jshargo/medical-interview-conversations huggingface dataset:
Patient: No, nothing like that. 

Doctor: OK. Do you have any allergies? 

Patient: Um, sometimes in the fall like I get a bit sniffly and, but other than that, I don't know of any allergies to any foods or medications. 

Doctor: OK. And how about immunizations? Are you up to date?
Patient: Yeah, they're all up to date. 

Doctor: Any lung conditions or heart conditions that run in the family? 

Patient: Uh, my father did recently have a heart attack at age of 58 I think he was, he, he's fine though, but that's that's about it. 

Doctor: OK, um any cancers that run in the family?
Patient: Um, no, I don't think so. 

Doctor: OK. And, and do you smoke?
Patient: Uh, yeah, yeah I do. 

Doctor: OK, how much do you smoke? 

Patient: Probably, I would say a pack a day. 

Doctor: Pack a day, OK. For how long?
Patient: Ah, probably since in my 20s, so at least 10 years now. 

Doctor: OK, have you ever thought about cutting down?
Patient: Yeah, especially with this pandemic going on, it's been, I've been trying to cut down just because like I don't want to get the, get COVID and then you know my lungs are probably already weaker because of the smoking. So I've been trying to cut down. 

Doctor: Yeah, for sure it's good that you're trying to cut down. We have resources to help you if you ever need them.
Patient: Yeah, for sure. 

Doctor: Do you do marijuana? 

Patient: No, no, I've never tried marijuana. 

Doctor: OK, how about other recreational drugs?
Patient: No, um, besides alcohol, nothing else. 

Doctor: OK, and then um, I guess I'll ask you about the alcohol, uhm, how much do you drink? 

Patient: Um, um, not that much. I'd probably say like a few times a week when there's a game on. I just grab a couple of beers, but that's about it. 

Doctor: OK. Uhm, and where do you live right now?
Patient: Yes, I just live just outside of London with my wife and daughter in a small townhouse. 

Doctor: OK and anyone else at home sick? 

Patient: No. I I've kind of stayed away once I noticed some symptoms. I'm just kind of just staying in my room, not getting out. I don't wanna make any of my families like. 

Doctor: Yeah, that makes sense. And have you traveled to anywhere recently?
Patient: No, umm, I haven't really traveled. I do I do go to work though I haven't in the last last week. I've told them that I've been having these symptoms, but other than that, no traveling. 

Doctor: OK. Uhm, OK, that's good. Those were all the questions I had for you today. Was there anything that you wanted to ask me or anything else that you wanted to discuss that I may have missed?
Patient: Uh, yeah, I I that I'm just wondering like I could it be COVID I I don't know. I don't know if someone in the office had it or yeah, it was just basically worried about, if I had COVID. 

Doctor: Yeah for sure. that's definitely something that we need to rule out, so we will be doing a COVID swab on you and and you will hear back in about 24 to 48 hours with the results. But regardless, because your symptoms overlap with symptoms of COVID especially umm, the loss of smell and taste, we do recommend that you isolate for 14 days and that includes trying to isolate from family members as well. So we'll, that's where we'll start. If it's not COVID, it could be another viral illness that's going around at this time of year. But, we'll start with, we'll start with these COVID swabs. How does that sound?
Patient: Yeah, I've noticed I've had this pretty bad cough for like the last couple of days. A little bit worried. Wanna talk to someone. 

Doctor: OK, so started two days ago. 

Patient: No about what day is it today? Today is Wednesday. It started on Sunday, Sunday. I noticed it getting really bad. 

Doctor: OK, so it got really bad. Then it was it was it still present but not as bad before that?
Patient: Yeah I think I had like a bit of like a raspy cough on like Friday but Sunday it was when I started getting nervous about it. 

Doctor: OK so almost a week, it sounds like. And what exactly changed on Sunday that you made it worse in your opinion?
Patient: So Sunday I started bringing I noticed like little spots of red kind of the the gunk I was bringing up. 

Doctor: OK.
Patient: And I kind of ignored it, but the next day they were still there. I started getting fever just in I felt off, you know. 

Doctor: OK. OK, so that you first notice that on Sunday, were you bringing up sputum before that and it just didn't have these spots or did it, did that part just start on Sunday? 

Patient: Sputum is kind of like the gunk up and bring it up? Yeah, it was. It's like this yellow custard, it’s got like well spots are red on it on Sunday. 

Doctor: OK, and before that did you have like the yellow custard without red? Or it all started at once all kind of started?
Patient: It all started at once to be honest. 

Doctor: Sorry, I know these are tricky questions, and you said that you've had some fevers. Can you tell me a little bit about that? When did that start? 

Patient: So that started, the Monday really is when I first started. I never took my temperature. I just felt hot. You know that's been going on pretty much until today. 

Doctor: OK, did you ever feel like you were really shaky?
Patient: Yeah, I've been getting the chills, especially last two days. 

Doctor: OK. So over this time you've had this cough, have you felt like you've had difficulty breathing? 

Patient: Not really, I feel a little bit winded doing things. I used to do like I take the stairs up to my apartment, but I have just happened really trying to exert myself that's been taking it easy so I haven't really noticed being out of breath. 

Doctor: OK, so probably if you were to get up and do a lot of physical activity you would feel worse.
Patient: Yeah, I could, probably I can still take the two stairs up to my apartment, but after that I started to feel pretty crummy. 

