jshargo/medical-interview-conversations huggingface dataset:
Patient: Uh, not other than just a hay fever, but nothing nothing else. I have like a lot of allergies. 

Doctor: Any allergies to medications? 

Patient: Oh, just sometimes when I take like a nasal spray I think I might have an allergy to the steroids that they give me and sometimes also some of the antihistamines I think I get some allergies from them. 

Doctor: OK. Uh, and any hospitalizations?
Patient: No, never. 

Doctor: Any surgeries?
Patient: Nope. 

Doctor: OK. Anybody in the family who have any illnesses? 

Patient: Just my father. He has type 2 diabetes but nothing else. 

Doctor: OK, and how do you support yourself currently financially?
Patient: Oh so I work just as like a mechanic just in the city and currently I just have myself to support. I live alone in an apartment, so I'm doing fairly well. 

Doctor: OK, and do you smoke?
Patient: I smoke around like I'd say 2 and a half to 3 packs per day. I know it's. Yeah, I have tried quitting before, but I would say I've been smoking since I was 18. 

Doctor: OK, and do you smoke marijuana?
Patient: No, no, no marijuana, no other drugs. 

Doctor: OK, and do you drink alcohol?
Patient: I'm I'm here because I, I've oddly been feeling really short of breath and have a fever or and a cough. 

Doctor: OK, when did the shortness of breath start and are you short of breath now?
Patient: It started about uh, I guess I could start yesterday. And a little bit, but it's getting better. 

Doctor: Started yesterday, OK, well I'm glad, it's getting better. When did the cough start?
Patient: It started around the same time. 

Doctor: OK, it is it. A dry cough or or wet cough?
Patient: It's a dry cough. 

Doctor: OK, is it? Is this cough new or if you had a cough before? 

Patient: No, it's it's kind of new. 

Doctor: Alright, have you brought up any, I know you said its been but have you brought up any blood?
Patient: No. 

Doctor: OK, and have you had any wheezing? 

Patient: No. 

Doctor: OK. And you mentioned a fever as well. Have you checked your your temperature today or yesterday?
Patient: Yeah, it was at 38 last night. 

Doctor: Are you feeling feverish today as well?
Patient: Yeah, a little bit. 

Doctor: OK, and uh. So have you had any any infectious symptoms, like runny or red eyes? 

Patient: No. 

Doctor: How about a runny nose or feeling congested?
Patient: No, no, it's just a cough. 

Doctor: Cough? OK. And what what, were you around any triggers yesterday or like around any anything that was out of the normal for you? 

Patient: I got a notice that this happens to me every time I go to my boyfriend's place, so I started dating, I started dating someone new about six months ago and every time I go to his place, a couple hours later I just like develop these symptoms, just kind of odd. I thought that I was just getting a cold. But now that it's happened like three times, I'm thinking maybe you have some sort of an allergy like maybe,  I don't know. Maybe it's like yeah, I'm just allergic to something. Maybe his plants or something. I don't know. 

Doctor: OK, and it does this happen each time that you go go to his house?
Patient: Um, yeah, yeah. Kind of almost yeah, that's like you haven't like. I haven't been to his place very often because of the pandemic. But yeah, every time I go kinda feel really crappy after. 

Doctor: I see OK and, uh, are there any other environments you can think of where this happens or have these symptoms happen at any other point?
Patient: No, I don't think so. 

Doctor: OK. And have you had a sore throat?
Patient: No. 

Doctor: How about any losses of smell or or taste?
Patient: No. 

Doctor: OK, and have you had any chest pain? 

Patient: No, no. I haven't. 

Doctor: K, and have you had any nausea or vomiting
Patient: No. 

Doctor: Alright, and any abdominal pain or diarrhea? 

Patient: No. 

Doctor: Any urinary problems like painful urination or frequency?
Patient: No. 

Doctor: Have you had any muscle aches or body pains?
Patient: Yeah, yeah. Just act different feeling achy and kinda tired these past well like 12 to 14 hours. 

Doctor: I see OK, so it has been kind of like all over or there are particular muscles sore or our body part?
Patient: No, it's it's like all over. 

Doctor: OK, and you've been fatigued as well? 

Patient: Oh yeah. 

Doctor: OK. Have you had any headaches?
Patient: No. 

Doctor: Any skin changes or rashes?
Patient: Uh, no. 

Doctor: Alright. And then how about any night sweats or chills? I know you mentioned fevers. 

Patient: No, I've just been feeling hot. 

Doctor: OK, I mean, how was your weight been over the last several months? Is it like have you lost weight or gaining weight or is up in the same?
Patient: Kind of in the same. 

Doctor: OK. And uh, in the past, have you been diagnosed with any medical conditions?
Patient: No, I'm pretty healthy. 

Doctor: OK, you see. Yeah, you haven't had asthma in the past or or anything like that?
Patient: No. 

Doctor: OK, any allergies to medications you're aware of or or environmental things like or dust or pollen?
Patient: No no. Which is why I was kind of surprised. I'm usually fine and I spend a lot of time outdoors so, I don't know. Yeah, I was surprised when this happened when I went to his place. 

Doctor: OK, did you ever get these kind of symptoms if you are like yeah or around smoke or or anything like that, you could maybe be inhaling or or even if you are outside in the cold?
Patient: No. 

Doctor: OK, and you get seasonal symptoms like throughout the year you get like itchy runny eyes or like. Like a runny nose? 

Patient: No, no. That hasn't happened to me. 

Doctor: OK, and do you take any medications?
Patient: I just take a birth control pill. 

Doctor: And when, how long have you been on that for? 

Patient: About three years. 

