jshargo/medical-interview-conversations huggingface dataset:
Patient: Uh no, that I just was wondering if I if you think I I don’t, needed an X Ray or like you think that anything is broken. Kind of like concerned about today, because of this pain. 

Doctor: Yeah. And for sure, um so right now it just to me it sounds like a whiplash injury and so kind of like low impact. But just to be certain, we can order an X Ray to rule out any fractures or dislocations. And in terms of like the management plan, for pain management you can rest, you can either apply heat or cold packs to your neck for 15 minutes every couple of hours or so. You can try some over the counter pain medications like Ibuprofen or Tylenol. And if it still doesn't get better, we can try like, we can try injections to the area to relieve some of that pain, but something else in conjunction we can try as physiotherapy and they'll basically help you with. Range of motion exercises and try to strengthen the muscles in that area and to improve your posture and normal movement. And that's kind of where we can start for now. And if it doesn't get any better, we can talk about alternative management plans, does that sound OK?
Patient: It does, yeah, that that makes sense. Thank you. 

Doctor: OK, yeah, no worries.
Patient: Yeah, so I have like a really sore throat, started last night. 

Doctor: Oh I'm sorry, uh. Can you, can you tell me a little bit more about that? So you, um, you've only had this sore throat for one night? 

Patient: Yeah, I just I think it's getting worse. It's at the back of my throat and it's kind of burning. 

Doctor: Mmm, OK. Do you have um, do you have any other symptoms?
Patient: Um, like I think my voice is kind of like raspy. I feel like I might be losing my voice. 

Doctor: OK, do you, do you have a runny nose? 

Patient: No, not that I've noticed. I said it hurts when I swallow, right. I don't have a runny nose. 

Doctor: No, OK. And do you have any pain in your ears?
Patient: Uh. I haven't noticed no. 

Doctor: Any any sinus headaches, any sort of pain in and around your cheeks or pain in your forehead as you're trying to bend over?
Patient: Uh, no. No headache. 

Doctor: Nothing like that, OK. Have you had any pain in your chest? 

Patient: No. 

Doctor: Any difficulties breathing?
Patient: No. 

Doctor: OK um. Any cough? 

Patient: No. 

Doctor: Alright, so all you've experienced so far is since yesterday evening you've had a sore throat with difficulty swallowing, and hoarse voice. Have you experienced any malaise, or do you feel feverish? Or do you have any chills?
Patient: I definitely feel like really tired. I think I had. I think I had chills like yesterday. And I think when I first got here, they took my temperature and said it was like it was like pretty high. The nurse when I first got here. 

Doctor: I see I see, um. Have you, um. I'm just going to ask you about a couple other symptoms. Just um. Just to rule out some causes. Um, have you had any difficulties breathing?
Patient: No, no, that's OK. 

Doctor: OK, um, you have been, have you had any muscle aches or pains? 

Patient: No, not not that. 

Doctor: OK, have you noticed that your eyes have been more runny, more red? Anything like that?
Patient: No. No, nothing in my eyes. 

Doctor: OK, any pain in your belly? 

Patient: Uh, it's like my whole belly's been like a little like sore or but it's it's pretty much like mild. 

Doctor: When did that start?
Patient: Yeah, just like this morning I don't know. I haven't been eating a lot 'cause it just hurts to eat. I don't know if I'm just hungry. Like I've just been eating like ice cream 'cause it feels nice. 

Doctor: Yeah.
Patient: But I probably shouldn't just eat ice cream. 

Doctor: Ahaha. Um have you have you had any changes in your bowel movements? Any diarrhea, any constipation? 

Patient: Uh, no. 

Doctor: Alright alright, any nausea or vomiting?
Patient: Uh, no vomiting. I feel like my throat. It just feels so like swollen but when I'm trying to talk with makes me feel a little bit nauseated. 

Doctor: Your throat feels swollen, have you have you noticed any changes in, have you found that it's difficult for you to talk? Is your speech slurred?
Patient: Uh, no, it's not slurred. It's just like sore because it's kind of like when I'm swallowing. You know. 

Doctor: Have you noticed any changes in your sense of smell? Do you feel like you can smell less?
Patient: I think that's pretty normal. 

Doctor: OK, what about taste? I know that you're not eating much 'cause you can't swallow, but do you feel like you can taste, your sense of taste is decreased? 

Patient: Uh, uh, no. I think that's good. Yeah, yeah, I think, I mean mostly eating like really cold stuff, but I can taste it all. 