Doctor: OK. Is there anything else that you can think of that makes it feel worse?
Patient: No. 

Doctor: Has anything helped it to feel better at all? 

Patient: Bringing up gunk makes it feel better for a little while. 

Doctor: So you kind of just clear it up and that feels a little bit better?
Patient: Yeah, I haven't taken some Tylenol at home and that helps a little bit. 

Doctor: OK, have you felt a sore throat at the same time? 

Patient: After an awful lot of coughing, yeah, it starts to feel a little raw. 

Doctor: Have you had a runny nose?
Patient: Yeah, bit of 1 back in the day, maybe a week ago, but that kind of gone away by now. 

Doctor: Have you felt any chest pain?
Patient: Yeah. Yeah I got pain kinda on the right. 

Doctor: OK. Have you ever have you ever had anything like this before? 

Patient: No never. Actually Doc, you're saying something that makes it feel worse? Taking a deep breath makes it feel pretty bad. 

Doctor: OK, and. I'm just going to circle back to this chest pain. You said you feel it on the right side. Is it always there or is it just when you take a deep breath or is it kind of on and off?
Patient: It's kind of always there. It gets a little bit worse with coughing and when I take a pretty big deep breath. 

Doctor: Yeah, OK, but if you were just laying down, not coughing, is that pain there?
Patient: Yeah yeah, specially notice over the last day, 

Doctor: OK.
Patient: Kind of dull. 

Doctor: OK. And have you had any weight loss recently? 

Patient: No, not really. 

Doctor: K. Have you traveled anywhere recently?
Patient: Went to Sarnia. About a week back for work but. 

Doctor: OK, were you in contact with anyone that that was sick? 

Patient: Nope, just been keeping to myself mostly. 

Doctor: OK, so in terms of your own medical history, do you have any chronic conditions that you see your family  for regularly?
Patient: Yeah, he’s given me a pill for a cholesterol. 

Doctor: OK. And do you know the names of any medications that you take? 

Patient: Lipitor. 

Doctor: OK is that the only one?
Patient: Yeah 

Doctor: OK. Have you ever had any surgeries?
Patient: Uh, my wisdom teeth out as a as a kid. 15 or so I think. 

Doctor: OK. Do you have any allergies?
Patient: No. 

Doctor: I’m just going to ask you a few questions about your lifestyle and like do you live here in town?
Patient: Yeah, I live here in town, got a girlfriend living in apartment. 

Doctor: OK, you live with your girlfriend,
Patient: Yeah. 

Doctor: Do you have any pets?
Patient: Cat, yeah. 

Doctor: Do you do anything for work or are you retired?
Patient: Yeah, I still work a consultant for the chemical plant, so West. Mainly in Sarnia. 

Doctor: So have you had a lot of exposure to chemicals throughout your career? 

Patient: Now they've always been pretty good for keeping us safe. I'm on the engineering side of things, so I don't really work too much in the plant directly. You know, 

Doctor: OK. Here, well, do you drink alcohol?
Patient: Once in a blue moon. 

Doctor: Do you smoke?
Patient: Yeah. 

Doctor: How much would you say that you smoke?
Patient: Got a pack a day. 

Doctor: Long is that been going on for?
Patient: Geez, must have picked it up when I was 15. 

Doctor: OK. Do you use any other substances? 

Patient: Like drugs? 

Doctor: Yeah, cannabis or any other recreational drugs.
Patient: Smoke the odd joint from time to time, but haven't in years now. 

Doctor: Do you have any family history of any respiratory illnesses?
Patient: Respiratory illness, like lungs? 

Doctor: Yeah, exactly. 

Patient: Think my grandpa died of lung cancer, actually he was a pretty big smoker too though. 

Doctor: OK. OK, well thank you for sharing all of that with me, so I'm going to go over this with the physician I’m working with and we should be back shortly together to talk to you about the next steps.
Patient: Hi, um I'm here because I've had this awful sore throat for the past four days. Doesn't seem to be getting any better and I think I'm developing a fever now. 

Doctor: Have you checked your temperature? 

Patient: No, I haven't checked my temperature, I'm just really hot. 

Doctor: We'll check that here then. And, uh, do you, OK so you've had this sore throat for four days and a fever. Have you had any difficulty swallowing?
Patient: Yeah, um not, like I can drink OK, but it's really hard for me to eat solid foods right now. 

Doctor: Um why is that? 

Patient: Oh it just hurts. 

Doctor: Yeah, OK, but it's not that you can't um, you can't sort of like, you don't feel like it's getting stuck?
Patient: No, no, nothing like that. 

Doctor: Um and have you noticed any changes in your voice? Do you find that your voice is more hoarse?
Patient: Um a little bit uh but I think that's just because I try not to talk as much since my throat is so sore. 

Doctor: OK, OK and uh have you had a runny nose? 

Patient: No, no runny nose. 

Doctor: Uh a cough?
Patient: No. 

Doctor: OK. Have you had any difficulties breathing?
Patient: No. 

Doctor: Any sort of um congestion, do you feel like your nose is stuffy or hurts your, uh, in your cheeks or your head when you bend down? 

Patient: No. 

Doctor: No, OK. Um so all you have is a sore throat and this fever, OK um and um, OK. You have a headache?
Patient: Um no headaches. 

Doctor: Do you feel like you've been confused or just feeling not yourself?
Patient: No, nothing like that. 

Doctor: OK. Any uh changes in your hearing or your vision? 

