Older patient stopped birth control a few days ago and developed spotting.

Provider questions ask abdominal pain/cramping, vaginal discharge, sexual intercourse or local products, urinary changes, itching, and vaginal dryness.

Followup-Q row followupq_train_000070 provides the patient message, provider-written clarification questions, and candidate source stratum nonurgent. The constructed turns preserve the symptom trajectory implied by these questions and do not introduce unrelated complaints.

I stopped taking my birth control a few days ago and started spotting today. I am older and thought I would not have periods anymore. Should I be concerned?

I need to clarify whether this is light withdrawal bleeding or postmenopausal bleeding that needs evaluation. Do you have abdominal pain, cramping, vaginal discharge, recent intercourse or local products, urinary changes, itching, or vaginal dryness? Also, when was your last natural period before birth control?

Initial source text does not clarify pain, discharge, local irritation, urinary symptoms, dryness/itching, or menopausal timing.

No abdominal pain, only mild cramping, no discharge, no urinary changes, no itching. I have vaginal dryness. My last natural period was more than a year ago before I was on hormones.

Because you may be postmenopausal and now have new bleeding after stopping hormones, you should arrange a nonurgent clinician or gynecology evaluation. Seek urgent care if bleeding becomes heavy, you feel faint, or you develop severe pelvic pain or fever.

Source questions exclude acute severe symptoms, while postmenopausal-pattern bleeding supports nonurgent professional 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.

Bloating that is uncomfortable and worrying.

Provider questions ask about urination, bowel movements, regularity, swelling elsewhere, shortness of breath, decreased chores, cough, onset, OTC medications, dry/itchy skin, jaundice, appetite, fluids, and diet.

Followup-Q row followupq_train_000071 provides the patient message, provider-written clarification questions, and candidate source stratum safety_net. The constructed turns preserve the symptom trajectory implied by these questions and do not introduce unrelated complaints.

I have been feeling really bloated and uncomfortable lately. I am getting worried and want to discuss what might be going on.

I need to check whether this is likely digestive bloating or a fluid/organ warning sign. Any change in urination or bowel movements, swelling elsewhere, shortness of breath, reduced ability to do chores, cough, yellowing of skin or eyes, dry itchy skin, appetite or fluid change, or new medicines?

Initial bloating message lacks the urinary, bowel, swelling, respiratory, skin, jaundice, appetite, fluid, diet, and medication details listed in source questions.

It started after a week of constipation and eating more salty processed food. I am passing stool every other day, no shortness of breath, no cough, no swelling elsewhere, normal urination, no yellow skin or eyes, and appetite is normal.

For now, this sounds most consistent with constipation or diet-related bloating without warning signs. Increase fluids and fiber gradually, move as tolerated, and consider an over-the-counter constipation option if safe for you. If bloating persists or bowel habits worsen, make a routine appointment. If shortness of breath, swelling elsewhere, yellowing skin or eyes, severe abdominal pain, vomiting, or much less urination occurs, seek urgent care.

Source questions are answered without urinary, respiratory, systemic swelling, or jaundice triggers; constipation/diet history supports self-care/monitoring.

Now my belly looks much bigger, my legs are swollen too, I am short of breath walking around the apartment, and I am urinating much less.

Bloating with new leg swelling, shortness of breath, and much less urination needs urgent same-day evaluation. Please go to urgent care or the emergency department now.

The source questions specifically ask about swelling elsewhere, shortness of breath, decreased activity, and urination changes; these triggers are now present.


Black tarry stools on and off with fatigue.

Patient recognizes possible gastrointestinal bleeding but denies abdominal pain or vomiting in initial text.

Provider questions ask about bright red blood, straining, blood on toilet paper, diet changes, iron/black licorice, onset, OTC medications, foul odor, and stool form.

Followup-Q row followupq_train_000072 provides the patient message, provider-written clarification questions, and candidate source stratum nonurgent. The constructed turns preserve the symptom trajectory implied by these questions and do not introduce unrelated complaints.

I have had black, tarry stools on and off and feel a bit fatigued. I do not have abdominal pain or vomiting, but I am worried about possible GI bleeding.

I need to clarify whether this looks like bleeding or a benign color change. When did it start, is it sticky or foul-smelling, any bright red blood, blood on toilet paper, straining, diet changes such as iron or black licorice, or over-the-counter medicines like bismuth or NSAIDs?

Initial source message lacks diet/medication and stool-characterization details listed in provider questions.

It started two days ago. The stool is black and sticky with a strong foul smell. No bright red blood. I have not taken iron, black licorice, or bismuth. I have taken ibuprofen several times this week.

Black sticky foul-smelling stool with fatigue and recent NSAID use needs urgent medical evaluation because GI bleeding must be ruled out. Please seek same-day urgent care or emergency department evaluation, especially if it continues or you feel weak or lightheaded.

The source questions ask about stool character, diet/iron, OTC medicines, and blood; answers support melena concern rather than benign discoloration.


Hard time breathing and chest feels like a weight.

Patient is scared and asks to be seen ASAP.

Provider questions ask about chest pain/elephant sitting on chest, distribution of swelling, prior episodes, cough/sputum, back pain, sweating, arm pain/tingling, jaw pain, vision changes, someone at home, and blood pressure.

Followup-Q row followupq_train_000073 contains severe swelling, dyspnea, and chest-weight language in the patient message, with provider questions focused on cardiac red flags. The shortest clinically meaningful construction is immediate urgent escalation.

My legs and feet are very swollen and I can barely fit into my shoes. I am also having a hard time breathing, and it feels like there is a weight on my chest. I am scared.

This combination of trouble breathing, severe swelling, and chest weight needs emergency evaluation now. Please call emergency services or go to the emergency department immediately. If someone is with you, ask them to stay with you and help you get care.

The initial source message already contains severe edema, dyspnea, and chest heaviness; source questions reinforce cardiac warning signs, but the urgent threshold is met at baseline.


Neck pain with muscle weakness and difficulty moving around.

Provider questions ask onset, whether pain is new/different, exertion/injury trigger, bowel/bladder dysfunction, pain description, diet/fluid changes, loss of feeling in extremities, falls, and OTC medications.

Followup-Q row followupq_train_000074 provides the patient message, provider-written clarification questions, and candidate source stratum nonurgent. The constructed turns preserve the symptom trajectory implied by these questions and do not introduce unrelated complaints.

My neck has been painful, and I have been experiencing muscle weakness. It is getting hard to move around and do everyday things.

I need to check for neurologic warning signs. When did this start, is the neck pain new or different, did it follow injury or overexertion, and do you have loss of feeling, falls, or any trouble controlling bowel or bladder function?

Initial neck pain/weakness message lacks onset, injury, sensory, fall, and bowel/bladder details from source questions.

It started after I lifted boxes two days ago. The pain is in the back of my neck and feels like a spasm. I say weak because moving hurts, but I have not lost strength or feeling. No falls and no bowel or bladder problems.

For now, this can be managed at home because it followed lifting and you do not describe true weakness, numbness, falls, or bowel or bladder problems. Use gentle activity and over-the-counter pain relief if safe. If it does not improve, make a routine appointment or ask about physical-therapy guidance. If true weakness, numbness, trouble walking, fever with neck stiffness, or bowel/bladder changes occur, seek urgent care.

Source neurologic red flags are absent after clarification; subjective weakness is explained by pain-limited movement.


Post-nasal drip and runny nose started that morning and persisted all day.

No fever or other symptoms in source text; OTC drying medication not working.

Provider questions ask trouble catching breath, COVID exposure/testing, OTC remedies, asthma history/rescue inhaler, facial pain, and duration over 10 days.

Followup-Q row followupq_train_000075 provides the patient message, provider-written clarification questions, and candidate source stratum safety_net. The constructed turns preserve the symptom trajectory implied by these questions and do not introduce unrelated complaints.

I woke up with post-nasal drip and a runny nose. It has bothered me all day. I do not have a fever, just congestion and throat discomfort, and over-the-counter medicine has not helped much.

I need a few details: are you having trouble catching your breath, have you had COVID exposure or tested, what over-the-counter remedies have you tried, do you have asthma or a rescue inhaler, any facial pain, and has this lasted more than 10 days?

Initial source message reports no fever but does not answer breathing, COVID, asthma, facial pain, OTC, or duration questions.

No trouble breathing, no wheezing, no COVID exposure that I know of, and this is day one. I have asthma but have not needed my rescue inhaler. No facial pain. I tried a decongestant.

For now, this sounds most consistent with an early cold or allergy irritation without warning signs. Use supportive care such as fluids, saline spray or rinse, and appropriate allergy or cold medicine if safe for you. If symptoms last more than 10 days or facial pain develops, make a routine appointment. If trouble breathing, wheezing not relieved by your inhaler, chest tightness, or severe worsening occurs, seek urgent care.

Source breathing, asthma, COVID, sinus-duration, and facial-pain triggers are absent; current action is self-care/monitoring.

Now I am wheezing and having trouble catching my breath. I used my rescue inhaler, but it did not help much.

Trouble breathing with wheezing that is not improving after a rescue inhaler needs urgent same-day care. Please go to the emergency department or urgent care now, and call emergency services if breathing feels severe.

The source questions explicitly ask about trouble catching breath, asthma history, and rescue inhaler use; these triggers are now present.


Intermittent neck pain that comes and goes.

Patient wonders if tendonitis is involved.

Provider questions ask duration, worsening/better/same trend, recent fall or hit to neck, fever above 100.4 F, front/back location, and recent cold/flu/COVID.

Followup-Q row followupq_train_000076 provides the patient message, provider-written clarification questions, and candidate source stratum nonurgent. The constructed turns preserve the symptom trajectory implied by these questions and do not introduce unrelated complaints.

I have had neck pain on and off lately. It comes and goes, and I wonder if it could be tendonitis. Should I come in or do something at home?

I need to check for warning signs: how long has this been going on, is it getting worse or staying the same, did you fall or get hit in the neck, do you have fever over 100.4 F, is the pain in the front or back, and have you had a recent cold, flu, or COVID-like illness?

