart failure; echocardiography was recommended.

Source clinician attributed possible dyspnea to Brilinta or reduced ejection fraction/fluid accumulation and requested swelling, orthopnea, and cough; source recommended continuing Brilinta and arranging echocardiography.

My dad had an angioplasty one month ago. Now he gets short of breath and numbness in his hands when he walks, but otherwise he is normal. He takes Concor, Ascard, Lipiget, and Brilanta. Please help.

Do not stop Brilanta without his cardiologist. I need a few details: does he have swelling in the feet, trouble breathing when lying flat, or a cough?

Source clinician warned not to stop Brilinta and asked about foot swelling, orthopnea, and cough.

He has no foot swelling, no cough, and no difficulty breathing when lying down. The shortness of breath only happens during walks.

He should arrange follow-up with his cardiologist or doctor for assessment and echocardiography, while continuing prescribed medicines unless his doctor changes them. Brilanta can cause breathlessness, but heart function should also be checked.

Source clinician discussed Brilinta-related dyspnea and recommended echocardiography to assess ejection fraction/fluid accumulation.

Now he also has swelling in his feet and gets breathless when lying down.

These symptoms need prompt medical review because they can suggest fluid accumulation or reduced heart pumping after angioplasty. Contact his cardiologist or doctor promptly for evaluation and do not stop Brilanta on your own.

Source clinician identified swelling and orthopnea as symptoms that would support fluid accumulation and need treatment/evaluation.


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.

Patient has sore throat since yesterday and slight fever 37.4 C.

Patient suspects swollen tonsil and has used juice, salt-water gargles, and paracetamol as needed.

Source clinician asked about cough, difficulty breathing, recent China travel, and COVID exposure.

Source answer is only a clarification response.

Source clinician only asked about cough, difficulty breathing, recent travel, and COVID exposure; no source-anchored final action or trigger-action rule is available.

I have had a sore throat since yesterday with a slight fever of 37.4 C. I suspect my tonsil is swollen. I gargled warm salt water and took paracetamol if needed.

Do you have cough or difficulty breathing, and have you had recent travel or exposure to someone with COVID-19?

Source clinician asked about cough, difficulty breathing, travel to China, and exposure to possible COVID-19.


Patient had sex for the first time and has delayed period.

Gynecologist performed blood test and it was negative.

Source clinician stated serum beta-hCG less than 3 mIU/mL rules out pregnancy.

Source clinician attributed delay to stress/hormonal readjustment and advised waiting another week; progesterone could be considered if menses do not arrive.

Source clinician ruled out pregnancy by serum beta-hCG and advised waiting another week.

I had sex for the first time and then did not get my period. A gynecologist took a blood sample and it was negative, but my period is still a week late. What could be the reason?

With a negative serum beta-hCG, pregnancy is ruled out in the source context. A first sexual experience and stress can delay a period. Wait another week, and if it still does not come, follow up with your gynecologist about next steps.

Source clinician stated beta-hCG under 3 mIU/mL ruled out pregnancy and advised waiting another week, then progesterone if needed.


PriMock57 source begins with jaw pain but clinically relevant issue is left arm numbness for two weeks.

Patient reports mild weakness holding objects and playing piano.

Patient had a 20-minute left peripheral visual disturbance two weeks ago.

Source plan is urgent neurology review to rule out MS, with A&E for progressive weakness, vomiting, visual disturbance, or fits.

Source clinical note recommends urgent neurology review to rule out MS and A&E for progression or recurrent severe neurologic symptoms.

I have pain in my jaw, but I also typed that quickly and I am not sure it explains the problem.

What is the main symptom you are worried about, and where exactly do you feel it? Any numbness, weakness, vision change, vomiting, or problems walking?

Source transcript starts from jaw pain but the clinician clarifies the main problem and neurologic symptoms.

The bigger issue is that my left arm has been numb for about two weeks and it is getting worse. I have tingling in my second, third, and fourth fingers, mild weakness when holding things and playing piano, and I had a 20-minute disturbance in my left peripheral vision two weeks ago. My walking is normal and I have no fits.

These neurologic symptoms need urgent neurology review. If weakness progresses, vision symptoms return, vomiting develops, you have a fit, or weakness affects other limbs, go to A&E immediately.

Source clinician plan: urgent neurology review to rule out MS, with A&E if progressing weakness, vomiting, visual disturbance, or fits occur.


Patient has diarrhea for three days with mild abdominal pain and one episode of vomiting.

Four to five watery/loose stools per day.

No blood, no mucus, no fever, no foreign travel, no dehydration, still eating and drinking.

Source diagnosis gastroenteritis; advised soft diet, fluids, probiotics, stool sample if over one week or blood, appointment if more than eight episodes/dehydration.

Source clinician diagnosed gastroenteritis and advised soft diet, fluids, yogurt/probiotics, and safety-netting for prolonged diarrhea, blood, or dehydration.

I have really bad diarrhea and I am confused about what to do.

How long has it been going on, how many times a day are you going, and is there blood, mucus, fever, vomiting, severe pain, recent travel, or trouble keeping fluids down?

Source transcript clinician asked duration, frequency, stool character, blood/mucus, fever, vomiting, travel, and hydration details.

It has been three days. I go about four to five times a day, watery or loose. I had mild abdominal pain and vomited once, but I can still eat and drink. No blood, no mucus, no fever, no travel, and I do not feel dehydrated.

This fits gastroenteritis that can be managed with fluids and a soft diet for now. Start with crackers, soup, mashed foods, and consider yogurt as a probiotic. Seek medical review if it lasts more than a week, you see blood, episodes become very frequent, or you become dehydrated.

Source note: gastroenteritis; advised soft diet, plenty of fluids, probiotics, stool sample if over one week or blood, appointment if high frequency/dehydration.


Patient has acute onset central/left-sided chest pressure for one to two hours.

Pain is 7/10, feels like someone sitting on chest, began while gardening.

Radiates to left shoulder and arm and is associated with nausea and shortness of breath.

Patient has high cholesterol and high blood pressure; source plan called ambulance for possible MI.

Source clinician documented possible MI and called an ambulance for further investigation and assessment.

Tell me more: when did it start, what does it feel like, how severe is it, does it spread to the arm, shoulder, jaw, or back, and are you short of breath, sweaty, or nauseated?

Source transcript begins with chest discomfort and clinician asks onset, character, severity, radiation, and associated symptoms.

It started suddenly about two hours ago while I was gardening. It is pressure in the middle or left side of my chest, like someone is sitting on my chest, about 7 out of 10, and it is still there.

Ongoing sudden chest pressure like this needs emergency assessment. Please call an ambulance now rather than waiting or driving yourself.

Source note describes acute chest pressure 7/10 with possible MI and ambulance plan.

It also goes into my left shoulder and arm, and I feel nauseated and short of breath. I have high blood pressure and high cholesterol.

This is very concerning for a heart attack. Call an ambulance now and stay with someone while waiting.

Source note includes radiation to left shoulder/arm, nausea, shortness of breath, hypertension, hypercholesterolemia, and ambulance call for possible MI.


Patient developed acute shortness of breath at rest while watching TV.

Patient had a C-section a few weeks earlier.

Telephone heart rate roughly 120 bpm, tachycardic and regular.

Family history includes mother with clots in legs; source differential PE and plan further examination/investigation in acute setting.

Source clinician documented possible pulmonary embolism and acute-setting investigation after recent C-section, shortness of breath at rest, and tachycardia.

When did it start, is it happening at rest, do you have chest pain, cough, fever, leg swelling, a fast heartbeat, or any recent pregnancy, surgery, or immobilization?

Source clinician asked onset, associated symptoms, C-section history, cough, chest symptoms, and heartbeat.

It started suddenly over the last hour while I was watching TV. I had a C-section about four weeks ago. I also feel my heart racing.

Sudden shortness of breath at rest after a recent C-section with a racing heart needs urgent assessment in an acute setting to rule out a clot in the lung. Please seek emergency care now.

Source note: SOB at rest, C-section 2-4 weeks ago, tachycardia, differential PE, plan acute examination/investigation.

My heart rate feels about 120. My mother has had clots in her legs. I do not have fever and the baby is fine.

That reinforces the need for emergency assessment now. Possible pulmonary embolism after recent C-section should not be managed at home.

Source note includes HR roughly 120 and family history of clots, with PE differential and acute-setting plan.


Patient has wheezing and shortness of breath for two days after cleaning a dusty environment.

Symptoms are worse at night and worsening over two days.

Patient is now having problems speaking in full sentences; source differential acute asthma exacerbation/allergy and plan antihistamine plus further examination/investigation.

Source note identifies acute asthma exacerbation/allergy and further examination/investigation; inability to complete sentences is a severe breathing feature.

When did it start, what triggered it, is it getting worse, do you feel short of breath, and can you speak full sentences?

Source transcript clinician asked timing, dust trigger, worsening, breathlessness, and ability to talk.

It started after I cleaned a dusty room two days ago. It has gradually worsened, especially at night. I had asthma as a child and hay fever, but I am still able to speak normally.

Because the wheeze and shortness of breath are worsening over two days with a past asthma history, you should arrange medical assessment and discuss treatment such as inhaler therapy or allergy management.

Source note documents childhood asthma/hay fever, dust trigger, worsening wheeze/SOB, and plan for further examination/investigation.

Now I am short of breath and sometimes I cannot finish full sentences when talking.

Trouble speaking in full sentences with wheezing is urgent. Please seek emergency or urgent medical care now.

Source note states the patient is now having problems speaking in full sentences, consistent with urgent asthma-exacerbation assessment.


Patient has felt unwell for eight days: sore throat followed by dry nonproductive cough.

No sputum, no blood, no chest pain, no asthma, non-smoker, no significant travel history.

Mild shortness of breath not at rest and not limiting; gradually improving; looks well.

Source safety-net: review if worsening symptoms especially sudden shortness of breath; further review if not better in five days.

Source clinician reassured, expected improvement, advised self-care and review if worsening sudden SOB or no better after five days.

