D: What brings you in today?

P: So I've been having just a worsening breathlessness. I've been also having a cough, and I think I might have also had a fever in the last couple weeks.

D: OK, um so the breathlessness started six weeks ago, correct?

P: Yeah.

D: OK and then when did the cough start?

P: I'd say around the same time the breathlessness started, so around six weeks. 

D: OK. And then the fever? 

P: The fever I've kind of had on and off in the last couple weeks. I would say two to three weeks.

D: OK, OK um and do you, how often are you having this breathlessness?

P: Um I would say it's pretty much there most of the time. It sometimes gets worse when I'm exerting myself, but I think just baseline, I feel like I've been able to breathe less heavily than before.

D: OK, so alright, and how long does it last when you do get it? Or is it just always there?

P: Uh, it's kind of just there, but then when it's getting worse like it lasts a couple minutes to, I would say like 10 to 15 minutes and then it goes back to like just the normal breathlessness.

D: OK, and if you were to describe the quality of your breathlessness, would you say that it feels like a kind of like a burning feeling, like you're having a hard time catching your breath or does it feel like you're breathing too fast?

P: I think it's more I just can't seem to take like deep breaths. And then when I get breathless, I I really try to take a deep breath but I just can't find myself catching my breath at that time. So it's just more not being able to catch my breath.

D: OK, sure. And are there things that make make it better or worse?

P: Uh, not really, I think it's sometimes moving around too much, but like nothing, nothing really causes it.

D: OK, um, and was there any sort of trigger six weeks ago that you think may have like caused all of your symptoms?

P: Oh I'm not sure I I don't think there was any triggers.

D: OK, has anyone around you been sick?

P: So there there are some people living in my house that have a bad cough over the last few weeks.
 
D: OK.

P: So yeah. 

D: So they have similar symptoms to you as well then?

P: Yeah, some of them like don't really have the shortness of breath and it's just like a cough. 

D: OK.

P: But yeah, there are some of them also have some shortness of breath. 

D: OK, OK. And have you traveled anywhere recently?

P: So I actually came to Canada one year ago. I'm originally from India and I I'm I came here to study. 

D: OK. OK, um alright. If you were to rate your breathlessness from one to 10, 10 being the worst, how bad is your breathlessness?

P: It can get pretty bad. Like I I would say up to an 8 sometimes, maybe a couple times a week. 

D: OK, and have you ever experienced this before?

P: No, this is like the first time I'm having this issue.

D: OK, and do you feel like it's getting worse, better, has it changed since you started having these symptoms? 

P: I think it's getting worse and that's why I was getting a bit scared and I came here. 

D: OK. Yeah, that was a good call and have you had any changes to your smell recently?

P: No, no changes to smell.

D: Any anything like a runny nose or stuffy nose?

P: Uh, no, not really, no. 

D: No? OK, how about a sore throat?

P: No, no sore throat.

D: No sore throat, any changes to your taste?

P: Nope. 

D: Any changes in hearing?

P: Nope. 

D: Ear pain or discharge from your ears?

P: No, nothing like that. 

D: OK, any eye pain? 

P: No.

D: Changes in your vision?

P: Nope. 

D: Any discharge from your eyes?

P: Nope.

D: OK, and you mentioned fever and some night sweats. How often are you getting these night sweats and do they feel like chills?

P: I think in the last two weeks I've been getting it more frequently, like I would say every other night I I feel, I would feel chilly at one point and then I'll break out into night sweats or have to take off my blanket. I think I measured it once or twice over the week and it did show like a fever of 102.

D: OK, OK. OK, and any changes to your skin like rashes? 

P: No, nothing like that. 

D: Any weight loss?

P: I would say I think I'm losing a little bit of weight over the last couple weeks. I haven't really weighed myself, but I feel that I have lost some weight.

D: OK yeah, and the coughing, are you coughing up any blood?

P: Uh, I don't think so. Sometimes, like when I cough up like sputum, there is like a little bit of pink, pink tinged sputum as well. Sometimes it's like brownish in color and sometimes it's green, but I haven't actually coughed up any blood.

D: OK, um and you said there's some sputum like pink tinged sputum. How much sputum would you say you cough up every time you cough?

P: Maybe like a like a spoonful I would say.

D: OK. And do you ever feel like you're wheezing?

P: Uh, no, I I don't think so. I I don't really notice any noises when I'm breathing. 

D: OK. And, alright, so any chest pain?

P: No, no chest pain at all.

D: OK. How about swelling in your legs or in your limbs?

P: No, no swell leg swelling. 

D: No leg swelling? OK, um how about do you feeling like your heart's racing? 

P: No.

D: No OK. OK, and any nausea or vomiting?

P: No, no nausea or vomitting. 

D: How about changes in your bowel movements?

P: No. 

D: OK, how about changes in urinating?

P: No, it's been fine.

D: Alright any headaches? 

P: No headaches.

D: Any dizziness or fainting spells? 

P: No, nothing like that.

D: OK, no confusion or memory loss?

P: No.

D: OK, and are you otherwise healthy? Do you have any medical conditions?

P: Um I think when I was back in India a couple years ago, they did give me some antibiotics for like a chest infection, but I couldn't really afford the medications and didn't take them. I didn't finish the course, but other than that, nothing else.

D: OK, did they mention what type of chest infection it could've been?

P: No, I don't really remember. I think it was some kind of pneumonia.

D: OK, OK. Are you on any medications?

P: Just uh I take Tylenol sometimes, like it hasn't really been helping. 

D: OK. And, are you allergic to anything?

P: No, not that I know.

D: OK, are you up to date with all your immunizations? 

P: Yeah, as far as I know. 

D: OK. And and is there any family history of lung conditions or heart conditions? 

P: Nope.

D: No OK, how about cancers?

P: No cancers that run in the family, no.

D: OK OK, so you mentioned you moved to Canada from India about a year back. Where do you live now? 

P: So I live in it's, we have like a student house with some of the students who came from India as well, and there's six of us living together in in a house. 

D: OK, OK, and are they sick as well or no?

P: Yeah, so three of them actually have like, two of them have a cough and one of them has some shortness of breath as well.

D: OK. And have they been to a doctor? Have they been investigated? Were they ever given a diagnosis?

P: No, not that I know of. I think I might be the first one who actually went to a doctor.

D: OK, OK. Um, do you smoke?

P: I smoke like I would say like 5 cigarettes a day.

D: OK, how long have you been smoking for?

P: Around 10 years.

D: OK, that's, it's been a while then. Um, and do you do you drink alcohol?

P: No, I I don't drink and I don't do any drugs either. 

D: OK, OK. Are you sexually active?

P: Not currently, no.

D: No, OK. Have you ever had unprotected sex?

P: No. 

D: No?, OK. OK, um, did you have any questions or concerns? Anything you wanted to discuss that I hadn't asked you about?

P: Um, so yeah, this is just like my first time visiting a doctor in this country and like I was just very scared that it might be something serious, so just wanted to know what it can be. 

D: Yeah, for sure. So the first thing we want to rule out is TB. Because you have recently moved to Canada from a country where it is, I believe it is endemic, so and some of your most of your symptoms fit with TB and how it presents so we just want to make sure it's not that because it is highly infectious and and we don't want it to spread. So, we can do like a AFB smear or I think they have other diagnostic work up for that too. So we'll do that first. If not, we can check to see if it's like another, another typical pneumonia, we can do a chest X Ray for that as well. If both of those turn out to be negatives, then we'll have to work you up further for other things, like COPD, or lung cancer. How does that sound? 

P: That sounds good. Thank you.