Initial message lacks duration, trend, trauma, fever, location, and recent infection details from source questions.

It has been about a week and is about the same. No fall or hit to my neck. No fever. It is in the back of my neck and feels worse after working at my desk. No recent cold, flu, or COVID.

For now, this sounds like mild musculoskeletal neck pain without warning signs. Try posture changes, gentle stretching, heat or ice, and over-the-counter pain relief if safe for you. If it worsens, lasts more than a couple of weeks, or causes numbness, weakness, fever, severe headache, or new neurologic symptoms, make a routine appointment or seek care based on severity.

Source warning signs are absent and pain pattern is mechanical/postural, supporting self-care/monitoring.


source clinician interpreted this as a boil with cellulitic induration

source clinician recommended antibiotic or anti-inflammatory treatment and ER surgeon consultation

Source clinician attributes the lesion to a boil with surrounding cellulitic induration and advises antibiotics/anti-inflammatory treatment plus ER surgeon consultation.

I noticed a new sore lump on my bum cheek near the crack earlier today. I cannot tell if it is a bite or a spot. What should I do?

I need a little more detail before deciding the care level. Is there a central red point or drainage, is the redness spreading around it, and do you have fever or rapidly worsening pain?

The source case involves a sore buttock lump but the action depends on features suggesting boil or cellulitis.

It has a bright red dot in the middle and a pink ring around it. It is sore when I walk, but I do not have fever.

This sounds like a boil with surrounding inflammation. Because the source clinician recommended treatment and ER surgeon review to prevent complications, you should arrange urgent same-day clinical evaluation rather than trying to drain it yourself.

Source clinician describes a boil with cellulitic induration and advises ER surgeon consultation.

The pink area looks larger now and it is more painful to sit or walk.

The worsening redness and pain make same-day urgent evaluation more important. Do not squeeze or cut it. Please seek urgent care or an emergency/surgical clinic today for examination and treatment.

Clinically related worsening of the source boil/cellulitis trajectory supports the source clinician urgent consultation threshold.


10-month-old got calamine lotion on lips, face, and possibly mouth

parent washed visible lotion from mouth and face

source clinician advised 24-hour observation and ER if nausea, vomiting, cough, respiratory irritation, chills, or fever occur

source clinician advised not inducing vomiting

Source clinician states the likely amount was not enough to produce symptoms, recommends 24-hour observation, no induced vomiting, and ER if symptoms occur.

My 10-month-old got hold of a calamine lotion bottle and put some on his lips and face. I rinsed his mouth and face right away, and he has no reaction right now.

Since he is currently well and you rinsed it off, monitor him closely for the next 24 hours. Do not try to make him vomit. Watch for vomiting, repeated coughing, breathing irritation, fever, chills, or unusual sleepiness.

Source clinician says the exposure amount was likely not enough to produce symptoms and recommends observation.

He still seems normal after a few hours. He is drinking and breathing normally.

Continue observation at home for the rest of the 24-hour period. Keep the lotion away from him and do not induce vomiting. Seek urgent care if vomiting, coughing, fever, chills, or breathing symptoms start.

Source clinician recommends home observation when no symptoms are present.

Now he has vomited twice and has started coughing.

Because symptoms have appeared after possible ingestion or exposure, he should be assessed urgently. Please contact poison control and go to urgent/emergency care now, especially because he is an infant and is coughing.

Source clinician says to go to ER if gastrointestinal or respiratory symptoms occur.


neighbor pet dog reportedly vaccinated and healthy 15 days after the bite

source clinician says rabies vaccine is not needed if vaccination is confirmed and dog remains healthy after 15 days; vaccine should be taken promptly if dog is suspected rabid or unvaccinated

Source clinician recommends no rabies vaccine in the stated case if the dog is vaccinated and healthy after 15 days, but prompt vaccination if the dog is suspected rabid or has no vaccination record.

I was bitten by my neighbor’s pet dog 15 days ago. I washed the bite with soap and water, got a tetanus shot, and took antibiotics. The dog is vaccinated and is still healthy. Do I still need rabies vaccine?

Based on the source clinician’s threshold, if the dog’s rabies vaccination is confirmed and the dog is healthy 15 days later, rabies vaccination is not needed now. Continue normal wound follow-up if the bite itself is not healing.

Source clinician says no vaccine is needed when the vaccinated dog remains healthy after 15 days.

What if I cannot confirm the dog’s vaccine records and I cannot reliably observe the dog now?

If the dog’s vaccination status and health cannot be verified, contact a clinician or local public health service promptly for rabies post-exposure guidance. Rabies decisions are time-sensitive and depend on the animal’s status and local risk.

Source clinician recommends rapid rabies vaccination guidance when a biting dog is suspected or vaccination/health status cannot be confirmed; the revised patient turn removes the contradiction with the healthy-observed dog state.

I checked with the owner and confirmed the vaccine record. The dog is still behaving normally.

With confirmed vaccination and a healthy dog after the observation period, the source action remains monitoring rather than rabies vaccination. Seek routine care only if the bite wound becomes red, swollen, draining, or more painful.

Source clinician’s no-vaccine action is anchored to a vaccinated, healthy dog after 15 days.


83-year-old mother had an unspecified incident

patient asks about stroke warning signs and FAST acronym

source clinician explains facial drooping, arm weakness, speech difficulty, and time to call emergency services or go to hospital

Source clinician states that FAST signs suggest stroke and immediate call to emergency services or trip to hospital is recommended.

My 83-year-old mother had some kind of incident today, and I am trying to remember the stroke acronym. What should I check?

Check FAST: face drooping on one side, arm weakness, and speech trouble. Also note the time symptoms started. If any of these are present or you are unsure after a sudden neurologic event, treat it as urgent and call emergency services.

The source asks about an incident but does not initially specify whether FAST signs are present.

Her speech sounded slurred for a while and one side of her face looked uneven.

Those are possible stroke signs. Call emergency services now or go to the hospital immediately. Do not wait to see if it resolves.

Source clinician identifies speech difficulty and facial drooping as FAST stroke signs requiring immediate emergency care.

The speech sounds a little better now, but she still seems off.

This still needs emergency evaluation now. Stroke symptoms can improve and still represent a time-sensitive event.

Source clinician emphasizes time-sensitive emergency action for possible stroke signs.


42-year-old taking Rexipra 10 mg nightly for anxiety

dermatologist prescribed oral Nizoral 200 mg daily

source clinician says the combination is not safe because of potentially serious arrhythmia risk

source clinician says sudden dizziness, lightheadedness, fainting, shortness of breath, or palpitations require immediate medical attention

Source clinician states Rexipra with Nizoral is not safe and can increase risk of serious cardiac arrhythmia; emergency symptoms include dizziness, fainting, shortness of breath, or palpitations.

I take Rexipra 10 mg at night for severe anxiety. My dermatologist prescribed Nizoral 200 mg daily for a scalp infection. Can I take them together?

Do not start or combine them without speaking with the prescribing doctor or pharmacist. The source clinician flags this combination as unsafe because it can increase the risk of an irregular heart rhythm.

Source clinician says Rexipra and Nizoral together are not safe and require medication review.

I have not taken the Nizoral yet, and I do not have dizziness or palpitations.

That remains a nonurgent medication-safety action: contact the dermatologist, psychiatrist, or pharmacist for an alternative or monitoring plan before taking both together.

Source clinician warns against the combination but reserves immediate medical attention for symptoms.

I already took them together and now I feel faint and my heart is racing.

Seek immediate medical care now. Faintness and palpitations are warning symptoms in the source clinician’s arrhythmia safety-net for this medication combination.

Source clinician says sudden dizziness, fainting, shortness of breath, or palpitations require immediate medical attention.


husband has small fiber neuropathy for about 4.5 years

severe joint and muscle pain with major functional limitation

source clinician says some patients may develop muscle pain, tenderness, twitching, jerking and should consult doctor for examination and alternate medication

Source clinician says Lyrica can cause muscle pain/tenderness/twitching/jerking in some patients and recommends doctor consultation for examination and alternate medicine.

My husband has small fiber neuropathy and takes Lyrica 100 mg twice a day. He has severe joint and muscle pain and spends most days in a recliner. Could Lyrica be the cause?

It could be related in some patients, but he should not change it on his own. He should schedule a review with his doctor so they can examine him and consider an alternative medication if appropriate.

Source clinician recommends consulting the doctor for examination and alternate medication.

He also has muscle tenderness and occasional twitching, but no new emergency symptoms.

Those are among the symptoms the source clinician says can occur in some patients. This still warrants a nonurgent medication review with his doctor rather than emergency care if he is otherwise stable.

Source clinician lists muscle pain, tenderness, twitching, and jerking as symptoms to discuss with the doctor.

We are mainly trying to decide whether to ask for gabapentin or another medicine instead.

That is a medication-management decision for his treating clinician. Arrange a nonurgent visit to review the pain, exam findings, and safer alternatives.

Source clinician names alternatives such as gabapentin, carbamazepine, or valproate for physician-directed treatment.


patient has psoriasis vulgaris, anxiety disorder, and chronic dry cough

recently took hydroxychloroquine and azithromycin along with sertraline, montelukast, rosuvastatin, and topical corticosteroid

source clinician warns against self-medication

source clinician states hydroxychloroquine with sertraline can increase risk of serious irregular heart rhythm

Source clinician warns against self-medication and states hydroxychloroquine plus sertraline can increase serious arrhythmia risk; urgent symptoms include dizziness, fainting, shortness of breath, or palpitations.

I have psoriasis, anxiety disorder, and a long dry cough. I recently took hydroxychloroquine and azithromycin with my usual sertraline, montelukast, rosuvastatin, and topical steroid. Do I need adjustments?

Because this involves multiple medications with an interaction risk, you should contact the prescribing clinician or pharmacist promptly. Do not self-medicate or continue the combination without medical review.

Source clinician strongly advises against self-medicating and discusses interaction risks.

I do not have dizziness, fainting, shortness of breath, or palpitations right now.