Patient: No. 

Doctor: OK, any um and do you feel like your heart's beating very fast?
Patient: Uh no. 

Doctor: Do you feel short of breath? 

Patient: Nope. 

Doctor: Any uh belly pain?
Patient: Uh no. 

Doctor: OK, any diarrhea or constipation? 

Patient: No. 

Doctor: Any fatigue?
Patient: No. 

Doctor: Weight loss? Unintentional. 

Patient: No weight loss, no. 

Doctor: Uh and uh do you have any medical conditions?
Patient: Uhm no, I don't think so. 

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

Patient: Uh yeah the only one that I haven't gotten is um that HPV vaccine. 

Doctor: OK OK, um OK, any uh, did you get the flu shot?
Patient: Oh, I didn't get that this year. 

Doctor: OK, well we recommend that you you get your vaccines and um also the uh HPV vaccine. Um it's it's best to get the HPV vaccine earlier on. It's a little bit less effective as you um go past a certain age, you are still obviously nowhere close to that, but it's,  I I don't believe it's covered after the age of 26 either, so it's best if you get it done earlier. And let's go back to your symptoms, then. Have you had any surgeries? 

Patient: Uhm, I got my appendix removed when I was 13. 

Doctor: Anything else?
Patient: No. 

Doctor: OK, are you taking any medications including over the counter? 

Patient: No, I just take my multivitamins. 

Doctor: And uhm are you um are you currently living alone or do you live with someone?
Patient: I live with my parents and my two siblings. 

Doctor: And uh do you feel safe at home?
Patient: Yes. 

Doctor: OK. Are you um currently sexually active? 

Patient: No. 

Doctor: OK. Um do you plan on being sexually active in the near future?
Patient: Uh no, not before I finish high school. 

Doctor: OK, alright. Um and um are you uh, do you uh drink alcohol? 

Patient: No. 

Doctor: OK, do you smoke?
Patient: No. 

Doctor: Have you tried marijuana or any recreational drugs?
Patient: I haven't. 

Doctor: OK. Are things going well at, are you in school right now? 

Patient: Um yep, I'm in grade 10. 

Doctor: OK. Are things going well?
Patient: Yes, I would say so. 

Doctor: Any bullying uh at school? 

Patient: No. 

Doctor: OK, any um any any concerns about depression or anxiety?
Patient: No. 

Doctor: OK OK alright and uh you uh traveled anywhere recently? 

Patient: No, I've been um just at school and home. 

Doctor: So it's not it's not virtual, it's in person?
Patient: So half the day is in person and the other half is virtual. 

Doctor: OK and are you maintaining social distancing at school, wearing a mask?
Patient: Yeah we do, except sometimes I guess like I don't know if you have to drink water or something, we take it off. 

Doctor: Yeah, sure, OK. Um and uhm, I suppose just um OK. What was I gonna ask? Um do you uh, so no travels, OK. Do you feel like you've been in contact with someone who might be sick or might have Covid? 

Patient: Uh I don't think so. 

Doctor: No, OK alright. And have you looked at your throat? Does it look swollen or red?
Patient: Yeah, it looks pretty swollen and red. 

Doctor: Well, that's all the questions, oh one more question actually. Do you have um any medical conditions that run in the family? 

Patient: Um no, I don't think so. Maybe like high blood pressure. 

Doctor: Uh all right, well um that's all the questions I had. We'll do a physical exam, have a look inside your throat. Um given uh the symptoms that you have, it sounds like you have um an an inflammation or swelling of your throat which could be caused by bacteria or viruses. It could be something like um mono, or it could be um strep throat. Um it could be other things as well. Um seeing that your symptoms are somewhat overlapping with the symptoms for covid, we would also like to do a Covid test. Um we'll do a rapid strep test here as well um just to rule it out and then uh we'll uh ask you to quarantine for the next 14 days um until or at least until your covid swabs are back or your symptoms improve um and we'll let you know about um the management based on the strep test result. Do you have any questions?
Patient: Yeah I had last night um so I'm having this pain in my right wrist. Yeah, but last night. I I tripped over something and I I ended up like landing on my hand to help break the fall and this morning I woke up and I have some like bruising on my hand and it's it's really sore to touch it. 

Doctor: OK, and which right, which hand is this?
Patient: It's my right hand. 

Doctor: OK, and when you had your fall, when was your fall? 

Patient: So it was last night, probably like at 10:00 PM, something like that. Went out with a few friends for dinner and drinks. 

Doctor: OK, and do you remember how high you fell from or what what you fell onto?
Patient: Yeah, I was standing height. We were just kind of walking down the street and I tripped over something on the curb. I think there is that yeah maybe like a pothole or something like that and so I felt right onto the concrete with my hand. 

Doctor: OK, did you hit your head at all or lose consciousness?
Patient: No, nothing like that. 

Doctor: OK, so it was. It was mainly your hand that got injured. 

Patient: Yeah, it was just it mostly right my hand. 

Doctor: OK and are you having any pain on movement or if you press on it?
Patient: Um yeah, I do get some pain pain if I'm trying to move the wrist around and it hurts her to press on it as well. 

Doctor: OK, and do you notice any kind of swelling or bruising?
Patient: I do, yes. There's some swelling and bruising. 

Doctor: OK, and if you had to describe where the swelling and bruising in the pain are, how would you describe it? 