I have a cold with cough and sore throat for about a week. I had to miss work and I am worried it could be something serious.

Can you tell me whether the cough is dry or productive, whether there is blood, chest pain, shortness of breath at rest, fever, asthma, smoking, recent travel, weight loss, or worsening symptoms?

Source transcript clinician asked cough details, sputum/blood, chest pain, shortness of breath, fever symptoms, past history, travel, and red flags.

It started as a sore throat and then a dry cough. No sputum, no blood, no chest pain, no asthma, no smoking, and no significant travel. I have mild shortness of breath only with activity, not at rest, and it is gradually improving.

This sounds like a self-limited cold or viral upper respiratory infection. Rest, fluids, and simple symptom relief are reasonable. You should continue to improve over the next several days.

Source note says the patient looked well, symptoms were gradually improving, mild SOB was not at rest or concerning, and self-care/safety-netting was appropriate.

Five days later, it still is not better, although I do not have sudden severe shortness of breath or chest pain.

Since it has not improved after the expected period, arrange a nonurgent medical review. Seek urgent care sooner if you develop sudden or worsening shortness of breath, chest pain, coughing blood, or become much more unwell.

Source clinician advised further medical review if no better after about five days, and urgent review for worsening symptoms especially sudden SOB.


Patient reports low appetite and low energy over several weeks.

Source transcript adds difficulty getting up, daytime low energy, poor eating, difficulty sleeping, lower mood, poor focus, and reduced sex drive.

Source transcript documents no suicidal ideation.

Past medical history includes hypothyroidism treated with thyroxine.

Source clinician impression includes depression and possible hypothyroid contribution, with TSH, FBC, examination, and GP review planned.

PriMock57 source note recommends TSH, FBC, examination, and GP review after documenting depressive symptoms, hypothyroidism history, and no suicidal ideation.

Lately I have not had much appetite or energy. Getting through the day has felt harder than usual.

How long has this been going on, and have you had low mood, sleep problems, or any thoughts of harming yourself?

The source starts with low appetite and low energy, but the clinician had to ask further history before deciding the plan. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been about eight weeks. I struggle to get up in the morning, have low energy during the day, eat very little, sleep badly, feel low, and find it hard to focus. My sex drive is lower too. I do not have any thoughts of harming myself. I started a new job two months ago. I have hypothyroidism and take thyroxine.

You should book a GP review. Your symptoms could fit depression, and your thyroid level should also be checked. A GP can examine you and arrange blood tests such as thyroid function and a full blood count.

The source note records depressive symptoms, hypothyroidism, no suicidal ideation, and a plan for TSH, FBC, examination, and GP review.


Transcript clinically concerns chest tightness rather than jaw pain.

Patient reports three hours of chest tightness with slight shortness of breath, wheeze, cough, and recent cold symptoms.

Patient has asthma, hay fever, dust allergy, salbutamol/Ventolin, and Clenil inhaler.

Patient had not been using inhalers reliably in the preceding week.

Source clinician impression is asthma exacerbation, with salbutamol, Clenil with spacer, prednisolone 40 mg for five days, and safety-netting for worsening shortness of breath.

PriMock57 source clinician diagnosed asthma exacerbation and safety-netted to seek further medical attention if shortness of breath worsened.

My chest has been feeling tight today and I am worried it might be my breathing.

How long has the chest tightness been going on, and are you short of breath or wheezing?

The source clinician asked about duration, shortness of breath, cough, wheeze, and asthma history before deciding treatment. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It started about three hours ago. I am a little short of breath and wheezy, with a slight cough after a cold last week. I have asthma and usually use salbutamol and Clenil, but I forgot them while away and have barely used them this week.

This sounds like an asthma flare that needs clinician review and treatment advice, including correct use of your reliever and preventer inhalers and assessment of whether a short steroid course is needed. Seek urgent help if your breathing worsens or the reliever is not helping.

The source plan included salbutamol, Clenil with spacer, prednisolone, and safety-netting for worsening shortness of breath.

Since then my breathing has got worse. I feel short of breath even sitting still, I am wheezing more, and my salbutamol is not helping much.

You need urgent medical care now. Use your reliever inhaler as directed while arranging urgent help, and call emergency services if you are struggling to breathe, cannot speak in full sentences, or feel faint.

The source safety-net instruction was to seek further medical attention if shortness of breath worsened.


Patient reports two to three days of nausea and lower abdominal aching with feeling hot and sweaty.

Patient reports urinary frequency without dysuria or urgency.

Patient had recent constipation that resolved.

Patient is sexually active, has an implant, recent spotting, and last menstrual period about three and a half weeks ago.

Source clinician differential includes constipation, PID, STI, and UTI, with further examination and investigations, pregnancy test, and blood tests planned.

PriMock57 source plan recommends further examination and investigations, including pregnancy testing and blood tests, for lower abdominal pain with urinary and reproductive-history features.

I have had a really upset lower stomach for the last couple of days and I feel sick and sweaty.

Where is the pain, and do you have vomiting, diarrhea, urinary symptoms, vaginal bleeding, or any chance of pregnancy?

The source clinician asked about vomiting, bowel symptoms, urinary symptoms, and reproductive history before making the plan. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It is a constant aching pain low in my abdomen. I feel nauseated but have not vomited. I feel hot and sweaty. I am urinating more than usual but it does not burn. I was constipated last week but that has settled. I am sexually active, have an implant, had some spotting, and my last period was about three and a half weeks ago.

You should be examined and have tests arranged, including a pregnancy test and urine or infection testing. This needs professional assessment because causes can include UTI, pelvic infection, STI, pregnancy-related problems, or bowel causes.

The source clinician listed constipation, PID, STI, and UTI and planned examination, pregnancy test, U&E, and further investigation.


Patient reports blood in stool and intermittent abdominal pain with bloating and gas.

Provider follow-up questions target duration, dizziness, falls, whether blood is on paper or mixed in stool, sudden pain, location, pain quality, palpitations, diet, and Eliquis use.

External action anchor used for construction: stable small-volume rectal bleeding with abdominal symptoms warrants nonurgent professional evaluation, while lightheadedness, falls, heavy bleeding, or sudden severe abdominal pain would raise urgency.

The source message reports blood in stool and abdominal pain; the provider questions identify key red flags and bleeding-character details needed before deciding urgency.

I have noticed some blood in my stool and I have also been having abdominal pain, bloating, and gas. The pain is not constant, but I am concerned.

How long has this been happening, and is the blood on the paper or mixed into the stool? Are you lightheaded or dizzy?

The source provider questions ask about duration, dizziness, falls, blood location, palpitations, sudden onset, and pain location/quality. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been about a week. The blood is bright red and mostly on the toilet paper with a little streaking on the stool. The pain is mild cramping low in my belly with bloating. It did not come on suddenly. I do not feel lightheaded or dizzy, have not fallen, and do not have palpitations.

You should arrange a nonurgent medical visit to evaluate the rectal bleeding and abdominal symptoms. Seek urgent care sooner if bleeding becomes heavy, stool turns black, pain becomes severe or sudden, or you feel faint or dizzy.

The constructed response follows the source questions by using stable bleeding and no dizziness, falls, palpitations, or sudden severe pain to support nonurgent evaluation.


Patient reports bleeding after intercourse that is not heavy.

Provider questions target duration, last menstrual period, abnormal or purulent discharge, fever, hysterectomy, weight loss, night sweats, dyspareunia, odor, family history of endometrial or ovarian cancer, Synthroid adherence, and pregnancy possibility.

External action anchor: postcoital bleeding without acute instability warrants nonurgent professional pelvic/cervical evaluation.

The source message and provider questions support a postcoital-bleeding case requiring clarification of infection, pregnancy, systemic symptoms, and cancer-risk features.

I have been having some bleeding after intercourse. It is not heavy, but it worries me. Could this be serious, and should I come in soon?

How long has this been happening, when was your last period, and could you be pregnant?

The source provider questions ask about duration, LMP, discharge, fever, pain with intercourse, odor, systemic symptoms, cancer family history, and pregnancy. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has happened a few times over the last two weeks. My last period was about three weeks ago and I do not think I am pregnant. I do not have fever, pelvic pain, painful sex, abnormal discharge, odor, weight loss, or night sweats.

You should book a nonurgent in-person visit for pelvic and cervical evaluation. Postcoital bleeding can come from benign irritation, infection, cervical changes, or other gynecologic causes, so it should be checked even though it is not heavy.

The constructed action uses the source's postcoital bleeding complaint and red-flag questions, with acute red flags absent but professional evaluation still warranted.


Patient reports weeks of trouble fully emptying bladder and nocturia several times per night.

Provider questions target symptom trend, dysuria, hematuria, abdominal pain, bladder distension, new medications, confusion, foamy urine, and new or worsening extremity tingling.

External action anchor: chronic incomplete emptying/nocturia without acute retention or neurologic symptoms warrants nonurgent professional evaluation.

The Followup-Q provider questions identify the key severity and red-flag details for urinary retention symptoms.

For weeks I have had trouble fully emptying my bladder and I get up to use the bathroom multiple times at night. It is disrupting my sleep.

Is this getting worse, and do you have pain, blood in the urine, or a swollen lower abdomen?

The source provider questions ask about trend, dysuria, hematuria, abdominal pain, distension, new medications, confusion, foamy urine, and neurologic symptoms. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It is staying about the same. It does not burn, I do not see blood, and I do not have abdominal pain or a tight swollen lower belly. No new medicines, confusion, foamy urine, or new tingling or weakness.

You should schedule a nonurgent medical visit. Weeks of incomplete emptying and nighttime urination should be evaluated for urinary retention, prostate or bladder problems, medication effects, infection, or other urinary causes.

The constructed action follows the source symptom pattern with acute retention, infection, confusion, and neurologic red flags absent.


Patient reports sneezing and swollen, itchy lips.

Provider questions target sudden onset after new medication, trouble catching breath, OTC response, rash, spontaneous limb swelling, and family history of similar swelling.

External trigger anchor: mild isolated itchy lip swelling without breathing or throat symptoms may be monitored with allergy treatment; breathing difficulty or throat/tongue swelling warrants urgent care.