Doctor: OK. And any prior surgeries or hospitalizations?
Patient: Oh no. 

Doctor: Alright, and can you tell me a little bit about where you're living currently and two you're living with?
Patient: I live alone, uh? I have an apartment next to the University. 

Doctor: OK, and any potential for being around anybody who's been sick like your boyfriend or his family or or anywhere else? 

Patient: No, I've just been visiting him and I just go grocery shopping. I've just I've been doing schooling online. Yeah, I don't think so. I'm usually very careful, I'm not. Yeah, I'm not maintaining social distancing with my boyfriend. He's in my social circle, but yeah, other than that no one I think yeah. 

Doctor: Ok. And have you traveled anywhere?
Patient: No. 

Doctor: Alright then are you currently working or going to school? 

Patient: I'm going to school. 

Doctor: OK, cool and uh. And are you currently sexually active?
Patient: Yep. 

Doctor: OK, and are you using birth control. Are you using condoms? 

Patient: Yep. OK, any concern for any sexually transmitted infection at this time?  No. No, I'm very careful. 

Doctor: OK? And do you smoke cigarettes?
Patient: Sometimes if, like during like parties and stuff, but I haven't really been drinking much 'cause there's nothing going on. 

Doctor: OK yeah I see. And uh do use any recreational drugs? 

Patient: No. 

Doctor: Alright, then umm in the family is there a history of any lung problems or any any heart problems?
Patient: Um just high blood pressure. My mom and dad have it. 

Doctor: OK. And so I wanted to ask about the boyfriend's house as well. Is there any pets in the home there?
Patient: Oh yeah. Yeah, he has this cute little parrot. And he also has a cat. 

Doctor: OK, and do you have any pets at your house? 

Patient: No, no I don't. 

Doctor: Oh, OK. So that I think that was everything that I wanted to ask on on history today, was there anything else I forgot to mention or you wanted to to bring up?
Patient: I don't think so, no. 

Doctor: OK, so it sounds like there's potentially could be caused by an allergen such as which could be   from an animal like a parrot or a cat that is causing just a reaction and it's bringing these symptoms on like called hypersensitivity pneumonitis, but also we can't rule out asthma as well as being a trigger of kind of the cough and shortness of breath is being around allergens as well, so we'll order pulmonary function test, and maybe some, uh, uh, imaging and chest x-ray and we will go from there.
Patient: I've had this pain in my back thats kind of like in my lower back and my buttocks and it's now radiating down to my right leg. I've had this for awhile now, but it's getting worse and I just want to come get it checked out. 

Doctor: OK, and how long have you had this pain for? 

Patient: About a month. 

Doctor: OK, and has gone worse at all like did you have the it radiating through your leg before or is that something that happened after?
Patient: That's something that happened after that happens that that's been going on for the past week. 

Doctor: OK, and is this pain constant or does it come and go? 

Patient: And it's pretty much always there, but certain things can make it worse. Like if I'm walking or doing certain activities it can it can make it worse. 

Doctor: OK. And did you have any back pain before this month?
Patient: No, not, I mean no, not really. 

Doctor: OK. An what kind of pain would you say it is. Is it like a sharp stabbing pain or is it more so a dull aching pain?
Patient: Um usually or well before it was like a mild achy pain, but now it can be. It's sharp and it feels like a burning sensation. 

Doctor: OK, a burning sensation, where would you say that burning sensation is? 

Patient: It's like down my buttocks to the right leg. 

Doctor: OK, and do you feel any kind of numbness or tingling with it?
Patient: Um a little, a little bit of tingling. Yeah, a little bit of tingling. 

Doctor: OK, and how would you rate the pain from a scale of zero to 10, 10 being the worst pain you've had in your life?
Patient: So usually it's about like a 5 to 6 out of 10, but when it gets bad and um sharp, I'd give it an 8 out of 10. 

Doctor: OK, and are there any kind of motions or positions that cause you more pain?
Patient: Yeah, so I'd say like just any sort of physical activity, like if I'm on my feet a lot, it hurts. 

Doctor: Mmm.
Patient: Yeah, that's pretty much the only thing that I can think of right now. 

Doctor: OK, did anything happen one month ago or before this pain started. Like any injuries or falls that might have caused this pain?
Patient: Um no like a long time ago, like 6-7 years ago I injured my back at work but. I just did some conservative treatments for that and it went away. 

Doctor: OK was it your lower back. 

Patient: Yes. 

Doctor: OK. And what do you do for work?
Patient: I used to work on an assembly line, so I used to. Like carry heavy objects and things like that. Like car parts. 

Doctor: OK, and do you still work there?
Patient: No, I don't. 

Doctor: OK when did you stop working there?
Patient: About three years back. 

Doctor: OK and is there any other work you do currently?
Patient: Um I work from home now. I do daycare at home. 

Doctor: OK. OK, and just getting back to the pain so it's kind of in your lower back, your buttocks and then it goes to your right upper leg?
Patient: Mmmm 

Doctor: Does it move anywhere else besides that or those are the regions that it stays in?
Patient: No, those are kind of the only regions that I'm experiencing it right now. 

Doctor: OK. And do you get more pain leaning bending forward or would you say extending your back?
Patient: I would say ext.. Extending my back hurts more. 

Doctor: OK and you get pain with sitting down?
Patient: Um sometimes. 

Doctor: OK, how about lying down? 

Patient: Um lying down I guess it depends on the position. If I am straight on my back it's it's not too bad, but if I like I'm hunched over or something like that, it hurts. 

Doctor: OK, I see OK and have you tried any medications over the counter and painkillers that have helped?
Patient: I tried some ibuprofen and some like topical.. um like ointments but it helps temporarily and then the pain comes back. 