Patient: Um so I have a sharp pain right at my wrist. I kind of. I feel it mostly at the base of my thumb, kind of right at the wrist, and that's where the swelling and bruising is as well. 

Doctor: OK and, is it right under your palm or uh at the back of your hand on the wrist?
Patient: At the back of the hand, at the wrist and base of the thumb. 

Doctor: OK, OK, alright, and what kind of pain are you feeling? Is this sharp, is it a dull aching? 

Patient: Oh yeah, it's really sharp. It feels like sorry just stabbing me in the hand. 

Doctor: OK, and how how much would you rate the pain on a scale of zero to 1010 being the worst pain you felt in your life?
Patient: If I'm not moving it around, it's a three, but if I move it, it goes up to like a 9 out of 10. 

Doctor: OK, and is it radiating or moving anywhere else onto your hand? 

Patient: No, I don't feel it anywhere else. 

Doctor: OK, and do you have any kind of pins and needles sensation tingling or numbness anywhere in your hands?
Patient: No, nothing like that. 

Doctor: OK, anything that makes the pain worse or better? 

Patient: Um yeah I tried some anti-inflammatories that did help with taking the edge off a little bit and. But the pain just came right back and then also like just moving it at all hurts even texting on my phone was really bugging me. 

Doctor: OK. Yeah, so we definitely, uh, you went, so you had the fall yesterday or?
Patient: Yeah it was yesterday. 

Doctor: OK, OK. Alright. So when did it start hurting? Did it start hurting right away or has it gotten worse at all?
Patient: Yeah it started hurting right away and it's. Well, this morning it's a a bit worse yeah. 

Doctor: OK. Do you have any other symptoms at all like fever, chills, headache, anything like that? 

Patient: No. 

Doctor: Any dizziness or fainting?
Patient: No. 

Doctor: OK, any diarrhea, constipation?
Patient: No. 

Doctor: Any changes in your vision, hearing a balance?
Patient: Nope, nothing like that. 

Doctor: OK, but yeah, so your main concern today is this pain in your wrist? 

Patient: Yeah exactly. 

Doctor: OK, alright and do you have any past medical conditions you've been diagnosed with?
Patient: Yeah I do. I have a Asthma and I use an orange inhaler daily. It's been well controlled, I'll use, I haven't used the blue one in awhile. 

Doctor: OK, so it's pretty well controlled. Yeah, and do you take any other medications at all?
Patient: Just a Multi vitamin. 

Doctor: OK
Patient: And vitamin D as well. 

Doctor: OK, alright, and have you been hospitalized in the past or had any surgeries? 

Patient: Yeah I had my my tonsils out and my wisdom teeth out when I was a teenager and or tonsils when I was a kid actually. Um and a c-second for my son. 

Doctor: OK any complications at all with that at all?
Patient: No no every every that was OK. 

Doctor: OK, OK, and have you injured your right hand or broken any bones before?
Patient: No, I haven't. 

Doctor: OK, so this is the first injury on your right hand? 

Patient: Mmm 

Doctor: OK and do you have any family history of any medical conditions at all?
Patient: Yeah my my uncle died of a heart attack when he was in his 60s and I think my Grandfather also had had a heart attack as well. Um yeah, that's about it. 

Doctor: OK. And in terms of your work, do you work currently? 

Patient: Um yeah I do, I I work um in a restaurant and so. And this will be a difficult for my job coming up with an injured wrist I and hand. I I just restarted and I'll have to be carrying a lot of different things, and so I just hope it's not broken. 

Doctor: Oh, I see. Yeah, it might definitely that's that might be concerning if you know well, we'll get that check though on X Ray and everything, but we just need to do a few few more questions and some examination as well. How would you describe your living situation right now?
Patient: Oh so. I'm living on on my own actually in an apartment. 

Doctor: OK. And do you currently smoke? 

Patient: Um no, I've I. I've never smoked, I couldn't with having asthma so I just stayed away from all of that. 

Doctor: OK, OK, and do you drink alcohol?
Patient: Yeah I do I. I have a couple of bottles of wine per week. 

Doctor: OK. Alright, uh, a couple of bottles a week, so how much would you have in an average day?
Patient: I'll probably I guess, probably like two or three glasses of wine a day. 

Doctor: OK. Yeah, so we definitely recommend for women. Uh to limit themselves to an maybe one to two, max 2 glasses of wine a day as it can have health effects in the future in terms of drinking and on your liver. OK, and other than that I just had a few questions. Do any recreational drugs like marijuana? 

Patient: No, stayed away from that as well. 

Doctor: OK, OK, so I'm just going to ask you questions about specifically to examine your wrist so you notice. So can you. Are you able to move your wrist around? Are you able to make a fist?
Patient: I I can but it I can't really bad my thumb and it it it hurts a lot. So I can bend my fingers but my thumb is kinda out. 

Doctor: OK, due to the joints in your thumb hurt at all. 

Patient: Um no. 

Doctor: OK. An any pain anywhere else like on your fingers or your elbow?
Patient: No. 

Doctor: OK, and. What movement would you say hurts the most? 

Patient: I I. Probably just moving the the wrist like flexing and extending the wrist 

Doctor: OK and where the swelling you said is at the base of the thumb, right?
Patient: Yeah, exactly at the base of the thumb on the on the back of the hand there are some bad bruising and swelling there. 

Doctor: OK is it warm at all to touch? 

Patient: No, it doesn't feel warm. 

