jshargo/medical-interview-conversations huggingface dataset:
Patient: No. 

Doctor: Or feeling like your heart's racing or, or beating really fast? 

Patient: No. 

Doctor: Okay. And, um, have you had any fevers or chills?
Patient: No, not that I've noticed. 

Doctor: Have you had any night sweats?
Patient: No. 

Doctor: And how has your weight been over the last several months? Have you had any weight loss or gain? 

Patient: Uh no, it's been pretty stable. 

Doctor: Okay. Um, and have you had any abdominal pain?
Patient: Um, no. 

Doctor: Any diarrhea?
Patient: No. 

Doctor: Or any urinary problems? 

Patient: No. 

Doctor: Okay. Um, and in the past um, oh sorry, before that, have you had any nausea or, or vomiting?
Patient: No. 

Doctor: Okay. Uh, and any confusion or, or changes to um, um memory? 

Patient: No. 

Doctor: Okay, uh, or loss of taste or sense of smell?
Patient: Uh no. 

Doctor: Okay uh, so the, you've been experiencing this cough that's been getting worse over the last couple of days, as well as bringing up some yellow sputum, um, and been short of breath. Have you been experiencing any other symptoms? 

Patient: No, that's pretty much it. 

Doctor: Okay. Um, and in the past, have you um, been diagnosed with any medical conditions?
Patient: Um, I have diabetes, I have high blood pressure and I have high cholesterol. 

Doctor: I see. Alright, and do you take uh, medications for those things?
Patient: Yes, so I am on ramipril for the high blood pressure, rosuvastatin for the cholesterol, and insulin for the diabetes. 

Doctor: Okay, thank you. And uh, you mentioned you had a similar episode in the past. Um, what, uh, were you diagnosed with COPD before?
Patient: I was, I was diagnosed with COPD about five years back. 

Doctor: Okay, did you have pulmonary function tests for this? The test where you had to breathe into a tube. 

Patient: Um yeah, I had that done like five years ago. 

Doctor: Okay, um, alright um, just wanted to see if it was uh like formally diagnosed. Sometimes people uh, um, yeah, it's important to have that, uh, those tests done. Um, and do you have any allergies?
Patient: Um, no none. None, yeah. 

Doctor: Okay. Um, and uh, are your immunizations up to date? 

Patient: Yes, I believe so. 

Doctor: Okay, um and have you had any surgeries or, or um, hospitalizations?
Patient: Um, I had my Gallbladder removed when I was in my 50s. Um, and I had a hip fracture three years ago. 

Doctor: Okay, and how is your mobility now? 

Patient: Um pretty good. My hips still give me some issues once in awhile, but um, for the most part, it's been okay. 

Doctor: Okay, that's good. It sounds like the rehab went well.
Patient: Yeah. 

Doctor: And uh, right now, can you tell me um, a little bit about your living situation? Like where you're living and who you're living with? 

Patient: Um, I live by myself in an apartment on the 1st floor. 

Doctor: Okay, um and, do you smoke cigarettes?
Patient: Uh no, I quit two years ago. 

Doctor: Okay, and that's, that's great. Um, prior to that, how long did you smoke for, and how much? 

Patient: Oh, for like 40-plus years um, I used to smoke a pack a day. 

Doctor: Okay, well that's great that uh, that you quit, so congratulations.
Patient: Thank you. 

Doctor: And do you drink alcohol? 

Patient: I drink once in a while. Like maybe every other day, I'll have a glass of wine. 

Doctor: Okay, and um, uh anybody, or sorry, have you been around anybody who's been sick recently?
Patient: Uh no. 

Doctor: You said you went to the stores and stuff like that.
Patient: Yeah, maybe from there, yeah. 

Doctor: Okay, and have you traveled anywhere else, outside of the city?
Patient: Um, not recently, no. 

Doctor: Alright, um, and any exposures to any like dust, chemicals, things like that? 

Patient: Um, I live in an old building so maybe. Um, but it hasn't bugged me before. 

Doctor: Okay, uh, and are you working currently or, or retired?
Patient: I'm retired. 

Doctor: Okay, well, what did you do before? 

Patient: I used to work uh, on the assembly line for Chrysler. 

Doctor: Okay, were there any exposures uh, there that you were aware of, like things that you were breathing in?
Patient: Uh not that I was aware of, but they were always like smoke and fumes and things like that because it was like a factory, so maybe. 

Doctor: Right, okay, that makes sense. Um, and in the family, are there, anybody who, who's had problems with their hearts or lungs?
Patient: Um, my mom had lung cancer when she was 50. And, like, all the, like diabetes, hypertension and high cholesterol runs on my, ran on my father's side of the family. 

Doctor: I see, did anybody have uh, heart attacks or, or stroke? 

Patient: Uh, yeah, so my father had a heart attack when he was 49. Uh, stroke I'm not too sure about. 

Doctor: Okay, thank you. And, um, so that was all I wanted to ask about. Um, was there anything else that you wanted to add that I maybe forgot?
Patient: Um, no, that's about it, but I, how can I treat myself now? How do I make this cough go away? 

Doctor: For sure, so, um, we will first get your vitals here and we'll see if your oxygen levels um, are low, then it would be important to put on some oxygen first, um, just to make sure that that's stable. Um, and from there we will um, get a chest x-ray um, and uh, run some lab work to, to try to help figure out the, the diagnosis better, but in the meantime, we'll use um, some inhalers because it's possible that this is a COPD exacerbation similar to uh last year, um, and the inhalers should help open up the airways and dilate, so make breathing easier, and then um, also if it is a COPD exacerbation, it will likely require antibiotics, as well as some steroids for the, the inflammation for five days. Uh, but since your symptoms currently overlap with uh, COVID as well, you'll have to get a, a COVID nasal swab. 