Doctor: OK, let's see and. Other than that, so other than this pain that's been going on do you have any fevers or chills? 

Patient: Uhm No, no fevers or chills. 

Doctor: OK, no night sweats?
Patient: No. 

Doctor: Any increased fatigue? 

Patient: No, no. 

Doctor: Any rashes or skin changes?
Patient: No 

Doctor: Any uh. Any cough or cold symptoms recently?
Patient: Um no nothing like that. 

Doctor: OK and apart from your back, any kind of joint or muscle pain anywhere else in your body? 

Patient: No. 

Doctor: Any changes in your bowel movements?
Patient: Nope. 

Doctor: Any stool incontinence for your urinary incontinence?
Patient: No. 

Doctor: OK, and any kind of numbness or paresthesia like around just your lower back and buttocks? 

Patient: No, no numbness just like that, tingling, burning feeling. 

Doctor: OK, OK any recent weight changes like any significant weight loss?
Patient: No. 

Doctor: OK. Any muscle weakness at all in that area?
Patient: I'm finding it hard to walk. 

Doctor: Harder to walk? OK. Are you limping at all? 

Patient: Yeah, I'm putting more weight on my left leg. 

Doctor: OK. And do you feel, so you mention you feel tingling going down your right leg? Do you feel any kind of numbness at all?
Patient: No. 

Doctor: No, OK alright do you have any kind of urinary or fecal retention like at all?
Patient: No, I'm going. I'm using the washroom OK. 

Doctor: OK, uh. Do you have any history of any cancers at all?
Patient: No. 

Doctor: No OK. Are you on any. So do you have any past medical conditions you've been diagnosed with?
Patient: No. 

Doctor: No. Do you take any medications regularly?
Patient: No, I don't. I just take calcium and vitamin D and other but multi vitamins. 

Doctor: OK, any allergies to any medications?
Patient: No. 

Doctor: Have you had any previous surgeries or have you been hospitalized for any reason? 

Patient: No. 

Doctor: No, OK, any family history of any autoimmune conditions, any heart or lung conditions?
Patient: Um no not that I know of. 

Doctor: OK, an and, currently you said you work from home. How would you describe your living situation like? 

Patient: I would say I it's it's OK. I live in an apartment with my husband. 

Doctor: OK. And currently do you smoke?
Patient: No. 

Doctor: OK, and do you drink alcohol? 

Patient: I'll have a glass of wine like once a week. 

Doctor: OK, and do you use any recreational drugs?
Patient: Um so I've I've been using cannabis oil for the past month just to see if it helps with the pain. 

Doctor: OK, and has that been working for you at all?
Patient: A little bit I think. 

Doctor: OK. OK, so those are some of the questions I had. And I'm just gonna ask a few questions about just examining the areas that are giving you trouble. So along your back, if you if you were to press down on from the middle to your lower back, any kind of pain when you press down. 

Patient: Um lower back, yes. 

Doctor: OK, So what kind of pain is it like sharp or is it kind of a dull aching pain?
Patient: When I press down it feels sharp. 

Doctor: OK, and do you have you notice any kind of swelling in your legs or, near the areas where you have pain swelling or redness, or  any warmth? 

Patient: Um it seems to. Actually, no, it's not. It's not warm. 

Doctor: OK. And in terms of just movement, are you able to bend down?
Patient: I can bend down, it's just hard for me to get back up. 

Doctor: OK See and how about like bend sideways. 

Patient: I can do that. 

Doctor: OK nd how about if you're laying flat are you able to raise your legs without bending your knees?
Patient: I can do that, yeah, actually no. I can't. Sorry that that hurts. 

Doctor: So your right leg hurts when you do that?
Patient: Yeah 

Doctor: OK, great. And other than that, like when you when you do any of those movements, can you, do you get like that tingling again?
Patient: Yeah it does. Yeah. 

Doctor: OK alright and when you stand up and walk how would you describe, are you having any kind of limping at all?
Patient: Um a little bit of limp yeah,  I'm putting more weight on the left leg. 

Doctor: OK, alright, so yeah, those are just some of the questions I I had for you today. Do you have any questions at all?
Patient: Um no, what can I do about this back pain and how long do you think I'll have it for? 

Doctor: Yeah, so it's been happening for one month right and you're getting some symptoms in in your lower leg, so normally we would wait before we do any kind of diagnostic imaging. But since you're also having these other symptoms we we were worrying about sometimes lower back pain can lead to something called sciatica. It's just when one of the nerves get pinched, and then that's why you're getting the tingling around your right upper leg. So what we can do is. We can do if you haven't had an X Ray, we can do an X Ray of your lower back. And then we can also do an MRI.
Patient: OK 

Doctor: And. Based on what results come back at the same time we will, I will give you some information about some anti- inflammatory medications you could take to help relieve some of your pain, but other than that I will also refer you to some physiotherapy. That will help you do some exercises at home. Just ways to protect your back as well as strengthen some of your muscles to help deal with some of that pain. Yeah, so we'll get the results back. And then we'll go from there.
Patient: OK, sounds good. Thank you. 

Doctor: You're welcome. Take care.
Patient: Yeah, so I've had this cough that started within the last day and uhm, I've also been particularly short of breath as well. 

Doctor: OK. Can you tell me about the, the cough, how, is it dry cough or wet cough? 

Patient: It's wet, I've been bringing up, uh, sputum that's uh, It's just, it leaves a really bad taste in my mouth when bringing it up. 

Doctor: What color is the sputum?
Patient: It's kind of, uh, like, yellowish green, type color. 

Doctor: Havey you noticed any blood? 

