jshargo/medical-interview-conversations huggingface dataset:
Patient: I, I think my Grandfather had a like pancreatic cancer. 

Doctor: OK, OK. Um, alright, so do you live at home correct? 

Patient: Yeah, I live with my parents and my younger sister. She's 12. 

Doctor: She's 12, Is she healthy?
Patient: Yeah she is. 

Doctor: OK, good and have you guys traveled recently?
Patient: Um no we've been, we've been at home. 

Doctor: OK, OK, Um, and do you smoke?
Patient: No, I don't smoke. 

Doctor: No, How about marijuana?
Patient: I I've tried it once or twice but it was just those couple times, nothing that I do or used regularly. 

Doctor: OK, And how about alcohol? 

Patient: No, no alcohol. 

Doctor: No alcohol. OK, are you sexually active?
Patient: No, I'm not. 

Doctor: No, OK um. Is there a possibility that? Or actually sorry I should rephrase that. Have you kissed anyone recently? 

Patient: Um I. Well, I I guess I kinda have a girlfriend now. Um that we, that I started hanging out with about two months ago. 

Doctor: OK, OK.
Patient: And so I guess yes. 

Doctor: OK, alright, well that's good. Um have, has she had any of these symptoms? 

Patient: Uh, well she she was, wasn't feeling well for awhile back, but, I don't think it was this bad for her. 

Doctor: OK. Actually, and she's better now?
Patient: Yeah, she's better now. 

Doctor: OK. Alright, so you mentioned you're not sexually active. If you were to be, make sure you use protection. Um and OK. So everything at home is OK then? No ones, no ones sick at home you mentioned, right? 

Patient: Yeah, no ones, no ones sick at home. 

Doctor: OK. And school is going OK?
Patient: Um yeah, schools been been going OK for the most part it's been tough these last few weeks feeling like this though. 

Doctor: Yeah for sure. And are you and your girlfriend in an exclusive relationship?
Patient: Uh. I I think so yeah. 

Doctor: OK, I ask because there's something called what you may be familiar with um it's called the kissing disease. In medical terminology, it's called mono, as caused by a virus called EBV, and so it could be that so we're covering all our bases. 

Patient: Oh, I've heard of mono before. 

Doctor: Yeah,
Patient: OK. 

Doctor: It's it's likely it could be up there in terms of what you have, so I think those were all the questions I had for you. Did you have any questions for me? Anything you wanted to add?
Patient: Um, no, I think that's you covered everything. 

Doctor: OK alright so I will will go off a few, we'll try to cover our basis and get you tested for mono which I would have to do like a monospot test and we can do rapid strep test as well to see if he has something called strep throat. But yeah, we'll see what those results come back as. And we'll go from there. Does that sound good? 

Patient: Yeah, no, that sounds good. 

Doctor: OK, thank you.
Patient: Hi, this morning I read after I woke up by I coughed up some phlegm and there was some blood in it and it it totally scared me. 

Doctor: OK, and was this the first time that happened?
Patient: Uhm, yeah, I've never I never noticed blood in my sputum before. 

Doctor: OK, but have you been coughing recently? 

Patient: Uh yeah, I have, uh, had a cough recently leading up to this. 

Doctor: OK, and how long have you had the cough for?
Patient: Uhm, I've had it for uhm, yeah, about about four weeks. 

Doctor: Wow, four weeks. OK. Do you know if you did anything prior to that, any new exposures or being around someone ill like anything like that that might have caused your cough? 

Patient: Yeah, I was just down in a, I went to Haiti on a on a trip for a, for a volunteer program with my school and I don't know I definitely notice there is a lot of people down there coughing. 

Doctor: OK, and were you at all living like close quarters or were you crammed into like like smaller spaces at all when you were there?
Patient: Yeah, we were kind of like living with the locals while we while we were there. It was part of the experience for volunteering. I was there for almost two months as part of, part of my my summer break through University. 

Doctor: OK, and did you notice, uh, at all any potential exposures to tuberculosis? Anyone there that had tuberculosis? Or found out later?
Patient: Yeah, there were definitely some people around that I heard of who who mentioned tuberculosis, but I don't know if anybody specifically who had it. 

Doctor: OK. And the cough that you've been having for the last four weeks at, is it like a wet cough? Are you producing any sputum or phlegm, or is it more of a dry cough?
Patient: Uh, I have been producing some phlegm, um, but it's been just kind of white, yellowish. 

Doctor: Up until this morning?
Patient: Yeah or moreso clear actually, up until today where I saw some blood. 

Doctor: OK. And how much blood was in the phlegm? Was it like a significant amount it filled the whole production or just little streaks?
Patient: Um it was pretty red. It, ah, yeah it was bright red and it was covering the, the issue. 

Doctor: OK and have you had any similar episodes before?
Patient: I've never brought up blood before. 

Doctor: And after this morning, was that the only time you had that or did you did it recur at all? 

Patient: Um, it was just that time just this morning on the tissue and then a little bit in the toilet and it looked like a lot in the in the water. 

Doctor: OK, I see and how often are you coughing in like an average day? Are you coughing throughout the day or does it come and go?
Patient: Uhm, it's been pretty severe through throughout the day. I've been just coughing or coughing a ton. 

Doctor: OK, anything that makes your coughing go away or makes it worse at all? 

Patient: Not-nothing seems to help. I've tried various over the counter medications and and stuff for, for cough and nothing has seemed to help it. 

Doctor: OK, and are you having any other symptoms at all, like shortness of breath, sore throat, runny nose, anything like that?
Patient: Uhm, nothing like like that. I mean the back of my throat, might feel a little itchy from the coughing, but not really sure. 