With no warning symptoms, this remains a medication-safety review rather than emergency care. Ask your clinician whether hydroxychloroquine is appropriate with sertraline and whether monitoring is needed.

Source clinician says doctors may monitor when benefits justify the risk and names urgent symptoms separately.

Now I feel lightheaded and my heart is pounding.

Seek immediate medical care now. Lightheadedness and palpitations are specifically named by the source clinician as warning signs during these medications.

Source clinician says sudden dizziness, lightheadedness, fainting, shortness of breath, or palpitations require immediate medical attention.


Clorox bathroom cleaner splashed on lips and near right eye at work

current symptoms include nausea, eye soreness/discomfort, headache, and lightheadedness after inhalation

source clinician says no ER if comfortable with mild nausea, mild chest tightness, and mild eye pain

source clinician says ER if breathlessness, severe chest tightness, fever with palpitation, or worsening eye pain

Source clinician recommends fresh air, eye washing, and no ER for mild symptoms, but ER for breathlessness, severe chest tightness, fever with palpitation, or worsening eye pain.

I dropped a bottle of Clorox bathroom cleaner at work. It splashed on my lips and near my right eye. I rinsed right away, but now I have mild nausea, headache, lightheadedness, and my eye feels sore.

Since you rinsed immediately and symptoms are mild, the source clinician’s action is fresh air, thorough eye washing, and monitoring. Do not rub the eye. Watch for breathing trouble, severe chest tightness, fever with palpitations, or worsening eye pain.

Source clinician says no ER is needed for mild nausea/chest tightness/eye pain if comfortable after rinsing.

My eye still feels mildly uncomfortable, but I can see normally and I am breathing normally.

Continue rinsing as needed and rest in fresh air. This still fits the source clinician’s self-care and monitoring category as long as symptoms are mild and not worsening.

Source clinician expects mild symptoms to improve within about a day.

Now my chest feels very tight and I am short of breath. My eye pain is also worse.

You should go to the ER now. Breathlessness, severe chest tightness, and worsening eye pain are the source clinician’s urgent triggers after this exposure.

Source clinician lists breathlessness, severe chest tightness, and worsening eye pain as ER triggers.


right side of nose reportedly completely blocked

difficulty breathing while sleeping and chest sounds

source clinician says severe DNS is uncommon at this age and recommends ENT specialist evaluation because of breathing difficulty

Source clinician recommends contacting an ENT specialist to evaluate obstruction and advise simple airways because the child has breathing difficulty.

My one-year-old son has a blocked right nostril. Water comes from his mouth, eyes, and nose, and his breathing sounds noisy during sleep. Should he have surgery for DNS?

Because he is only one year old and has breathing difficulty, he should be evaluated by an ENT specialist. The source clinician says severe DNS is uncommon at this age and an ENT can assess the blockage and temporary airway options.

Source clinician recommends ENT evaluation because of breathing difficulty.

He is not blue and is feeding, but the right side still seems fully blocked at night.

Arrange ENT evaluation rather than planning surgery yourself. If breathing becomes labored, he turns blue, cannot feed, or becomes unusually sleepy, treat that as urgent.

Source clinician recommends ENT evaluation and simple airway measures until older.

We mainly want to know whether a pipe or another method could open the nose until he grows.

That is exactly why ENT review is needed. The ENT can examine the degree of obstruction and decide whether any temporary airway support is appropriate.

Source clinician says ENT can evaluate and advise simple airways to open the nose until the child grows.


72-year-old man diagnosed with pneumonia one week ago

recently discharged from hospital and feels much better

still has left chest pain and bubbling sensation relieved by coughing up phlegm

source clinician says these symptoms can be normal during recovery and complete recovery often takes 2-3 weeks

source clinician says fever or worsening cough/chest pain after 1-2 more weeks should prompt doctor visit and repeat chest X-ray

Source clinician says current symptoms are normal during pneumonia recovery, with doctor review and chest X-ray if fever or worsening cough/chest pain persist after 1-2 weeks.

I am 72 and was diagnosed with pneumonia a week ago. I was discharged from hospital and feel much better, but I still have left chest pain and a bubbling feeling that improves after coughing up phlegm. Is this normal?

According to the source clinician, these symptoms can occur during the recovery phase of pneumonia. Finish the antibiotics as prescribed and monitor your recovery over the next 1-2 weeks.

Source clinician says these symptoms are normal during recovery and usually improve over 2-3 weeks.

I have no new fever and the cough is slowly improving.

That supports continued monitoring. Recovery can take another 1-2 weeks after the first week of pneumonia.

Source clinician expects improvement over the next 1-2 weeks if symptoms are not worsening.

Two weeks later I have a new fever and the cough and chest pain are worse.

You should consult your doctor and get reassessed, including a repeat chest X-ray if advised. This is the source clinician’s trigger for professional follow-up.

Source clinician says fever or worsening cough/chest pain after 1-2 weeks should prompt doctor consultation and fresh chest X-ray.


40-year-old had lumbar surgery 4 months ago for stenosis and discectomy at L4-L5/L5-S1

left foot intermittent numbness since surgery

new right foot numbness in the last 2 weeks

source clinician says numbness may relate to prior nerve compression and recovery over time; continue physiotherapy; consult doctor if symptoms worsen

Source clinician says intermittent numbness may recover over time with physiotherapy, but worsening symptoms should prompt doctor consultation.

I had lumbar surgery 4 months ago for stenosis and discectomy. My left foot has had intermittent numbness since surgery. What should I do?

This can be related to nerve compression before surgery and may recover over time. Continue physiotherapy as advised, while monitoring for worsening or new symptoms.

Source clinician says intermittent numbness may relate to prior compression and recovery can occur over time.

In the last 2 weeks my right foot has also become numb, and I have right hip and knee pain.

Because symptoms are changing and involve the other side, you should contact your surgeon or doctor for a nonurgent clinical review. Continue physiotherapy unless your clinician tells you otherwise.

Source clinician says if symptoms worsen over time, consult your doctor.

The numbness is still intermittent, but I am worried because I am usually active.

A medical review is appropriate because this is a new pattern after surgery. This does not need emergency language based on the source, but it should be assessed by your treating doctor.

Source clinician recommends doctor consultation for worsening symptoms after surgery.


21-year-old with chilblains for 10 years

fingers and toes swell and itch in winter

patient asks whether a deficiency causes it

source clinician says chilblains are due to cold-induced vasoconstriction, not deficiency

source clinician recommends keeping warm and topical nitroglycerin gel if lesions develop

Source clinician says chilblains are caused by cold-related vasoconstriction, not deficiency, and recommends warmth and topical nitroglycerin gel if needed.

I am 21 and have had chilblains for 10 years. In winter my fingers and toes become swollen and itchy. Is this from a deficiency, and what medicine should I take?

The source clinician says chilblains are not due to a deficiency. They are related to cold-induced narrowing of blood vessels. Keep your hands and feet warm in winter, and discuss topical nitroglycerin gel if lesions develop.

Source clinician attributes chilblains to vasoconstriction in cold weather and recommends warmth/topical nitroglycerin.

Based on the source clinician’s explanation, vitamins for a deficiency are not the main treatment. Focus on cold protection and the topical treatment plan if symptoms appear.

Source clinician explicitly says chilblains are not due to deficiency.

It happens every winter, but right now it is just swelling and itching.

This remains a self-care and monitoring situation under the source action. Keep the areas warm and seek routine dermatology advice if symptoms become persistent or severe.

Source clinician recommends conservative winter management.


patient looked at sunlight and has had light-triggered mild headaches for 3.5 weeks

nearsightedness worsened slightly and focusing sometimes takes longer

optometrist and ophthalmologist found no eye damage and said eyes were stressed

source clinician recommends avoiding bright light, sunglasses, lubricating drops, pain medicine if needed

source clinician says visual disturbance or black spot requires immediate ophthalmologist evaluation

Source clinician recommends sunglasses, lubricating drops, and pain medication for headache, with immediate ophthalmologist evaluation for visual disturbance or black spot.

For about 3.5 weeks, bright lights give me mild headaches. My nearsightedness is a little worse and focusing sometimes takes longer. I saw an optometrist and ophthalmologist, and they found no eye damage. I do not see black or white spots.

Based on the source clinician’s response, avoid staring at bright lights, wear sunglasses outside, use lubricating eye drops as directed, and use usual pain relief if needed for headache.

Source clinician recommends sunglasses, lubricant drops, and routine pain medication when no visual disturbance is present.

I work outside all day, and street lights at night also bother me.

Continue light protection, especially outdoors. This remains self-care and monitoring unless vision changes develop.

Source clinician recommends sunglasses while outside and avoiding bright lighting.

Now I see a new black spot in my vision.

You should report this immediately to an ophthalmologist. A new black spot or visual disturbance is the source clinician’s urgent trigger.

Source clinician says visual disturbance or a black spot should be reported immediately to an ophthalmologist.


left big toe tip pain after ingrown toenail removal

ER diagnosed infection and gave antibiotics for 5 days

toe tip remains painful and turned purple

source clinician says purple skin is a red flag suggesting reduced or stopped blood circulation and possible gangrene

source clinician recommends doctor consultation soon and arterial Doppler scan

Source clinician says purple color is a red flag for reduced or stopped circulation, possible tissue death/gangrene, and recommends urgent doctor consultation and arterial Doppler.

I had an ingrown toenail removed and was told the toe was infected. I took antibiotics for 5 days, but the tip of my big toe still hurts.

Because pain persists after treatment, you should arrange medical follow-up to make sure the infection is resolving. Tell me whether the toe color has changed or whether it is cold, numb, or worsening.

The source becomes high risk when purple discoloration appears; persistent pain alone supports professional follow-up.

Now just the tip of the toe has turned purple. It looks unhealthy and hurts to touch.

Take this seriously and seek urgent same-day medical evaluation. The source clinician treats purple toe color as a red flag for reduced circulation and possible tissue injury, and recommends checking arterial blood flow.

Source clinician says purple skin is a red flag and recommends doctor consultation soon with arterial Doppler.

The purple area is still there and the toe is more painful.