Doctor: OK, OK, and if you press on are you getting any bony pain in that area, like if you press on a bone?
Patient: Yeah, um, so I have been, I have this cough, I'm coughing up blood so that's made me a little bit worried, um, so I thought I should come and get, get it investigated. 

Doctor: OK, yeah no definitely, that, that's definitely concerning, is, so when did this start?
Patient: It, the coughing up blood started about a week and a half ago. 

Doctor: Mhm. 

Patient: Uhm, but it's not getting any better, and it's not stopping. 

Doctor: OK and did it start, did the cough just start, uh with, uh, blood in the cough or what, did it just start as a normal cough first?
Patient: It started off as a normal cough first. 

Doctor: OK, and did you have any kind of production of sputum with yellow or greenish material at all?
Patient: Uh, not really, I mean there, it's, it was a little bit yellow, but now it's just mostly blood. 

Doctor: OK  and did you have any, did you, were you in contact with anyone that was sick recently, or did you have any travel? 

Patient: I recently immigrated to Canada from India. 

Doctor: OK, and were you in contact at all when you were in India with anyone who might have had tuberculosis or was sick at all around you?
Patient: Uh, I mean it's possible, like people get sick in my family all the time in India, so it's possible. 

Doctor: And were you at all, in India when, were you were you living in like close quarters like in a smaller space with other people at all? 

Patient: I have a big family so we all live together. 

Doctor: OK.
Patient: Uh, so it's yeah, so there are about like ten of us. 

Doctor: OK great, so it started one, you said around one and a half weeks ago.
Patient: Yeah, that's right. 

Doctor: OK, and is it like a constant cough? Or does it come and go?
Patient: It's uh, it's pretty constant, well, I guess it comes and goes, it's, it's not there all the time. 

Doctor: OK, and have you had this happen before at all? 

Patient: No, never. 

Doctor: OK. Right, is there anything that makes your symptoms better or worse?
Patient: Uhm, I don't think so, nothing that, nothing I've tried has worked. 

Doctor: OK, and do you have any other symptoms like a fever or shortness of breath, anything like that?
Patient: I have been feeling chills and uhm, I haven't actually taken my temperature, but I feel hot, so it's possible that I have a fever. 

Doctor: OK, and do you, do you have any significant weight loss at all in the past few weeks?
Patient: Yeah, now that you mention it, I think I've lost about ten pounds in the past month. 

Doctor: OK, and how much do you weigh? 

Patient: Right now I weigh a hundred and ten. 

Doctor: OK, so yeah, definitely, that's more than like the ten percent, yes, that is pretty significant. Have you been experiencing any night sweats?
Patient: Yes, yeah, I've been having night sweats. I thought that was just me being hot, but I guess, I feel chilly and then I have night sweats so I probably do have a fever. 

Doctor: OK, and how about fatigue? Are you, do you feel more tired throughout the day?
Patient: Uh, yeah, I would say so. 

Doctor: OK, and do you have any symptoms like chest pain or racing heart or anything like that? 

Patient: No, nothing like that. 

Doctor: OK, uhm, any headaches, nausea, vomiting?
Patient: Uhm, no. 

Doctor: Any changes in your bowel movements? 

Patient: uh, nope. 

Doctor: OK, any issues with your sleep or appetite?
Patient: No. 

Doctor: OK and, um, any exposures to fumes or dust or animals or pets?
Patient: No. 

Doctor: OK, and uh, currently right now, have you been in contact with anyone else, do you go to work or anyone living with you right now? 

Patient: So I go to work, uhm, I'm working for an assembly line, so there are a lot of people around me and I live with two housemates. 

Doctor: OK, and anyone at work or your housemates, anyone showing any similar symptoms at all?
Patient: No, I don't think so. I haven't asked them, but nothing I've seen. 

Doctor: OK, and previously do you have any medical conditions that you were diagnosed with?
Patient: Nope, I'm healthy otherwise. 

Doctor: OK, any allergies? 

Patient: No, no allergies. 

Doctor: OK, any kind of loss of taste or smell?
Patient: Uh, no, nothing like that. 

Doctor: OK, are you on any medications at all? 

Patient: Uhm, no, just some vitamins. 

Doctor: OK, and any previous hospitalizations or surgeries?
Patient: Uh, no. 

Doctor: OK, other than that, have you had any family history of any heart or lung conditions? 

Patient: Nope, nothing like that. 

Doctor: OK, uhm, currently right now, so you live with roommates. Is it like an apartment, is it a home, like a house?
Patient: I live in an apartment. 

Doctor: OK, uhm, do you currently smoke?
Patient: No. 

Doctor: OK, do you drink alcohol?
Patient: No. 

Doctor: Any recreational drugs like marijuana? 

Patient: No. 

Doctor: No, OK, alright, so those are all the questions we had. Do you have any questions or concerns?
Patient: No, what do you think I have and is there anything I need to do right now? 

Doctor: Yeah, So what, uh, some of your symptoms are concerning, especially the coughing up blood, which is something that we always think of with tuberculosis. You don't have any history of, uh, family history of lung cancer or anything like that, so right now, especially since you just moved from India where tuberclosis is endemic, we need to make sure that we test you for tuberculosis. In the meantime though, you will need to stay in the hospital and be in an isolated room, uh, where we can filter some of the air and make sure, it's a very infective condition if you do have it so while you're getting all the tests done, you will need to stay here in an isolated room. Also, we will get some sputum smears and cultures to test for TB and we will also, I will need to, if the test comes back positive we will need to contact public health and let your contacts know as well. Lastly, we will also be getting, since you're having the hemoptysis, like coughing up blood, we will, we might also do a chest X-ray to see if you, if you have active TB. 