The source questions explicitly ask about new medication, trouble catching breath, rash, abnormal swelling, and family history.

I have been sneezing a lot and my lips are swollen and itchy. I am worried it might be an allergy.

Did this start suddenly after a new medication or food, and do you have trouble breathing or tongue or throat swelling?

The source provider questions ask about sudden onset after new medication, trouble catching breath, OTC response, rash, limb swelling, and family history. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It started after I was outside around pollen. My lips are mildly puffy and itchy, but my tongue and throat feel normal and I can breathe normally. I do not have a rash or swelling elsewhere. An antihistamine helped the sneezing a bit.

For now this can be managed as a mild allergic reaction with an antihistamine you can safely take and close monitoring. If breathing trouble, tongue or throat swelling, widespread rash, faintness, or rapidly worsening swelling appears, the action changes to emergency care.

The follow-up answers rule out the source airway and systemic swelling triggers.

Now my tongue feels swollen and I am having trouble catching my breath.

This needs urgent emergency care now. Tongue swelling with trouble breathing can be a serious allergic reaction. Call emergency services or use emergency allergy medication if prescribed while getting help.

The source questions identify breathing difficulty and abnormal swelling as the key safety triggers.


Patient reports diarrhea for a few weeks, persistent but not initially alarming.

Provider questions target trend, weight loss, travel, blood in stool, lightheadedness, dizziness, falls, entirely liquid stool, bad smell, C. difficile history, fever, recent antibiotics, abdominal pain/gas/flatulence, diet, supplements, testicular pain, chest pain, palpitations, and anxiety.

External action anchor: persistent diarrhea for weeks warrants nonurgent professional evaluation; blood in stool with dizziness or falls warrants urgent care.

The source provider questions identify red flags for chronic diarrhea and dehydration/bleeding, including blood, dizziness, falls, weight loss, fever, recent antibiotics, and C. difficile history.

I have had diarrhea for a few weeks. It has been persistent, but I am not sure if it is worth coming in for a check-up.

Is it getting better or worse, and is there blood, fever, weight loss, recent travel, or dizziness?

The source provider questions ask about trend, weight loss, travel, blood, dizziness, falls, watery stool, foul smell, fever, antibiotics, and C. difficile. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It is staying about the same. I have loose stools a few times a day and some gas, but no blood, fever, weight loss, dizziness, or falls. I have not traveled, taken antibiotics, or had C. diff before.

Because diarrhea has lasted for weeks, you should arrange a nonurgent medical visit to look for causes and decide whether stool testing or other evaluation is needed. Keep hydrating and seek urgent care if you see blood, feel faint, develop fever, or worsen quickly.

Persistent diarrhea for weeks remains after the source red flags are denied, supporting nonurgent professional evaluation.

Today there is blood in the stool and I feel lightheaded when I stand. I almost fell in the bathroom.

You need urgent medical care now. Blood in the stool with lightheadedness or near-falling can mean significant dehydration or bleeding and should be assessed promptly.

The source provider questions specifically ask about blood in stool, lightheadedness, dizziness, and falls.


Patient reports seasonal allergies with itchy eyes, congestion, and sneezing, with inadequate OTC relief.

Provider questions target duration, OTC response, fever, breathing difficulty, COVID, asthma/inhaler response, facial pain, symptoms over 10 days, tongue swelling, new medication, unilateral red eye, and purulent eye drainage.

External trigger anchor: uncomplicated seasonal allergies support self-care; tongue swelling or trouble breathing requires urgent care.

The source questions distinguish allergic rhinitis/conjunctivitis from fever, asthma symptoms, sinus/eye infection, tongue swelling, and new-medication reaction.

My seasonal allergies are rough right now. My eyes are itchy, I am congested, and I keep sneezing. Over-the-counter medicine is not giving enough relief.

How long has this been going on, and do you have fever, trouble breathing, asthma symptoms, tongue swelling, or eye drainage?

The source provider questions ask about fever, trouble catching breath, COVID, asthma/inhaler response, facial pain, duration, tongue swelling, new medication, red eye, and purulent eye drainage. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been four days. I do not have fever, trouble breathing, tongue swelling, facial pain, a new medication, one red eye, or pus-like drainage. I have asthma, but this does not feel like an asthma flare and I have not needed my inhaler.

This fits seasonal allergies for now. You can continue an antihistamine you can safely take, use saline rinses, and consider a nasal steroid or allergy eye drops if appropriate. Seek care if symptoms last more than 10 days with facial pain, eye drainage, or breathing symptoms.

The follow-up answers rule out the source red flags and support allergy self-care.

After taking a new medicine today, my tongue feels swollen and I am starting to have trouble breathing.

Get urgent emergency care now. Tongue swelling with breathing trouble after a new medication can be a serious allergic reaction.

The source provider questions identify tongue swelling, new medication, and breathing difficulty as safety triggers.


Patient reports worsening arthritis flares with swelling and pain affecting daily life.

Provider questions target affected joints, duration, trend, red/hot/purulent joints, fever, OTC medications, and prednisone response.

External action anchor: worsening arthritis flares without septic-joint features warrant nonurgent professional treatment adjustment; fever with hot red joint would be urgent but is absent.

The source questions emphasize joint location, duration, trend, redness, heat, purulent material, fever, OTC medications, and prednisone response.

My arthritis flare-ups have become much worse and unpredictable. Some days I can barely move my joints because of pain and swelling. Rest and ice are not enough.

Which joints are affected, how long has this been going on, and are any joints red, hot, or associated with fever?

The source provider questions ask which joints are affected, duration, trend, redness, heat, purulent material, fever, OTC medication use, and prednisone response. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It is mostly my knees and hands. It has been worsening over the past month. The joints are swollen and painful, but not red, hot, or draining anything. I do not have a fever. Ibuprofen and ice help only a little, and prednisone helped in the past.

You should arrange a nonurgent clinician visit to reassess your arthritis flare pattern and adjust the treatment plan. Seek urgent care sooner if a joint becomes hot, very red, severely painful, or you develop fever.

The constructed action follows the source questions: worsening flares need professional adjustment, while fever/hot/red/purulent joint red flags are denied.


Patient reports fatigue and random sweating episodes.

Provider questions target unintentional weight loss, fever, duration, trend, pregnancy, LMP, cough, rash, sick contacts, foreign travel, new medication, and ankle pain or joint swelling.

External action anchor: persistent unexplained fatigue and sweating warrant nonurgent professional evaluation; fever with confusion, shortness of breath, or inability to maintain intake warrants urgent care.

The provider questions screen for fever, weight loss, pregnancy, cough, rash, exposure, travel, medications, and joint symptoms.

I have been exhausted all the time and I get random sweating episodes out of nowhere. I am worried something might be wrong.

How long has this been going on, and do you have fever, weight loss, cough, pregnancy possibility, or new medication use?

The source provider questions ask about weight loss, fever, duration, trend, pregnancy, LMP, cough, rash, sick contacts, travel, medication changes, and joint swelling. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been about three weeks and is slowly getting worse. I have not lost weight, do not have a fever, cough, rash, sick contacts, foreign travel, new medicines, pregnancy possibility, or joint swelling.

You should schedule a nonurgent medical check-up. Persistent fatigue with unexplained sweating can have many causes and may need an exam and basic testing, even without emergency features.

Persistent symptoms remain after the source red flags are denied, supporting professional evaluation.

Today I developed a fever over 102 F, I feel confused, and I am short of breath walking across the room.

You need urgent medical care now. Fever with confusion and shortness of breath can signal a serious illness and should be assessed immediately.

The source questions include fever and respiratory symptoms, and confusion is treated as an urgent systemic red flag.


Patient reports difficulty starting urination, foul-smelling cloudy urine, and worry about needing evaluation.

Provider questions target duration, trend, dysuria, hematuria, abdominal pain, bladder distension, new medications, confusion, vaginal discharge/lesions/ulcers, new sexual partner, travel, nausea, vomiting, chills, and pregnancy possibility.

External action anchor: suspected lower urinary tract infection without systemic or pregnancy red flags warrants nonurgent professional urine testing/treatment.

The source message and questions support a urinary-symptom case requiring UTI/STI/pregnancy red-flag clarification.

Sometimes it is hard for me to start peeing, and when I do, my urine smells bad and looks cloudy. Should I come in and get checked?

How long has this been going on, and do you have burning, blood, fever or chills, back pain, or possible pregnancy?

The source provider questions ask about duration, trend, dysuria, hematuria, abdominal pain, distension, medications, confusion, vaginal symptoms, sexual partner, travel, nausea, vomiting, chills, and pregnancy. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been three days and is about the same. It burns a little when I pee, and the urine is cloudy and smells bad. I do not have blood, back pain, swollen lower abdomen, fever, chills, nausea, vomiting, confusion, vaginal discharge, lesions, ulcers, a new sexual partner, or pregnancy possibility.

You should arrange a nonurgent clinician visit or urine test for possible UTI and treatment advice. Seek urgent care if you develop fever, back or flank pain, vomiting, confusion, pregnancy concern, or inability to urinate.

The source questions support nonurgent urinary evaluation when lower urinary symptoms are present without systemic, pregnancy, retention, or neurologic red flags.


Patient reports trouble breathing through the nose due to congestion and stuffiness, on and off all day, with nasal spray not helping much.

Provider questions target duration, OTC response, fever, trouble catching breath, COVID exposure, asthma/inhaler response, facial pain, symptoms over 10 days, tongue swelling, new medication, unilateral red eye, and purulent eye drainage.

External trigger anchor: isolated nasal congestion supports self-care; trouble catching breath or tongue swelling warrants urgent care.

The source questions identify fever, breathing difficulty, COVID exposure, asthma response, facial pain, tongue swelling, medication trigger, and eye infection features.

I am having a really tough time breathing through my nose because it is congested and stuffy. It has been on and off all day and nasal spray is not helping much.

Is this only nasal blockage, or are you having trouble catching your breath? How long has it been going on?