Patient: Okay, okay for sure. 

Doctor: Okay, so uh, we'll get that started.
Patient: I brought my son in today because he had a fever that started two days ago and, and then since then he he's had a cough that started as well and it it he's been short of breath. It looks like he's like breathing faster and just having a harder time to breathe. 

Doctor: OK, uhm, before the fever, did you notice any other symptoms, like a runny nose or a stuffy nose? 

Patient: No, nothing like that. Yeah, the fever kind of came on pretty, pretty suddenly it seemed like. 

Doctor: OK, and did you take his temperature at home?
Patient: I did, yeah. It was like 38.7 and then like two days ago and then it was high again, like yesterday and today. 

Doctor: OK, and you mentioned the coughing started soon after the fever, correct? 

Patient: Yeah, yeah kind of like the day after e started having getting this cough. 

Doctor: OK and is it a dry cough or is it a productive cough?
Patient: It's, uh, yeah, he is bringing up a little bit of sputum, yeah he's doing it. 

Doctor: OK, what color is the sputum?
Patient: Uh, it's a maybe like like greenish, greenish, yellow? 

Doctor: Greenish yellow, OK. Any blood in there?
Patient: No, I haven't noticed any any blood. 

Doctor: OK, and does he seem short of breath or wheezy? 

Patient: No wheezing, but he does have some shortness of breath. 

Doctor: OK. And the service of bread started with a cough?
Patient: Ii did, yeah. 

Doctor: OK. Uhm, how much shortness of breath is he having? Is it just when he's exerting himself or is it at rest as well?
Patient: I'd say ah, even at rest now he's like breathing faster. 

Doctor: OK, umm, and it does anything help with that? So does sitting up help? Or, uh, you know, getting fresh air or anything like that? 

Patient: No. But you'd say, like taking a smaller breaths helps because like if he if he takes a deep breath and he gets, he gets like chest pain. 

Doctor: OK, OK, and how about when he's laying down?
Patient: No, he hasn't said anything like, like that for laying down just I think when he's just taking a deep breath, he said. 

Doctor: OK, is it waking him up from sleep? 

Patient: Uh, no. 

Doctor: No, OK. How about chest pain?
Patient: Yeah, so yeah he's had some pain when he, when he just really takes that deep breath in. 

Doctor: OK. Does he ever feel like his heart's racing? 

Patient: Uhm, no. 

Doctor: No, OK. Uhm how about any dizziness or fainting spells?
Patient: No, he doesn't have anything like that. 

Doctor: OK, has he had a sore throat? 

Patient: No, no. 

Doctor: Any changes in vision or hearing?
Patient: No. 

Doctor: Uh, smell or taste? 

Patient: No. 

Doctor: No. Weight loss?
Patient: No, he's been gaining weight well. 

Doctor: OK, how about any rashes?
Patient: Nope, I haven't noticed any. 

Doctor: OK, uhm, and then any numbness or tingling? 

Patient: No, he hasn't said anything like that. 

Doctor: OK, muscle aches or joint aches?
Patient: No. 

Doctor: Changes in his bowel movements?
Patient: Nope, yeah, that's been been getting out, no diarrhea or anything like that. 

Doctor: OK. Changes in his voiding? 

Patient: Nope, he hasn't had any urinary problems. 

Doctor: OK. And is he an otherwise healthy child? Umm, does he have any longstanding medical conditions?
Patient: No, he doesn't. That's uh, this was so surprising, he's been healthy. 

Doctor: OK. Has he, so he's never had any hospitalizations or surgeries?
Patient: No, he hasn't. 

Doctor: OK. How about his mother's pregnancy with him? Were there any complications at that point? 

Patient: Nope, everything went went well. No complications and he was like a good birth weight and went home right away. 

Doctor: OK. OK, and how about the delivery itself? Any complications during that, that point?
Patient: Oh no, not it was a vaginal delivery and it was normal. 

Doctor: OK. And he didn't need to be hospitalized as a newborn for anything like jaundice or shortness of breath?
Patient: Uh, nope, he hasn't had any any reason to be hospitalized. 

Doctor: OK. Uhm alright. And has he been hitting all his developmental milestones as well as like his height, weight and head circumference milestones? 

Patient: He has, yeah, he's been growing well and reaching the developments stones, milestones. 

Doctor: OK, is he on any medications?
Patient: Uh, no he's not on any medications. 

Doctor: OK. Any allergies? 

Patient: No allergies. 

Doctor: Uhm, is he up to date with all his immunizations?
Patient: He is, yeah. 

Doctor: OK. Any family history of lung or heart conditions.
Patient: Uh, no, nothing like that. 

Doctor: OK. Have about cancers in the family?
Patient: No, no cancers luckily. 

Doctor: Can you think of anyone he's been in contact with who's also been sick?
Patient: Yeah, maybe, he has a younger sister that goes to daycare and she was sick last week with like she had a cough and stuff as well. 

Doctor: OK. OK, and does she have a fever as well? 

Patient: She did, yeah, she got better. Right uh, last week we we had to take her to to see the DOCTOR: and she got antibiotics for that. Actually for, for a few days. 

Doctor: OK, OK. And have you traveled anywhere recently?
Patient: No, we've been at home. 

Doctor: OK. Does anyone at home smoke?
Patient: No. 

Doctor: No, OK. And who lives at home with him?
Patient: So it's me, his mom, and then his younger sister. 

Doctor: OK. Any old carpets, mold, dust, asbestos, anything that could exacerbate his condition? 

Patient: No, I don't think so. It's a newer home. 

