Comprehensive chronic disease and nodule management. Supports hypertension, diabetes, cardiovascular disease, thyroid nodule (TI-RADS), breast nodule (BI-RADS), lung nodule (Fleischner guidelines), chronic prostatitis (NIH-CPSI), and chronic allergic conditions. Provides condition-specific monitoring, complication screening, personalized targets, and evidence-based lifestyle recommendations. Triggers on: hypertension, diabetes, high blood pressure, high blood sugar, thyroid nodule, breast nodule, lung nodule, prostatitis, prostate, chronic condition, disease management.
Specialized skill for managing chronic diseases and nodules with personalized care plans, complication prevention, and evidence-based targets.
| Category | Systolic | Diastolic | Action |
|---|---|---|---|
| Normal | <120 | <80 | Maintain healthy lifestyle |
| Elevated | 120-129 | <80 | Lifestyle modifications |
| Stage 1 | 130-139 | 80-89 | Lifestyle + consider medication |
| Stage 2 | ≥140 | ≥90 | Medication + lifestyle |
| Crisis | ≥180 | ≥120 | Emergency evaluation |
| Risk Category | Target BP |
|---|---|
| Low CV risk (<10%) | <140/90 mmHg |
| Moderate risk (10-20%) | <130/80 mmHg |
| High risk (>20%) | <130/80 mmHg |
| Diabetes + HTN | <130/80 mmHg |
| CKD + HTN | <130/80 mmHg |
| Elderly (≥65) | <130/80 mmHg (if tolerated) |
| Parameter | Frequency | Target |
|---|---|---|
| Home BP | 2x/day (morning/evening) | <130/80 mmHg |
| Weight | Weekly | Stable |
| Sodium intake | Daily log | <2300 mg/day |
| Exercise | Weekly log | 150 min/week moderate |
| Medication adherence | Daily | >90% |
DASH Diet Components:
Exercise Prescription:
| Population | Fasting BG | Post-Meal BG | HbA1c |
|---|---|---|---|
| Most adults | 80-130 mg/dL | <180 mg/dL | <7.0% |
| Pregnancy | <95 mg/dL | <140 mg/dL | <6.5% |
| Elderly/frail | 90-150 mg/dL | <200 mg/dL | <8.0% |
| High hypo risk | 100-180 mg/dL | <200 mg/dL | <7.5% |
| Range | Target | Clinical Significance |
|---|---|---|
| 70-180 mg/dL | >70% | Time in target range |
| <70 mg/dL | <4% | Hypoglycemia |
| <54 mg/dL | <1% | Severe hypoglycemia |
| >180 mg/dL | <25% | Hyperglycemia |
| >250 mg/dL | <5% | Severe hyperglycemia |
| Complication | Screening Test | Frequency |
|---|---|---|
| Retinopathy | Dilated eye exam | Annually |
| Nephropathy | UACR + eGFR | Annually |
| Neuropathy | Monofilament test | Annually |
| CVD | BP, lipids, ECG | Each visit / Annually |
| Foot ulcers | Comprehensive foot exam | Annually (high risk: quarterly) |
When Ill (fever, vomiting, infection):
| TI-RADS Level | Points | Malignancy Risk | Management |
|---|---|---|---|
| TR1 | 0 | <2% | Benign, no FNA |
| TR2 | 2 | <2% | Not suspicious, no FNA |
| TR3 | 3 | ~5% | Follow-up if ≥2.5cm, FNA if ≥2.5cm |
| TR4 | 4-6 | 5-20% | Follow-up if ≥1.5cm, FNA if ≥1cm |
| TR5 | ≥7 | >20% | Follow-up if ≥1cm, FNA if ≥1cm |
| Feature | 0 Points | 1 Point | 2 Points | 3 Points |
|---|---|---|---|---|
| Composition | Cystic | Spongiform | Mixed | Solid |
| Echogenicity | Anechoic | Hyperechoic | Isoechoic | Hypoechoic |
| Shape | - | - | Wider-than-tall | Taller-than-wide |
| Margin | Smooth | - | Ill-defined | Extrathyroidal |
| Echogenic Foci | None | Large | Punctate | - |
| TI-RADS | Size | Initial Follow-up | Ongoing |
|---|---|---|---|
| TR3 | <2.5cm | 1 year | Every 1-2 years if stable |
| TR3 | ≥2.5cm | Consider FNA | - |
| TR4 | <1.5cm | 1 year | Every 1-2 years if stable |
| TR4 | ≥1.5cm | Consider FNA | - |