Patient: No, I haven't seen any blood. 

Doctor: And it only started yesterday. What about the difficulties breathing, when did that start?
Patient: Yeah, that started really within the last twelve hours or so. 

Doctor: And can you tell me if it's gotten better or worse since then? 

Patient: Yeah, it's been, it's been getting worse, uhm, and the phlegm, also smells really bad. 

Doctor: OK. When do you have difficult, like, is there anything that makes the, shortness of breath, worse?
Patient: Yeah, if I, uhm, when I was having a cigarette earlier today, it got a bit worse and when I went out to get the Mail today I, I just couldn't do it. I, I had to just sit down. 

Doctor: And that what happened to you before, right? 

Patient: No, I usually uhm, am able to go out and get the mail, no problem, yeah. 

Doctor: OK. Uh, and say two days ago, were you feeling perfectly fine?
Patient: I was yeah, I wasn't sick at all. 

Doctor: OK, so you've had this bad cough and you've had some difficulties breathing since yesterday. Have you had a headache at all? 

Patient: No, no headache. 

Doctor: Any, uh, runny nose?
Patient: No, it's really, no. 

Doctor: Any congestion?
Patient: No. 

Doctor: No, OK. Have you had any pain in your chest? 

Patient: Uh, no pain. 

Doctor: When you're breathing in or breathing out any pain at that time? or deep breathing?
Patient: No, I haven't had any pain. 

Doctor: OK, have you had any palpitations or you feel like your heart's racing?
Patient: Uh, yeah, I do. I feel like my heart has been beating a little bit faster. 

Doctor: OK. And any pain in your belly?
Patient: No. 

Doctor: Nausea or vomiting? 

Patient: Uh no, but, well I guess I have felt a little nauseous with the, uhm, bad taste in my mouth. 

Doctor: OK, and any uh diarrhea or Constipation?
Patient: Uhm no, I haven't anything like that. 

Doctor: OK, any sore throat? 

Patient: Uhm, no. 

Doctor: OK alright uhm, any other symptoms that I haven't talked about, that you experienced over the past day?
Patient: No, it's really been, uhm, yeah, this cough and bringing up this, this sputum and being short of breath. 

Doctor: OK, uhm, can you tell me about your past uh, medical history, do you have any medical conditions?
Patient: Uh yeah, I have uhm, high blood pressure. 

Doctor: Mhm. 

Patient: I also have acid reflux, so uh, gerd I think, think it's called? 

Doctor: Yeah.
Patient: And, uhm, high cholesterol as well. 

Doctor: OK, ok.
Patient: And I've also been, had issues with anxiety in the past as well. 

Doctor: In terms of medications, are you taking any? 

Patient: Yeah, I take uhm, an ACE inhibitor, statin, uhm, and uh, medication for my stomach, I think, like Pantoprazole. 

Doctor: OK, and uh, how well has your gerd been controlled?
Patient: Uh, it kind of, it bugs me most days, its not so bad, I mean, sometimes I'll get a little bit of heartburn and acid in the, in my mouth, but it depends on what I eat so I really try to stay away from some, some foods. 

Doctor: So the PPI hasn't completely curbed the, the acid reflux, you still get it?
Patient: Yeah, I still get it. It's definitely helped though it was a lot worse before, uh starting it. I've been on been on it now for a few years. 

Doctor: OK, and as for your anxiety, do you ever get panic attacks?
Patient: No, I haven't had any, any panic attacks. 

Doctor: OK, alright. Do you have any allergies? 

Patient: No. 

Doctor: OK, so you said that these symptoms started yesterday and they were quite sudden, uh, was there anything that you were doing yesterday or the day before that was different or unusual?
Patient: Well, yeah, I mean yesterday I, or, yeah, I had a bit more to drink than, uh, usual, more alcohol I mean. So, I mean, could that have something to do with it? I'm not sure. 

Doctor: It could potentially. Did you, were you, were you drunk and did you pass out?
Patient: Yeah, I think so. My, my friends, uh yeah, that's what my friends were, were saying anyway. 

Doctor: OK, and uh, talking about alcohol, how much do you usually drink? 

Patient: I usually, like, like four to six beers a day, but uh, yeah, yesterday was certainly more than that. 

Doctor: Have you considered reducing the amount of alcohol you drink? Has it affected you in any way?
Patient: I mean I, I'm retired now so, uhm, I don't know, I, I feel like it's been fine maybe, uh, I feel like it's been fine. 

Doctor: OK, OK, I suppose we could talk a little bit more about that later if you want uhm, as four to six beers is quite a lot actually, and it can affect your health in certain ways, but we can, we can chat more about that later.
Patient: OK. 

Doctor: And, uh, do you smoke?
Patient: Yeah, I smoke, uhm, a half a pack of cigarettes per day. It was well over a pack before, so I've cut down a little bit. 

Doctor: No, that's great. OK, do you plan on cutting it down further or do you wanna stay right there?
Patient: Yeah I have been, have been trying, just too, too darn expensive these days, so, been trying to cut back. 

Doctor: Yeah, yeah, that's fair, alright. What about marijuana? Do you consume marijuana? 

Patient: No, I don't. 

Doctor: Any recreational drugs?
Patient: Nope. 

Doctor: Alright, do you have any family history of any medical problems? 

Patient: Uh yeah, my, my father had, uh, he ended up having liver disease actually, he passed away from that I think. And he had heart problems too. He was a lifelong smoker and didn't really, didn't really take care of himself. 

Doctor: Hmm, I see. Do you, do you have a family doctor?
Patient: Uh, I do. I haven't seen my family DOCTOR: in a number of years now though. 