Doctor: OK. Are you having any headaches or nausea or vomiting?
Patient: Nothing like, well, a little bit of nausea maybe, but no vomiting. 

Doctor: OK. How often you getting nausea? 

Patient: Uh, it's coming after like if I'm having a really big cough, coughing fit I could feel a little nauseous after but it doesn't last very long. 

Doctor: OK, are you having any fevers or chills?
Patient: Yeah, I've been having ah, so fevers throughout the day, but feeling really hot, and and really sweaty at night. 

Doctor: OK, how often are you getting night sweats? 

Patient: Uhm, also a few times this past week, I've what woke up soaked. 

Doctor: OK. And have you at all measured when you felt, measured your temperature when you felt like these chills and night sweats?
Patient: No, I haven't measured my temperature yet. 

Doctor: OK. Have you noticed at all, uh, any increased fatigue throughout the day?
Patient: Yeah, but I've definitely been more more tired. I haven't been able to concentrate on, umm, on my schoolwork. 

Doctor: OK. And, um, have you been having any shortness of breath?
Patient: Just after the, like coughing really, but otherwise, ah, no. 

Doctor: Any chest pain? 

Patient: No chest pain. 

Doctor: Any feeling that your heart is racing?
Patient: No, nothing like that. 

Doctor: OK, any swelling in your limbs at all? 

Patient: No. 

Doctor: Ok. Any loss of sense of taste or smell?
Patient: Uh, no, nothing like that. 

Doctor: OK, any changes in your bowel movements?
Patient: Um, no. 

Doctor: OK, any changes in your urination?
Patient: No. 

Doctor: OK, any changes at all in your sleep?
Patient: Uhm, just been, well, I haven't been sleeping as well, waking up all sweaty and the cough is kept me up a little bit too. 

Doctor: OK, any changes in your appetite?
Patient: Uh, no, I've been eating OK. 

Doctor: Have you noticed at all any weight loss over the last few months?
Patient: Yeah, I think I'm down like 15 pounds since the summer time, which is great. 

Doctor: OK, have you tried to lose weight at all or is it just been completely unintentional? 

Patient: Uh, well I, I mean my, my appendix was taken out a few months ago and so I guess after that I, well, maybe wasn't eating and eating as much, but I mean I wasn't really trying to lose weight. 

Doctor: OK, and have you had any recent exposure to any fumes or dust or animals?
Patient: Uh, no, my my parents have a dog at home, but I've been away at school, so. 

Doctor: OK. OK, uh, in terms of your overall health, have you been diagnosed with any medical conditions before? 

Patient: Uh, no, I'm uh, healthy. 

Doctor: So like no asthma or anything like that?
Patient: No, nothing like that. 

Doctor: OK, are you on any medications currently?
Patient: Uh. Yeah, I take an oral contraceptive pill. 

Doctor: OK um, and when did you start that?
Patient: Probably about five years ago. 

Doctor: OK. Do you have any allergies, to any medications or any environmental allergies at all?
Patient: Uh, yeah, I think Septra, gives me a rash. 

Doctor: OK. Um, any previous hospitalizations?
Patient: No, I've never been in the hospital before. 

Doctor: OK, any previous surgery? So you said you had the appendix removed but anything else?
Patient: Uh, no the appendix was the only thing. 

Doctor: OK. Any family history of asthma or any lung conditions? Any cancers that run in the family?
Patient: Um, yeah but well, my grandfather had lung cancer, but he smoked for his entire life. And my mom has had diabetes for quite some time, but no, no lung problems. 

Doctor: OK, any heart attacks in the family or any autoimmune conditions?
Patient: No. 

Doctor: OK, and currently what is your living situation like? 

Patient: So I live with uh, four roommates here going to school. 

Doctor: OK, and so do you work right now or you just a student right now?
Patient: Just a student. 

Doctor: OK. And currently do you smoke? 

Patient: Uhm, I'mm smoke maybe maybe socially so, maybe a pack of cigarettes a week at the at the most. 

Doctor: OK. And any recreational drug use like marijuana?
Patient: Uh, yeah I'll smoke one or two joints on on the weekend with friends socially. 

Doctor: OK yeah, so yeah. This uh, the smoking marijuana or cigarettes make your symptoms worse at all? 

Patient: Uhm, it depends. Yeah, sometimes I can. It can bring on some more coughing. 

Doctor: Yeah, so yeah, we always recommend cutting down or quitting smoking whenever, whenever we see patients who are smoking, especially like, you're fairly young. And you know your grandfather had history of lung cancer with smoking throughout the year. So as early as we can quit smoking, the better for the long term health of your lungs, but whenever you're thinking of quitting, or if you want any more resources about quitting, just let me know. We can set up a separate appointment for that.
Patient: OK, that that sounds good. Yeah, maybe maybe next appointment we can talk about that. 

Doctor: OK, sounds good. Um. Any, uh, so no recreational, so just besides marijuana. Any other recreational drugs like cocaine or crystal meth, anything of that sort? 

Patient: Ah, no. Well, sometimes I at parties maybe a few times a year with friends will use ecstasy or something like that, but that's only a few times a year. 

Doctor: OK. Uh, and any alcohol?
Patient: Yeah, I'll have a few drinks on the weekend with with friends usually. Like rum or beer. 

Doctor: OK. Yeah, so this is all the questions I had for you today. Any, any questions or concerns or any ideas of what you think this might be? 

Patient: Uhm, I don't know. I'm really concerned about the the blood that I brought up like I mean is this cancer or, uh, uh tuberculosis like one of those tuberculosis infections that I heard about while I was away? 