Doctor: OK, good. Umm, so those are all the questions that I had for you. Did you have any questions of your own?
Patient: Uhm, no, I, no that was everything I think. The only I I guess other thing that that I forgot to mention is that just he doesn't really like his appetite's been a little bit lower couple of days as well. But uh, he hasn't had any, like nausea or vomiting though. 

Doctor: OK, OK, yeah, that's good to know. Uhm, so because some of his symptoms overlap with those of Covid, we will do a swab on him and you should hear back in about 24 to 48 hours with those results and he should isolate for 14 days because of those symptoms. And it doesn't, it sounds more in keeping with the picture of community acquired pneumonia, so for that we will get a chest x-ray, we'll check his oxygen and his temperature and if the chest x-ray shows consolidation umm, or some sort of infiltrate, it is likely that he has pneumonia. So, we will start by giving him some amoxicillin populate or cefuroxime for five days, and just keep monitoring his symptoms. They should resolve in about 5 days when the course of antibiotics is complete. If his condition gets worse like he's getting neurological deficits like weakness or seizures, just take him to the ER. And if symptoms don't resolve in five to seven days, we can do further work up or things like fungal infections or TB, or things like that. How does that sound?
Patient: Hi, yes it's nice to meet you. I've been having this cough that's been going on for the last few days and I have had difficulty breathing. 

Doctor: Oh, I'm so sorry to hear that. When did this start?
Patient: Oh, so the cough started about 3 days ago. Yeah, the shortness of breath has come on since then. 

Doctor: OK, well let's focus on the shortness of breath first and then we'll talk about your cough as well. So you noticed that you had difficulties with breathing sometime within the past three days. When do you find that it's difficult for you to breathe? Is there anything that makes breathing more difficult for you?
Patient: Yeah, not really. Actually, it's been well, but just bad after I cough. 

Doctor: So say walking up the stairs or doing any exercise doesn't make it worse?
Patient: Not really, I've been able to do the same amounts of of activity I guess. 

Doctor: OK, so there's really no relationship with activity with your shortness of breath. OK, and I can see that you're able to sort of talk in full sentences.  OK, how is it making it difficult for you to do things at home, your difficulty breathing? 

Patient: I am a little bit, I mean, I feel I just haven't been feeling very good overall so I've been resting these last couple of days mostly. 

Doctor: OK, and your cough, you said that started three days ago. Is it a dry cough or wet cough?
Patient: It's dry. It's a dry cough. 

Doctor: OK, and there's no sputum production with it? Anything coming up at all?
Patient: No, I haven't noticed anything like that. 

Doctor: OK, and is there anything that's making the cough better? Did you take anything? Any medications for it?
Patient: I tried some over the counter stuff but it didn't help. 

Doctor: OK alright. Other than the difficulty breathing and the cough, have you noticed any other symptoms? 

Patient: Yeah, I've been really tired. I guess I've just sort of been  resting the these last few days and I've had a headache as well. 

Doctor: OK. Can you tell me a bit more about your headache?
Patient: Yeah, it feels like somebody is just squeezing the top of or just squeezing the sides of my head. 

Doctor: Have you had a headache like this before? 

Patient: I have, yeah. I usually get them when I'm dehydrated. Or maybe I haven't slept well. And that's also been the case for the past two to three days. Yeah, it's been kind of off and on, there are some times that are worse than others, but I've noticed that I had it for the most part for the last few days, OK, 

Doctor: Have you taken anything for your headache? Any pain meds?
Patient: Yeah, I've been taking some Advil, it's helped. 

Doctor: And so you talked about being tired, having a headache, difficulties breathing, and coughing over the past three days. Have any of these symptoms gotten worse overtime?
Patient: Yes, I would say, but both the cough and the shortness of breath has been getting worse over these last few days. 

Doctor: OK, and have you had any chills or have you checked your temperature? 

Patient: I haven't checked my temperature, but I felt like I've had a fever or might be getting a fever. 

Doctor: We can check your temperature here. And have you had any muscle aches?
Patient: Yeah, I guess I felt a bit achy. 

Doctor: Any redness in the eyes? Or any runny nose or sore throat like flu-like symptoms? 

Patient: Umm, I have, I don't know maybe my nose is a little bit congested, but not really running. 

Doctor: OK. And have you had any change in your sense of smell?
Patient: No, I haven't noticed that. 

Doctor: What about your sense of taste? Are you able to taste things?
Patient: Yeah, I think so. 

Doctor: Have you noticed any rash anywhere on your body? 

Patient: Umm, no,  I haven't. 

Doctor: OK, any changes in your bowel movement, diarrhea or constipation?
Patient: No, no, nothing like that. 

Doctor: Any chest pain?
Patient: No, I haven't had any. 

Doctor: OK. Alright, well it sounds like you have multiple symptoms right now that started about 3 days ago. You're feeling tired, you have a headache, difficulties breathing, some muscle aches and you've been feeling feverish. You've also had this cough, and your nose is feeling congested. Is there anything else that that you've been experiencing over the past three days that I haven't talked about yet?
Patient: No, as you mentioned, the headache's there too, then yeah, that's everything. 

Doctor: OK, umm, alright, can you tell me about your past medical history? Do you have any medical conditions?
Patient: Yeah, I have asthma and GERD I think. 

Doctor: Umm, does the shortness of breath that you're experiencing feel similar to the asthma attacks in any way? 

Patient: No, I haven't had any issues with like asthma attacks in a long time. 

Doctor: Do you have an inhaler?
Patient: I do but I don't use it very often. 

Doctor: I see, did you use it over the past three days at all? 

Patient: Yeah I did try it and it didn't really seem to help that much. 

Doctor: Uh, and other than that, have you had any any surgeries in the past?
Patient: Uh, I had a colonoscopy two years ago. 