Patient: OK 

Doctor: So those are, those are some of the things that we'll get started with. Is that OK with you? Any questions or concerns?
Patient: Uhm, no nothing like that, uhm do I need to isolate? 

Doctor: Yeah, so we will keep you in an isolated room right now, when you're getting all those tests. And if you do have TB, you will need to isolate, uhm, and stay away from contacts, not be at work, we will, if you do in fact have TB, which it seems likely right now, you will be started in hospital on a ,like antibiotic therapy, uh, which consists of like four different medications and people with the active TB will do have to isolate during that time period, so yeah, we'll get some of those tests done and, we'll get back to you as soon as possible.
Patient: Yeah, my chest is really hurting. 

Doctor: OK, and where where does it hurt exactly? 

Patient: It's hard to say the exact location, but more on the left side of my chest. 

Doctor: OK, and is it like what kind of pain is it? Is it like a dull aching pain, or is it as sharp or stabbing pain?
Patient: The pain is. It's stabbing, but also it feels really really tight in my chest. 

Doctor: OK, and if you're to rate it on a scale of zero to 10, zero being the least amount of pain you felt in your life and 10 being the worst, how much would you rate it?
Patient: I think at 6. 

Doctor: Six, OK. And when did it start?
Patient: It started this morning just right after I got out of bed. 

Doctor: OK, so you weren't doing anything like you weren't doing any activities, you just woke up from sleep? 

Patient: Yeah I got outta bed. I was just trying to get dressed and all of a sudden I got this tightness and and stabbing pain on the left side of my chest. 

Doctor: OK, approximately how many hours ago was that?
Patient: I I would say about. Six hours ago. 

Doctor: OK, and has it been as a pain getting worse at all?
Patient: Uh, it's it's getting worse. 

Doctor: It's getting worse, OK. And have you had any similar sort of pain in the past before? 

Patient: Um nothing like this before. 

Doctor: No, OK. And is the pain going anywhere else or is it just staying in your chest?
Patient: The pain is just in my chest. 

Doctor: OK. And does anything that you do make it feel better?
Patient: Sitting up tends to make it feel a bit better. 

Doctor: OK, and does anything you do make it get, make the pain get worse? 

Patient: It gets worse every time I breathe in. 

Doctor: OK, and what kind of pain do you get when you breathe in?
Patient: It's a sharp stabbing pain. 

Doctor: OK and apart from the pain, are you having any other symptoms like a cough or shortness of breath and anything like that?
Patient: Yeah, with the pain, I'm having a hard time breathing. 

Doctor: OK. OK, I just have a few other questions. Uh, have you recently had any kind of trauma or injury to your chest at all? 

Patient: Um no. 

Doctor: OK, have you traveled at all recently?
Patient: I was in in Italy for the past three weeks actually, just got back last night. 

Doctor: OK. And have you been experiencing any kind of nausea or vomiting, or fever or chills?
Patient: No. No nausea or vomiting. I did take my temperature, no. Sorry I did not take my temperature, but I've been having chills the last few days. 

Doctor: OK, uh, and uh, yeah, just curious have you been having any kind of swelling at all in your feet or ankles? 

Patient: Ah, my legs felt a bit swollen on the way back on the airplane, but they tend to swell so I didn't think anything of it. 

Doctor: OK so they have swollen up before but you saw them swollen this time as well?
Patient: Yeah. 

Doctor: OK. And have you been feeling at all fatigued at all? 

Patient: I've been really tired with all of the traveling, so I think maybe I'm just jet lagged. 

Doctor: OK, have you noticed that all your heart racing, like any palpitations?
Patient: Yeah, since this morning it's felt like my heart is is racing. 

Doctor: OK, have you noticed any skin changes at all? Any rashes? 

Patient: No rashes. 

Doctor: OK, have you noticed any cough, coughing at all?
Patient: I've had a cough since last week, but it feels much worse today. 

Doctor: OK, and has there been any kind of green slimy mucus in your cough at all? 

Patient: No, it's been a dry cough. 

Doctor: Dry cough, OK. and have you noticed at all coughing up blood?
Patient: No blood. 

Doctor: OK. And have you recently had any infections in the last month? 

Patient: Yeah, a couple of weeks ago I had a runny nose and sore throat and a little bit of a headache but. I feel better from that now. 

Doctor: OK, and to just go away by itself, or did you have to take any medications?
Patient: It just went away on its own 

Doctor: OK. Have you been feeling any kind of dizziness at all?
Patient: I have a little bit of yeah, um dizziness when I when the pain gets really bad. 

Doctor: OK, and I know you mentioned some swelling in your legs and your ankles, but have has any of your legs been hurting at all?
Patient: My left leg hurts really bad right now, but my entire body has been achy these past few days. 

Doctor: OK, and then you're right, like do you know where it hurts?
Patient: Um. I think just like in the calf. 

Doctor: In the calf, OK. OK, and do you have any past medical history any like hypertension that like diabetes? So any conditions that you've been diagnosed with? 

Patient: No, I I'm healthy. 