Doctor: Yeah, well, you know it's, it's a good idea to see your family  on a regular basis, specially when you're getting older, because sometimes you might need changes in your medications, or there might be checkups or screenings that they might want to do. It's for your own benefit, you know, maybe even just seeing them once a year would be a good idea. I would definitely recommend that you book an appointment with them just for a checkup in the next couple of weeks. Is there a reason why you don't see your family  too often? 

Patient: I just haven't been, uhm, sick and I've been able to, to refill my prescriptions, mostly from just calling in, so. 

Doctor: OK, ok, I see, uhm, alright, and do you live alone or do you live with other people?
Patient: Yeah, I live with my wife. 

Doctor: OK, alright, and are you able to take care of things like groceries or finances, or shoveling snow or cleaning the house, or do you need any assistance with those sort of household activities? 

Patient: Yeah, we moved, uhm, actually into an apartment last year. It's made it a lot easier in terms of the housework and that sort of thing. But I've been able to, uhm, I do the the grocery shopping and share the the chores around, around the house. I do, I'll use a cane sometimes. I, I injured my knee a number of years ago, but other than that, things are OK. 

Doctor: OK, OK, good to hear. That reminds me, have you had any surgeries in the past?
Patient: Just on my, my left knee. I had a left knee replacement a few years ago. 

Doctor: OK alright and have you any had, had any hospitalizations? 

Patient: No. 

Doctor: OK, alright, uhm, so sounds like you've had a day of this wet cough with the, this, a bad smelling sort of sputum that's, that's yellowish green in color, and you've also had difficulties breathing for the past twelve hours, uh, so much so that you can't even go out to get mail and your hearts been racing. It's possible that while you were drunk that you might have, and given that you have acid reflux, that you might have accidentally have something go inside your breathing tube from, from your mouth or something that came up from your stomach and sometimes when that happens, food items can or other things can get lodged in your lungs and can become, uhm, can attract bacteria to, uh, to replicate and cause a bacterial infection, so it's possible that, that's what happened But it could also be a viral pneumonia or a viral infection in your chest. we'll get a chest x-ray done, we'll have some labs done as well, and we'll likely start some antibiotics. Have you recently been on any antibiotics?
Patient: No, I haven't. 

Doctor: And you don't have any allergies to any, correct? 

Patient: Correct. 

Doctor: Alright, OK, we'll also do a physical exam just to give a listen to your, to your lungs and see how they're doing and then go from there. Do you have any questions for me?
Patient: I was just bringing my son and he's just had cough for the last couple of days. I thought about a day and a half ago, it doesn't feel like a cold. He hasn't been too sick, but I was a little bit worried and I wanted to get him seen to see if there's anything we could do. 

Doctor: Yeah, for sure. It's a good thing that you brought him in. So the cough, is it consistent? Or does it come and go? 

Patient: It seems to be a little bit worse at night. He'll have this cough during the day. Sometimes I'll notice when he's playing. He's had these coughing fits that last for up to a minute but usually recovers from. He hasn't been too active to be honest. He's been a little bit slowed down these last couple of days, but in regards to consistency, I'd say it's a little bit worse at night. 

Doctor: OK, any other triggers like dust or the cold air? Anything like that?
Patient: I haven't really noticed anything. We've been mainly keeping inside due to covid, right? I think my wife left a window open the other night, and maybe the cough was a little bit better. I'm not sure. It's kind of hard to tell when we sleep. 

Doctor: Yeah, have you tried anything for it, like have you given him any over the counter cough medications? 

Patient: No, we're a little scared to give him anything. He's so young. He's 2 1/2. We haven't been really giving him any medications to be honest. 

Doctor: OK, good. And if you were to describe the quality of this cough, would you say it's barky? Is it harsh?
Patient: Barky might be a good word to describe it, like he's had colds before his coughs were quiet but this sounds harsh. It sounds like he's really trying to cough hard there. Very violent sometimes. 

Doctor: OK OK. And has he ever had a cough like this in the past? 

Patient: No, never. 

Doctor: OK, and then in terms of the timeline, is it getting worse? His cough?
Patient: I think it has been to be honest. He was a little ill like he had a runny nose a couple of days ago, maybe two days ago and then the cough started but it only really started getting noticeably different about the night of the first day, about two days ago so. Now it's been more present I suppose,than it was when he just first had it. 

Doctor: OK, and is it a dry cough or does he bring up sputum?
Patient: Sputum like phlegm,no he doesn't bring anything up really, so dry. 

Doctor: OK so no blood as well right? 

Patient: No blood. 

Doctor: OK,  does he have any shortness of breath with his cough?
Patient: I feel like when he has the coughing fits, he's winded. He's weak after them. Sometimes he cries after them or before the middle can be a trigger for it, but just resting normally, he doesn't seem that out of breath, no. 

Doctor: OK any wheeziness? 

Patient: No, not really. He's able to breathe. I can't really hear him breathing that much. Sometimes at night after a bad cough he'll be really winded. And yeah, it does sound like a little different when he's breathing, but just right now he sounds normal. 

Doctor: OK, and any reason for you to think he has chest pain?
Patient: He hasn't any sort of chest pain. He says his throat hurts, but I don't think it's his chest. 

Doctor: Has he had any fevers?
Patient: No, no rashes. 

Doctor: How about weight loss?
Patient: No weight loss, he's a fairly healthy kid. 

Doctor: And his vision and hearing are normal? 

Patient: You know, I haven't gotten him formally assessed yet, but seems to be able to read pretty well from a distance. He's not in school yet, but I haven't noticed anything, and he can hear fine. I think he responds when I call. 