Doctor: Yeah, so definitely, a cancer is pretty unlikely because you're fairly young and you've just recently started smoking, but one of the things that we're concerned about is your recent travel history being in close quarters. So definitely we need to get a chest X-Ray and we can even do a sputum culture to test for tuberculosis. And then based on the results, we might have to start you on like a whole antibiotic regiment if it does come back as tuberculosis. Yeah, we'll, we'll, we'll get those investigations done first and then we'll go from there.
Patient: OK, thank you. 

Doctor: We'll also get some blood work done as well, so that'll be done before your next appointment. 

Patient: Alright, that sounds good. Thank you. 

Doctor: You're welcome.
Patient: Uh yeah, hi, I just came in here today cause uh, lately, for the last couple of months, I've been getting these coughing fits. They don't really seem to be going away and I was a bit concerned. 

Doctor: So you've had this, when did this start?
Patient: Uh, I would say probably during the winter uh it, it kind of started, where I started having um, just coughing fits when I'm walking to school and then also during like gym class I started having these coughing fits and sometimes I also felt like I couldn't breathe. 

Doctor: Um, okay. Okay, what did you, is there anything, so it's basically worse when you're um, doing some sort of an exercise such as walking um, or being in the gym class, and it's also worse in the cold?
Patient: Yeah. Yeah, and then also like, I remember when I was walking down the street and someone was smoking and then I just completely just started having that episode right after I walked past them. 

Doctor: Okay um, alright. Uh um okay, sorry, one moment. Okay um, so is there anything that makes your cough better? What do you do to make it go away? 

Patient: Uh, I just basically have to, if I, if I'm doing any kind of activities, just take a moment, sit down for like 10 to 15 minutes and then it seems like it goes away on its own. 

Doctor: And you said that sometimes you also have difficulties breathing with it?
Patient: Yeah, like a couple of times it got really bad where I had to um like, it was difficult get, it was, it was like I was trying to take deep breaths for air, but uh it was, it just felt like I couldn't. 

Doctor: I see. So this started a couple of months ago, has this ever happened to you before that?
Patient: No, before that I've been fine. 

Doctor: Okay, and so I'm going to ask you about a couple other symptoms. Let me know if you've experienced any of these in the past couple of months. Um, so have you had a headache that accompanies the cough? 

Patient: Uh no. 

Doctor: Um, any changes in your vision or your hearing?
Patient: No. 

Doctor: Any confusion? 

Patient: No. 

Doctor: Um any, um, runny nose or stuffy nose or sinus congestion?
Patient: Uh no, not really. 

Doctor: Okay, any sore throat? 

Patient: Uh no. 

Doctor: Any um, chest pain?
Patient: Um, sometimes when I get like really bad coughing fits, like it sometimes starts hurting in my chest as well. 

Doctor: Yeah. Um, does it go away when you stop coughing? 

Patient: Yeah, it goes away after, I just take some rest. 

Doctor: Um, have you had any belly pain?
Patient: Uh no, not at all. 

Doctor: Do you feel like your heart's racing? 

Patient: Uh, no. 

Doctor: Any changes in your, any nausea or vomiting?
Patient: No. 

Doctor: Any acid reflux? 

Patient: Uh, no. 

Doctor: Okay, um, and any certain muscle aches or joint pains?
Patient: Um no, nothing like that. 

Doctor: Any numbness or tingling in your arms or legs?
Patient: No. 

Doctor: Okay, let's get back. Okay, great, it sounds like that the, the cough is sort of the main symptom here that you have. Um, is the cough dry or wet?
Patient: It's usually uh, it's usually dry. 

Doctor: Uh sorry, can you say that again? 

Patient: It's usually dry. 

Doctor: Okay um, have you ever brought up any sputum or any blood?
Patient: Uh never any blood, I have like on occasion, like sometimes brought up some sputum. 

Doctor: Okay, alright. Um okay, and, uh, have you been vaccinated?
Patient: Uh, yeah, all my immunizations are up to date. 

Doctor: Okay, good good good. Um, does the cough sound like a barky cough or a muffled cough, or um, does it have a specific characteristic? Does it sound different than when you're sort of coughing to clear your throat, for instance? 

Patient: Uh yeah, it's like pretty, it can get pretty harsh. I also noticed like uh, there's like this weird noise I started making like right after when I'm trying to take deep breaths in. 

Doctor: Okay, okay. Okay, so you're wheezing. Okay, so you ever um, cough so much that you end up vomiting?
Patient: No, no that hasn't happen yet. 

Doctor: Um, and do you, so you mentioned that it's worse when you're in the cold or exercising, and smoking makes it worse? What about things like dust or pollen? Um, say when you're cleaning the house and there's also dust, does that make things worse, or is it worse in a specific time of the year when you're outdoors? 

Patient: Uh, now that you mention it, yeah, like if we're ever in the basement or anything like that, I, I do start getting like kind of irritation um, in my throat, and that kind of, sometimes I have also coughed at those times. 

Doctor: Alright. Uh, can you tell me, okay so, can you tell me if you have any medical conditions that you've been diagnosed with?
Patient: No, nothing else, I've been pretty healthy. 

Doctor: Okay. Had, did, when you were a child, did you have any sort of rash? Did you have eczema? 

Patient: Oh I, yeah, so I did I, at one point I was using like this cream um, probably when I was ten. Just for some eczema on my hands. 

Doctor: Okay. And um, have you ever had allergic rhinitis, which is basically sort of having um, red or teary eyes, itchiness on the face, a runny nose at certain times of the year, or in um, areas with mold or dust, or termites and things like that? Have you had anything like that as a child or right now?
Patient: Uh, not that I know of, no. 