The source provider questions ask about duration, OTC response, fever, trouble catching breath, COVID exposure, asthma/inhaler response, facial pain, tongue swelling, medication trigger, and eye findings. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It is just my nose feeling blocked. I can breathe normally through my mouth and do not feel short of breath in my chest. It started today. I have no fever, COVID exposure, asthma symptoms, facial pain, tongue swelling, new medication, red eye, or eye drainage.

This can be managed at home for now as nasal congestion. Use saline spray or rinse, fluids, and an appropriate decongestant or allergy medicine if safe for you. Seek care if you develop fever, facial pain lasting several days, symptoms over 10 days, or true trouble breathing.

The follow-up answers distinguish nasal congestion from the source breathing and allergic-swelling red flags.

After using a new nasal spray, my tongue started swelling and now I am having trouble catching my breath.

Get urgent emergency care now. Tongue swelling with trouble catching your breath after a new product can be a serious allergic reaction.

The source provider questions include tongue swelling, new medication exposure, and trouble catching breath as safety triggers.


Patient reports heavy periods with clotting for weeks and perimenopause-type symptoms such as mood swings and hot flashes.

Provider questions target duration, LMP, lightheadedness, dizziness, falls, pads/tampons per day, discharge, fever, hysterectomy, weight loss, night sweats, pain with intercourse, odor, family history of endometrial/ovarian cancer, pregnancy possibility, blood in urine, and transplant medications.

External action anchor: heavy menstrual bleeding with clots but no hemodynamic instability warrants nonurgent professional evaluation.

The Followup-Q questions identify bleeding volume, dizziness/falls, pregnancy, infection, cancer-risk symptoms, and medication considerations.

My periods have been pretty heavy lately with a lot of clotting, and I am also having mood swings and hot flashes. It has been going on for weeks and I am concerned.

When was your last period, how many pads or tampons are you using per day, and do you feel lightheaded?

The source provider questions ask about LMP, dizziness, falls, pad/tampon count, discharge, fever, hysterectomy, weight loss, night sweats, pregnancy, blood in urine, and transplant medications. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

My last period started about a week ago. I am using about six pads a day, with clots, but I am not soaking a pad every hour. I do not feel lightheaded or dizzy and have not fallen. I do not have fever, abnormal discharge, pregnancy possibility, weight loss, night sweats, or blood in my urine.

You should book a nonurgent visit for abnormal uterine bleeding evaluation. Heavy periods with clots can occur around perimenopause but should be assessed, especially if the pattern is new or persistent.

The constructed action follows the source bleeding-severity questions: no instability is present, but persistent heavy bleeding with clots needs professional evaluation.


Patient reports profuse sweating episodes at rest and feeling warm without clear trigger.

Provider questions target duration, fever, trouble catching breath, COVID/flu, exposure, OTC remedies, lightheadedness, dizziness, falls, LMP, chest pain, shortness of breath, palpitations, vomiting, poor intake, severe chills, pregnancy, headache, and confusion.

External action anchor: recurrent unexplained sweating warrants nonurgent professional evaluation; sweating with chest pain, shortness of breath, palpitations, or lightheadedness warrants urgent care.

The source questions include cardiopulmonary red flags associated with sweating episodes: chest pain, shortness of breath, palpitations, lightheadedness, dizziness, and falls.

I have weird sweating episodes on and off throughout the day, even when I am just sitting. I also feel warm even when the room is cool.

How long has this been happening, and do episodes come with chest pain, shortness of breath, palpitations, fever, or lightheadedness?

The source provider questions ask about fever, breathing, COVID/flu, lightheadedness, dizziness, falls, LMP, chest pain, shortness of breath, palpitations, vomiting, poor intake, severe chills, pregnancy, headache, and confusion. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been happening for about two weeks. I do not have chest pain, shortness of breath, palpitations, fever, dizziness, falls, vomiting, severe chills, headache, confusion, or pregnancy possibility.

You should arrange a nonurgent check-up because recurrent unexplained sweating can have hormonal, infection-related, medication, or other causes. Seek urgent care if it occurs with chest pain, shortness of breath, palpitations, faintness, or confusion.

The source red flags are denied, but recurrent unexplained sweating remains and supports professional evaluation.

This episode is different. I am sweating heavily, my chest hurts, I feel short of breath, my heart is racing, and I feel lightheaded.

You need urgent medical care now. Sweating with chest pain, shortness of breath, palpitations, and lightheadedness can be a time-sensitive heart or breathing problem.

The source questions identify chest pain, shortness of breath, palpitations, and lightheadedness as key red flags.


Patient reports trouble breathing through the nose because it is stuffed up.

External trigger anchor: isolated nasal stuffiness supports self-care; tongue swelling or true trouble catching breath warrants urgent care.

The provider questions distinguish nasal congestion from fever, asthma, COVID exposure, sinus/eye infection, tongue swelling, new medication reaction, and true breathing difficulty.

My nose is all stuffed up and I am having trouble breathing through it. Can you help?

The source provider questions ask about duration, OTC response, fever, trouble catching breath, COVID, asthma/inhaler response, facial pain, duration over 10 days, tongue swelling, medication trigger, and eye symptoms. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It is only nasal blockage. It has been three days. I can catch my breath fine and do not have fever, COVID exposure, asthma symptoms, facial pain, tongue swelling, new medication exposure, red eye, or pus-like drainage.

This can be managed with self-care for now: saline spray or rinse, fluids, humidified air, and an appropriate allergy or decongestant medicine if safe for you. Seek care if symptoms last more than 10 days, facial pain develops, or you have true breathing trouble.

The follow-up answers rule out the source red flags and support self-care/monitoring.

Now my tongue is swelling and I am having trouble catching my breath.

Get urgent emergency care now. Tongue swelling with trouble catching your breath can be a serious allergic reaction.

The source questions explicitly include tongue swelling and trouble catching breath as urgent safety triggers.


Patient reports heavy, painful menstrual clotting that is different from prior periods and worries about age-related causes such as hormonal changes or fibroids.

Provider questions target duration, LMP, dizziness, falls, pad/tampon count, discharge, fever, hysterectomy, weight loss, night sweats, painful periods, pain with intercourse, odor, family history of endometrial/ovarian cancer, and pregnancy possibility.

External action anchor: persistent heavy painful bleeding with clots but no instability warrants nonurgent gynecologic evaluation.

The source message reports heavy painful clotting; provider questions cover bleeding severity, pregnancy, infection, systemic symptoms, and cancer-risk context.

I am having clotting during my periods, and the bleeding has been quite heavy and painful on and off. It feels different from my usual rough periods, and I am worried it could be fibroids or hormonal changes.

How long has this been happening, when was your last period, and how many pads or tampons are you using?

The source provider questions ask about duration, LMP, dizziness, falls, bleeding volume, discharge, fever, hysterectomy, weight loss, night sweats, painful periods, pain with intercourse, odor, family history, and pregnancy. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

This has been going on for three cycles. My last period started five days ago. I use about five to six pads a day and pass clots, but I am not soaking a pad every hour. I do not feel dizzy or lightheaded and have not fallen. I do not have fever, abnormal discharge, pregnancy possibility, weight loss, night sweats, or pain with sex.

You should schedule a nonurgent gynecology or primary-care visit. A new pattern of heavy painful periods with clots should be evaluated for causes such as fibroids, hormonal changes, or other uterine conditions.

The source red-flag questions are answered without instability, while the heavy painful clotting pattern remains and supports nonurgent evaluation.


Patient reports bad gas for weeks with discomfort and uncertainty about whether to be seen.

Provider questions target belching, flatulence, constipation, chest pain, reflux, simethicone response, weight loss, blood in stools, bowel habit changes, lightheadedness, dizziness, falls, watery stool, foul smell, new diet, and supplements.

External trigger anchor: gas/bloating without red flags supports self-care or nonurgent follow-up; associated chest pain with dizziness warrants urgent care.

The source questions screen for gastrointestinal red flags and associated chest pain, lightheadedness, dizziness, and falls.

I have had pretty bad gas for weeks and it is getting uncomfortable. I do not know if I should worry or come in.

Are you mainly belching, passing gas, or constipated, and do you have chest pain or blood in the stool?

The source provider questions ask about belching, flatulence, constipation, chest pain, reflux, simethicone response, weight loss, blood in stools, bowel changes, lightheadedness, dizziness, falls, watery/foul stool, diet, and supplements. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It is mostly bloating and passing gas. I started eating a lot more beans and protein bars. I do not have chest pain, reflux, blood in the stool, weight loss, watery or foul-smelling stool, dizziness, or falls. My bowel movements are otherwise normal.

This can be managed with self-care for now. Try reducing gas-producing foods and carbonated drinks, eating slowly, and using simethicone if safe for you. If symptoms persist despite diet changes or bowel habits change, routine follow-up would be appropriate.

The follow-up answers rule out the source red flags and identifies a diet trigger.

This time the discomfort has turned into chest pain, and I feel lightheaded when I stand up.

You need urgent medical care now. Chest pain with lightheadedness should not be assumed to be gas and needs prompt assessment.

The source provider questions include associated chest pain and lightheadedness/dizziness/falls as safety-relevant features.


Patient reports heartburn and diarrhea, antacids not helping much, and frequent bathroom trips.

Provider questions target duration, symptom duration, trend, blood in stools, bowel-character/frequency changes, OTC response, weight loss, lightheadedness/dizziness/falls, entirely liquid stool, foul smell, antibiotic exposure, C. difficile history, travel, diet, supplements, pregnancy possibility, stool frequency, and incontinence.

External action anchor: persistent heartburn with frequent diarrhea and no immediate red flags warrants nonurgent professional evaluation.

The provider questions specify the red flags and stool-frequency details needed for escalation timing in heartburn plus diarrhea.

I have been having heartburn and diarrhea. Antacids are not helping much, and I feel like I am running to the bathroom all the time. Should I come in or manage it myself?

How long has this been going on, how many times a day are you having diarrhea, and is there blood or dizziness?