Doctor: OK, has he had a stuffy or runny nose?
Patient: Yeah yeah, that's kind of how it first started three days ago. Maybe had a runny nose. OK, yeah. 

Doctor: Does he still have a runny nose? 

Patient: Umm, a little bit less now. No, not as much now. 

Doctor: OK. And his taste, any reason to believe there are any changes there?
Patient: Well, we've been kind of spoiling him a bit, just giving him ice cream. His throat hurts a little bit and he seems to still like it, so it's hard to tell. 

Doctor: OK, so he has a little bit of a sore throat as well? 

Patient: Yeah. 

Doctor: OK OK, and then any dizziness or fainting spells that you've noticed?
Patient: No fainting or dizzy spells, but he's really gassed after he has like a coughing fit and he doesn't want to stand up, he'll just be sitting down or he wants to be held. 

Doctor: OK, is he more irritable than usual? 

Patient: Yeah after he has a bad coughing fit, he wants to be soothed and he'll be crying, but it's just more of because he's worn out, I believe he's tired. 

Doctor: Yeah, OK, and then any confusion or memory loss?
Patient: No. 

Doctor: OK, and then in terms of his bowel movements, have things been normal from that standpoint? 

Patient: Oh yeah, process of potty training him, but no, no real changes. 

Doctor: OK, so no diarrhea, no constipation, no blood in the stool?
Patient: No. 

Doctor: OK and he's passing gas? 

Patient: OK yeah I'd say so. 

Doctor: Any nausea or vomiting?
Patient: No. We haven't been really feeding him solid meals, it's because he's been sick, we've been trying to give him soup and liquids for the most part because his throat hurts, but he's able to keep them down. So no, no nausea, no vomiting. 

Doctor: OK, and then how about changes in his appetite? 

Patient: Yeah, he's not eating as much but still, we're trying to force food into him to keep his energy up. Most of time he always will be asking for snacks in the afternoon, but now not so much. 

Doctor: OK. Alright and any anything else that I missed that he's been experiencing over the past few days?
Patient: No, just the cough. 

Doctor: OK, and then he otherwise healthy? Does he have any longstanding medical conditions? 

Patient: No longstanding medical conditions. Yeah, nothing really. We had a little bit of stay in the NICU, just because he was a little bit underweight, but no, nothing really. 

Doctor: OK. And then his mother's pregnancy with him? Any complications at that point?
Patient: Yeah he's a little pre term. 34 weeks I think. 

Doctor: OK, was he also underweight too?  You mentioned just a little bit. 

Patient: Yeah. 

Doctor: OK, and any complications during the actual delivery?
Patient: Yeah, not that I remember like she started going to labor early, like earlier than we expected. We thought it was just a regular contraction and that it will just resolve but she wound up proceeding when we showed up at the hospital 

Doctor: OK and then in terms of growth, weight and head circumference, has he been hitting all those milestones for the past 2 1/2 years? 

Patient: Yeah, we we bring him to the family DOCTOR: every couple of month for his regular checkups and nothing has been brought up to be concerning for his vaccines. He has been doing well. 

Doctor: OK and then how about other milestones like speech, movement, fine movement, all of that, like have those been normal? Is he on par with his peers?
Patient: Yeah, this is our first kid, but compared to his cousins he seems to be doing well. He's speaking, he's got little sentences, now he has good eye contact. He's a good kid. 

Doctor: OK, good good. Any hospitalizations or surgeries aside from when he was born? 

Patient: No no. 

Doctor: OK good and is he on any medications?
Patient: No, OK we give him like a flintstone gummy. 

Doctor: OK, is he up to date with all his immunizations? 

Patient: Yeah. 

Doctor: Any allergies?
Patient: Not that we know of. 

Doctor: Any family history of lung conditions? 

Patient: So my grandfather, so his greatgrandfather I suppose passed away from lung cancer. He was a heavy smoker though. On my mom's side there's some breast cancer. No,  nothing really that comes to mind for lungs. 

Doctor: And any heart conditions?
Patient: No, not that we know of. 

Doctor: And how about other cancers?
Patient: No, not that I know of. 

Doctor: OK, how about asthma, eczema or allergies in the family? 

Patient: You know, I think my sister is allergic to peas, but she was never sick from them like go to the hospital.  I don't think there are any allergies in the family. 

Doctor: OK, good, has he been in contact with anyone who's been sick recently?
Patient: You know, like 5 days ago we had a playdate with his cousin. And we kind of thought that that's where he got the cold from. Like the runny nose, but it just turned weird, you know. 

Doctor: OK and how's this cousin doing? 

Patient: Last time I talked to Charlotte, Hank seems to be doing well so. 

Doctor: Alright, and has he traveled to anywhere recently? Have you any of you traveled anywhere recently?
Patient: No, with covid and everything, we have just been keeping to ourselves. 

Doctor: And with who and where does he live?
Patient: He lives with me and his mother in a house 

Doctor: OK. Any old carpets or mold or concerns for asbestos? Anything like that at home?
Patient: I don't know when this house is built. I don't think there's any asbestos in it and it's all hardwood. So no. 

Doctor: OK, good. Anyone at home smoke? 

Patient: No, no. 

Doctor: OK, good. So those were all the questions that I had. Do you have any questions for me?
Patient: No, no that's it, no. 