Doctor: Okay. Alright, uh do you have any, um, I guess going back, were you a healthy child, growing up?
Patient: Yeah, as far as I know, I, I didn't really have any concerns from like the school or home at all. 

Doctor: Okay, that's great. Do you uh, did you ever have any hospitalizations?
Patient: No. 

Doctor: Any surgeries? 

Patient: No. 

Doctor: Are you taking any medications?
Patient: Uh, no medications. 

Doctor: Are you still using the eczema cream? 

Patient: No, no. That kind of just went away on its own, or like right after I used the cream. Like it's good now. 

Doctor: Okay, good. Are you allergic to anything?
Patient: No, I don't think so. Maybe just like environmental allergies sometimes, in the springtime. 

Doctor: What happens then?
Patient: Um, just sometimes like uh, I don't know if it's like a pollen allergy like I, I do get some, I guess I do get like some nasal congestion and things like that. 

Doctor: Um, have you ever seen an allergist? 

Patient: No, I haven't. 

Doctor: No. Uh, who prescribed the cream for the eczema?
Patient: Um, just a, it was like at a walk-in clinic. 

Doctor: Okay, okay. Um alright, and do you have any family history of any um, lung-related problems? Or any other problems?
Patient: Um, my older sister has asthma, and uh, I don't know if anyone else in the family has asthma. Um, I think my father has high blood pressure. 

Doctor: Alright, and you mentioned that things are going well at school. Um, who do you live with at home?
Patient: Yeah so I live with my older sister, and my mom and dad. 

Doctor: Okay, okay. And things are good at home? Do you feel safe?
Patient: Yeah, yeah, I feel completely safe. 

Doctor: Any concerns about bullying at school?
Patient: No, no, not at all. 

Doctor: Okay are you uh, are you taking any marijuana or any street drugs?
Patient: No, no, my parents would kill me. 

Doctor: What about alcohol? 

Patient: Uh, I'll come, I've, I haven't tried it um, yet, at all. 

Doctor: Okay, okay. Just wanted to mention that the conversation that we're having right now is confidential between you and me. Um, unless you mentioned anything that harms you or harms anyone else so, so feel free to discuss whatever or talk openly about um, any issues that you have. Um, okay, and um, are you sexually active?
Patient: No, no. 

Doctor: Alright, okay. So um, that's all the information I needed. Uh given that you've had these coughing fits for the past couple of months that are, that have certain triggers, uh, and also given that you've had a history of eczema, and your sister has asthma, so kind of, sort of runs in your family in a way. You might also have a diagnosis of asthma potentially. Um, and so, what I would recommend is that you get um, testing done and um, uh I guess before I sort of talk a little more about this, I just want to get a sense of how severe your asthma, if it's asthma at all, um if, does it, does it affect your ability to, you said school was going okay, does it affect your ability to do well at school at all?
Patient: Um definitely in, in gym class, but other than that it hasn't really affected me. 

Doctor: Does it wake you up at night?
Patient: No, so far no. I, I like, I get pretty good sleep. 

Doctor: Okay, okay. Um, and how often, I guess is, do these episodes occur? How many times a week, or how many times a month? 

Patient: Uh, so they just started like two months ago, and I've had like maybe four or five of them in total. 

Doctor: Okay, okay. Uh, and they kind of get better on their own. Okay, so we can sort of talk about these, sorry, puffers that you might need to, to use as needed. Um, your sister might have some of those, so you might be familiar with what I'm talking about.
Patient: Hi, so yeah, so I just came in here today at I've been having just this congestion around my nose and face like it's just something that just started an around 5 days ago. And it's been getting worse, but I started to get like these headaches as well as just pain around my cheeks. 

Doctor: OK. It all started about five days ago. OK alright. Have you, can you tell me about your headaches?
Patient: Yeah, so there, I started getting these headaches just two days ago, but like it's more than a headache, it's kind of mainly over the cheeks and then it goes and just above the nose 

Doctor: I see. 

Patient: The light kind of up into the forehead. 

Doctor: Yeah, do you feel like it's worse when you're bending down or squatting?
Patient: How I'm not sure, actually. 

Doctor: OK. Alright, and do you have any other symptoms? Do you have a runny nose or sore throat or cough?
Patient: Uhm, I don't have a cough. I don't have a sore throat. I do sometimes get a runny nose though like every every now and then. 

Doctor: OK. In the past five days?
Patient: Yeah, I probably had like, it's usually in the morning I sometimes get a runny nose. 

Doctor: And what what comes out of your nose? What do you see? 

Patient: Uhm, over the last week it's kind of like almost like a yellowish discharge. 

Doctor: Have you had any difficulties breathing?
Patient: Uhm no, I I don't, no. 

Doctor: Like that OK. Have you uhm had any chest pain? 

Patient: No. 

Doctor: OK. Uhm any other any other symptoms that you've experienced over the past five days?
Patient: I also like I. I do also feel like a fullness and pressure going into my ears as well. And then I'm not sure, but yesterday I was feeling a little warm throughout the day. I didn't get a temperature but I don't know if I had a fever or not. 

Doctor: Have you had any I guess like weight loss or any night sweats?
Patient: No. 

Doctor: No. OK. Any muscle aches?
Patient: No, not that I know. 

Doctor: Any fatigue or malaise?
Patient: I have been feeling a bit tired over the last few days, but I'm I don't know if that's because of this. 

Doctor: Have you had contact with anyone who could be sick in the past week or two? 

Patient: Uhm, my my daughter actually had a sore throat, just a, her last week, and she went to see a doctor. 

Doctor: Uhm, do you know if she had a COVID test done?
Patient: Oh yeah, she she did have a COVID test done, that was negative. 