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

Doctor: OK, do you take any birth control or multi vitamins?
Patient: Yeah, I take a daily birth control pill and also a daily multi vitamin. 

Doctor: OK, and how long have you been on the birth control pill?
Patient: Um, for two years. 

Doctor: OK, any hospitalizations recently? 

Patient: Um none that I can think of. 

Doctor: Any ill Contacts?
Patient: No. 

Doctor: Any surgeries in the past?
Patient: No surgeries. 

Doctor: OK, in your family, has anyone had any conditions like has anyone passed away from a heart attack any cancers, anything like that? 

Patient: No cancer, but my mother died of a heart attack when she was 43. And my grandma also had a heart attack when she when she was younger. I wanna say in her 50s but I don't exactly remember how old. 

Doctor: And currently right now, where do you live? Do you live in like a house, apartment?
Patient: Yeah, I live in an apartment by myself. 

Doctor: OK, and do you currently work? 

Patient: Yeah, I'm in charge of um a retail store as a manager there. 

Doctor: OK and do drink?
Patient: Sometimes on weekends or if I'm socializing with friends, but not very often. 

Doctor: OK, and do you use any recreational drugs like marijuana? 

Patient: Never. 

Doctor: OK, and do you smoke?
Patient: Yes, I smoke about 2 packs of cigarettes per day. And I've been smoking since I was 12. 

Doctor: OK. Alright and in terms of your daily routine like do you get any exercise?
Patient: Uh, not really. Life's a bit too busy and hectic right now right now, unfortunately. 

Doctor: OK. And how about your diet like what is your regular diet look like? 

Patient: A lot of fast food. I know I could work on that, but again, with the busy lifestyle we tend to eat a lot of fried foods and fatty foods. I know I could do better. 

Doctor: OK. Great thank you.
Patient: I'm just bringing my son today because he's been how many episodes where I'm eat hell gets all this coughing fit and become wheezy and become shorter breath and I mean after a period of time it goes away, but it's been happening every so often. 

Doctor: Does he still have these symptoms? 

Patient: Like right now he's OK. When the symptoms come on, they last for I don't know, maybe 30 minutes, 60 minutes or or even less. But yeah it happens maybe once or twice a week where and it's been going on for a, a couple of months now. Yeah, he actually had a viral infection like a few months ago and I thought it was just that. It leared up and then he's just had a few more of these episodes, but without those kind of symptoms so. 

Doctor: Hm? So all this started a couple months ago.
Patient: Yeah. 

Doctor: Do you find that there and you mentioned that it happens about one to two times a week? Is there anything specific happening at that time? Any triggers that result in these symptoms?
Patient: Well I will say I think I like exercise. I find yeah like soccer practice. Yeah, after maybe, or even during a game, like when things are really intense. Yeah, I think during soccer I've I've kind of noticed it. And then at night time as well. It kind of randomly, he'll have this cough. 

Doctor: OK. So I guess it's do you feel like it's affected by cold weather as well or no? 

Patient: Um, maybe yeah, like if he yeah completely in the winter time. Like I know when he goes outside if he yeah he takes like a deep breath or something like that. He'll talk about having shortness of breath or difficulty breathing in the cold weather. 

Doctor: OK, other than the and I guess the cough. Is he coughing up anything, or is it kind of a dry cough?
Patient: It's dry. 

Doctor: OK. Does he have any like chest pain during these episodes. 

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

Doctor: Alright, any fevers?
Patient: No, he had a little bit of a fever at the that one time a few months ago, but he hasn't. So that's right. I think he had a some sort of illness then, but he hasn't had any fevers. 

Doctor: I see. OK, any headaches?
Patient: No, he hasn't said anything like that. 

Doctor: OK. And how has he had any other symptoms so anything like racing heart or belly pain or muscle aches or any changes in his bowel movements or urinary symptoms?
Patient: Uh no, I haven't heard him, uh, I complain about anything like that. I think I'll everything like that's been normal. 

Doctor: OK. So when he has these episodes, how like how severe are they? So how difficult is it for him to breathe? 

Patient: Ah, well, you certainly when it first starts, I mean for the first minute or two. Yeah, he that when I think particularly at soccer practice school have a really hard time catching his breath, but like he would, he stops playing and rests and really tries to make sure that he is I don't know, just trying to to breathe and it kind of goes away. He's been able to manage it OK. 

Doctor: OK, alright and I have these symptoms that have interfered with his daily activities? Does he for instance, try to avoid soccer practice. Or does he have difficulties falling asleep at night?
Patient: Yeah, definitely wakes him up a few and every once in awhile at night and he does have to take it a little easier at soccer for sure. So yeah, I am thinking it is affecting him. 

Doctor: OK. And otherwise has he been, has he had any medical conditions that he's been diagnosed with?
Patient: Uh, no, well he had some rashes when he was younger that he would get some some creams for, but that's mostly resolved now. 

Doctor: OK, any hospitalizations or surgeries? 

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

Doctor: OK, uhm. And just going back to his birth and your pregnancy, were there any complications at the time of pregnancy?
Patient: Um, there was a prolonged labor, I think, but he was delivered vaginally and at term 

Doctor: OK. OK, that's great.
Patient: And he, oh sorry, I was just going to say normal weight as well. 

Doctor: OK good has, was he kept in the in ICU for a couple of days after, was he sent home?
Patient: I think they, like he was kept for not an ICU he was kept for one day I think so just monitor for infection because it was like prolonged labor but he was OK. OK, so yeah we were able to go home. 