Doctor: OK, well, from the sounds of it, he most likely has some sort of viral infection. We will do a COVID swap to rule that out because some symptoms do seem to overlap with COVID and we want to make sure to rule that out. So we'll take a swab. Those PCR results should come back in about 24 to 48 hours. In the meantime, he should isolate for 14 days at home and if it's not COVID, it could be another viral infection like parainfluenza, also known as croup. So for that, for any of these viral infections, actually the best treatment is to stay at home and make sure that he's very well hydrated and eating well. If his symptoms persist for three to five days or more, or if his symptoms worsen, especially if he has like a seizure or urological issues, he should go to the ER and if his symptoms do become worse, we can also prescribe him some steroids or epinephrine just to open up his airways. And if it's really, really bad he might be hospitalised as well. So just keep an eye on on that for now. And if you have any questions or concerns, just give us a call. How does that sound? 

Patient: A little scary. Sounds good. OK, I'll just keep an eye on him for the next five days. 

Doctor: Give us a call if his symptoms are becoming worse or if they're not resolving and we will try to do an assessment on him. Of course we will do a physical exam today and will let you know how severe his symptoms are. Most children will get over their infection on their own and he likely won't need any additional treatments.
Patient: Not so well I I feel like I've been having just worsening breathlessness and a cough for it's been going on for two years now and I just can't seem to get rid of it. 

Doctor: OK, the cough and breathlessness both started two years ago? 

Patient: Yeah, I would say approximately around the same time. 

Doctor: OK, OK. Um, do you always have the breathlessness, or does it come and go?
Patient: Um, I think it's, I feel short of breath most of the times, but it's mainly just gets worse when I'm exerting myself when I'm walking more than usual or just working in the garden. 

Doctor: OK, OK, um and same thing with the cough? It gets worse when you're walking around?
Patient: Yeah, I would say so. 

Doctor: OK. And was there any sort of trigger for this two years ago? Anything that you remember?
Patient: Um, no, it kind of just started gradually on its own. No, no real triggers that I can remember. 

Doctor: OK, and, does anything make it worse or better besides the exertion?
Patient: Uh, no, I think that's pretty much the only thing that really makes it worse. 

Doctor: OK, and how would you describe your breathlessness? Is it that you're breathing too fast or you can't catch your breath? 

Patient: It's I think it's more so just I can't catch my breath and sometimes I just have trouble being able to take like a full breath. 

Doctor: OK, OK. Um, and out of 1 to 10, 10 being the worst, how bad is your breathlessness?
Patient: It can get up to I would say like an eight sometimes when I'm doing a lot of work. 

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

Patient: Not before the two years, before I I never felt anything like that. 

Doctor: OK, and you mentioned it's gradually been getting worse, right?
Patient: Yeah, I would say so. 

Doctor: OK, and the cough, um, do you ever cough up any blood?
Patient: No, it's uh, it's usually just a dry cough. No, no I don't produce any mucus or blood. 

Doctor: OK. OK. Um, and do you feel like you're wheezy? 

Patient: No, I haven't heard any kind of wheeziness at all. 

Doctor: OK. Any issues with your breathlessness when you're laying down?
Patient: No, I'm completely fine laying down. 

Doctor: OK and it's not waking you up at night, right? 

Patient: No. 

Doctor: OK um, have there been any changes to your taste recently?
Patient: No, not that I know. 

Doctor: Any changes to your smell?
Patient: No. 

Doctor: Have you experienced a sore throat? 

Patient: Nope. 

Doctor: Runny nose or stuffy nose?
Patient: Nope, not that I know of. 

Doctor: OK, changes in your hearing or ear pain?
Patient: No. 

Doctor: Changes in your vision or eye pain? 

Patient: No, nothing like that. 

Doctor: OK, and have you noticed any fevers?
Patient: Um, maybe some chills here and there, but not not really a fever, no. 

Doctor: OK, and you mentioned chills. How about night sweats?
Patient: Um, just a few times per week I would maybe have to take off my blanket sometimes I notice a lot of my sweat covering the bed sheets. That's been going on for about, say a couple months now. 

Doctor: OK, OK um any weight loss?
Patient: I think over the last few months I may have lost like around 3 three kilograms. 

Doctor: OK, OK, any rashes on your body? 

Patient: Not that I know, no. 

Doctor: OK. Um, how about uh like feeling you're like you're tired?
Patient: Um, yeah, I feel pretty tired sometimes, but I just thought it was because I'm getting older. 

Doctor: OK, fair enough. How about chest pain? 

Patient: No chest pain, no no. 

Doctor: Any swelling in your arms or legs?
Patient: No, not that I've noticed. 

Doctor: OK and how about feeling like your heart's racing?
Patient: No heart has been fine. 

Doctor: OK. And how about changes to your bowel movements? 

Patient: No, I go pretty regularly. 

Doctor: OK and urine, any changes there?
Patient: Nope. 

Doctor: OK, how about nausea and vomiting? 

Patient: Uh, no. 

Doctor: Headaches?
Patient: Uh, no. 

Doctor: OK, um any dizziness or fainting spells? 

Patient: No. 

Doctor: No? Ok, um how about confusion or memory loss?
Patient: Not that I know of, no. 

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

Patient: I do have high blood pressure and I think they said like my prostate is larger than normal. Um, but nothing else. 

Doctor: OK, and have you been sick in the past?
Patient: Uh, in terms of like breathing, I think maybe as a child like I may have had like a pneumonia but nothing else. 

Doctor: OK, and are you on any medications?
Patient: Just ramipril for my high blood pressure. 

Doctor: OK, um how long have you been on that medication for? 

Patient: Uh, for a pretty long time, I would say more than 10 years. 

Doctor: OK and no issues, side effects with that, right?
Patient: No, and my blood pressure is pretty well controlled on that medication. 

Doctor: OK, good, um, any allergies? 

Patient: No. No allergies. 

Doctor: Are you up to date with all of your immunizations?
Patient: Yeah I got my shingles and my pneumonia vaccination everything like that. 