Doctor: OK, and alright, are you, do you have any medical conditions that you've been diagnosed with?
Patient: Uh, I just have a high cholesterol and high blood pressure. 

Doctor: Do you take medications? 

Patient: Yeah, so I just take umm, it's like a thiazide diuretic for blood pressure and then just Atorvastatin for cholesterol. 

Doctor: Any allergies?
Patient: Uh, no, no allergies. 

Doctor: Any medical conditions that run in the family, including any heart conditions or lung conditions or cancers? 

Patient: Uhm, yeah, so hard conditions, both my dad and uncle have had heart attacks in their 50s. But yeah, that's that's it. That's all, that's all that I know and we also have cancer on my mothers side. My uncle from my mothers side had bladder cancer. 

Doctor: OK. OK. Uhm, and do you you mentioned that you have a daughter. Do you, who do you currently live with?
Patient: I live with my two daughters and my wife. 

Doctor: OK, and what do you do for, do you work? 

Patient: Yeah, currently I'm working from home. I'm an accounting clerk. 

Doctor: Alright, and do you smoke at all or did you smoke in the past?
Patient: Yeah, I I, I do smoke but I've cut down significantly in the past few years. I currently only smoke, uh, probably two or three cigarettes a day. I was, I was smoking like almost a pack a day a few years back. 

Doctor: Oh, that's great. It's great that you're trying to cut down. Do you intend on getting the getting down the smoking even further? 

Patient: Yeah, that's that's the plan. If I can do that, hopefully by the end of this year, that would be great. 

Doctor: That's wonderful. Do you smoke marijuana at all?
Patient: No. 

Doctor: Uh, do you smoke any recreational drugs?
Patient: No. 

Doctor: Any alcohol?
Patient: Alcohol, just, uh, probably just on the weekends or have a couple of beers. 

Doctor: OK alright, uhm. So, I guess from the symptoms that you've described, it sounds like you likely have a condition called acute rhinosinusitis where you have inflammation of the sinuses in your face and potentially some inflammation in your nose as well, and often it's caused by a virus and it usually gets better in a couple of weeks. And the best thing to do is just conservative management. Try to rest and, if, if you know taking any medications, over the counter medications is helping you feel better, if you feel like Tylenol, sort of reducing some of that pressure or if doing a, taking a steam bath is sort of helping relieve that pressure, try those. Drink a lot of water to try to sort of lear out all that mucus that's that's building up. I'll also do a physical exam and talk to my attending and confirm all this information with him and we can go from there. 

Patient: Great sounds good, thank you.  DOCTOR: Uhm, also sorry before for in the call because the symptoms are started recently and they do uhm, overlap with some of the symptoms that if  with COVID might have, it might be a good idea to get a COVID swab done as well, so we'll do that today and you would have to quarantine and stay away from the people at your home as well, until the results are out, and then if it's positive, public health will let you know what to do.  Alright, sounds good. Thank you so much. 

Doctor: Welcome.
Patient: I'm doing OK. Thank you. How are you? 

Doctor: I'm well thanks. What brings you in today? 

Patient: So, usually we go to my favorite pizza spot for lunch and these last couple of days I've noticed I just can't taste it. 

Doctor: OK, when you say the past couple of days, do you mean two days, three days, four days?
Patient: I would say the last two days, yeah, just yesterday and today. 

Doctor: OK, so loss of taste, so you can't taste anything or you can only taste some things or you're just not getting the full depth of your taste? 

Patient: Yeah, I really noticed it with the pizza, but with like other things too, it's just a yeah, really plain, it doesn't  really have any flavor with the food that I'm eating. 

Doctor: OK, so it kind of tastes like cardboard.
Patient: Yeah, kind of, and I think, like, I mean part of that is that I maybe not smelling it as well either. 

Doctor: Yeah, OK. Umm, did you have any trauma to the area like the mouth area or the nose area in the past couple of days or days leading up to that? 

Patient: Umm, no, not at all, no. 

Doctor: OK and do you have a fever at all?
Patient: Umm, I don't think so no. 

Doctor: OK, you have a cough?
Patient: Yeah, I've had a cough. 

Doctor: OK, a similar timeline? 

Patient: Yeah, that's when the cough started, maybe three or four days ago. 

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

Doctor: OK, so no sputum, no blood? 

Patient: No sputum and and no blood. 

Doctor: And do you feel wheezy at all?
Patient: No wheeziness. 

Doctor: How about shortness of breath?
Patient: Umm, maybe after coughing, I've had a hard time catching my breath. 

Doctor: OK, sure, yeah. And how about any fatigue? Do you feel like you're more tired than usual?
Patient: Yeah, these past few days I have definitely. I felt more tired, I've been sleeping a lot more throughout the day and just I don't know, kind of lazy. 

Doctor: Yeah, and I know you mentioned you're having a hard time tasting. How about your appetite though? Do you feel like you've lost appetite?
Patient: I think appetite's been OK. I've been hungry. 

Doctor: Yeah, OK umm, how about muscle aches?
Patient: Umm, no, just tired. 

Doctor: OK and chest pain?
Patient: No chest pain. 

Doctor: Alright, do you have a feeling like your heart's racing?
Patient: No, nothing like that. 

Doctor: OK, any changes in your bowel movements? 

Patient: Umm, yeah, well, I had diarrhea this morning actually. 

Doctor: OK, so some diarrhea this morning.
Patient: None before that though. It was just the one or kind of two times, but it hasn't happened since then. 

Doctor: OK, no constipation?
Patient: No. 

Doctor: No blood in your stool?
Patient: I know I didn't see anything red. 

Doctor: OK, how about your stool seeming like it's very dark? Almost to the point where it looks black?
Patient: Oh no, it it wasn't dark like that. 