| TR5 | <1cm | 1 year | Annual for up to 5 years |
| TR5 | ≥1cm | FNA recommended | - |
Significant Growth:
Action for Growth:
Reassurance Points:
When to Seek Care:
| BI-RADS | Malignancy Risk | Management |
|---|---|---|
| 0 | Incomplete | Additional imaging needed |
| 1 | 0% | Negative, routine screening |
| 2 | 0% | Benign, routine screening |
| 3 | <2% | Probably benign, 6-month follow-up |
| 4A | 2-10% | Low suspicion, biopsy consideration |
| 4B | 10-50% | Moderate suspicion, biopsy recommended |
| 4C | 50-95% | High suspicion, biopsy strongly recommended |
| 5 | >95% | Highly suggestive of malignancy |
| 6 | 100% | Known biopsy-proven malignancy |
| Age | Primary Modality | Additional |
|---|---|---|
| <30 | Ultrasound | MRI if high risk |
| 30-39 | Ultrasound + Mammogram | - |
| ≥40 | Mammogram + Ultrasound | MRI if dense breasts |
| BI-RADS | Follow-up | Duration |
|---|---|---|
| 1-2 | Routine screening | Annual (age ≥40) |
| 3 | 6, 12, 24 months | If stable at 2 years → routine |
| 4A-C | Biopsy | Within 2-4 weeks |
| 5 | Biopsy + Oncology | Immediate |
Fibrocystic Changes (Common, Benign):
When to Evaluate:
Self-Awareness (not formal self-exam):
Risk Reduction:
| Nodule Size | Low Risk Patient | High Risk Patient |
|---|---|---|
| <6mm | No routine follow-up | Optional CT at 12 months |
| 6-8mm | CT at 6-12 months | CT at 6-12 months, then 18-24 months |
| >8mm | Consider 3-month CT, PET, or biopsy | Consider 3-month CT, PET, or biopsy |
| Type | Size | Management |
|---|---|---|
| Pure GGN | <6mm | No routine follow-up |
| Pure GGN | ≥6mm | CT at 6-12 months, then every 2 years until 5 years |
| Part-solid | ≥6mm | CT at 3-6 months, then annual for 5 years |
Low Risk:
High Risk:
Significant Growth:
Action for Growth:
5 A's Approach:
Pharmacotherapy Options:
Reassurance:
Warning Signs:
Domains:
Total Score: 0-43
| Severity | Score Range |
|---|---|
| Mild | 1-9 |
| Moderate | 10-18 |
| Severe | 19-43 |
| Category | Name | WBC in EPS | Culture |
|---|---|---|---|
| I | Acute Bacterial | Positive | Positive |
| II | Chronic Bacterial | Positive | Positive |
| IIIA | Inflammatory CPPS | Positive | Negative |
| IIIB | Non-inflammatory CPPS | Negative | Negative |
| IV | Asymptomatic | Positive | Negative |
CPPS = Chronic Pelvic Pain Syndrome
Category II (Chronic Bacterial):
Category III (CPPS - Most Common):
Dietary Modifications:
Physical Measures:
Stress Management:
| Parameter | Frequency |
|---|---|
| NIH-CPSI score | Every 4-6 weeks |
| Urinalysis | Every 3 months |
| PSA (if age ≥50) | Annually |
| Post-void residual | If voiding symptoms worsen |
| Type | Timing | Common Triggers |
|---|---|---|
| Seasonal | Spring/Fall | Tree pollen, grass, ragweed |
| Perennial | Year-round | Dust mites, pet dander, mold |
| Occupational | Work days | Chemicals, dust, latex |
| Severity | Sleep | Daily Activities | Symptoms |
|---|---|---|---|
| Mild | Normal | Normal | Bother some |
| Moderate-Severe | Disturbed | Impaired | Troublesome |
Step 1 (Mild Intermittent):
Step 2 (Moderate-Severe or Persistent):
Step 3 (Refractory):
Step 4 (Severe Refractory):
For Seasonal Allergies:
Pollen:
Dust Mites:
Pet Dander:
Common Triggers:
Management:
Emergency Action Plan:
| Factor | Correlation | Recommendation |
|---|---|---|
| Sodium intake | r = 0.6-0.7 (positive) | Reduce to <2300 mg/day |
| Exercise frequency | r = -0.5 to -0.7 (negative) | 150 min/week moderate |