Doctor: Any reason for that?
Patient: Uhh, my father had colon cancer when he was in his 60s. 

Doctor: I see OK, and any hospitalizations? 

Patient: No. 

Doctor: OK. Do you take any medications? I know you have puffers. Any medications, including over the counter pills?
Patient: Yeah, I'll take like a Zantac or like Tums sometimes for reflux. 

Doctor: And, uh, any allergies to food, medications, or environmental allergies?
Patient: Yeah, I have environmental allergies. I think like usually they come on in the springtime. 

Doctor: In terms of family histories, you did mention that your dad had colon cancer. Any other medical problems that that run in your family? 

Patient: Umm, no. 

Doctor: OK. And do you currently smoke?
Patient: No, I don't and have never smoked in the past. 

Doctor: OK, what about marijuana?
Patient: Umm, no. 

Doctor: OK, do you or have you ever had alcohol? 

Patient: I will have some wine on the weekends, maybe a glass or two with dinner. 

Doctor: OK, sounds good and have you ever had any street drugs?
Patient: Like a long time ago, maybe when I was in college, once or twice. 

Doctor: Alright, sounds good, and have you had any contact with any sick people? Anyone who's sick recently?
Patient: Not that I know of. I mean, I went to a few stores here and there that I had been going to. I've been working from home so maybe at one of the stores. And I would imagine I were wearing a mask and of course trying to maintain social distancing as much as possible. But yeah, you never, really know. 

Doctor: What about any other travels or any travels at all outside the city or the country recently? 

Patient: Umm, no, I had been at home. 

Doctor: Alright. So I guess that's all I wanted to know. I'll go talk to the attending and we'll come back and do a physical exam and maybe ask a couple more questions and then discuss the management with you. Does that sound good to you?
Patient: I can't, I can barely breathe for like 2 days now and I've been coughing and been having like a little bit of pain in my chest. 

Doctor: OK, the pain in your chest, uh can you point point out or can you describe the pain to me, is that sharp or is it dull? 

Patient: Um, it's hard to say, I haven't really had this before. Um, it's more like it just kind of hurts just in the middle and it gets worse like when I cough and when I if I take like a really deep breath, it will hurt, yeah. Does that make sense? 

Doctor: Yeah, so the shortness of breath and chest pain, they occurred simultaneously right? On the same day, like 2 days ago?
Patient: Yeah, I mean now that I think of it, I maybe started coughing a little bit earlier than that. But when it got harder to breathe is pretty well around the same time that I started feeling more the pain. 

Doctor: OK, alright so let's focus on the coughing first. Are you coughing up any blood at all?
Patient: Uh, no, I haven't noticed any blood. 

Doctor: OK. And how about sputum? 

Patient: I guess I guess it feels like there's some like mucus, I don't know kind, kind of like spit looking, but maybe like thicker than that. 

Doctor: OK, is it yellow?
Patient: Yeah, yeah. Yeah well yeah, it's creamy yellow. 

Doctor: OK, sure, and are you wheezing with the cough? 

Patient: I I don't think so. 

Doctor: No, OK, um and is it is your shortness of breath worse with exertion?
Patient: I haven't been doing much really 'cause I've just been so wiped out. Um, till probably I guess it's kind of, I'm really, you know, haven't been getting up very much. I'm normally really active like I I train for triathlons and I I'm not like a couch potato, right? And I feel like I've been just kind of sitting down. 

Doctor: OK. Um, do you have the chest pain at rest as well, or is it just with the coughing? 

Patient: Like if I take a deep breath I'll have it. But no, I don't think not not like right now. Not like just sitting here. 

Doctor: OK. And the coughing, how often are you coughing?
Patient: Oh, like it kind of varies. I feel like I get up in the night kind of sweaty and I'll cough for for a while. And it it'll keep me up, and then during the day, it's like I might go, you know, a couple hours without, but then I'll cough and I'll kind of keep going for a few minutes so, it's a lot, like probably, yeah, I probably don't go more than like 2 hours without. 

Doctor: OK, OK. And how far can you walk before you start feeling shortness of breath? 

Patient: I mean, I haven't been walking very far. Like I I walked in here from the parking lot and that was fine, but I'm tired. 

Doctor: OK, OK, and I just want to ask you some other questions. Um, Jessica, so have you had any fevers race recently?
Patient: I don't actually have a thermometer at home that works, but I like I said, when I've been getting up in the night coughing, I've been like really hot and sweaty. Kinda gross like feel like I just I feel like soaked and but yeah, I don't have a thermometer. 

Doctor: Um, OK, so these night events that you're describing, are they more chills or night sweats?
Patient: Well, I don't know, it just feels like when you know when you're, I don't like when you're a kid and you get really sick and your parent tells you have fever like I don't have an actual temperature. 

Doctor: But do you feel hot?
Patient: I feel hot, yeah. 

Doctor: OK, OK. And have you lost any weight recently?
Patient: No, I mean I'd like to, but no, no. 

Doctor: OK and any changes in your vision? 

Patient: Uh, no. 

Doctor: Hearing?
Patient: No. 

Doctor: Smell?
Patient: No. 

Doctor: Any, do you have like a stuffy nose? Runny nose? 

Patient: Maybe a little little bit. It's been more the coughing that's that's bothered me. So I haven't thought that much about it. 

Doctor: OK, sorry you said your nose was stuffy or runny?
Patient: So it's a little stuffy, maybe a little. 

Doctor: OK, OK um, and have you had any like pressure behind your eyes in your head?
Patient: No no no. 

Doctor: OK, no headaches?
Patient: No no. 

Doctor: No dizziness or fainting spells? 

Patient: Like I feel tired but I haven't I don't know I haven't like fainted. 

