D: What brings you in here today?

P: Yeah, I've had this cough and it's just not going away.

D: OK, and how long have you been having this cough for?

P: I think it started about a month ago.

D: OK, and is it a dry cough or is it a wet cough?

P: I I'm bringing up some phlegm if that's what you mean. 

D: Yeah, so you're bringing up phlegm when you cough?

P: Yeah.

D: And is it, what color is it? 

P: I it looks pretty dark and and sometimes red.

D: OK, so do you think there's blood in your phlegm?

P: Yeah, the dark it does kind of look like blood, so that's what scared me and wanted me to come in today.

D: OK, and, how much phlegm would you say you're putting out like per every time you cough?

P: I'd say every time I cough, I'm bringing up at least a teaspoon of of the dark sputum.

D: OK. And so this started four weeks ago. It has it been a constant like you've been constantly coughing or does it come and go?

P: I it it's there pretty much all the time, but especially bad in the morning.

D: OK. And do you remember if anything changed or you did something differently, or anything that happened before you started having this cough?

P: Uh, I had a cold a few weeks back, but, it was just a runny nose and it seems that the cough has been kind of lingering around.

D: OK. And do you find that it's been getting worse at all?

P: Yeah, the cough has been getting worse.

D: And have you had any previous episodes of this?

P: I I've had a smokers cough now for several for several years, but it's really just this past month that that it's gotten really bad and I have it all day long.

D: OK. And, uh, are you coughing every day or every other day? Like, how often would you say you're coughing?

P: Uh daily.

D: Daily? OK, is there anything that makes your cough go away or get worse?

P: Uh, nothing that seems to really make it any worse or better. 

D: OK, and do you have any other symptoms like shortness of breath or runny nose, sore throat, anything like that?

P: Uh nothing I can think of, just just this cough that's been bugging me. 

D: OK. And have you traveled outside of the country at all recently?

P: Yes, I've been working in the Philippines for the last three years.

D: And, uh, have you been experiencing any fevers or chills or night sweats?

P: I felt like, uh, a little bit hot. I might have a fever now so yes, no chills though. 

D: How about night sweats?

P: I have been sweating more at night too. Yeah, I have to get up and  change my pajamas sometimes.

D: OK. And how often has this been happening? 

P: Um, I'm changing my pajamas and it's sometimes the sheets, uh, maybe a couple of times per week.

D: OK, and have you been feeling more more tired, more fatigued at all recently?

P: Yeah, my energy has just been really down. I've been really fatigued. 

D: And do you find that you ever have any chest pain or shortness of breath?

P: I sometimes I do have some pain over on the right side of my chest.

D: Is this pain, what kind of pain is it?

P: I'd say it's kind of like a, uh it's a stabbing kind of, uh, uh pain and I only really notice it when I take a deep breath. 

D: OK. And how about shortness of breath, have you been experiencing anything like that?

P: I only really get short of breath when I'm going for a hike or up to my 4th floor apartment.

D: Any changes in your skin that you've noticed, like any rashes at all?

P: No rashes.

D: And how about your sleep? Have you been getting enough sleep on a daily basis? 

P: Uh just the, uh sweating at night has been annoying because it wakes me up sometimes, but other than that sleep has been OK.

D: OK, and how about your appetite?

P: I feel like I've been eating OK. Regular diet.

D: And have you had any significant weight changes recently? 

P: Uh yeah I'm down like 15 pounds over the last few months and I haven't really made any changes to my diet or exercise, so I haven't really been trying.

D: OK. Um, any recent infections at all? 

P: Just the cold that I was talking about it a few weeks ago, and that's where the runny nose kinda went away.

D: OK, um, and have you at all, either here or when you were working in the Philippines have been exposed to someone with tuberculosis?

P: I believe some of the, uh people I was helping over there did in fact have tuberculosis.

D: OK, and have you had a TB skin test done at all?

P: I've had one in the past, but I can't really remember the last time and it was normal though, when when I had it a few years ago.

D: OK, but nothing since you've been back at all?

P: No, the last test must be at least a few years ago.

D: OK. And in terms of just in your environment, at work and at home, are you exposed to any mold or any pets?

P: No pets at home, and, uh, I don't think there's any mold in the home either.

D: Do you notice any kind of tingling or numbness in your limbs or any muscular weakness?

P: I I, I mean, I'm really tired all the time and kind of feel weak that way, but, no muscular weakness.

D: And have you previously been diagnosed with any medical conditions like high blood pressure, diabetes, anything else?

P: Uh just a chronic bronchitis with a smokers cough.

D: OK. And do you take any medications? 

P: Yeah, I take, uh, a beta agonist inhaler, an inhaled corticosteroid and another type of anti muscarinic inhaler.

D: OK, and do you have any allergies to any medications?

P: No allergies.

D: Any allergies at all to any environmental exposures?

P: I don't think so, no.

D: Any hospitalization in the past?

P: No.

D: And any surgeries in the past?

P: No surgeries.

D: And have you been in contact with anyone who is ill? I know you mentioned in the Philippines, you were exposed to some people with TB, but anything since then?

P: Not that I can think everybody's been healthy.

D: OK, and and in your family, has there been any history of any cancers or heart attacks? Any any medical conditions?

P: No heart attacks, but uh my father died of lung cancer when he was 67.

D: And currently do you live in an apartment building? Is there anyone you live with?

P: Yeah, I live with my girlfriend in an apartment.

D: OK, and do you work currently?

P: Yeah, I've been doing some housing work in the Philippines, the last seven, several years.

D: OK. And do you currently drink?

P: Uh no I don't drink alcohol.

D: Any recreational drugs like marijuana?

P: No.

D: Uh, any and you smoke cigarettes at all? 

P: Yes, I I do smoke cigarettes, I I've smoked most of my life, similar to my my father, probably 1 to 2 packs per day.