Doctor: OK, good, any abdominal pain? 

Patient: No. 

Doctor: Any issues swallowing food?
Patient: Umm, no issues swallowing food. My throat has felt a bit itchy. I mean I've been coughing alot. 

Doctor: Does it feel sore as well?
Patient: Not really or just kind of yeah, kind of scratchy. 

Doctor: OK, have you had a runny nose or a blocked nose? 

Patient: Umm, not really. 

Doctor: No, OK, any rashes?
Patient: Umm, no. I haven't noticed any rashes. 

Doctor: OK, and are things normal with your urine?
Patient: Yeah they are. 

Doctor: How about dizziness or fainting spells? 

Patient: Umm, a little bit dizzy I when I got out of bed this morning, but we sat back down for a couple of minutes. I felt better. 

Doctor: OK, good good. Do you think that this morning you were dizzy because you were dehydrated? Or is this like a normal thing for you?
Patient: I mean, I guess I could have been dehydrated. I didn't even think of that, but I mean, since the food didn't taste so great, I don't know. I probably didn't eat as much yesterday or the last couple of days. Maybe I haven't eaten as much. 

Doctor: OK, Yep. OK, do you feel weak?
Patient: I don't know, maybe. Maybe a little weak, but umm, just way more tired. 

Doctor: OK, any confusion or memory loss?
Patient: Umm, no, I have been able to do some of my school work. 

Doctor: OK, good. And you mentioned no rashes, right?
Patient: No rash. 

Doctor: OK, any weight loss over the past couple of months? 

Patient: Nothing like that. No weight change, it's been the same. 

Doctor: OK, how about umm night sweats or chills?
Patient: I felt a bit, umm, hot but not sweaty, just hot. 

Doctor: OK, so kind of like you have a fever?
Patient: Yeah, I guess so, maybe. 

Doctor: Sure any muscle aches?
Patient: Umm, no muscle aches. 

Doctor: Have you been around anyone who's been sick recently? 

Patient: Yeah there is this guy in my class who was sick in class last week. 

Doctor: What kind of symptoms did he have?
Patient: Well, he had a cough and fever. Yeah, I think he had a cough and a fever and somebody said that. Maybe a sore throat or something like that. 

Doctor: OK, so yeah, some symptoms overlap with yours I guess. Have you traveled anywhere recently? 

Patient: Oh no, I've been at home. We just started back at going in person to school again. 

Doctor: OK, that's good. And are you otherwise healthy?
Patient: Yeah, I haven't been diagnosed with any medical conditions in the past. 

Doctor: Oh good, OK. And do you have any allergies? 

Patient: Possibly cats but we don't have any pets at home. 

Doctor: OK, good have you been around cats recently?
Patient: No. 

Doctor: OK and then any hospitalizations or surgeries in the past?
Patient: I did have my appendix taken out like 4 four years ago. Yeah, at the beginning of high school, but that was the only surgeryand everything went well. 

Doctor: OK, are you up to date with all your immunizations?
Patient: I am, yeah. I have my immunization card here actually. 

Doctor: OK, good. Any family history of lung conditions or heart conditions that you know of? 

Patient: I know my grandfather had lung cancer, but he smoked his whole life also. Also diabetes but don't know if he had any heart problems though. 

Doctor: OK, I'm sorry I forgot to ask you, are you on any medications?
Patient: Umm, I'm not. 

Doctor: OK, and do you smoke? 

Patient: Umm, I don't. 

Doctor: OK, how about marijuana?
Patient: Uh, no. Oh, but I guess I use a vape every once in a while.. 

Doctor: With like marijuana? 

Patient: No, it's like those flavored ones. 

Doctor: Oh OK, yeah. How often do you use that?
Patient: It's like a few times a day. 

Doctor: OK, and is there any tobacco in there or nicotine? 

Patient: I think there might be, but umm, I don't know. I usually just buy the flavored ones. 

Doctor: OK, well, you should probably look into if it has tobacco or nicotine, because neither of those are good for your health. And so we can, you know, have a discussion later on trying to cut down or quitting completely if you are open to that.
Patient: Yeah, sure. 

Doctor: I'll just continue on asking you some other questions. Do you drink alcohol?
Patient: Umm, no. 

Doctor: And who do you live with? 

Patient: I live with my mom, my step dad, and then my younger sister. 

Doctor: OK, do you guys live in a house?
Patient: We live in a townhouse. 

Doctor: OK, in the city you said? 

Patient: Yeah, yeah, I live close. I go to high school not too far from here. 

Doctor: Oh, that's nice. And any concerns with the living arrangements in terms of you know, like it being an old building, old carpets, mold, anything like that?
Patient: No, I live in a nice place. It's usually like really clean. 

Doctor: OK, good, umm alright, so those are all the questions I had for you. Did you have any questions or any concerns that you wanted to bring up?
Patient: I guess the only thing that I was concerned about was possibly having COVID. 

Doctor: Yeah, you know, that's probably top on my list of things to investigate you for, so I would say COVID or other viral illnesses that could be going around this time of year. That would have less of a similar presentation, and so we will do a COVID swab for you. And in the meantime, if you could isolate for 14 days, regardless of whether the swab comes back positive or negative, and that would be great. If the swab comes back positive, we will notify public health and they'll try to trace where you could have caught this from and if it turns out it's not a viral illness, we will try to work you up for any bacterial infections which can be treated with antibiotics. So that's where we will start, does that sound good?
Patient: Yeah, that makes sense. 