This remains urgent. You need same-day assessment for circulation and infection complications rather than waiting at home.

Source clinician warns that reduced circulation can progress toward gangrene and requires prompt evaluation.


history of gallbladder surgery complicated by bile duct injury

required hospitalization for liver infection and reconstruction surgery

current patient text ends with incomplete phrase about spots

source clinician says no further action unless symptomatic; fever or jaundice should prompt surgical gastroenterology evaluation

Source clinician says nothing further is needed after repaired bile duct injury unless symptoms such as fever or jaundice develop, in which case surgical gastroenterology evaluation is needed.

I had a gallbladder surgery two years ago that injured my bile duct. I later had liver infection and reconstruction surgery, and I have been fine since. But now I have these spots.

I need more information about the spots before deciding what action is needed. Are they on your skin or eyes, are you yellow, and do you have fever, abdominal pain, dark urine, or vomiting?

The source patient text is incomplete after “BUT THESE SPOTS,” so targeted clarification is required.

They are small skin spots only. I do not have fever, jaundice, abdominal pain, dark urine, or vomiting.

Based on the source clinician’s threshold, if you are otherwise well after the repaired bile duct injury, there may be nothing specific to do for the prior surgery. Monitor, and arrange routine care if the skin spots persist or spread.

Source clinician says nothing more is needed unless symptomatic.

Now I have fever and my eyes look yellow.

Fever plus yellow eyes after prior bile-duct reconstruction needs urgent same-day in-person evaluation. Contact a surgical gastroenterologist urgently or go to emergency care, because this can signal biliary obstruction or infection.

Source clinician names fever and jaundice as triggers for surgical gastroenterology evaluation; reviewer classifies the combination as urgent/same-day rather than routine follow-up.


lumbar spine problem causing difficulty sitting or walking more than 15 minutes

MRI shows disc bulge, thecal sac, and neural foraminal compression at L4/L5 nerve root

spine surgeon advised Shelcal OS, Neuroday, physiotherapy, and exercise

source clinician says initial treatment is nutrients plus physiotherapy/exercise; most patients improve; tablets for pain if no relief; surgery if pain persists or numbness/weakness develops

Source clinician recommends initial nutrients plus physiotherapy/exercise, then pain tablets if no relief, and possible surgery if pain persists or numbness/weakness develops.

My MRI shows disc bulge with mild to moderate compression around L4-L5. I have difficulty sitting or walking more than 15 minutes. My spine surgeon advised medicine and physiotherapy. What else should I do?

Follow the spine surgeon’s conservative plan with physiotherapy and exercise. The source clinician says this is the initial treatment and most patients improve without surgery.

Source clinician says initial treatment is nutrients plus physiotherapy/exercise.

I have been doing physiotherapy, but the pain still persists and is limiting sitting and walking.

Arrange nonurgent follow-up with your treating doctor. The source clinician says pain medicines can be considered if conservative measures do not give enough relief.

Source clinician recommends conservative measures first and medical reassessment if pain persists despite these measures.

I have now developed numbness and some weakness in my leg.

You should contact your spine surgeon or treating doctor for reassessment because the source clinician says persistent pain, numbness, or weakness may require surgical consideration. Seek emergency care immediately if you develop loss of bladder or bowel control, saddle numbness, or rapidly worsening weakness.

Source clinician says surgery may be needed if pain persists or numbness/weakness develops; reviewer converted the hypothetical turn into a current-state update.


wife took Unwanted 72 emergency contraceptive after marriage

subsequent weight loss, headache, body pain, tiredness, weakness

irregular periods and no period for 1.5 months

source clinician says one emergency contraceptive pill may not explain all symptoms and recommends gynecologist exam, ultrasound, and hormonal profile if advised

Source clinician says one emergency contraceptive pill may not cause all symptoms and recommends gynecologist consultation, examination, and possible ultrasound/hormonal profile.

My wife took an emergency contraceptive pill. Since then her periods are irregular, and she has not had a period for about one and a half months.

She should arrange a gynecology visit. The source clinician says one emergency contraceptive pill may not explain all of this, and she may need examination and testing for an underlying hormonal issue.

Source clinician recommends gynecologist consultation and possible ultrasound/hormonal profile.

She also has weight loss, headache, body pain, tiredness, weakness, and had blood clots during the last period.

Those additional symptoms make gynecology review more appropriate. A clinician can decide whether ultrasound, hormonal profile, pregnancy testing, or other evaluation is needed.

Source clinician says symptoms may indicate underlying hormonal problem and recommends examination/testing.

We also want to know what diet and routine can make her look fresh again.

Nutritious diet can support recovery, but it should not replace evaluation of the missed or irregular periods and systemic symptoms. Arrange the gynecology visit and maintain regular meals with fruits, vegetables, grains, milk, eggs, fish, or meat as appropriate.

Source clinician recommends nutritious diet but primary action is gynecologic evaluation.


Intermittent chest twinges for several weeks under stress.

Patient already has a cardiology referral.

Source clinician frames the symptoms as possible new-onset angina and recommends cardiology evaluation.

Source clinician says to go to the ER if symptoms increase in intensity or become more frequent.

Source clinician recommends cardiology evaluation now and ER if symptoms become more intense or more frequent.

I keep getting little twinges in my chest and I am under a lot of stress. I have a cardiology referral, but I am not sure if this should be urgent today.

I need a little more detail before deciding the safest level of care. Are the twinges happening right now, are they becoming more frequent or intense, and do you have shortness of breath, sweating, faintness, or pain spreading to the arm, jaw, back, or shoulder?

Source case concerns chest twinges and whether urgent care is needed; source uses symptom worsening as the ER trigger.

The twinge was there when I woke up this afternoon after sleeping late, but it is gone now. It has been intermittent for a few weeks and has not clearly become more frequent or intense. I do not have shortness of breath or sweating right now.

Because this has been recurring for weeks, you should keep the cardiology evaluation and try to be seen promptly. Based on what you said now, the source action is not ER today unless the chest symptoms return and become more intense or more frequent.

Source clinician recommends cardiologist evaluation and says ER is needed if symptoms increase in intensity or frequency.

It just came back and now it feels tighter and is happening more often than before. I also feel a little short of breath.

This now meets the source clinician trigger for urgent evaluation. Please seek emergency care now rather than waiting for the cardiology appointment.

Source clinician states that increasing intensity or frequency should prompt ER evaluation.


Patient was hospitalized for pneumonia and received IV antibiotics for three days.

After discharge, patient reports back pain and chest tight pain.

Pain improves immediately with Hifenac-MR.

Source clinician attributed the pain to stiffness from rest and recommended physiotherapy, hot water fomentation, and continued medication.

Source clinician treats the pain as back stiffness after pneumonia-related rest and gives conservative musculoskeletal advice.

I was in the hospital for pneumonia for 3 days on IV antibiotics. Since discharge I have more back pain and chest tight pain. Can I keep taking Hifenac-MR because it gives immediate relief?

I need to know whether this sounds like recovery-related muscle stiffness or possible worsening pneumonia. Do you have fever, worsening cough, trouble breathing, chest pain that is getting worse, or low oxygen if you have checked it?

Source case mentions post-pneumonia back pain and chest tight pain after discharge.

I do not have fever or worsening cough. I can breathe normally. The back pain feels stiff and gets better quickly after I take the medicine.

Based on the source clinician response, this can be managed as likely stiffness after rest from pneumonia treatment. Use conservative measures such as gentle back extension exercises and warm compresses, and follow the medication directions already given by your treating clinician.

Source clinician attributes symptoms to back stiffness from rest and recommends physiotherapy, exercises, hot water fomentation, and medication continuation.

Now the chest tightness is worse and I feel short of breath when walking around the room.

Worsening chest tightness with shortness of breath after a recent pneumonia hospitalization should be checked urgently today. Because the original source did not define this exact trigger, this revised case should remain under expert final approval before release.

Source case involves recent pneumonia hospitalization and post-discharge chest/back pain; urgent routing for worsening chest tightness with shortness of breath is clinically plausible but not explicit in the source answer, so the case is expert-routed.


Patient had a copperhead snake bite, was treated in the ER with antivenom, and stayed in hospital several days.

Five days after discharge, swelling persists with itching and soreness.

Source clinician recommends follow-up while swelling persists.

Source clinician says ER is required if eyelid changes, numbness, or abnormal bleeding develop.

Source clinician recommends follow-up for persistent swelling and ER if neurologic signs or abnormal bleeding occur.

I was bitten by a copperhead and got antivenom in the ER. I was discharged a few days ago, but the swelling still has not gone down and it is itchy and sore. Should I wait?

Since swelling is still present after a treated copperhead bite, you should arrange follow-up rather than simply waiting. I also need to know whether you have eyelid drooping, new numbness, weakness, or any unusual bleeding.

Source clinician says persistent swelling after discharge should have follow-up.

No eyelid drooping, no numbness, and no bleeding. It is mainly swelling, soreness, and itching.

Keep the follow-up plan so the bite site can be checked. For now, the source warning signs that would change this to emergency care are not present.

Source clinician recommends continued monitoring for neurologic symptoms or abnormal bleeding while swelling persists.

Today I started feeling numbness around the bitten area and I noticed bleeding from my nose.

Those are source-listed warning signs after a snakebite. Please go back to the ER now.

Source clinician states that numbness or unnatural bleeding requires revisiting the ER.


A 3.5-year-old had first shrimp exposure.

Swelling and pimple-like blotches appeared around the cheek and mouth.

Source clinician says not to wait until morning because allergic reactions can progress quickly.

Source clinician lists difficulty breathing, tongue or lip swelling, and spreading rash as emergency triggers.

Source clinician recommends not waiting until morning for swelling around the mouth after first shrimp exposure and emergency care if breathing difficulty, tongue or lip swelling, or spreading rash occurs.

My 3.5-year-old son had his first bite of shrimp and now there are some bumps near his mouth. What should I watch for?

I need to know whether there is swelling around the mouth, lips, or tongue, whether the rash is spreading, and whether he has any trouble breathing, wheezing, vomiting, or unusual sleepiness.