Doctor: OK, so you're tired, do you feel weak at all like you can't move a certain limb?
Patient: Oh no, that that's all fine. 

Doctor: That's all fine, OK? 

Patient: I haven't like wiped out like I said. 

Doctor: OK, OK, um do you get this shortness of breath or difficulty breathing when you're laying down?
Patient: I mean, I've mostly been laying down lately, um, so yeah, like I kinda have it all the time. 

Doctor: All the time? OK, but it's not worse when you're laying down or standing up? 

Patient: Don't think it's worse, no. 

Doctor: OK, and have you noticed any swelling?
Patient: Um, I don't think so, no. 

Doctor: OK, any palpitations like you feel like your heart's racing? 

Patient: No. 

Doctor: No um, and then how about in terms of like your abdominal system? Any pain there?
Patient: Oh no, nothing. I mean it's like a little sore just 'cause I'm coughing all the time but yeah, but yeah, not not like, not anything like noticeable. 

Doctor: OK, and then how about your stools? Have they been normal?
Patient: Yeah yeah. 

Doctor: And then how about your urine, is that, has everything been normal from that standpoint? 

Patient: Yeah yeah. 

Doctor: OK OK um, and then, have you had any issues with breathing or coughing in the past?
Patient: No, I mean, I like I said I'm really active. I do a lot of like right, I've been like training for a triathlon, like I haven't had any problems before. 

Doctor: OK, OK um, any any past medical conditions that you know of? 

Patient: Uh, I got like I am a type 1 diabetic. 

Doctor: OK, OK, have you ever, OK, have you ever had a pulmonary function test in the past?
Patient: Well, maybe when I was like kid or like a teenager. 

Doctor: And any recent chest X-rays ECG's any other investigations you've done so far? 

Patient: No, like I have been, I've been really healthy. 

Doctor: OK, good and are you on any medications?
Patient: Um, like I take a, my insulin. 

Doctor: Yeah. 

Patient: And like I take I take a statin. Is that what it's called? 

Doctor: OK. Is that because you have high triglycerides or like cholesterol?
Patient: Uh, I, they just said 'cause I like had diabetes that I should probably start taking it. 

Doctor: OK yeah alright. 

Patient: There's no like a big problem. It was just, you know, my family doctor. I think my my dad has diabetes and he he he had heart problems so, like she also my family DOCTOR: knows my dad too so I don't know if that has something to do with it. 

Doctor: OK. OK, and then yeah, I guess I will talk about family history since you brought it up. Any lung issues in the family?
Patient: Uh, not that I know of like. 

Doctor: OK.
Patient: Just I mean the heart like my dad had a heart attack. I don't know if that counts as like it's close to the lungs. 

Doctor: How old was he? 

Patient: Um? It wasn't that long ago he was like in his 60s. 

Doctor: OK.
Patient: Yeah. 

Doctor: OK. Um, I'm gonna name a few things and you let me know if this is in your history, OK, in your
Patient: Maybe like my cousin, but yeah, not like my mom or dad. 

Doctor: OK, cystic fibrosis?
Patient: No. 

Doctor: OK alpha one antitrypsin deficiency? 

Patient: I don't think so, no. 

Doctor: Pulmonary fibrosis?
Patient: No no. 

Doctor: OK, OK. And are you up to date with all your immunizations? 

Patient: Like I I always I always got like the ones I was supposed to. Um, I normally like normally where I go into work, there's like a pharmacy outside and I would get my flu shot. But this year it's like I'm working from home, I haven't even been around there so I didn't get it this year. But I have all the normal ones. 

Doctor: OK, and then do you smoke Jessica?
Patient: No. 

Doctor: No? Do you smoke marijuana?
Patient: No no. 

Doctor: Any other recreational drugs? 

Patient: What like alcohol? 

Doctor: Um, no other than alcohol, like cocaine or meth, anything like that?
Patient: Ah, no. 

Doctor: OK no? OK, and yeah, do you drink alcohol?
Patient: Oh like if I'm like with friends, maybe on a weekend. 

Doctor: OK OK. 

Patient: Couple drinks or something. 

Doctor: OK, and have you been in contact with anyone who's been sick around you?
Patient: Like I said, I work I work from home so I've been seeing very many people. Um, I like I, geez. I my my sister, I saw my sister and like she, I guess she works she works in like a retirement home. 

Doctor: OK.
Patient: Like she, I don't think she was sick. 

Doctor: OK. OK, is it possible that she was in contact with someone who may have been sick?
Patient: I think it's I mean it's possible like that's what she does for her work, right? She works at like a retirement home, so yeah possible. 

Doctor: OK, and what what kind of work do you do Jessica?
Patient: I'm an accountant. 

Doctor: OK, and have you traveled anywhere recently? I know with COVID obviously that's hard. 

Patient: I wish I wish, but you know I haven't been anywhere. Like I said, I've just been at home. 

Doctor: OK. Um, in particular, have you been in a country where TB is endemic and have you been in any of those countries in the past, like 5 to 10 years?
Patient: I don't know like I've been to the like the states before COVID. I I don't, I didn't really haven't traveled anywhere cool in a long time. 

Doctor: OK, OK. Um, so just kind of going through what it could be that you have right now. I'm thinking a few things and we kind of like to go through and make sure we're not missing anything. So in terms of like vascular stuff it could be something like like CHF or pulmonary embolism and that stands for congestive heart failure, but you're very young. You seem like you're very healthy, so that's probably lower on our differential obviously. 

Patient: OK, yeah hopefully. 

Doctor: An infection would be the biggest one right now with the cough with it seems like you have chills and night sweats. Yeah, so would have to do more in terms of taking your temperature, and see if you can do like more
Patient: See I never come in besides like because I you know need my insulin. I never even go to the, I didn't even want to come in and just like it wasn't going away. 