The source provider questions ask about duration, trend, blood, bowel changes, OTC response, weight loss, dizziness/falls, watery/foul stool, antibiotics, C. difficile, travel, diet, supplements, pregnancy, frequency, and incontinence. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been about two weeks and is not improving. I have diarrhea about six times a day. There is no blood, weight loss, dizziness, falls, fever, foul smell, recent antibiotics, C. diff history, travel, pregnancy possibility, or incontinence.

You should arrange a nonurgent medical visit. Heartburn with two weeks of frequent diarrhea that is not improving may need medication review, stool testing, or other evaluation even without emergency signs.

Persistent frequent symptoms remain after the source urgent red flags are denied, supporting nonurgent professional evaluation.


Patient reports shortness of breath during everyday activities and night sweats with fatigue.

Provider questions target duration, chest pain, palpitations, symptom duration and relief, rest dyspnea, dyspnea with chest pain, history of DVT and no blood thinner, fever, surgery, immobilization, weight gain, leg/abdominal swelling, orthopnea, waking gasping, lightheadedness, dizziness, falls, asthma/inhaler response, reflux, and PTSD symptoms.

External action anchor: new shortness of breath with prior DVT and no anticoagulation is delay-unsafe and warrants urgent same-day evaluation; chest pain, rest dyspnea, or unilateral swelling further strengthens urgent escalation.

The source provider questions explicitly include history of DVT without blood thinner, dyspnea features, chest pain, palpitations, swelling, orthopnea, dizziness/falls, and asthma response.

I have shortness of breath even with everyday activities like walking or going up stairs, and I have also been having night sweats. I feel a bit more tired than usual.

How long has this been going on, and do you have chest pain, shortness of breath at rest, leg swelling, dizziness, or a history of blood clots?

The source provider questions ask about chest pain, palpitations, rest dyspnea, DVT history/no blood thinner, surgery, immobilization, swelling, orthopnea, waking gasping, dizziness/falls, and asthma symptoms. Second-pass revision compressed the clarification prompt to reduce question burden while preserving source-relevant red-flag and timing checks.

It has been about a week. I am short of breath with stairs but not at rest. I do not have chest pain or palpitations. I had a DVT before and I am not on a blood thinner now. I have not had recent surgery or immobilization, and I do not notice leg swelling. My asthma inhaler has not helped much.

You need urgent same-day medical assessment. New shortness of breath with a history of DVT and no current blood thinner should be checked promptly to rule out a blood clot or other serious cause.

The source provider question explicitly notes history of DVT and not being on a blood thinner; new shortness of breath is the current symptom.

Now I am short of breath even sitting still and I have chest pain when I breathe in.

Call emergency services or go to the emergency department now. Shortness of breath at rest with chest pain, especially with prior DVT history, is urgent.

The source questions include rest dyspnea and chest pain coinciding with shortness of breath as urgent features.


20-year-old patient has taken prescribed tuberculosis medicines for about 6 months.

Patient reports new facial acne while on anti-tuberculosis medication.

Source clinician states acne can occur with rifampin and lists liver-injury symptoms that should be reported to a doctor.

Source clinician says anti-TB medications are generally tolerated, acne can occur with rifampin, and fever, right upper abdominal pain, vomiting, or jaundice should be reported to the doctor.

I am 20 and have been taking the tuberculosis medicines my doctor prescribed for about 6 months. I have acne on my face now. Could this be from the TB medicine, and will it harm me later?

Acne can occur with some TB medicines, including rifampin. Do not stop your TB medicines on your own. Keep taking them as prescribed and mention the acne to your TB doctor at your next review, especially if it is severe or spreading.

Source clinician identifies acne as a possible rifampin side effect and says anti-TB medicines are generally tolerated.

I also noticed orange-colored urine and tears, but I do not have fever, vomiting, abdominal pain, or yellow eyes.

Orange urine or tears can happen with rifampin. Since you do not have symptoms suggesting liver injury, this can be monitored while you continue treatment as prescribed. Tell your treating doctor if the acne or skin symptoms become troublesome.

Source clinician lists orange-colored urine, saliva, or tears as common anti-TB medication effects and reserves doctor reporting for liver-injury symptoms.

Now I have fever, vomiting, pain on the right side of my upper abdomen, and my eyes look yellow.

These symptoms could suggest liver injury from TB medication. Contact your treating doctor urgently today or go to urgent/emergency care if you cannot reach them. Do not take extra doses until a clinician tells you what to do.

Source clinician says fever, right upper abdominal pain, vomiting, and jaundice should be reported to a doctor.


Patient has known shellfish, iodine, and novacaine allergies and carries an EpiPen and Benadryl.

New rubber gloves caused hand itching and slight puffiness, with similar mild facial reaction after touching the face.

Source clinician distinguishes contact dermatitis from immediate latex allergy and lists breathing difficulty, chest pain, low blood pressure, and anaphylaxis as severe reactions.

Source clinician says mild contact-type symptoms can be managed by avoiding latex and using antihistamines, while symptoms such as difficulty breathing, chest pain, low blood pressure, or anaphylaxis indicate a serious reaction.

I put on new rubber gloves to wash dishes and my hands started itching with slight puffiness. I may have rubbed my face and got a similar mild reaction. I have several allergies and carry an EpiPen and Benadryl.

This could be a latex or glove-related reaction. Remove the gloves, wash the skin, avoid using that pair again, and use latex-free gloves. If symptoms stay mild and you have no breathing trouble, throat swelling, dizziness, or widespread hives, an antihistamine may be enough.

Source clinician says avoiding latex gloves and antihistamines are appropriate if there is no rapid breathing or rhinitis and the reaction subsides.

The itching is calming down after I took the gloves off. I do not have wheezing, throat tightness, chest pain, dizziness, or a racing heartbeat.

That pattern fits a mild glove-related skin reaction. Continue avoiding latex or the suspected gloves, monitor the skin, and use latex-free alternatives. Seek care if the swelling worsens or the rash does not settle.

Source clinician states that if the reaction subsides and there are no respiratory symptoms, antihistamines and avoidance are appropriate.

Now I feel tightness in my throat and chest, I am short of breath, and I feel lightheaded after the glove reaction.

Use your EpiPen as prescribed and call emergency services now. Breathing trouble, throat or chest tightness, and lightheadedness after an allergic exposure can be anaphylaxis.

Source clinician lists difficulty breathing, chest pain, low blood pressure, and anaphylactic shock as serious immediate latex-allergy reactions.


43-year-old female reports kidney stones that moved into the bladder a couple of days ago.

Patient now has abdominal pain, lower back pain, pale stools, and constipation.

Source clinician considers pancreatitis or obstructive jaundice and recommends clinical evaluation with CT and blood, urine, and stool tests; ER if jaundice, distension, vomiting, or further symptoms develop.

Source clinician recommends abdominal CT and laboratory testing and says to visit the ER rather than wait if jaundice, distension, vomiting, or further symptoms develop.

I am a 43-year-old woman. I was told kidney stones broke down into my bladder a couple of days ago. Now I have abdominal pain, lower back pain, pale stools, and constipation, but I cannot see my doctor for a couple more days.

This needs medical evaluation because pale stools with abdominal and back pain can come from a liver, bile duct, pancreas, or gastrointestinal problem, not only kidney stones. Arrange medical care and testing as soon as available, including the tests your clinician thinks are needed.

Source clinician recommends CT abdomen and blood, urine, and stool testing for possible pancreatitis or obstructive jaundice.

I still have pain and pale stools, but I am not vomiting, my belly is not swollen, and my eyes are not yellow.

You should still keep the medical appointment and be evaluated for the pale stools and pain. Since you do not have the worsening symptoms described, it is reasonable to arrange prompt non-emergency evaluation rather than wait indefinitely.

Source clinician recommends investigation even before emergency triggers appear.

Since then my eyes look yellow, my abdomen is more swollen, and I have started vomiting.

Go to the emergency department now. Jaundice, abdominal distension, and vomiting with this pain pattern should not wait for a later appointment.

Source clinician says not to wait and to visit the ER if jaundice, distension, vomiting, or further symptoms develop.


30-year-old patient had osteomyelitis and surgery removing the top left rib.

The stitch site is oozing pus; GP suspects infection and has taken a swab; surgeon said chest X-ray was acceptable.

Source clinician says culture is appropriate, antibiotics can be selected after results, and emergency care is needed for severe pain or high fever.

Source clinician supports GP culture and antibiotic selection after results, with emergency care if severe pain or high fever develops.

I had osteomyelitis a few months ago and had the top rib on my left side removed. The stitch area is oozing pus. My surgeon said the chest X-ray looked fine, but my GP thinks there may still be infection and took a swab.

Continue the GP follow-up and wait for the swab result unless symptoms worsen. A culture is the right step because it can guide the antibiotic choice if this is a wound or skin infection.

Source clinician says the GP culture is appropriate and antibiotics can be chosen once the culture returns.

The drainage is still there, but I do not have a high fever and the pain is not severe.

Keep following the GP plan and make sure you receive the culture result. If you remain without high fever or severe pain, this can usually wait for the planned culture-guided treatment rather than emergency care.

Source clinician says it is okay to wait on culture results if there is no severe pain or high fever.

Now I have a high fever and the surgery area is severely painful.

Go to emergency care now. High fever and severe pain at a postoperative infection site need urgent assessment.

Source clinician says severe pain at the site or high fevers should prompt Emergency care.


Caregiver reports a 10-month-old with a dark purple line around the lips.

Infant has recurrent temperature over 38 C, painful chesty cough, and wheeze; oxygen levels were checked the same day and reportedly fine.

Source clinician discusses anemia and cyanosis and says emergency attention is needed if blue or purple lips occur with diminished consciousness, cold clammy skin, or difficulty breathing.

Source clinician states that emergency care is necessary if blue or purple lips are associated with diminished consciousness, cold clammy skin, or difficulty breathing.

My 10-month-old has a dark purple line around his lips, like lip liner. He keeps getting temperatures over 38 C and has a painful chesty cough and wheeze. His oxygen levels were tested today and were fine.