Doctor: OK great, well have a great day.
Patient: Umm, yeah so I just came in today with, I've been having a few symptoms for the last I would say 5 days. So I've had, it started with a sore throat just five days ago, kind of just very irritating sore throat sensation that's kind of gotten worse over the last few days. And then I started getting a fever four days ago and it has been going on for the last couple of days as well. And the highest temperature I measured on myself was 38.8 degrees Celsius and yeah, so that, that's, that's my main concern right now. 

Doctor: OK and, since the sore throat started 5 days ago has it been getting better, worse or staying the same?
Patient: I would say it's getting worse. I have some pain with swallowing food as well as, like now, even when I'm talking a little, I'm getting some pain as well. 

Doctor: OK, have you been able to maintain your appetite?
Patient: I do feel like I've lost a bit of my appetite over the last three to four days. 

Doctor: OK, and have you noticed any changes to your voice?
Patient: Uhm, I don't think so, not yet, I, but I think, like the way it's hurting right now, I feel like it's coming. 

Doctor: Alright, so have you notice any like neck swelling? 

Patient: Yeah, now that you mention it, I, I do have like these two lumps on the right side of my neck, like kind of right below the jaw. 

Doctor: OK. Are they painful?
Patient: Uhm, not, not really. Like when I'm pressing on them they don't really hurt, but I definitely have two lumps. 

Doctor: I see, OK. We'll, certainly look into that on the physical exam. OK, and uh, and you mentioned that you've also been really tired over these last few days?
Patient: Yeah, I've, I haven't really had much of an appetite, kind of just, I've skipped work, just trying to take it easy like just napping the whole day, as much as I can. 

Doctor: OK, and so you've been experiencing fatigue. Have you had any, any headaches?
Patient: No headaches, no. 

Doctor: Alright, how about any eye redness or runny nose, or? 

Patient: Uh no, no runny nose, or, so I, I don't have headaches, but I, I, I think I was having some body aches just yesterday. 

Doctor: OK, so any particular area that, that's aching?
Patient: Uhm, not really. It's kind of just like a general, like I don't know if it was, it was because I was lying around the whole day, but just kind of a general pain throughout the body. 

Doctor: OK. And have you been experiencing any difficulties, or sorry, have you been experiencing any cough?
Patient: No, not really. 

Doctor: OK, how about any shortness of breath or trouble breathing?
Patient: No. 

Doctor: OK, have you had any wheezing?
Patient: No wheezing. 

Doctor: Alright, and how about any chest pain? 

Patient: No, no, no chest pain. 

Doctor: Have you had any heart palpitations or, or feeling like your heart's racing?
Patient: No. 

Doctor: OK, uhm, and, maybe you had any lightheadedness or, or dizziness? 

Patient: Uh, no, not really. 

Doctor: Have you had any abdominal pain?
Patient: Uhm, actually, yeah, yesterday when I was, uhm, like when I was having the body pain, I also noticed a little bit of abdominal pain just, like on the upper, I would say upper left side. 

Doctor: OK, and, and how would you describe this pain and how long has it been going on for? 

Patient: Just since yesterday. It's, it's not really like, I would say it's more of a discomfort than a pain, but I definitely do feel like like something's just not right in that area. 

Doctor: I see, is there anything that you do that, that makes that, that feeling worse, or make, that make it better?
Patient: Yeah, like I, I try not to lie on that side. I have to go on to the other side. 

Doctor: Alright, did you notice this in the last couple of days as well? 

Patient: Yeah, that, that just started yesterday. 

Doctor: OK. Have you had any nausea or vomiting?
Patient: No. 

Doctor: How about any diarrhea? 

Patient: No. 

Doctor: Alright, and have you had any fevers or, or sorry, yeah, you mentioned you had a fever of 38.2. And have you had any chills?
Patient: Uhm, no chills, well, yeah, I would say a couple nights ago I might have had some chills, but mainly it's just been, I've been feeling more hot and I have been kind of getting like night sweats. 

Doctor: OK, you've been having night sweats this week or have they been going on longer? 

Patient: No, just, just this week. 

Doctor: Alright, have you had any changes to your weight over the last several months?
Patient: No, it's been pretty steady. 

Doctor: Alright, and the fever this week, has it been there the whole time, or has it come and gone? 

Patient: It kind of comes and goes. I've probably taken temperatures like every day. But I would say it's definitely, for the last few days it's been more of a fever, like the nightsweats sensation. Before it was a bit fine, like, but the highest temperatures have been in the last few days. 

Doctor: OK, have you noticed any skin changes or rashes?
Patient: Uhm, just like, I, I don't know, like I don't think there are any changes, but I did notice some, like kind of just pink, pink spots on my arm the other day. 

Doctor: OK, well uh, were they itchy?
Patient: No, they weren't really itchy. Just like a couple I would say like raised, not raised spots, just like flat, kind of pinkish spots. 

Doctor: OK, and has that, has that spread anywhere or has it gone away? 

Patient: No, hasn't really started spreading yet, I just noticed it on, on my arm, and I, I don't think it has really spread at all. 

Doctor: OK, this is on, on one arm?
Patient: Yeah. 

Doctor: OK. And you've had some body aches, uh, have you had any joint pains?
Patient: No join pains, no. 

Doctor: OK, and are you currently sexually active? 

Patient: Yes. 

Doctor: Alright, and could you tell me a little bit about your partners or, or partner and I, and I was wondering if you use condoms?
Patient: Yeah, so I, I just have one partner right now, my fiance, and we Uh, I actually like have in an IUD, so like we, we don't use condoms, but like we're pretty honest and safe with each other. I fully trust him, like he doesn't have any partners or anything like that and I only have, I don't have any other partners as well. 

Doctor: OK, have you had a sexually transmitted infection before?
Patient: No, never. 