Doctor: Yeah yeah. And then other things like COPD, pulmonary fibrosis, and like like cancer stuff is super low on the differential right now, so. Yeah, so um. So yeah, so for right now we'll start. We can start by doing some blood work. First I do a physical exam, of course. And then from there we would kind of do some blood work to see if your white blood cell count is high. And then we can do a chest X-ray to see if there is like a consolidation if there's pneumonia, or you know or, or anything viral? Um, do you have any questions?Anything that you wanted to add that I missed? 

Patient: I don't think I don't think so, um yeah, I just hope I can get feeling better. Hope it's not anything serious like I I think yeah, I just hope it's like I hope like you said it's like I got like an infection or something and it will just be gone soon. 

Doctor: Yeah yeah it does sound like it from the timeline like you started coughing two days ago, and then the difficulty breathing or shortness of breath also two days ago and then the chest pain just seems like it's from you coughing a lot.
Patient: Hi, I've had um I've had a cough for the past um three days and uh I also developed a fever, um I think, so I checked it yesterday night, it was um 38. And uh I just decided to uh come into the walk in clinic just to um just to get myself checked out. 

Doctor: Yeah certainly, it it sounds like you um have had a fever as well, so uh with the cough, you said that started three days ago, has it been getting uh any better or any worse? 

Patient: It's gotten a little bit better, I'd say. 

Doctor: OK, that's good. Um and and prior to three days ago, um did you have a cough before or was it a new new cough?
Patient: It's a new cough. 

Doctor: Alright, and uh are you bringing up any sputum? 

Patient: No. 

Doctor: Um are you bringing up any blood?
Patient: No. 

Doctor: And have you had any shortness of breath? 

Patient: Uhm no, I haven't. 

Doctor: OK, um how about any wheezing?
Patient: Yeah, I guess a little bit. 

Doctor: A bit, OK. Um is it uh, are you having any chest pain? 

Patient: Uhm, no. 

Doctor: OK, um and so you mentioned um, with a fever have have you had any chills?
Patient: Yeah I did. Um I had the chills yesterday. 

Doctor: OK. And have you had any night sweats? 

Patient: Uhm, no. 

Doctor: Alright, and um have you had any eye redness, runny nose, or even a sore throat?
Patient: No, I haven't. 

Doctor: Alright, have you had any uh nausea or vomiting?
Patient: Uh no. 

Doctor: Uh a loss of taste or loss of smell? 

Patient: No. 

Doctor: OK and any um abdominal pains?
Patient: Uhm, no. 

Doctor: Any uh diarrhea?
Patient: No. 

Doctor: You got any urinary problems?
Patient: No. 

Doctor: OK, and have you had any skin changes or uh rashes?
Patient: No. 

Doctor: And how has your energy been? Have you had fatigue?
Patient: Um a little bit. 

Doctor: Alright, and have you had any muscle aches or or body pains? 

Patient: Uhm, not much. No, but yeah, it's just I've been feeling, yeah, I guess a little bit. I have been feeling achy, uhm but I just thought it was my fibromyalgia acting acting up, but yeah, it's it's been worse over the past three days. 

Doctor: OK. Uh so you've had um this cough, a dry cough, a fever, chills, and uh been more tired and and been a little bit more achy these past uh three days. Have you had any other symptoms?
Patient: I don't think so. 

Doctor: OK, and have you tried anything to make it better? 

Patient: Uh I just took a day or two off of work and I just rested and um had a lot of uh hot water. It helped me, uh It helped with the cough. 

Doctor: OK great, and um have you had any uh like symptoms like this before?
Patient: Yeah, um, yeah I mean, when I I guess I get sick I do get similar symptoms like when I get the cold or the flu, but I usually have like a runny nose um or like a stuffy nose, but that's kind of different this time, a little bit. 

Doctor: OK, and in the past have you been uh diagnosed with any medical conditions?
Patient: I have fibromyalgia and uh I um also have schizophrenia. 

Doctor: OK, and are you taking medications currently?
Patient: Uh yeah. Uhm, I take um quetiapine and uh I just I take Advil um when my uh joint pains are really bad. 

Doctor: OK, and do you have a um somebody that follows you along for either uh fibromyalgia or or schizophrenia? 

Patient: Um my family doc. And then um yeah, it's pretty much just him. Um he, yeah. 

Doctor: OK. And uh do you have any allergies to medications?
Patient: No. 

Doctor: Alright and um are you aware if your immunizations are up to date?
Patient: Um yeah. 

Doctor: Alright, and could you tell me, alright then sorry actually, uh have you had any hospitalizations or uh previous surgeries?
Patient: Uhm well, I uh I've been hospitalized. I I was kept in the psych unit for a couple of days, um two years ago. But nothing other than that. 

Doctor: OK. Um and it's been stable since then? 

Patient: Yeah. 

Doctor: OK, great. And I um I just wanted to ask a little bit about um your personal history. I was just wondering if you could talk a little bit about uh where you're living and and who you're living with.
Patient: Uh sure, so I'm living with my um I'm living with my husband and uh we live in an apartment. 

Doctor: OK, and has he been sick or has anybody you've been around been sick? 

Patient: Uhm, he was sick last week but he got better on his own. 

Doctor: OK, and were were his symptoms similar to yours or or uh or were they different?
Patient: Um they were kind of different, I would say. He just had a um he had a sore throat and uh that kind of lasted for three or four days, and then he just got better. 

Doctor: OK, and um are you currently working or um?
Patient: Um I uh no, I'm a I'm a stay at home, I just stay at home, I don't work. 

Doctor: OK, and so and have you traveled anywhere or any other uh potential exposures? 

Patient: Uh no. 