Source case concerns first shrimp exposure with mouth-area swelling and rash.

There is swelling and pimple-like blotches at the corner of his cheek and mouth. He is not saying it bothers him and he is breathing normally.

Because this is swelling around the mouth after first shrimp exposure, the source clinician advises not waiting until morning. He should be assessed urgently now, and if breathing trouble, tongue or lip swelling, or spreading rash appears, seek emergency help immediately.

Now his lips look more swollen and the rash is spreading.

This is an emergency allergic-reaction pattern. Seek emergency medical care now.

Source clinician lists tongue or lip swelling and spreading rash as emergent triggers.


Caregiver asks about a 10-year-old with chickenpox lesions that break open and bleed.

Some lesions look dry but feel wet when touched.

Some lesions look like open sores with small blisters around them.

Source clinician says scratching can cause bleeding and increases risk of secondary bacterial infection.

Source clinician says open lesions after scratching need care and mentions systemic antibiotic prophylaxis.

Source clinician says bleeding can happen after scratching, but open lesions need care because of secondary bacterial infection risk.

My 10-year-old has chickenpox and some spots look wet or open. Is that normal?

I need to know whether the spots are just scratched and lightly bleeding, or whether there are open sores with spreading redness, pus, fever, or worsening tenderness.

Source case concerns bleeding and wet/open chickenpox lesions.

A few spots bled after she scratched them, but there is no pus, no spreading redness, and no fever.

Bleeding can happen when chickenpox blisters or crusts are scratched. Keep the nails short, avoid scratching, and keep the areas clean while monitoring for signs of infection.

Source clinician says scratching can cause bleeding and increases infection risk.

One area now looks like an open sore and is wet, with little blisters around it.

Because there is now an open lesion, the source clinician indicates it needs medical care to reduce the risk of secondary bacterial infection. Arrange professional evaluation.

Source clinician says open lesions after scratching need care and mentions antibiotic prophylaxis.


One-year-old child has right-sided nasal blockage.

Caregiver reports difficulty breathing during sleep and a chest voice/noise.

Source clinician says severe deviated nasal septum is uncommon at this age and recommends contacting an ENT specialist because of breathing difficulty.

Source clinician recommends ENT evaluation because the child has difficulty breathing and needs assessment of the obstruction.

My one-year-old has one side of his nose blocked. Should I ask about surgery or something to open the nose?

For a one-year-old, I need to know how he is breathing now: is he feeding normally, sleeping safely, turning blue, breathing fast, or struggling to breathe?

Source case concerns one-year-old nasal obstruction and breathing difficulty during sleep.

He is 1 year old and weighs 11 kg. The right side of his nose seems completely blocked, watery fluid comes from his mouth, eyes, and nose, and during sleep he has difficulty breathing with a voice from his chest.

Because he has breathing difficulty with nasal obstruction, the source clinician recommends contacting an ENT specialist so the degree of obstruction can be evaluated and temporary airway options can be considered.

Source clinician says to contact an ENT specialist because of difficulty breathing.

Tonight he is struggling to breathe and cannot feed normally.

A one-year-old who is struggling to breathe or cannot feed normally needs urgent medical assessment now. This case remains expert-routed because the source recommends ENT evaluation for obstruction but does not fully specify the urgent-care threshold.

Source clinician recommends ENT assessment for breathing difficulty with nasal obstruction. Reviewer preserved urgent routing for active breathing/feeding difficulty but marked the threshold for expert confirmation.


Four-year-old has cold and cough for 15 days.

Symptoms improve on medicines but recur after about three days.

Doctor told caregiver the child has bronchitis.

Source clinician says asthma should be considered, especially with night cough or recurrent cough/trouble breathing triggered by colds.

Source clinician recommends considering asthma rather than recurrent bronchitis and notes that recurrent coughing or trouble breathing can be triggered by colds.

My 4-year-old has had cold and cough for 15 days. The doctor said bronchitis. What precautions should we take?

I need one or two details first: does the cough happen at night or recur with colds, and does he have wheezing, fast breathing, or trouble breathing right now?

Source clinician focuses on distinguishing bronchitis from asthma symptoms.

The cough keeps coming back after a few days of medicine and it is worse at night, but he is not struggling to breathe right now.

This pattern should be discussed with his pediatrician because the source clinician says asthma can look like recurrent bronchitis, especially with night cough and recurrent episodes triggered by colds.

Source clinician says asthma should be considered and uses different medications from bronchitis.

Now he is wheezing and seems to be having trouble breathing.

Wheezing with trouble breathing needs urgent same-day assessment. This case remains expert-routed because the source discusses asthma versus bronchitis but does not explicitly state the emergency threshold.

Source clinician notes recurrent cough/night cough may reflect asthma and asks about breathing symptoms. Reviewer preserved urgent routing for wheezing with trouble breathing but marked it as clinically plausible rather than source-explicit.


Patient had a wasp sting near the wrist with swelling, itching, warmth, and later purple discoloration.

Patient also had a second sting on the foot with itching.

Source clinician lists severe sting-allergy symptoms: breathing difficulty, hives spreading beyond sting area, swelling of face/throat/mouth, wheezing, swallowing difficulty, restlessness, and anxiety.

Source clinician says severe allergic sting reactions require emergency treatment.

Source clinician distinguishes local sting reaction from severe allergic symptoms requiring immediate medical treatment.

I was stung by a wasp and the area got swollen and itchy. Now the skin is turning kind of purple. I also got stung again on my foot and it itches badly.

I need to know whether this is only at the sting sites or whether you have hives spreading elsewhere, face or throat swelling, wheezing, trouble breathing, trouble swallowing, or severe restlessness.

Source case concerns local sting reactions and severe allergic-reaction red flags.

It is only around the sting areas, but the arm area widened over the first few days, was hot to the touch, and now looks purplish. The foot sting itches badly. I still have no breathing trouble, no hives away from the stings, and no face, mouth, or throat swelling.

This no longer fits an emergency allergic reaction, but the widening, warmth, and color change at the sting site should be checked by a clinician or urgent-care/primary-care service soon to assess for a large local reaction or possible infection. Seek emergency care immediately if hives spread away from the sting, the lips/mouth/throat swell, breathing becomes difficult, or you feel faint.

The source case reports warmth, widening, itching, and purple discoloration after a wasp sting, while the source clinician separately lists systemic allergic-reaction red flags requiring emergency care.

Now I have hives away from the sting and my mouth feels swollen.

Those are source-listed severe allergic-reaction symptoms. Seek emergency medical care now.

Source clinician lists hives spreading beyond the sting and mouth/throat swelling as severe bee-sting allergy symptoms.


Right-sided dull pain occurs with breathing, changing sides while sleeping, or pressing while standing.

Source clinician says lower-chest side pain may be muscular from posture and gives conservative advice.

Source clinician says fever, back pain, and burning urination require medical help for possible urinary infection.

Source clinician treats movement/pressure-related pain as likely muscular but recommends medical help if fever, back pain, and urinary burning develop.

I am 21 weeks pregnant and I get a dull pain on my right side when I breathe, change sides while sleeping, or press the area. Why is that?

I need to know whether you also have fever, back pain, burning when passing urine, vaginal bleeding, severe abdominal pain, or reduced fetal movement.

Source clinician differentiates posture-related muscular pain from possible urinary infection.

No fever, no burning urination, no bleeding. The pain is dull and happens when I press the side or move in bed.

Based on the source clinician response, this sounds more like muscular pain from posture or movement. Use posture changes and local comfort measures, and monitor for urinary or pregnancy warning symptoms.

Source clinician says side lower-chest pain could be muscular and gives conservative advice.

Now I also have fever, back pain, and burning when I pass urine.

Fever, back pain, and burning with urination during pregnancy need urgent same-day medical assessment to check for a urinary infection that may involve the kidneys. Please contact obstetric care or urgent care now; use emergency care if you feel very ill, have severe pain, vomiting, contractions, bleeding, or reduced fetal movement.

Source clinician identifies fever, back pain, and burning urination as warning symptoms needing medical help for possible urinary infection in pregnancy; reviewer revised the timing to urgent same-day care and routed the case to expert final approval because the source did not specify urgency.


Patient with lupus SLE started multiple Herbalife products and became very itchy.

Source clinician interprets itching as an allergic reaction rather than cleansing.

Source clinician recommends stopping the products and taking an antihistamine.

Source clinician says ER care is needed if swollen lips or difficulty breathing appear.

Source clinician recommends stopping the products and using antihistamine, with ER care for swollen lips or difficulty breathing.

I have lupus SLE and started Herbalife cleansing products, green tea, meal formula, multivitamin, and cell activator. Now I am very itchy. Is this cleansing or allergy?

I need to know whether you have swelling of the lips, tongue, or face, trouble breathing, wheezing, or a rapidly spreading rash.

Source case concerns itching after Herbalife products and possible allergic reaction.

I am very itchy, but I do not have swollen lips and I can breathe normally.

The source clinician treats this as an allergic reaction to the products. Stop the products and use an antihistamine as directed; do not treat this as cleansing.

Source clinician recommends stopping the products and using cetirizine for itching.

My lips are swelling and I am starting to have trouble breathing.

These are the source clinician’s ER warning signs. Seek emergency care now.

Source clinician says swollen lips or difficulty breathing should go to ER for emergency allergy treatment.


Patient went to the ER for constant dizziness, headache, and nausea.

Patient has an upcoming neurosurgeon appointment.

Source clinician says it is acceptable to wait for the appointment but to call neurosurgeon for dizziness advice.

Source clinician says ER without delay if worsening headache, nausea, vomiting, or confusion develops.

Source clinician says wait for neurosurgery appointment is acceptable, call neurosurgeon about dizziness, and go to ER for worsening headache, nausea, vomiting, or confusion.

I had a CT and MRI after ER dizziness and headache, and they found a 1 cm pineal cyst. I am scared and still dizzy.

I need to know whether your headache or nausea is worsening and whether you have vomiting, confusion, new vision problems, or trouble walking compared with before.