| Sleep quality | r = -0.6 to -0.7 (negative) | Prioritize 7-8 hours |
| Stress level | r = 0.4-0.6 (positive) | Daily meditation 10 min |
| Alcohol intake | r = 0.4-0.5 (positive) | Limit to ≤2 drinks/day |
| Potassium intake | r = -0.4 to -0.5 (negative) | Increase potassium-rich foods |
| Factor | Correlation | Recommendation |
|---|---|---|
| Carb intake | r = 0.6-0.7 (positive) | Control refined carbs |
| Post-meal exercise | r = -0.5 to -0.6 (negative) | 15-30 min walk after meals |
| Medication adherence | r = 0.7-0.8 (positive) | Set reminders, pill organizer |
| Fiber intake | r = -0.4 to -0.5 (negative) | 25-30g fiber/day |
| Sleep duration | r = -0.4 to -0.5 (negative) | 7-8 hours sleep |
| Stress level | r = 0.5-0.6 (positive) | Stress management techniques |
Thyroid Nodule:
| Factor | Correlation | Recommendation |
|---|---|---|
| Iodine intake | U-shaped | 150 mcg/day (not too little, not too much) |
| TSH level | r = 0.5 (positive) | Monitor TSH every 6-12 months |
| Cancer anxiety | r = 0.6 (positive) | Reassurance: TR3 <5% risk |
Breast Nodule:
| Factor | Correlation | Recommendation |
|---|---|---|
| Cycle phase | Cyclical | Track timing; many are fibrocystic changes |
| Caffeine | r = 0.3 (positive) | Consider reduction if symptomatic |
Lung Nodule:
| Factor | Correlation | Recommendation |
|---|---|---|
| Smoking history | r = 0.6-0.8 (positive) | Critical: Smoking cessation |
| Nodule growth | Variable | Follow Fleischner guidelines |
Every chronic care consultation produces:
# [Condition] Management Report
**Date**: YYYY-MM-DD
**Condition**: [Hypertension / Diabetes / Thyroid Nodule / etc.]
---
## 🚨 Risk Assessment
**Current Status**: [Controlled / Needs Attention / Urgent]
**Risk Level**: 🟢 Low / 🟡 Medium / 🔴 High
**Key Concerns**:
- [Concern 1]
- [Concern 2]
---
## 📈 Current Metrics
| Parameter | Current | Target | Status |
|-----------|---------|--------|--------|
| [Parameter 1] | [Value] | [Target] | ✅/⚠️/❌ |
| [Parameter 2] | [Value] | [Target] | ✅/⚠️/❌ |
---
## 🔗 Correlation Insights
### [Factor A] ↔ [Condition]
**Correlation**: r = [value] ([Strength])
**What this means**: [Interpretation]
**Action**: [Specific recommendation]
---
## 📋 Action Plan
### Today
- [ ] [Action 1]
- [ ] [Action 2]
### This Week
- [ ] [Action 3]
- [ ] [Action 4]
### This Month
- [ ] [Follow-up test/appointment]
- [ ] [Goal]
---
## 📅 Follow-Up Schedule
| Test/Visit | Due Date | Status |
|------------|----------|--------|
| [Test 1] | YYYY-MM-DD | Due/Completed |
| [Test 2] | YYYY-MM-DD | Due/Completed |
---
## ⚠️ When to Seek Immediate Care
- [Red flag symptom 1]
- [Red flag symptom 2]
- [Red flag symptom 3]
---
## 📚 Patient Education
[Condition-specific education points]
---
**Disclaimer**: This analysis is based on your provided health data and is for informational purposes only. It does not replace professional medical diagnosis or treatment. Always consult your healthcare provider for medical concerns.
Hypertension Crisis:
Diabetes Emergency:
Nodule Red Flags:
| Skill | Relationship |
|---|---|
| musculoskeletal-care | Osteoporosis bone density management, fracture risk assessment |
| fitness-coach | Exercise prescription for chronic conditions |
| medication-manager | Medication adherence tracking |
| nutrition-advisor | DASH diet, diabetic diet, calcium/Vitamin D |
| vital-monitor | BP, glucose trend tracking |
| preventive-care | Screening schedules |
Version: v2.0 Created: March 2026 Maintainer: Family Doctor Team