Doctor: OK, um and do you smoke cigarettes?
Patient: I do. 

Doctor: OK yeah, how much?
Patient: Uh two or three a day. 

Doctor: And and for how long or for, when did you start smoking? Sorry. 

Patient: Uh so I've been uh smoking since I was uh 20 years old, so about 30 years ago was when I started. 

Doctor: OK and and have you could, have you thought of, have you tried to quit before?
Patient: Uhm I did, but then I just didn't. Uh I just went back to it. Um but I'm trying to cut down. 

Doctor: OK, uh it's good that you've been able to cut down, so congratulations on that. Um and do you drink alcohol? 

Patient: Uhm I I do. Uh, I'll drink um sometimes with my friends maybe uh once a month or once in two three months. Um but I haven't been going out with them since the pandemic started, so I haven't had much to drink. I haven't had anything to drink um since the past year. 

Doctor: OK. Um I see. And uh have you had any um history of heart or lung conditions in the family?
Patient: Hi, yesterday I was grocery shopping and, yeah, just in the parking lot somebody bumped into my car and this morning I woke up and my neck is just really painful. It hurt yesterday a little bit, but I mean it was so mild I didn't think much of it. But today it's it's quite a bit worse. 

Doctor: OK, so can you tell me how this accident happened? Were you sitting in the passenger seat and the driver? And was the impact from like behind at the back of your car or at the front?
Patient: It was at the back so I was the driver and was just going over a speed bump in the parking lot so slowed down quite a bit and the person behind me must not have, and they bumped into me. There's just some scratches on the bumper. They didn't hit too hard, but I, I guess maybe hard enough. 

Doctor: OK, and did the neck pain start immediately after? 

Patient: Uh no it's I, like not immediately, yeah, I think it started a bit later on and then worse a bit, a bit today. 

Doctor: OK. Alright, and is there pain anywhere else on your body?
Patient: Uh really like my. No, just just really, my neck. 

Doctor: OK. OK, and does anything feel broken? Do, are there bruises anywhere? Any obvious signs of trauma? 

Patient: No, I can’t, I didn't notice anything like that and I can move my neck around so I don't think any I don’t, I don't think anything is broken. Just hurts a lot. 

Doctor: Alright, and is a pain constantly there or does it come and go?
Patient: It kind of comes and goes, it just it's worse with movement. If I just kinda sit still, I don't notice much pain, but if I'm betting my head forward or. Mostly backwards, so I'll get, I'll get pain. 

Doctor: OK, and you said this happened yesterday, right?
Patient: Yeah yeah, this happened yesterday afternoon. 

Doctor: OK. Um and does anything make this better? Like have you tried ice, say any topicals any positions that that helps with the pain? 

Patient: I did try some like Advil last night, but like when I when the pain was coming on and it must've helped me sleep I guess, but I haven't tried any ice or anything like that, just mostly I guess resting. 

Doctor: OK so you said the pain is at the back of the neck does it radiate anywhere up into your head or down into your shoulders or lower or upper back?
Patient: Uhm. Maybe a little bit to the upper back, like when I like trap, trapezius, muscle area, or the traps like it if I push on those muscles around that area, I do get a little bit of tenderness. 

Doctor: OK, OK, and if you were to describe the quality of this pain, would you say it's sharp, dull, achy, throbbing? Uhm, how would you describe it? 

Patient: I would say it's sharp. Yeah, especially if I do any movements like it'll be feels like I mean, it stabbed in the neck. 

Doctor: OK, alright, and have you ever had it had pain like this in the past?
Patient: No, this is the first time. 

Doctor: OK. And do you feel like it's getting worse, the pain since it started yesterday? 

Patient: Yeah, it could be that at first I didn't even have any pain at all. Maybe it was just the adrenaline pumping or whatever, but now I can notice the pain. 

Doctor: OK. OK, and 1 to 10, 10 being the worst pain you've ever felt how bad is this pain?
Patient: It would be. I would say probably a 6 or a 7. 

Doctor: OK, OK and. Have you had any tingling or numbness?
Patient: No, I haven't had anything like that. 

Doctor: OK, any dizziness or fainting spells? 

Patient: No. 

Doctor: Confusion or memory loss?
Patient: No. 

Doctor: Any headaches? 

Patient: Um I. No. 

Doctor: No OK. And. Is this affecting your sleep at all?
Patient: Oh no, I guess like last night it was a little bit more difficult because I was just I slept I just on my back so that I wasn't moving around as much, so that was a little bit awkward, but I was able to sleep though. 

Doctor: OK, I know you said you have some pain with certain movements, but do you find it's hard to move your neck at all? 

Patient: Oh, it feels a bit stiff, but like I'm able to move it. But yeah, I feel stiff. 

Doctor: OK. Any issues with vision like is it blurry?
Patient: No. 

Doctor: No, how about ringing in your ears? 

Patient: No. 

Doctor: No, any sorry yes that, any issues concentrating on on tasks?
Patient: Um. Yeah, this morning I I guess it's been a little bit more difficult to focus on things, but maybe I was just worried like focusing on the pain in my neck. 

Doctor: Yeah, for sure. Any fevers or chills? 

Patient: No. 

Doctor: Any changes in your weight?
Patient: No, my weight it's been been the same. 

Doctor: Any changes to your hearing? 

Patient: No, that's been been normal. 

Doctor: Smell or taste?
Patient: That's been normal. 

Doctor: Um chest pain or heart palpitations?
Patient: No, nothing like that. 

Doctor: OK. No cough, shortness or breath, shortness of breath or wheezing?
Patient: No, none of that. 

Doctor: How about Issues with their bowel movements? 

Patient: No, I haven't had any diarrhea or any any any constipation nothing like that. 