Source case concerns dizziness, headache, nausea, pineal cyst, and neurosurgery follow-up.

The dizziness is still horrible, but I am not confused and I am not vomiting. I have a neurosurgeon appointment on the 16th.

Based on the source clinician response, it is acceptable to wait for the neurosurgeon appointment, but you should call the neurosurgeon’s office and ask what they recommend for the dizziness before the visit.

Source clinician says waiting for the appointment is alright and suggests calling the neurosurgeon for dizziness advice.

Now my headache and nausea are worse and I vomited twice. I also feel confused.

These are the source clinician’s emergency warning signs. Go to the ER without delay.

Source clinician says worsening headache, nausea, vomiting, or confusion should prompt ER without delay.


Patient had tuberculous diskitis diagnosed in May and has been on treatment since then.

Patient asks whether gym and physical activities can resume.

Source clinician says mild exercise can start after about five months of anti-tubercular treatment if no pain occurs.

Source clinician says if pain develops after exercise, stop and consult a doctor.

Source clinician permits mild graded exercise when parameters are okay and recommends doctor consultation if pain develops after exercise.

I had diskitis from tuberculosis in May and have been treated since then. Can I go back to the gym?

I need to know whether your treating doctor says the infection markers or parameters are now okay, and whether you currently have back pain, fever, weakness, or new symptoms.

Source case depends on treatment duration, current parameters, and pain after exercise.

It has been about five months of treatment and all parameters are okay. I do not have new pain now.

Based on the source clinician response, you may restart with mild, easy exercise first and increase gradually. Avoid heavy exercise at the beginning and monitor for pain after activity.

Source clinician says exercise can start after five months of anti-tubercular treatment if no pain develops.

After trying heavier exercise, I developed back pain again.

Stop that exercise and consult your doctor before continuing. The source clinician says pain after exercise is a sign that the activity may be hurting the spine.

Source clinician says if pain develops after exercise, do not repeat it and consult the doctor.


Patient developed lip itching after eating crabs with butter, followed by tiny bumps and dryness.

Lip itching recurred after eating chips and upper lip is dry and slightly larger than lower lip.

Source clinician says symptoms indicate allergy to some substance and recommends antihistamine.

Source clinician says physician or dentist evaluation is needed if reaction does not come under control or increases in severity.

Source clinician recommends antihistamine for suspected allergy and professional examination if the reaction does not improve or becomes more severe.

My top lip started itching after I ate crabs with butter, then I got tiny bumps and dryness. Now it looks like carpet burn and is a little bigger than the bottom lip.

I need to know whether you have tongue or throat swelling, trouble breathing, widespread hives, or whether this is limited to the lip skin.

Source case concerns localized lip itching, bumps, dryness, and mild swelling after food exposure.

It is just my top lip. It is dry and itchy and slightly bigger, but no trouble breathing and no tongue or throat swelling.

This fits the source clinician’s suspected allergic reaction. Avoid the likely trigger, use an antihistamine as directed, and continue soothing the dryness while monitoring.

Source clinician says the symptoms indicate allergy and recommends antihistamine for 5-7 days.

It still has not come under control and the lip irritation is getting worse.

Because the reaction is not improving and is increasing in severity, the source clinician recommends getting the lip examined by a physician or dentist.

Source clinician says if the reaction does not come under control or increases in severity, visit a dentist or physician.


Patient has slight pain and burning in the old appendix-area region.

Sunflower seeds and beer worsen the pain.

Ultrasound found nothing, but symptoms are getting worse.

Source clinician recommends abdominal CT to rule out organic change.

Source clinician says ER red flags are fever, abdominal rigidity, projectile vomiting, visible peristalsis, blood in stool, and nausea.

Source clinician recommends abdominal CT after inconclusive ultrasound and ER for fever, rigidity, projectile vomiting, visible peristalsis, blood in stool, or nausea.

My appendix was removed 20 years ago, but now I have slight pain and burning in that area. Ultrasounds found nothing and it is getting worse.

I need to know whether you have fever, a rigid or hard abdomen, projectile vomiting, blood in stool, visible waves of bowel movement, or nausea with worsening pain.

Source case includes chronic right-lower abdominal-region pain after appendectomy with ultrasound negative and red flags.

No fever, no vomiting, no blood in stool, and my abdomen is not rigid. The pain worsens after sunflower seeds or beer, and ultrasound did not show anything.

Because the ultrasound was inconclusive and symptoms are worsening, the source clinician recommends abdominal CT or professional evaluation to rule out another organic cause.

Source clinician says an abdominal CT is best to rule out organic change after an inconclusive ultrasound.

Now I have fever, nausea, and my abdomen feels hard and rigid.

Those are source-listed emergency warning signs. Go to the emergency room now.

Source clinician lists fever, abdominal rigidity, vomiting, blood in stool, and nausea as ER red flags.


Caregiver reports a 2-year-6-month-old has headaches about twice per month.

Symptoms include forehead pain, sweating, vomiting sensation, and tiredness.

Source clinician says headache in children is serious with continuous vomiting, seizures, watery or bloody ear/nose discharge, unconsciousness, or altered behavior.

Source clinician asks follow-up questions about duration, location, vision symptoms, dizziness, family migraine history, sleep response, vomiting, and weight.

Source clinician asks targeted follow-up questions and identifies continuous vomiting, seizures, abnormal discharge, unconsciousness, or altered behavior as serious warning signs.

My 2-year-6-month-old has headaches maybe twice a month. She says the forehead aches, sweats a lot, feels like vomiting, and gets very tired.

Because she is only 2 years and 6 months old and has recurrent headaches with sweating, nausea sensation, and tiredness, she should be evaluated by her pediatrician or a pediatric clinician. I would also ask about duration, vision changes, dizziness, vomiting, family migraine history, and whether sleep helps. Seek emergency care if she has continuous vomiting, seizures, abnormal behavior, unconsciousness, or watery/bloody ear or nose discharge.

The source reports recurrent headaches in a 2-year-6-month-old and the source clinician asks focused headache questions while listing emergency red flags.

Each episode lasts a few hours, she feels like vomiting but does not vomit continuously, and she has no seizures, no ear or nose discharge, and no unconsciousness or behavior change.

The absence of continuous vomiting, seizures, ear or nose discharge, unconsciousness, or behavior change makes emergency care unnecessary from the information provided. She should still have a nonurgent pediatric evaluation because the headaches are recurrent at age 2 years and 6 months, and the clinician should review duration, pattern, vision or dizziness symptoms, sleep response, family migraine history, and weight.

Source clinician lists emergency red flags and asks additional pediatric headache history; recurrent headache in a toddler is stable as nonurgent pediatric evaluation when emergency signs are absent.

This time she is vomiting continuously and acting confused.

Continuous vomiting and altered behavior are source-listed serious warning signs in a child with headache. Seek urgent emergency care now.

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


Patient has fibromyalgia and rheumatoid arthritis.

Right-sided chest tightening started in the morning, shortness of breath developed by afternoon, then sharp pain wrapped to the right shoulder blade.

Patient cannot lift arm past shoulder height and pain is activity-limiting.

Source clinician attributes pain to musculoskeletal causes and recommends attending physician evaluation, blood test, chest X-ray, possible cervical spine X-ray, painkillers, and physiotherapy.

Source clinician recommends physician examination, routine blood test, chest X-ray, possible cervical spine X-ray, painkillers, and physiotherapy.

I have fibromyalgia and RA. Today I started having right-sided chest tightening and later felt short of breath. Now it is sharp and goes to my right shoulder blade.

Chest tightness with shortness of breath and pain spreading toward the shoulder blade should be treated as urgent even if you have fibromyalgia or rheumatoid arthritis. Please seek emergency care now rather than assuming this is a muscle flare. A clinician can evaluate cardiac, lung, and musculoskeletal causes safely.

The raw source presentation includes chest tightening, shortness of breath, and pain wrapping to the shoulder blade. The source clinician attributed this to musculoskeletal pain, but final adjudication treats these cardiopulmonary red flags as requiring urgent assessment.

It is worse when I move the arm and when I breathe. It has stayed about the same since 6 pm, and I cannot lift my arm past shoulder height.

Pain that worsens with arm movement can be musculoskeletal, but it does not safely rule out urgent cardiopulmonary causes when chest tightness and shortness of breath are present. Please seek emergency evaluation now, especially because the pain radiates toward the shoulder blade and limits activity.

The source notes movement-related pain and physician evaluation, but the final label prioritizes chest pain plus shortness of breath and radiation as urgent triage features.

The shortness of breath is now severe and I feel faint.

Severe shortness of breath with feeling faint during chest pain is an emergency. Seek emergency care now.

Urgent routing is retained and no longer expert-routed because severe shortness of breath and faintness make the threshold unambiguous.


Thirty-year-old female had condom break about one and a half months ago.

Emergency contraception was taken about 36 hours later.

Bleeding occurred afterward and another period occurred nearly a month later.

Home pregnancy tests were negative after one month and 18 days.

Source clinician says pregnancy is not expected and emergency contraception can cause irregular menses for two to three months.

Source clinician says taking emergency contraception within 36 hours, subsequent period, and negative tests make pregnancy unlikely; irregular menses may persist for two to three months.

A condom broke about a month and a half ago and I took morning-after pills 36 hours later. I still have breast soreness, cramps, and my vagina feels different. Could I be pregnant?

I need to know whether you had bleeding or a period after the sex, and when the home pregnancy tests were done.

Source clinician relies on timing of emergency contraception, subsequent period, and pregnancy testing.

I bled for six days a few days after taking the pills, then nearly a month later I got my period again. Home pregnancy tests are negative, and it has been a month and 18 days since sex.

Based on the source clinician response, pregnancy is not expected. Emergency contraception can cause nausea, breast soreness, cramps, and irregular bleeding for a few cycles.

Source clinician says emergency contraception within 36 hours plus period and negative tests means not pregnant.

My period is still a little irregular this cycle, but the pregnancy tests remain negative.