I need to know whether he is struggling to breathe, unusually sleepy or hard to wake, cold and clammy, or whether his lips or tongue look blue rather than only a line around the lips. These details determine whether this is emergency-level.

Source clinician makes emergency care depend on purple or blue lips with diminished consciousness, cold clammy skin, or difficulty breathing.

He is awake, feeding, not cold or clammy, and he is not pulling in around the ribs or struggling to breathe. It is just the line around the lips, and the doctor said his oxygen was okay today.

Because he is breathing comfortably and had normal oxygen checked today, monitor closely and follow the doctor’s plan for the cough, wheeze, and fever. Seek pediatric care again if the fever or wheeze persists or worsens.

Source clinician reserves emergency care for lip discoloration with breathing difficulty, diminished consciousness, or cold clammy skin.

Now his lips look blue, he is very sleepy and hard to wake, his skin feels cold and clammy, and he seems to be working hard to breathe.

Call emergency services or go to the emergency department now. Blue or purple lips with sleepiness, cold clammy skin, and breathing difficulty can mean low oxygen.

Source clinician says emergency attention is necessary when blue or purple lips occur with diminished consciousness, cold clammy skin, or difficulty breathing.


65-year-old mother has had rheumatoid arthritis for nine years and is currently bedridden.

The user asks for an appointment on an emergency basis rather than providing current symptoms, medications, or functional details.

Source clinician asks about diet control and medications before advising.

Source clinician asks what diet control and medicines she is taking.

My mother is 65 and has had rheumatoid arthritis for nine years. She is bedridden now. I want to know what treatment is advisable and whether we can get an urgent appointment.

She should be assessed by a clinician or rheumatology service because she is 65, has long-standing rheumatoid arthritis, and is now bedridden. The clinician will need to review her current medicines, how quickly she became bedridden, whether she has fever or a newly hot swollen joint, and whether she can eat, drink, and pass urine normally. Use urgent care if the bedridden state is new or rapidly worsening, or if fever, severe new joint swelling, dehydration, confusion, or inability to pass urine is present.

Source patient text describes a 65-year-old with nine years of rheumatoid arthritis who is bedridden and seeking an appointment; the source clinician indicates that current management depends on medicine and diet details.


Patient has taken fluoxetine 20 mg for one week.

Patient reports stomach upset, occasional headache, and sore peeling lips.

Source clinician says symptoms may be fluoxetine side effects, including dry mouth, and advises fluids and lip moisturizer.

Source clinician attributes symptoms to possible fluoxetine side effects and recommends water and moisturizing the lips.

I have been taking fluoxetine 20 mg for a week. I have stomach upset and headaches at times, and my lips are sore and peeling. Is the peeling a sign that something is wrong?

These can be short-term side effects such as dry mouth or stomach irritation. Drink fluids, use a lip moisturizer, and monitor the symptoms. Do not stop fluoxetine abruptly; contact the prescriber if the symptoms become severe, you develop a rash or swelling, or the stomach upset persists.

Source clinician says the symptoms may be fluoxetine side effects and advises water and moisturizer for lip dryness.


23-month-old child has a small flat dot on the inside tip of the pointer finger.

Spot was red one week ago and is now dark purple or black.

Source clinician says this is suggestive of injury and may take 10 to 12 weeks to resolve.

Source clinician says the spot is suggestive of injury and complete resolution may take 10 to 12 weeks.

About a week ago I noticed a tiny flat dot on the inside tip of my 23-month-old daughter’s pointer finger. It was red last week and now it is dark purple or black. It is not going away. Should I be worried?

This sounds most consistent with a small injury or bruise changing color as it heals. Monitor it for gradual improvement; it can take weeks to fully fade. Arrange care if it grows, becomes painful, drains, or new spots appear.

Source clinician describes the lesion as likely injury-related and says complete resolution can take 10 to 12 weeks.


Patient is taking ciprofloxacin for a first UTI and is on day 5.

Urinary frequency has improved but urge to urinate, pelvic pressure, and weakness remain.

Source clinician states ciprofloxacin is effective and usually taken for 5 to 7 days.

Reviewer noted that persistent symptoms on day 5 make nonurgent clinician reassessment more appropriate than self-care-only monitoring.

Source clinician says ciprofloxacin is an effective UTI drug and may be taken for 5 to 7 days.

I am taking Cipro for my first UTI and I am on day 5. I am not running to the bathroom as much, but I still feel the urge to urinate and have pressure and weakness in my pelvic area and lower limbs. I planned to go back to my doctor Monday. Should I wait?

Because you are still having urinary urgency, pelvic pressure, and weakness on day 5 of treatment, contact the prescribing doctor or clinic for nonurgent reassessment rather than only monitoring at home. They may want to review the urine test, culture, antibiotic choice, or another cause of pelvic symptoms. Seek urgent care sooner if you develop fever, flank or back pain, vomiting, worsening weakness, pregnancy, or inability to urinate.

Source patient text reports persistent urinary urgency, pelvic pressure, and weakness on day 5 of ciprofloxacin and asks whether to wait; reviewer judged this should be nonurgent reassessment.


28-year-old friend had seizure disorder diagnosed in 2002 with left frontal granuloma and edema on brain CT.

He took Eptoin for three years and tapered under neurology advice.

He now has vague headaches and occasional giddiness, with impaired fasting glucose controlled by diet and exercise.

Source clinician recommends neurologist opinion and possible repeat brain imaging to rule out seizures or granuloma-related causes.

Source clinician recommends neurologist review and possible repeat brain imaging.

My 28-year-old friend had a seizure disorder years ago with a left frontal granuloma and edema on CT. He took Eptoin for 3 years and tapered it with his neurologist. Recently he has vague headaches and occasional giddiness. His blood work also showed impaired fasting glucose controlled by diet and exercise. Does he need a neurologist?

Yes. He should arrange a neurology review. The giddiness could represent minor seizure activity, and the headaches may need reassessment. The neurologist may consider repeat brain imaging and decide whether medication is needed again.

Source clinician recommends neurologist opinion and possible repeat brain imaging to assess seizures, granuloma, or other causes.


11-year-old child has had daily headaches for two weeks.

Before the headache she feels a nettle-sting sensation on the forehead; painkillers make the headache go away, but it returns.

Source clinician lists pediatric headache red flags, including continuous vomiting, seizures, ear or nose discharge, unconsciousness, and altered behavior; otherwise suggests migraine or tension headache.

Source clinician says pediatric headaches are serious when vomiting continuously, seizures, bloody or watery ear/nose discharge, unconsciousness, or altered behavior are present; without these red flags migraine or tension headache is more likely.

My 11-year-old has headaches every day for the past two weeks. Before the headache starts, she says her forehead feels like a nettle sting. Painkillers make it go away, but it keeps coming back. She is otherwise well.

I need to check for red flags first: has she had repeated vomiting, a seizure, watery or bloody discharge from the ears or nose, fainting or unconsciousness, or unusual behavior or confusion?

Source clinician identifies these pediatric headache red flags as the features that make headache serious.

No. She has not vomited, had seizures, fainted, had ear or nose discharge, or acted confused. She is normal between headaches.

Without those red flags, this is less likely to be an emergency and may fit migraine or tension-type headache. Keep a headache diary, avoid overusing painkillers, and arrange routine pediatric review if the daily pattern continues.

Source clinician says that without the listed red flags, migraine or tension headache is more likely.

Today she had a seizure and then became confused after the headache started.

Seek emergency care now. A seizure or altered behavior with headache in a child is a red flag that needs urgent assessment.

Source clinician lists seizures and altered sensorium or behavior as serious pediatric headache red flags.


Husband has right cervical lymph node FNAC suggestive of tubercular granulomatous lymphadenitis with ZN stain.

Source clinician recommends at least 2 plus 4 months of antitubercular treatment, baseline liver function tests, routine blood work, and repeat liver function tests after two weeks.

Source clinician says to inform the doctor immediately for tingling or burning in feet or visual disturbances.

Source clinician says the patient needs antitubercular treatment with baseline and repeat liver testing, and should inform the doctor immediately for tingling, burning feet, or visual disturbances.

My husband has a lump on the right side of his neck. FNAC says granulomatous lymphadenitis suggestive of tuberculosis in the right cervical lymph node, and ZN stain was done.

He should see his treating doctor to start a full antitubercular treatment course and baseline tests such as liver function and routine blood work. This is a professional-treatment issue, but it does not sound like an emergency from the information given.

Source clinician says FNAC suggestive of tubercular lymphadenitis requires antitubercular treatment and baseline liver/routine blood tests.

He started the TB medicines. His urine looks red-orange, but he feels better and has no tingling, burning feet, or vision problems.

Red-orange urine can happen with rifampicin. Keep taking the medicines as prescribed and keep the planned follow-up tests, including repeat liver function testing after about two weeks.

Source clinician states red stool or urine can occur due to rifampicin and recommends repeat liver function tests after treatment starts.

Now he has new blurred vision and burning in his feet after starting the TB medicines.

Contact his treating doctor urgently today. New visual symptoms or burning and tingling in the feet after TB medicines need prompt medication-safety review.

Source clinician says to inform the doctor immediately for tingling or burning in the feet or visual disturbances.


Patient has sudden lower front tooth sensitivity and throbbing pain.

Patient also reports chest tightness and difficulty breathing for a couple of days.

Source clinician focuses on dental sensitivity from exposed root surfaces and possible nasal breathing issues, but does not address the chest tightness and dyspnea.

Raw patient text reports chest tightness and difficult breathing; source clinician discusses dental causes but does not provide a cardiopulmonary escalation threshold.

My front lower teeth are really sensitive and throbbing. My chest also feels tight and it is difficult to breathe. This started suddenly a couple of days ago. I know I grind my teeth and they are worn down. Please help.

Because you have chest tightness and difficulty breathing, seek urgent medical care now. Dental sensitivity can be assessed after urgent causes of breathing difficulty and chest tightness are ruled out.

The raw patient text contains chest tightness and difficulty breathing; the source clinician response is dental-focused and does not resolve this red-flag symptom pair.


