Signora, se i sintomi aumentano, torni pure in ambulatorio.

Because this is a command addressed to Lei, the formal you in Italian.

For Lei commands, Italian uses the present subjunctive form:

• torna! = come back! / return! — informal, to tu
• torni! = come back! / return! — formal, to Lei

So in a medical context, torni is the normal polite form when speaking to a patient as Signora.

In this sentence, pure does not mean pure in the English sense.

After a command, pure often has a softening or reassuring effect. It can suggest things like:

• go ahead
• feel free to
• do
• please do

So torni pure in ambulatorio sounds gentler than just torni in ambulatorio. It makes the instruction feel more polite and reassuring, especially in a doctor-patient interaction.

Italian often uses the present tense in both parts of a real or likely condition:

• Se i sintomi aumentano, torni...

Literally, that is If the symptoms increase, come back...

This is very normal in Italian. English often does something similar too: If the symptoms get worse, come back.

So there is nothing unusual here: this is a standard real condition using the present tense.

When directly addressing someone, Italian usually does not use an article before titles like:

• Signora
• Signore
• Dottore
• Professore

So:

• Signora, ... = Ma’am, ...
• Dottore, ... = Doctor, ...

This is called direct address. The speaker is talking to the person, not talking about them.

Here Signora is a form of address.

It is being used a bit like:

• Ma’am
• Madam

In this sentence it helps set the tone as formal and respectful. That matches the use of torni, the formal command form.

Because the subject is i sintomi, which is plural:

• il sintomo = the symptom
• i sintomi = the symptoms

So the verb must agree with that plural subject:

• il sintomo aumenta = the symptom increases
• i sintomi aumentano = the symptoms increase

Literally, aumentano means increase.

But in a medical sentence like this, it often means that the symptoms:

• become stronger
• intensify
• get worse

So even if the English meaning shown to the learner is something like if the symptoms get worse, aumentano is a very natural Italian choice.

Both the preposition and the article matter here.

Ambulatorio means a clinic, outpatient office, or consulting room, depending on context. With places like this, Italian often uses in to express going to or being at that place:

• andare in ospedale
• essere in ufficio
• tornare in ambulatorio

So in ambulatorio is perfectly natural.

In some contexts, Italian can also use forms with an article, but in ambulatorio is a common and idiomatic way to say to the clinic / back to the office.

It is grammatically a command, but pragmatically it sounds polite and reassuring, not harsh.

That is because of several things:

• Lei form: torni
• respectful address: Signora
• softening particle: pure

So the overall tone is closer to:

• Please come back to the clinic if the symptoms increase
• Do come back to the clinic if the symptoms get worse

It sounds professional and courteous.

Yes. Ritornare and tornare can both mean to return / come back.

So these are both possible:

• torni in ambulatorio
• ritorni in ambulatorio

In everyday Italian, tornare is often the more common and simpler choice. That is why torni sounds very natural here.

Italian often puts the if-clause first, especially in instructions and warnings:

• Se i sintomi aumentano, torni pure in ambulatorio.

This is a very natural structure because it sets up the condition before giving the instruction.

Italian could also reverse the order:

• Torni pure in ambulatorio se i sintomi aumentano.

That is also grammatical, but the version with se... first is especially common in practical, spoken guidance.

No. The form torni may look like a subjunctive form, and historically it is the present subjunctive form of tornare, but here it is being used as the formal imperative.

Also, after se in this sentence, Italian uses the indicative:

• se i sintomi aumentano

So this is not a case of se triggering the subjunctive. The subjunctive-looking form appears because formal commands in Italian use that form.

It could be natural in some contexts, but it would mean something slightly different.

• torni = come back / return
• venga = come / please come

Since the patient is expected to return to a place they have already been, torni is especially appropriate. It highlights the idea of coming back.

So venga is possible in some situations, but torni fits this context better.

The first comma separates the form of address:

• Signora, ...

The second comma marks the end of the conditional clause:

• Se i sintomi aumentano, ...

This punctuation helps the sentence read clearly and naturally. It is similar to English punctuation in sentences like:

• Ma’am, if the symptoms worsen, please come back to the clinic.