Doctor: OK, any concerns currently? Any vaginal discharge or itchiness or, or pain? 

Patient: No, nothing like that. 

Doctor: OK, and have you been pregnant before?
Patient: No, I haven't no. 

Doctor: OK. And have you been diagnosed with any medical conditions before?
Patient: Uhm, just uh, I have had just eczema in the past, but that, that's fairly stable. It's been treated, I don't really have it anymore. 

Doctor: OK, do you take any medications regularly?
Patient: Currently, no, no. 

Doctor: Any allergies to medications?
Patient: No. 

Doctor: Alright, uhm, and any hospitalizations or surgeries in the past?
Patient: No. 

Doctor: OK. And could you tell me a little bit about your living situation currently, like, who you live with, and, and where?
Patient: Yeah, so I'm just living with my fiance and that's, we're living in like a small apartment. And right now we're not really seeing anyone else really during the pandemic. 

Doctor: OK, so have you been around anybody who's been sick? 

Patient: I just had to go into work like one day last week just to grab some of my stuff, but didn't really come into contact with anyone. My fiance does go to his work like a couple, like three or four times during the week, so I don't know if he got into contact with anyone, It's, it's hard to say. 

Doctor: Has he been sick at all? Like any, any cough, sore throat, anything, like that?
Patient: He did have a sore throat last week, but it kind of just went away on its own in a couple of days and compared to me, like, his was nothing really. 

Doctor: OK, uh. And have you traveled anywhere? 

Patient: No. 

Doctor: And do you smoke cigarettes?
Patient: No. 

Doctor: How about do you smoke marijuana or use any cannabis products?
Patient: Uh, probably smoke marijuana, just maybe once or twice a month. 

Doctor: OK, so it sounds like socially? 

Patient: Yeah. 

Doctor: Do you use any other recreational drugs?
Patient: No, nothing else. 

Doctor: OK. And do you drink alcohol? 

Patient: Yeah, I, Probably have some red wine every other day, I would say. 

Doctor: OK, and this is like one glass or two?
Patient: Yeah, no, It's just like a normal glass of wine. Maybe, like we probably go through like a bottle between both of us, like every two weeks, maybe. 

Doctor: OK. And in the family, has there been anybody who's had any cancers? 

Patient: No, no, no cancer is in the family. 

Doctor: OK, how about any genetic diseases or anything congenital that runs in the family?
Patient: Not that I know of. 

Doctor: OK. So that was everything that I wanted to ask about on history, and so next we'll go ahead and get vitals and do a physical exam. But did you have anything else that maybe I forgot to ask about, or any other symptoms maybe?
Patient: No, I don't think so. Do you think it can be covid at all? 

Doctor: Uhm, so covid does present in a variety of non specific ways and so it certainly could be on the differential for causing a sore throat and abdominal pain and as well as a fever. However, it could be caused by other things as well. Uhm, currently your constellation of symptoms, with the enlarged lymph nodes in the neck, sore throat, it sounds like you may have uhm, an inflamed spleen as well, which could all be signs and symptoms of something called EBV or, or mono. And it sounds like you might have had an exposure, like your husband or fiance rather may have had this last week with the sore throat. All that being said, today we'll do the monospot test to check for that as well as some blood work. And we will do a covid swab as well, just in case.
Patient: Thats great, thank you. 

Doctor: Awesome OK. It says here that you have been having a sore throat. Can you tell me a little bit more about that?
Patient: Sure, yeah the sore throat it started about four days ago. And it's really it's it's very sore. I can drink fluids OK but I'm even having some issues swallowing food. 

Doctor: OK, so you said four days ago? 

Patient: Yes, four days ago. 

Doctor: OK. So it's been kind of sore, some issues swallowing food OK, and over the last four days has it gotten worse, Better that it stayed the same?
Patient: Um the sore throat has it's got, it's getting worse for sure. 

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

Patient: I I, I guess when I was younger I had mono. And I had a sore throat when I had that, yeah. 

Doctor: OK, is there anything that makes it worse or like anything that makes it feel better right now?
Patient: No, not really. I've tried, you know, I've tried gargling with salt water. I've tried some painkillers like nothing, nothing seems to be working. 

Doctor: Uhm OK, and you said you've also had some difficulty breathing. 

Patient: Yeah, that's right. 

Doctor: Did that start around the same time?
Patient: That actually started yesterday, and it's gotten me very concerned. 

Doctor: OK. Yeah, I can understand how that would be concerning. We're definitely going to try to get to the bottom of it today. Um OK so started yesterday, said then has it gotten any worse? Is it the same way better? 

Patient: Um the, well, I guess it's getting worse, yeah. 

Doctor: Do you feel like it's all the time or is it on and off?
Patient: It's it's just there all the time. 

Doctor: Have you ever had any difficulty breathing in the past?
Patient: Um no no, no, not like this. 

Doctor: OK. Uh. Have you have you recently been in contact with anyone that's been sick? 

Patient: Um. I have, no. I don't leave the house much nowadays. I go to the grocery store, I go to the bank. Just essential things. 

Doctor: OK, have you traveled recently?
Patient: Um no, no, I haven't left the city for anything. 

Doctor: OK. Do you know if your immunizations are up to date? 

Patient: Ah yes, everything's up to date. 

Doctor: OK. That’s good. See you so I'm just gonna ask you about a few other symptoms. I just like to get an idea if there's anything else you been experiencing. Have you had a cough at all?
Patient: No. 

Doctor: Have you had a runny nose? 

Patient: No runny nose. 

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

Doctor: Have you had any chest pain? 

Patient: Ah nope, no chest pain. 

Doctor: Have you have you lost any of your sense of smell or taste?