Doctor: OK, and uh, in terms of family history, um, are there any heart or lung conditions that run in the family?
Patient: Uh, so yeah, my dad had quite a few problems. He had type 2 diabetes then he suffered from 2 strokes and then he also had a heart attack uh, in I think when he was like 56. But then he actually ended up dying of bowel cancer in his 70s. 

Doctor: OK. How about your mother? Is she alive? Is she healthy?
Patient: Um, my mom is alive, but she suffered from Type 2 diabetes and high blood pressure as well. And she also had, like hypothyroidism. And she also suffered from depression as well. 

Doctor: OK. Um OK, so do you live by yourself and where do you live? 

Patient: I live on an apartment and in apartment by myself right now. I do find it difficult getting out of the house recently just because of my shortness of breath, but other than that I feel that I'm pretty independent. 

Doctor: OK, and do you smoke?
Patient: No, I've never smoked in my life. 

Doctor: No? Um, how about other recreational drugs?
Patient: No no marijuana, no cocaine, nothing like that. 

Doctor: OK, how about alcohol? Do you drink alcohol? 

Patient: No. 

Doctor: OK, and do you still work?
Patient: Uh, no, I actually worked at just the hospital I used to volunteer, but now I just can't get out of the house. I feel just tired and short of breath all the time so just staying in my house most of the time. 

Doctor: OK, and has anyone around you been sick?
Patient: No, not that I know. 

Doctor: No um, and have you traveled anywhere recently?
Patient: No, No. 

Doctor: OK, um, have you been worked up for this in the past two years? Like have you had any chest X-rays or pulmonary function tests or anything like that? 

Patient: No, I've never really had this issue before, so no investigations. 

Doctor: OK, OK, well those were all the questions that I had. Did you have anything that you wanted to add that I maybe missed?
Patient: Uh, no, I just it's been going on for two years and I feel like it's getting worse and worse. And yeah, I'm just scared of having to, you know, go on oxygen or like just not being able to breathe at one point. 

Doctor: Yeah, for sure. So we will try to do a good job working you up for everything that we think it may be. And right now, it sounds like it could be pulmonary fibrosis either like you know an autoimmune process or triggered after like an infection that you may have had in the past. We will definitely also look into see if it's perhaps a lung cancer, asthma and you mentioned you don't smoke so we don't think it could be COPD but we'll also test for that in case all everything else comes back negative. 

Patient: OK, sounds good. Thank you so much. 

Doctor: Thank you. Take care you too.
Patient: Yeah, so I've had this cough, ongoing now for the last three days and I found I've had a more difficult time breathing as well. 

Doctor: OK, and So what came first? did the cough come first? 

Patient: Yeah, the cough started first. 

Doctor: OK and so it started three days ago?
Patient: Yeah. 

Doctor: When did the shortness of breath start? 

Patient: That started probably about two days ago. 

Doctor: OK, and the cough, can you describe it a little bit? Is it like a wet cough, a dry cough? How would you describe it?
Patient: Yeah, I brought up a little bit of sputum. It's been clear, mostly clear and sometimes dry as well. The cough's been getting worse over the last couple of days as well and hasn't really stopped either, it's just kind of ongoing all day. 

Doctor: OK, so it's it's pretty constant? 

Patient: Yeah, it's been constant. 

Doctor: OK, and how much sputum would you say you're bringing up?
Patient: I would say, uh, maybe like two teaspoons a day. It's only like a little bit in the tissues and I'm not bringing up sputum every time. 

Doctor: OK, and is your sputum at all yellow, green? Or does it have any blood tinge content in it? 

Patient: No, I haven't noticed anything like that. 

Doctor: OK, so it's mainly just white or clear.
Patient: Yeah, it's mostly, yeah, like whiteish or clear. 

Doctor: OK, uhm, and have you had anything like this happen before?
Patient: No, I haven't. 

Doctor: OK, and how would you describe the shortness of breath? Are you having trouble taking deep breaths or are you having trouble breathing when exerting yourself, like how would you describe it?
Patient: Yeah, I have like, a chest tightness. I find when I exert myself it gets worse and after I cough, I have a little bit of trouble catching my breath as well. 

Doctor: OK, When do you have the chest tightness, when did that start? 

Patient: Uh, yeah, that's started within the last two days as well, with the cough. 

Doctor: OK, so is it just the tightness when you cough or is it there just throughout?
Patient: Yeah if I take like a deep breath in, like, it just feels tight, like I can't get a deep breath. 

Doctor: OK, and have you had any kind of, like swelling in your calves, or pain in your calves at all?
Patient: No, I haven't had anything like that. 

Doctor: OK, and have you had any surgeries recently or have you been immobilized for a long time or admitted to a hospital or anything like that? 

Patient: No, I haven't had anything like that, I've been healthy. 

Doctor: OK, and have you had anything like a blood clot, either in your legs or traveling up to your lungs in the past before?
Patient: No, I haven't had anything like that. 

Doctor: OK, and have you been diagnosed with cancer or any other medical conditions? 

Patient: No, I haven't. 

Doctor: OK uhm, so would you say the coughing and the shortness of breath is getting worse, or it's about the same?
Patient: I'd say it's gotten a little bit worse over these last couple of days. 

Doctor: OK, and is there anything that makes your symptoms better or worse?
Patient: Yeah, if I exert myself it does make it a bit worse. It'll bring on the cough more, and shortness of breath. 

Doctor: OK, and how about any positional changes? Like, does lying down help? Does resting help relieve some of that tightness, cough and shortness of breath?
Patient: No, nothing like that has helped. 

Doctor: OK, and have you tried any kind of medications at all, over the counter?