Grandchildren were around a child who might have MRSA on the same day.

A 3-month-old infant is also in the house.

Source clinician says doctor consultation depends on development of symptoms such as fever or cough after contact and notes the MRSA exposure should be reported to the doctor.

Source clinician says no doctor visit is needed unless symptoms develop after contact; if fever, cough, or other symptoms appear, consult a doctor and mention MRSA exposure.

My grandchildren were around a child today who might have MRSA. We did not know until after my daughter took the child home. We also have a 3-month-old baby in the house. Do we need to take them to a doctor?

If no one has symptoms, they do not need a doctor just because of the exposure. Wash hands, avoid sharing towels, cover any cuts, and monitor for fever, cough, or skin sores. If symptoms develop, tell the doctor about the possible MRSA exposure.

Source clinician says action depends on whether anyone develops symptoms after contact.

No one has fever, cough, rash, boils, or skin sores right now, including the baby.

Continue monitoring and use hygiene precautions. Without symptoms, this remains a watch-and-wait situation rather than a current doctor visit.

Source clinician says people with no symptoms after exposure probably will not develop anything and should seek care only if symptoms appear.

The 3-month-old now has a fever and a red swollen spot on the skin after the exposure.

Have the baby assessed urgently today. A fever and a red swollen skin lesion in a young infant need prompt pediatric evaluation, and you should mention the possible MRSA exposure.

Source clinician says symptoms after contact, such as fever or cough, should prompt doctor consultation and disclosure of MRSA exposure.


8-year-old developed a headache while jumping rope at school.

He subsequently could not see the words on the page.

Doctors were concerned and wanted neurology evaluation as soon as possible.

Source clinician lists red flags and asks about duration, location, blurry or double vision, giddiness, family migraine history, behavior, sleep response, and vomiting.

Source clinician asks specifically about visual symptoms, giddiness, vomiting, seizures, unconsciousness, and behavior change, while the source patient reports that doctors wanted neurology evaluation as soon as possible.

My 8-year-old grandson was jumping rope at school when he got a headache and then could not see the words on the page. The doctors were concerned and want him to see a neurologist as soon as possible. Is this a migraine?

Because this headache began during exertion and was followed by a temporary vision problem, he should keep the prompt neurology assessment that his doctors recommended. I would still ask whether the vision problem is ongoing and whether he has vomiting, seizure, confusion, fainting, weakness, neck stiffness, or severe worsening pain, because those would require urgent care now.

Source patient text reports exertional headache with inability to see words and that doctors wanted neurology review as soon as possible; reviewer proposes 1A at the first turn pending expert approval.

The vision problem went away, he is acting normally, and he has no vomiting, seizure, weakness, confusion, or trouble walking.

Keep the neurology appointment as soon as possible, as his doctors advised, because exertional headache with a visual symptom should be evaluated. If the symptoms return or new neurologic symptoms appear, seek urgent care.

Source patient text states doctors were concerned and wanted neurology evaluation as soon as possible; source clinician asks targeted neurologic red-flag questions.

The vision problem has not gone away and now he is vomiting and seems confused.

Go to emergency care now. Persistent vision change, vomiting, and confusion with headache in a child need urgent assessment.

Source clinician lists vomiting and altered sensorium or behavior as serious pediatric headache red flags.


Male patient has a painful lump under the left nipple about the size of a quarter for a few weeks.

Patient also has stomach pain that prevents eating, immediate fullness, and extreme pain.

Source clinician says the nipple lump should be removed and biopsied and that the second problem looks serious.

Source clinician recommends removal and biopsy of the nipple lump and notes the stomach problem appears serious.

I am male and recently noticed a painful lump under my left nipple about the size of a quarter. I also have stomach pains that stop me from eating, and I feel full immediately with extreme pain. Please help.

You need an in-person medical evaluation. The breast lump should be examined and may need imaging or biopsy, and the stomach pain with early fullness also needs assessment. Arrange care promptly rather than treating this at home.

Source clinician says the lump should be removed and biopsied and that the stomach problem looks serious.


26-year-old had surgery five months ago for scar tissue and adhesion removal.

Gynecologist found a right ovarian cyst.

Patient has severe cervical pain with sex followed by severe abdominal cramps and lightheadedness, rectal pain before/during bowel movements, and abdominal pain during urination.

Source clinician considers recurrent adhesions, pelvic inflammatory disease, cystitis, proctocolitis, and ovarian cyst complications.

Source clinician identifies active pelvic inflammatory process and additional urinary/rectal pain causes as possibilities requiring evaluation.

I had surgery 5 months ago for scar tissue and adhesion removal. My gynecologist found a cyst on my right ovary. I still get severe cervical pain during sex, severe abdominal cramps afterward that make me lightheaded, rectal pain before and during bowel movements, and abdominal pain during urination. I am 26. What could it be?

You should arrange an in-person gynecology or medical evaluation. Recurrent adhesions, pelvic infection or inflammation, bladder infection, bowel inflammation, and ovarian cyst problems all need examination and testing rather than home treatment alone.

Source clinician discusses recurrent adhesions, PID, cystitis, procto-colitis, and ovarian cyst complications as causes requiring evaluation.


Patient has hepatitis E jaundice and was hospitalized for five days.

Patient reports improvement with total bilirubin down to 5 and liver enzymes around 1400.

Patient is resting and asks whether to switch from Monolive to Liv52.

Source clinician says acute hepatitis E is usually self-limiting, continue current supportive treatment, and watch for excessive sleepiness, bleeding, or inability to eat.

Source clinician recommends supportive care, continuing the current medication rather than switching, and watching for alarm signs.

I am recovering from jaundice due to hepatitis E. I was in the hospital for 5 days and now feel better. My total bilirubin is down to 5 and liver enzymes are around 1400. I am resting and taking Monolive, but Liv52 seems more famous. Should I change?

Do not switch supplements just because one is more popular. Continue the plan your doctor gave you, rest, eat as tolerated, and monitor recovery. Seek care urgently if you become excessively sleepy, have bleeding, or cannot eat or drink.

Source clinician says acute hepatitis E is self-limiting, supportive care is appropriate, and alarm signs are excessive sleepiness, bleeding, and inability to eat.


Patient has short episodes of tight feeling from back of head to temples, throat, and chest.

During episodes patient becomes emotional, cannot catch breath, and heart beats fast; episodes resolve in 2 to 3 minutes with sitting and breathing.

Patient reports recent MRI and heart evaluation were okay.

Source clinician interprets symptoms as anxiety or panic attacks and discusses psychotherapy techniques.

Source clinician says anxiety or panic attack is likely and suggests identifying triggers and psychotherapy techniques.

I think I may be having panic or anxiety attacks. I get a tight feeling in the back of my head that moves to my temples, throat, and chest. I get emotional, cannot catch my breath, and my heart beats fast. It goes away in 2 or 3 minutes if I sit and focus on breathing. A recent MRI and heart check were OK. Any ideas?

This pattern can fit panic or anxiety episodes, especially since the episodes are brief, settle with breathing, and you report a recent heart check was okay. When an episode starts, sit down, slow your breathing, and track triggers or stresses that seem to come before it. Seek urgent medical care if chest pain or breathing trouble is new, severe, lasts longer than usual, or does not settle; arrange nonurgent care if these episodes keep recurring or interfere with daily life.

Source clinician interprets the short resolving episodes as anxiety or panic-related and suggests identifying anxiety triggers and psychotherapy techniques rather than urgent evaluation in the current state.


3-month-old baby has trouble sleeping at night and wakes when put down after sleeping on caregiver lap.

Caregiver checked for blocked nose and reports no nasal blockage.

Source clinician frames this as comfort/security and suggests lying down with the baby and habit training.

Source clinician recommends comfort-based sleep habit changes rather than medical evaluation.

My baby is 3 months old. She cannot sleep at night. She sleeps on our lap, but when we put her down in bed she wakes up. We checked whether her nose is blocked, but it is not. What can we do?

This sounds like a sleep-settling and comfort pattern rather than an urgent medical problem. Try placing her down drowsy, keeping the sleep environment calm, and staying beside her briefly as she settles. Seek pediatric advice if she has fever, poor feeding, breathing trouble, or poor weight gain.

Source clinician describes the infant as seeking security and suggests lying down with her and changing sleep habits.


Patient has history of kidney stones and recently passed a stone.

Patient woke with terrible pain, nausea, feeling hot, and blood in stool.

Source clinician says kidney stones do not cause blood in stool and advises gastro-surgeon for bleeding per rectum and urologist for renal calculus.

Source clinician states kidney stones do not cause blood in stool and recommends GI and urologic professional evaluation.

I have a history of kidney stones and recently passed another stone. Today I woke up in terrible pain, feel like I am going to vomit, feel very hot, and there is blood in my stool. Could this be another kidney stone?

Blood in the stool is not explained by a kidney stone and needs urgent medical assessment, especially with severe pain and feeling hot. Seek urgent care today so both gastrointestinal bleeding and possible kidney-stone complications can be assessed.

Source clinician says renal calculus does not cause blood in stool and recommends GI and urology evaluation.


30-year-old friend swallowed two drops of phenol after mistaking it for milk.

Source clinician states emesis is usually not used for phenol poisoning because vapors can enter the lungs through the airways, but also reassures due to the small amount.

Source clinician notes that vomiting is usually avoided in phenol poisoning because of airway risk, while also stating that the reported dose was small.

My 30-year-old friend had two drops of phenol after mistaking it for milk. He vomited and drank a lot of salt water. Please advise about side effects.

Call poison control or seek urgent medical advice now. Phenol is a toxic chemical exposure, and vomiting after ingestion can increase airway risk. Do not give more salt water or try to induce more vomiting unless poison control or a clinician tells you to.

Source clinician notes that emesis is usually not used for phenol poisoning because vapors may enter the lungs through the airways; source also documents phenol ingestion and vomiting.


Question concerns risk that partner has trench mouth/ANUG during oral sex.

Partner has no bad breath and can eat normally.