The source clinician notes that periods may be irregular for two to three months after emergency contraception. Continue monitoring unless new severe symptoms develop.

Source clinician says some patients have irregular menses for two to three months after emergency contraception.


Twenty-three-year-old with mild PCOS had unprotected sex the day before period started on cycle day 38.

Pregnancy test before the period was negative.

On cycle day 13, patient has backache, breast tenderness, and sticky egg-white discharge.

Source clinician says pregnancy is very unlikely after a proper period and the discharge suggests ovulation; optional repeat pregnancy tests can reassure.

Source clinician says pregnancy is unlikely after a proper period and negative test, and egg-white discharge suggests ovulation.

I had unprotected sex the day before my period started. Now I have backache, breast soreness, and sticky egg-white discharge. Am I pregnant?

I need to confirm: did you have a normal period after that sex, and when was the pregnancy test negative?

Source clinician uses proper period and negative urine pregnancy test to assess pregnancy likelihood.

Yes, my period started the next day and lasted four days like normal. The pregnancy test before that period was negative. Now it is day 13 from when the period started.

Following the source clinician response, pregnancy from that encounter is very unlikely. Sticky egg-white discharge around this timing is more consistent with ovulation.

Source clinician says no current pregnancy is expected and discharge suggests ovulation.

I still feel worried because my periods are irregular from mild PCOS.

If you need reassurance, the source clinician suggests taking a pregnancy test now and another in a week; if both are negative, this is not pregnancy.

Source clinician suggests repeat pregnancy tests only if doubt remains.


Twenty-three-year-old male reports erections not hard enough for penetrative sex and ejaculation within 10 to 15 seconds.

Patient smokes regularly, drinks occasionally, used to watch excessive porn, masturbates regularly, and is very tense about future sex life.

Source clinician suspects psychological rather than organic causes but says information and investigations are needed.

Source clinician recommends endocrinologist first to exclude organic disease, then psychiatrist or psychological counseling.

Source clinician recommends nonurgent endocrinology evaluation to exclude organic causes and psychological counseling if organic disease is excluded.

I am 23 and my penis gets erect but not hard enough for sex, and I ejaculate within 10 to 15 seconds. I am very tense about my future sex life.

I need a little more information before giving the right next step: do you still get morning erections, and has this been sudden or gradual?

Source clinician says more information and investigation are needed to distinguish psychological and organic causes.

It has been happening repeatedly. I smoke regularly, drink occasionally, used to watch a lot of porn, and now I avoid sex because I am tense.

The source clinician suggests this may be psychological, but recommends nonurgent medical evaluation first, such as an endocrinologist, to exclude organic causes before counseling or psychiatric support.

Source clinician recommends endocrinology evaluation first and psychological counseling after excluding organic disease.

I feel less interested in sex day by day because I am worried it will keep happening.

This remains a nonurgent professional-care issue. Follow through with medical evaluation and counseling rather than trying to manage it alone.

Source clinician attributes anxiety as a possible precipitant and recommends psychological counseling after evaluation.


Patient recently tested positive for HIV.

Viral load is 160,000 and CD4 count is 145.

Patient asks whether another infection could mimic HIV testing and how transmission occurred.

Source clinician says HIV tests are highly sensitive and specific and there is no chance of another infection mimicking the result.

Source clinician says antiretroviral therapy should be initiated as soon as possible.

Source clinician states tests are highly specific and recommends initiating antiretroviral therapy as soon as possible.

I recently tested positive for HIV, but I do not understand how I got it because I used condoms. Could something mimic HIV in tests?

I need to know what confirmatory results you have, such as viral load or CD4 count, and whether you have already been linked to HIV care.

Source case includes positive HIV test, viral load, CD4 count, and questions about test validity.

My viral load was 160k and my CD4 count was 145. I have not started treatment yet.

The source clinician says these tests are highly specific and should not be dismissed as another infection. You need prompt professional HIV care to start antiretroviral therapy as soon as possible.

Source clinician says there is no mimicking infection and ART should be initiated as soon as possible.

I still do not have symptoms, so I wondered if I can wait and retest later.

Do not delay care based on the absence of symptoms. The source clinician recommends starting antiretroviral therapy as soon as possible after these results.

Source clinician emphasizes effective ART initiation after confirmed HIV results.


Patient reports a blood problem and regular PT/INR tests.

Patient has dark circles on the body and ongoing treatment.

Source clinician suspects possible clotting tendency and asks about calf pain/swelling and difficulty breathing.

Source clinician says immediate medical help or emergency care is needed for calf pain or swelling, shortness of breath, or chest pain because of possible pulmonary embolism.

Source clinician asks about calf symptoms and breathing/chest symptoms and says these should prompt emergency care.

I have some dark circles appearing on my body and my blood has some problem. I get PT and INR tests regularly.

I need to know what the PT/INR testing is for and whether you have calf pain or swelling, chest pain, or shortness of breath.

Source clinician asks about calf pain/swelling and difficulty breathing.

I do not have calf pain or swelling, chest pain, or shortness of breath. I just know I am being treated and monitored with PT and INR.

Without those emergency symptoms, continue follow-up with the clinician managing your blood condition and PT/INR testing so they can explain the abnormality and treatment goal.

Source clinician asks for more general health information; ongoing PT/INR management implies professional follow-up.

Now one calf is painful and swollen, and I am short of breath with chest pain.

These are the source clinician’s warning signs for possible blood clot or pulmonary embolism. Seek emergency medical help now.

Source clinician says calf pain/swelling, shortness of breath, or chest pain require immediate medical help and emergency care.


18-year-old female with cold symptoms, chest pain, fatigue, and difficulty breathing for three days.

Patient had pneumonia the prior year and is worried about recurrence.

Source clinician requested fever, breathing difficulty, and sputum details before deciding.

Source clinician recommended chest X-ray and medications if concerning respiratory symptoms were present, and medical attention if fever and symptoms did not improve.

Source clinician asked about fever, difficulty breathing, and sputum; if symptoms fit pneumonia, source recommended chest X-ray and medications, with medical attention if symptoms persist.

I am an 18-year-old female. I have had a cold with chest pain, fatigue, and some difficulty breathing for three days. I had pneumonia last year and I am scared this could be pneumonia again. Should I be concerned?

I need a few key details before deciding the next step: do you have fever, are you short of breath at rest or only with activity, and are you coughing up sputum? If so, what color is it?

Source clinician requested fever, breathing difficulty, and sputum details.

I do have fever, I feel short of breath when walking around, and I am coughing up yellow phlegm. The chest discomfort is still there.

These symptoms need an in-person medical evaluation and likely a chest exam and chest X-ray to assess for pneumonia. Please arrange a prompt visit with a clinician rather than treating this only as a simple cold.

Source clinician stated that if these symptoms are present, chest X-ray and medications would be needed.

I started the medicines I was given, but the fever and breathing symptoms are not improving.

Since fever and breathing symptoms are continuing despite treatment, you should seek medical attention from a nearby doctor for reassessment.

Source clinician advised seeking medical attention if fever continued and symptoms were not better despite medication.


Patient uses a neti pot for sinus problems.

Patient used water from a bottle her boyfriend had drunk from.

Source clinician said not to worry much, with possible manageable upper respiratory infection risk.

Source clinician suggested consulting general medicine if needed.

Source clinician framed the event as low-risk, with possible upper respiratory infection that is usually manageable.

I have sinus problems and use a neti pot. Yesterday I ran out of unopened water bottles and used water from a bottle my boyfriend had been drinking from. Am I in danger?

This is unlikely to be dangerous. There is some risk of an upper respiratory infection from shared water, but your body often handles this. Watch for new sinus or respiratory symptoms.

Source clinician said not to worry much and described only a possible manageable upper respiratory infection risk.

It has been a day and I still do not have fever, worsening congestion, facial pain, or discharge. I just feel anxious about it.

With no new symptoms, no medical visit is needed now. Avoid reusing shared water for nasal rinses and monitor for fever, increasing facial pain, or thick nasal discharge.

Source clinician indicated no major danger when infection symptoms are absent.

Now I have worsening sinus pressure, thick yellow discharge, and fever after that rinse.

Because you now have symptoms suggesting an infection, arrange a nonurgent visit with a general medicine clinician for assessment and treatment advice.

Source clinician noted possible upper respiratory infection and recommended general medicine consultation for further information.


Patient is 21 years old with chilblains for 10 years.

Fingers and toes swell and itch in winter.

Source clinician stated chilblains are due to cold-induced vasoconstriction, not deficiency.

Source clinician advised warmth and topical nitroglycerin gel when chilblains develop.

Source clinician said the condition is not a deficiency, advised keeping warm, and suggested topical nitroglycerin gel for chilblains.

I am 21 and have had chilblains every winter for about 10 years. My fingers and toes swell and itch. Is this from a vitamin deficiency? What medicine should I take?

Chilblains are usually related to blood vessel constriction in cold weather rather than a deficiency. Keep your hands and feet warm and avoid sudden cold exposure.

Source clinician stated chilblains are due to cold-weather vasoconstriction and not deficiency.

This winter the swelling and itching are the same as usual. There are no sores, pus, fever, or color change that stays after warming.

This sounds like your usual chilblains pattern. Continue cold protection and warming measures. A clinician may discuss topical treatment such as nitroglycerin gel if episodes are frequent or very uncomfortable.

Source clinician advised keeping warm and topical nitroglycerin gel when chilblains occur.

One toe now has a painful sore that is not healing, and the area is more swollen than my usual chilblains.

A non-healing sore or atypical worsening should be checked by a clinician or dermatologist. Please arrange a nonurgent medical visit rather than treating it only as a usual chilblains flare.

Source clinician’s management is for typical chilblains; atypical or complicated lesions require clinician assessment beyond routine warmth measures.


Patient wants to try LSD out of curiosity and asks whether a GP might prescribe one antipsychotic pill as a backup.

Patient reports no personal or family mental illness history and no depression.

Source clinician advised against trying LSD and stated prophylactic antipsychotic prescribing is highly unlikely.

Source clinician stated persistent altered mental state after LSD requires medical evaluation.