Doctor: OK, any nausea vomiting?
Patient: No nausea or vomiting. 

Doctor: Changes in your appetite?
Patient: Uh, no that my appetite's been good. 

Doctor: OK how about changes in urine? 

Patient: No, I haven't had any any changes to or any urinary symptoms at all. 

Doctor: OK, OK, that's good. And are you otherwise healthy? Do you have any longstanding medical conditions?
Patient: Uhm. No, I am otherwise healthy, I just I'd take birth control, and I am a multi vitamin but that's it. So no medical conditions. 

Doctor: OK, alright that's good um. And have you had any hospitalizations or surgeries in the past? 

Patient: Uhm, no, I haven’t. 

Doctor: No OK. How about medications? Are you on any?
Patient: Just the the the birth control that I'm I'm taking. I've been taking that for about five years now. 

Doctor: Five years OK, any side effects or any issues with that?
Patient: No, it's been good day I, I've been really happy with it overall too. They help regulate my cycles. 

Doctor: OK, OK, good. And then are you up to date with your immunizations? 

Patient: I am yes, I'll get the flu shot every year. 

Doctor: OK, that's good. Do you have any allergies?
Patient: I do, yeah, but it's I think they're just all environmental, 'cause I'll typically get issues with seasonal changes and then then it goes away. 

Doctor: Oh I see. OK, any family history of lung or heart conditions?
Patient: I think my dad has high blood pressure, and diabetes. Yeah, but no heart or or lung conditions. 

Doctor: OK, how about a musculoskeletal issues? 

Patient: I think maybe osteoarthritis and my grandpa, grandparents, but. 

Doctor: OK.
Patient: But yeah. 

Doctor: How about an autoimmune conditions? 

Patient: No, nothing like that. 

Doctor: No? OK how about cancers.?
Patient: Uh, no cancers. 

Doctor: OK. And then, do you smoke?
Patient: No, I don't. No I've never smoked before. 

Doctor: OK, how about marijuana? Do you consume that in any form? 

Patient: No, I don't. 

Doctor: OK. And then do you drink alcohol?
Patient: Every once in a while I'll have a glass of wine, but it's usually a social thing or or at Christmas. 

Doctor: OK. Come have out in terms of sick Contacts. Have you had any recently? 

Patient: I don't believe so. Um I've been going to work, I work as a bank teller, um but everybody at work hasn't been sick and we've been using masks and cleaning our hands and all of that sort of thing. 

Doctor: OK, OK, that's good. And how about travel? Have you had any recently?
Patient: No, I've been put at home, but looking forward to a vacation though. 

Doctor: Yeah for sure. And then, where do you work and who do you live with and where do you live? 

Patient: Yes, I I work at a bank. And I live with my husband and our time and our son, he’s, he's six. 

Doctor: OK, OK. OK, um those are all the questions I have for history. We can move on to the physical exam part of this interview. Did you have any questions before we did that?
Patient: Uh, no, no, that sounds good. 

Doctor: OK so if you have someone there with you, or if you have a mirror, or if there's any way you can take a look at the back of your neck as well as the front of your neck um. Do you see any redness or swelling in that area?
Patient: No, I don’t. 

Doctor: No, OK. Do you see any muscle atrophy? Any deformities or skin changes?
Patient: No, nothing like that. 

Doctor: OK. And then when you kind of just with the back of your hand, place it on your neck in the front as well as the back, does it feel warm at all? 

Patient: No. 

Doctor: No OK. And then I'm gonna get you to palpate certain areas so we'll start with the chin. Does that hurt when you press down?
Patient: No. 

Doctor: No OK, how about just where the thyroid would be?
Patient: No pain or yeah, no pain there. 

Doctor: No pain there OK. How about to the sides, kind of where your. Sternocleidomastoid muscles are?
Patient: Yeah, I think like a little bit of tenderness in the the front of the neck muscles there. 

Doctor: OK and then how about when you move towards the back and then on your C spine, cervical spine just like at the very back of your neck?
Patient: Yeah, so there's there's no pain when I push on the like bones I can feel like so, actually on that that like C spine itself there's no pain, but like oh off to the side so on the muscles. To the sides or there's a bit of tenderness. 

Doctor: OK, so kind of like where, so there's pain on their trapezius and deltoid muscles? 

Patient: Uhm. Uh. Yeah, more trapezius not so not so much deltoid and then also, um, like the the perispinal muscles. 

Doctor: OK, I see, alright. Uhm. OK, and then let's move on to some range of motion exam so I'm gonna get you to flex your neck. So look down at the ground all the way as much as you can. Does that hurt?
Patient: It does, yeah. 

Doctor: It does but you're able to fully flex your neck. 

Patient: Yeah, I can touch my chin to my chest all almost uh but yeah, I'll get pain at the back of my neck when I do that and the front. 

Doctor: And the front? OK. And then how about when you extend your head all the way back so that you're looking at the ceiling?
Patient: I’m able to do it still is a bit stiff and it's slow to get there, but again I I get pain at the back in the front of my neck when I'm doing this. 

Doctor: OK, OK, how about when you flex your neck to the side so that your right ear is touching your right shoulder?
Patient: Um yeah, I get there's a little bit of a pain in the muscles on the left side when I'm doing that 

Doctor: OK, and then how about when you do the opposite? Touch your left ear to your left shoulder so that you're laterally flexing your neck on the left side? 

Patient: A little bit of pain there too, but I'm able to do it though. 

Doctor: OK. So you're able to do all of these, it's just that you have some pain when you do that?
Patient: Yeah, exactly, I could do all of the movements, but yeah, it's pain and stiffness. 

Doctor: OK, OK. Those are all the questions that I had for you. Did you have any questions of your own?