Source clinician states ANUG usually has gum ulceration/necrosis, pain, bleeding, fetid odor, and difficulty eating.

Source clinician says protection and oral hygiene prevent such infections.

Source clinician reassures that the described absence of odor and normal eating makes ANUG unlikely and gives prevention guidance.

My partner performed oral sex on me, and I am worried he might have trench mouth or acute necrotizing ulcerative gingivitis. He does not have bad breath and can eat normal food. Can someone have trench mouth without bad breath and still eat normally?

Based on what you describe, trench mouth is unlikely. It usually causes painful, bleeding, ulcerated gums with a very foul odor, and eating is often difficult. Oral sex alone would not be expected to cause this condition. Use barrier protection if there are oral sores or infection risks, and maintain oral hygiene. If your partner develops gum pain, bleeding, ulcers, or foul odor, he should see a dentist.

Source clinician described ANUG features and gave preventive advice without recommending current medical care.


Teeth appear white/creamy with dark or black staining on the back portion.

Source clinician attributes symptoms to staining and plaque accumulation and recommends professional scaling and polishing.

Source clinician recommends professional teeth cleaning every six months and continued brushing.

I am 18. For a few years my teeth have looked creamy or white, but the back parts look dark or black, and I often have bad breath. Whitening toothpaste has not helped. My mother has a similar problem. What should I do?

This sounds most consistent with staining and plaque buildup rather than an emergency. You should arrange a nonurgent dental visit for professional cleaning, such as scaling and polishing. Continue brushing twice daily with a toothpaste that suits you. A dentist can also check for cavities, gum disease, or other causes of bad breath.

Source clinician recommends regular professional scaling and polishing.


Shortness of breath has lasted one week and has not resolved.

Patient feels phlegm she cannot bring up and heaviness in the right chest radiating to the back.

Source clinician states it may be pneumonia and that antibiotics may be needed.

Source clinician says the patient may have pneumonia and may need antibiotics.

I am a 23-year-old woman. I have had shortness of breath for a week and it has not gone away. I feel like I have phlegm I cannot bring up, and there is heaviness on the right side of my chest going through to my back. I have been taking herbal cough medicine but it has not helped. I am worried about COVID and afraid to go to the hospital.

Because your shortness of breath has lasted a week and you have chest heaviness with possible chest infection symptoms, you should be assessed by a clinician rather than continuing only herbal medicine. You may need an exam and treatment such as antibiotics if pneumonia is suspected. Seek urgent care immediately if breathing becomes severe, you have chest pain, blue lips, confusion, fainting, or you cannot speak in full sentences.

Source clinician identifies possible pneumonia and possible need for antibiotics.


There is enough space and the tooth appears straight.

Patient has trouble opening the mouth fully.

Source clinician says this can occur with wisdom-tooth eruption and should improve in a few days.

Source clinician says restricted mouth opening can occur with wisdom-tooth eruption and should improve after a few days.

My lower-left wisdom tooth is coming in. I have enough space, it seems to be growing straight, and I do not have tooth pain. About half the tooth is out, but I cannot open my mouth fully. Should I worry?

This can happen while a wisdom tooth is erupting and may settle over a few days. Keep the area clean, use usual pain relief if you can take it safely, and monitor. Arrange dental care if the limited opening does not improve, pain develops, swelling appears, or you have fever, pus, trouble swallowing, or worsening jaw stiffness.

Source clinician reassures and recommends symptomatic treatment rather than immediate care.


She has five brown marks: two about 2 cm and three about 0.5 cm.

Initial two appeared at 3 months; three more appeared by 9 months.

Marks are irregular and lighter among the newer lesions.

Source clinician says cafe-au-lait macules are possible but asks for photographs before recommending treatment.

Source clinician asks for photographs to confirm the lesion type and does not recommend medication yet.

My 9-month-old daughter has five brown marks. Two are about 2 cm and three are about 0.5 cm. The first two appeared when she was 3 months old, and three lighter ones appeared by 9 months. Are these birthmarks? Will they fade? Do we need precautions or medicine?

I would need to see clear photographs of the marks before giving a firm opinion. From the history alone, cafe-au-lait spots are possible, but the appearance matters. Please share photos or arrange a pediatric/dermatology review if photos cannot be assessed. Do not start any medication for the spots without an exam.

Source clinician explicitly requests photographs before deciding.


Patient had EGD with biopsy and polypectomy.

Doctor reportedly said no cancer; biopsy report may still be pending.

Patient has chest/sternal pain when swallowing and is taking pantoprazole.

Source clinician recommends continuing current medications, adding Gaviscon, reflux precautions, and considering manometry if symptoms persist.

Source clinician says endoscopy showed no cancer evidence, asks for biopsy report if available, and recommends continuing medications and reflux precautions.

I just had an EGD with biopsy and polypectomy. It showed a 2 cm hiatal hernia, and the doctor said no cancer, but I have a past history of breast cancer. Today I have chest and sternum pain when I swallow. I am taking pantoprazole. Will this subside, what should I eat, and can I be assured this is not cancer?

Based on the endoscopy information you describe, the source did not show evidence of cancer, although the biopsy report is the definitive follow-up if it is still pending. Continue pantoprazole as prescribed. You can use reflux measures such as avoiding lying down for at least two hours after meals, elevating the head of the bed, limiting citrus, tea, and coffee, and using an antacid/alginate after meals if advised locally. If swallowing pain persists or worsens, arrange nonurgent follow-up; if you develop severe chest pain, vomiting blood, black stools, fever, or trouble breathing, seek urgent care.

Source clinician recommends continuing medications, adding Gaviscon, lifestyle measures, and nonurgent manometry only if symptoms persist.


Left-sided headache since yesterday morning.

Intermittent and throbbing, with light sensitivity but no visual change.

No nausea, vomiting, neurological symptoms, rash, feverish feeling, or viral symptoms.

Source plan: check blood pressure and temperature, ibuprofen with food, call back if worsening/persistent headache, fever, rash, or new symptoms.

Source note supports tension headache/first migraine with no meningitic or neurologic features, plus safety-netting.

I need a few details first: when did it start, where is the pain, is it sudden or the worst headache of your life, and do you have fever, rash, vomiting, vision changes, weakness, numbness, confusion, or neck stiffness?

Raw complaint alone does not define headache urgency.

It started yesterday morning when I woke up. It is mainly on the left side, throbbing, and comes and goes but never fully disappears. Light bothers me, but my vision is normal. I have no vomiting, weakness, numbness, rash, neck stiffness, feverish feeling, or cold symptoms. I do not usually get headaches. I took paracetamol only.

This sounds more like a first migraine-type or tension-type headache than an emergency based on the negatives you gave. Check your temperature and blood pressure if possible. You can use ibuprofen with food if you can take it safely. Call back or seek urgent help if the headache worsens or persists, fever or rash appears, or any new neurological symptoms, vomiting, confusion, neck stiffness, or vision changes develop. If headaches become recurrent, arrange a routine review.

Source plan recommends BP/temp check, ibuprofen, and safety-netting rather than current professional care.


Dysuria for 6 days with burning/stinging when urinating.

Strong urine odor and lower abdominal pain are present.

No back/loin pain, fever, vomiting, vaginal discharge, or difficulty passing urine.

Source impression is likely UTI and plan is nitrofurantoin for 3 days with safety-netting.

Source clinician diagnosed likely UTI and prescribed nitrofurantoin with return precautions.

I need to know how long this has been happening and whether you have fever, back or flank pain, blood in the urine, trouble passing urine, vomiting, pregnancy possibility, or new vaginal discharge.

Raw dysuria complaint lacks features needed to distinguish uncomplicated UTI from urgent urinary infection.

It has been six days. It burns and stings when I pass urine, and the urine smells strong. I have some lower tummy pain in the middle and a few spots of blood in the urine. I can pass urine. I do not have fever, back or loin pain, vomiting, or vaginal discharge.

This sounds like a likely urinary tract infection. You should receive nonurgent professional treatment, such as a clinician-prescribed antibiotic or local UTI pathway. Start treatment as directed and drink fluids. Contact a clinician urgently if you develop fever, back or flank pain, vomiting, worsening pain, pregnancy concern, or symptoms that do not improve after treatment.

Source plan was nitrofurantoin and safety-netting for fever, back pain, persistent symptoms, or recurrence.


Anxiety symptoms have lasted about two months and began after a new stressful job.

Insomnia, low energy, anhedonia, avoidance, and low mood are present.

Palpitations with occasional chest discomfort last about 2 to 10 minutes and started with anxiety symptoms.

Source plan: self-referral to talking therapies/online CBT and blood test for palpitations.

Source clinician assessed work-related anxiety and insomnia and advised talking therapies plus blood test for palpitations.

I need a little more context first: how long has this been going on, did anything trigger it, and how is it affecting your sleep, work, appetite, and daily activities?

Initial anxiety complaint does not contain duration, function, or safety information.

It has been about two months and started after I began a new job. I dread going to work every morning. I sleep only about three or four hours, feel tired and low in energy, and I avoid things I used to enjoy like running, tennis, and seeing friends.

That sounds significant. I still need to check safety and physical symptoms: have you had thoughts of harming yourself, panic attacks, chest pain, palpitations, fainting, or any alcohol or drug use that may be contributing?

Source note includes mood, palpitations, alcohol, and suicide-risk assessment before final plan.

I have low mood most of the time but no thoughts of harming myself. I get palpitations that feel fast or irregular with some chest discomfort, lasting around 2 to 10 minutes, and they only started with the anxiety. I have not missed work. I drink on Friday and Saturday and sometimes overdo it, smoke occasionally, and do not use illicit drugs. My parents are supportive.

This fits work-related anxiety with insomnia, and the palpitations should also be checked. Please self-refer to talking therapies or CBT support, and arrange a nonurgent blood test or primary-care review for the palpitations. Contact a clinician sooner if anxiety or mood worsens, you feel unable to cope with work, palpitations become prolonged or occur with severe chest pain, fainting, or shortness of breath, or if any self-harm thoughts appear.

Source plan is talking therapies, online CBT, and blood test for palpitations.