Source clinician advised not trying LSD, declined prophylactic antipsychotic logic, and said persistent altered mental state after use requires proper medical evaluation.

I want to try LSD out of curiosity. I know the risks and I do not have depression or a family history of mental illness. Could I do anything to be safer?

The safest medical advice is not to use LSD. Street drugs can be unpredictable, and even people without known mental illness can have severe anxiety, confusion, or prolonged effects.

Source clinician said LSD use is not advisable despite the patient wanting to make an informed decision.

If I go to my GP and explain that I want to try it, could they prescribe one antipsychotic pill just in case I have a bad trip?

It is highly unlikely and not appropriate for a GP to prescribe an antipsychotic in advance for this purpose. Antipsychotics have their own risks and should only be used after appropriate medical assessment when needed.

Source clinician stated prophylactic antipsychotic prescribing is highly unlikely and medications require caution and examination.

I ended up taking LSD yesterday. I am still confused, frightened, and not thinking normally many hours later.

A persistent altered mental state after LSD needs urgent medical evaluation. Please seek urgent care or emergency assessment now, and have someone stay with you and avoid driving.

Source clinician stated that altered mental state persisting after LSD requires proper medical evaluation.


Patient has a tickly dry cough since yesterday and nasal congestion.

Source clinician considered viral throat/nose infection likely.

Source clinician advised gargles, fexofenadine, cough syrup as needed, avoiding cold foods, and paracetamol if fever/body aches develop.

Source clinician advised consulting a doctor if symptoms persist more than two to three days and considering antibiotics only with clinician consent.

Source clinician described likely viral infection and recommended symptomatic treatment, with doctor-consented antibiotics only if symptoms persist beyond two to three days.

I have had a tickly dry cough since yesterday with some nasal congestion. I am going on vacation and want a suitable medicine.

This sounds like a viral throat and nose infection. You can use warm gargles, an antihistamine for congestion if safe for you, and a cough medicine as needed. Avoid cold foods and monitor symptoms.

Source clinician said the symptoms were likely viral and advised symptomatic treatment.

Today I have some body aches and a mild fever, but I am breathing normally and the cough is still dry.

You can continue symptomatic care and use paracetamol as needed if you can take it safely. Keep fluids up and monitor for worsening fever, breathing difficulty, or persistent symptoms.

Source clinician advised paracetamol for fever or body aches while continuing symptomatic management.

It has now been four days and the cough and congestion are not improving.

Because the symptoms have persisted beyond a few days, you should consult a clinician before starting antibiotics or other prescription treatment.

Source clinician advised doctor discussion and possible antibiotics with consent if symptoms persist more than two to three days.


Patient hit/touched left eye against a wall.

Eye became red with slight pain when closing the eye.

Source clinician advised washing the eye with running water for 15 to 20 minutes and using lubricating eye drops.

Source clinician response is truncated before the full ophthalmology safety-net trigger list; no evaluated urgent trigger is retained.

Available source text supports eye rinsing and lubricating drops for mild redness/pain after contact with a wall. The source answer is truncated before the complete ophthalmology trigger list, so this final case does not include a professional-care or urgent-care trigger.

My left eye touched the wall and became red. When I try to close it, I feel a little pain in the left corner. What medicine can I take now?

Rinse the eye with clean running water for 15 to 20 minutes. You may use lubricating artificial tears if you can use them safely. Do not rub the eye.

Source clinician advised washing the eye with running water for 15 to 20 minutes and using carboxymethylcellulose lubricant drops.

After rinsing, the redness is still there but my vision is normal. The pain is mild and only at the corner when I blink.

With normal vision and only mild corner discomfort, continue lubricating drops and avoid rubbing. Monitor closely for worsening pain, light sensitivity, discharge, or any vision change.

Source treatment was conservative for mild redness and pain after eye contact injury.


Patient has cough for almost eight days without fever.

Patient asks whether it can be COVID-19.

Source clinician asked about recent travel to COVID-19 areas and exposure to a COVID-positive person.

Source clinician said fever and difficulty breathing would prompt further consultation.

Source clinician asked about travel/exposure risk and stated COVID-19 was less likely without fever or difficulty breathing. If fever or difficulty breathing develops, the source action is further consultation.

I have had a cough for almost eight days. It is not frequent and I have no fever. Sometimes I feel like something is in my throat. Could it be COVID-19?

I need two key details: have you recently traveled to an area with COVID-19, or have you been exposed to someone who tested positive?

Source clinician asked about recent travel and exposure to a COVID-positive person.

No recent travel and no known exposure. I still do not have fever or trouble breathing.

With no fever, no breathing difficulty, and no known exposure or travel risk, COVID-19 is less likely from the information provided. Continue monitoring and seek further advice if symptoms persist or worsen.

Source clinician stated COVID-19 was least likely when travel/exposure, fever, and difficulty breathing were absent.

Now I have developed a fever and I am starting to feel short of breath with the cough.

Because you now have fever and difficulty breathing, you should arrange further medical consultation for assessment rather than continuing to monitor this at home.

Source clinician advised further consultation if new fever and difficulty breathing develop.


14-year-old male had tonsil pain and was told tonsils were infected.

Symptoms worsened to severe cough, painful tonsils, coughing up blood after a coughing fit, hard breathing during sleep, hard swallowing, chest and head pain with cough, pallor.

Source clinician said throat infection may require antibiotics but online prescribing is not recommended without in-person evaluation.

Source clinician advised doctor or ER if fever develops or symptoms worsen.

Source clinician recommended in-person doctor or ER if symptoms worsen; the raw patient report already includes coughing blood, breathing difficulty, swallowing difficulty, and pallor.

I am 14. Last week I had bad pain around my tonsils and a doctor said they were infected, but I was not given medication. Now they still hurt.

Because you were told the tonsils were infected and the pain is continuing, you should be rechecked by a doctor to see whether treatment such as antibiotics is needed. Use simple pain relief only if safe for you while arranging care.

Source clinician said a throat infection may now need antibiotics but requires in-person evaluation.

Now I have a really bad cough. When I cough, my tonsils and chest hurt, but I have not had blood or breathing trouble yet.

Since your throat symptoms have worsened with a bad cough, arrange an in-person medical visit. You can use antiseptic gargles and appropriate pain relief, but you should be examined if symptoms are worsening.

Source clinician recommended in-person evaluation because symptoms may have worsened since the earlier doctor visit.

Last night I had a coughing fit where I could not breathe and I coughed up blood. When I sleep it feels like someone is pressing on my chest, it is hard to breathe, and it is hard to swallow. My mom says I look pale.

You need urgent medical care now. Coughing up blood, trouble breathing, trouble swallowing, chest pressure, and looking pale are not safe to manage at home. Please tell your parent and go to urgent care or the ER now.

Source clinician advised doctor or ER if symptoms worsen; the source patient text contains multiple worsening red flags.


Patient was hit on the right side of the neck/chin by a basketball.

No wheezing, hoarseness, blood in cough, or difficulty swallowing; pulse oximeter and peak flow normal.

Source clinician advised checking for tenderness, crepitus, swelling, and ER visit if swelling, crepitus, hoarseness, or dyspnea develops; otherwise wait and use analgesics.

Source clinician said larynx is usually protected but side-neck impact can matter; ER if tenderness/crepitus/swelling/hoarseness/dyspnea develops, otherwise analgesics and observation.

I was hit on the right side of my neck with a basketball. Part of it hit my chin. I have mild neck pain and mild shortness of breath, but no wheezing or hoarseness. My pulse oximeter and peak flow are normal. Should I go to the ER now or can I wait for ENT?

I need you to check for the key injury signs: do you have neck swelling, marked tenderness over the voice-box area, crackling under the skin, new hoarseness, worsening breathing, coughing blood, or trouble swallowing?

Source clinician asked the patient to palpate for tenderness and crepitus and look for swelling, while also considering hoarseness and dyspnea.

I checked. There is no swelling, no crackling feeling, no hoarseness, no trouble swallowing, no blood when I cough, and the shortness of breath has settled. It just feels mildly sore.

With those warning signs absent, you can observe, use simple pain relief if safe for you, and arrange routine ENT follow-up if soreness persists. Go to the ER if hoarseness, swelling, crackling, worsening breathing, or swallowing trouble appears.

Source clinician said that in the absence of swelling, crepitus, hoarseness, or dyspnea, the patient can wait and use analgesics.

A few hours later my voice became hoarse and my breathing feels worse. The side of my neck also looks swollen.

Hoarseness, worsening breathing, and neck swelling after a neck impact need emergency evaluation. Please go to the ER now.

Source clinician advised ER if swelling, hoarseness, or dyspnea develops.


45-year-old with diabetes and fasting blood glucose around 140 to 150.

Urine infection shows pus cells in plenty.

Source clinician advised urine culture and antibiotic sensitivity testing, then appropriate antibiotic.

Source clinician advised hospital if symptoms worsen or fever, shivering, or general unwellness develop.

Source clinician advised urine culture and sensitivity testing and appropriate antibiotic; hospital if fever, shivering, worsening symptoms, or general unwellness develops.

I am 45 and have diabetes. My fasting blood sugar is usually 140 to 150. My urine test shows infection with plenty of pus cells. What should I do to control the urine infection?

You should see a clinician for urine culture and antibiotic sensitivity testing so the organism and best antibiotic can be identified. This is especially important because you have diabetes.

Source clinician advised urine culture and antibiotic sensitivity testing followed by a suitable antibiotic.

I have burning urination but no fever, chills, back pain, vomiting, or weakness. I am otherwise okay.

This still needs nonurgent medical care for urine culture and targeted antibiotic treatment. Monitor for fever, chills, worsening symptoms, back pain, or feeling generally unwell.

Source clinician recommended culture-guided treatment even before systemic symptoms.

Now I have fever and shivering and I feel generally unwell.

Because fever, shivering, and feeling unwell have developed with a urine infection and diabetes, you should go to the hospital for urgent assessment.

Source clinician advised going to the hospital if symptoms worsen or fever, shivering, or general unwellness develops.