Doctor: OK, and I, what was I going to say. Forgot what I was going to say. How yeah, how has this growth and development been? Has he been seeing his  regularly? Any concerns there? 

Patient: Yeah he's been good with with growth. No concerns for that and his developments been normal as well. He's reached all of his milestones. 

Doctor: OK, and is he going to school?
Patient: Yeah, yeah, he's been going to school. He hasn't really been, he hasn't missed well he's missed one or two days actually, because of the cough, like on nights that he just didn't sleep well, so in the morning he's just well, not not feeling good for school so he has missed a couple of days over the last few months. 

Doctor: Okay. And does he, is there any other any conditions that run in the family? Including things like asthma or eczema, or allergic rhinitis or allergies.
Patient: Yeah, sister does have some bad allergies. Her nose runs all the time and she also has that asthma. His sister uses and a daily inhaler and then also W1. 

Doctor: I see. OK, and uh. How are things at home is he, is he doing well otherwise? Like at school and things like that, any stressors in his life?
Patient: No, he's been doing, uh, he's been doing well at school. He likes math and that that's been going, well. 

Doctor: OK, great. Has he ever tried any puffers?
Patient: No, he hasn't actually. 

Doctor: Has he been on any medications? 

Patient: Um, he he has not. 

Doctor: Any allergies that he has?
Patient: Not that I'm aware of, but I I think he might. I mean so like environmental or I don't know, something. He does get symptoms like a runny nose and itchy eyes sometimes, but usually go away pretty pretty quickly and he doesn't fuss about it too much so, yeah so. 

Doctor: From the symptoms that you've described so far, it sounds like he might also have asthma, but we will obviously have to do some testing and confirm that. Uhm, and also, it's given sort of the results, or even just like giving his symptoms, prescribe some buffers to help with those symptoms. Clearly it's affecting his life. He can't go to school or can't participate in soccer, or sometimes wakes up in the middle of the night, and that's not good. So, we'll we can be prescribed some puffers and see if those help and also get some testing done. Do you have any other questions for me?
Patient: Uhm, No, yeah I was just wondering about, so like the wheezing and all of that could be with from asthma too? 

Doctor: Uhm, yeah, I would think so, but again, we'll get the testing done and see if there are any other, any other causes.
Patient: Ok. 

Doctor: You said the wheezing sort of lasts only 30 to 30 minutes to an hour and then gets better? 

Patient: Yeah, I don't notice that any other times. 

Doctor: Yes, it's possibly, I mean, I would think it's asthma, but then we'll get the testing done and see.
Patient: So I've been having just a worsening breathlessness. I've been also having a cough, and I think I might have also had a fever in the last couple weeks. 

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

Patient: Yeah. 

Doctor: OK and then when did the cough start?
Patient: I'd say around the same time the breathlessness started, so around six weeks. 

Doctor: OK. And then the fever?
Patient: The fever I've kind of had on and off in the last couple weeks. I would say two to three weeks. 

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

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

Doctor: OK, so alright, and how long does it last when you do get it? Or is it just always there?
Patient: Uh, it's kind of just there, but then when it's getting worse like it lasts a couple minutes to, I would say like 10 to 15 minutes and then it goes back to like just the normal breathlessness. 

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

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

Doctor: OK, sure. And are there things that make make it better or worse?
Patient: Uh, not really, I think it's sometimes moving around too much, but like nothing, nothing really causes it. 

Doctor: OK, um, and was there any sort of trigger six weeks ago that you think may have like caused all of your symptoms?
Patient: Oh I'm not sure I I don't think there was any triggers. 

Doctor: OK, has anyone around you been sick? 

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

Doctor: OK.
Patient: So yeah. 

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

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

Doctor: OK.
Patient: But yeah, there are some of them also have some shortness of breath. 

Doctor: OK, OK. And have you traveled anywhere recently?
Patient: So I actually came to Canada one year ago. I'm originally from India and I I'm I came here to study. 

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

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

Doctor: OK, and have you ever experienced this before?
Patient: No, this is like the first time I'm having this issue. 

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

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

Doctor: OK. Yeah, that was a good call and have you had any changes to your smell recently?
Patient: No, no changes to smell. 

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

Patient: Uh, no, not really, no. 

Doctor: No? OK, how about a sore throat?
Patient: No, no sore throat. 

Doctor: No sore throat, any changes to your taste?
Patient: Nope. 

Doctor: Any changes in hearing?
Patient: Nope. 

Doctor: Ear pain or discharge from your ears? 

Patient: No, nothing like that. 

Doctor: OK, any eye pain?
Patient: No. 

Doctor: Changes in your vision?
Patient: Nope. 

Doctor: Any discharge from your eyes?
Patient: Nope. 

Doctor: OK, and you mentioned fever and some night sweats. How often are you getting these night sweats and do they feel like chills?
Patient: I think in the last two weeks I've been getting it more frequently, like I would say every other night I I feel, I would feel chilly at one point and then I'll break out into night sweats or have to take off my blanket. I think I measured it once or twice over the week and it did show like a fever of 102. 

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

Patient: No, nothing like that. 

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

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

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

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

Doctor: OK. And do you ever feel like you're wheezing?
Patient: Uh, no, I I don't think so. I I don't really notice any noises when I'm breathing. 

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

Patient: No, no chest pain at all. 

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