Doctor: Alright alright, um has it ever happened to you before?
Patient: Uh, no. Like I I had a cold like 2 weeks ago, but it wasn't like this though. That was more like runny nose and stuff. 

Doctor: I see. Um, have you done anything recently? Have you had contact with um with anyone who is sick?
Patient: Uh, my my girlfriend said that she was kind of, that her throat was feeling a little sore. I don't think it was as bad as as this but yeah, she said that. 

Doctor: Have you, um, have you been spending time with her recently? 

Patient: I haven't. I haven't seen her in a few days, but yeah, like I saw her I saw her really a few days ago. 

Doctor: OK, OK Um, have you traveled anywhere?
Patient: No, I wish. 

Doctor: Do you feel like you've had any contact with anyone with who might have COVID?
Patient: Oh, I don't. I don't think so. Mostly just to my girlfriend and my roommate right now. 

Doctor: Yeah yea, And do do you, do you know if they've been recently tested or if they might have had contact with anyone? Um, who maybe... 

Patient: Um, I dont think so. 

Doctor: OK.
Patient: They're. They're pretty like they're pretty they just have online classes and they only really like leaves to get groceries and like go exercise outside. 

Doctor: I see, OK, alright, um. Alright, I'm just going to ask you a couple of questions about your past medical history. Do you have any medical conditions?
Patient: Oh no, no, I'm like pretty healthy. Alright, alright 

Doctor: Nothing like asthma or COPD or any respiratory problems?
Patient: No, no. 

Doctor: No, and. Are you taking any medications, including any over the counter medications or herbal medications? 

Patient: Um no. 

Doctor: Alright um, do you have any allergies, including environmental allergies?
Patient: Oh, again, a little bit of a runny nose, like in the spring, but that's it. 

Doctor: OK um. Alright, and do you smoke?
Patient: Uh, no. 

Doctor: No, Ok. Do you consume alcohol? 

Patient: I drink like a couple beers on the weekends, but. Like I I yeah I play sports a lot and I don't like a lot of time on the weekends so I don't go out. 

Doctor: OK, alright do you consume any other drugs?
Patient: No, no. 

Doctor: No, OK. And you mentioned that you live with your roommate and you haven't had contact with anybody other than your roommate and your girlfriend. OK um. Have you... 

Patient: All my classes are online. 

Doctor: Alright alright um OK, well I'll I I'll go speak to my attending and we will I will discuss your medical history and with him and I will come back and discuss the plan with you.
Patient: Yeah, I've been feeling tired. 

Doctor: OK, and how many days would you say you've been feeling tired for?
Patient: I just came in here today, I usually don't come to the DOCTOR: that much unless I absolutely need it. Five days ago I started having this pain and swelling in my right knee. So and at first I thought it was just like my arthritis acting up but it's been getting more swollen and painful than usual, so I just wanted to come in and check it out. 

Doctor: OK, so when did you first notice that this pain, like when did it get more swollen and painful than usual?
Patient: So like I would say around 5 days ago it started getting more and usually I do get pain in some of my joints but I I don't really get swelling so that was a bit different. 

Doctor: OK, and is the joint hot as well, or is there a temperature change? 

Patient: It is, it does feel like if I touch the joint it does feel a bit warmer than the surrounding areas. 

Doctor: OK, does it look red?
Patient: It It definitely it definitely looks more red than my other knee. 

Doctor: OK, and so what knee is it that, that's bothering you right now? 

Patient: It's the right knee. 

Doctor: OK. And so this pain has been going on for the last five days. Has it been getting better, worse, or staying the same?
Patient: I think it's getting a. It's getting it was getting worse, but it's like a bit better right now. 

Doctor: OK. 

Patient: Yeah it comes and goes in severity though. 

Doctor: OK, and how would you describe the the pain. The character of it, is it sharp, dull, or achy?
Patient: It's it's like someone is stabbing me in the knee and it hurts the most when I'm moving the knee. 

Doctor: OK, and does the pain radiate anywhere? 

Patient: Uhm, I don't think so, no. 

Doctor: OK, so you're feeling it just in the knee and you said moving the knees is painful. Is there anything else that makes the pain worse?
Patient: Uhm, not really like resting it definitely helps, yeah, but I just have to keep it a bit immobilized. 

Doctor: OK, and is there anything that that makes the pain better that you've tried like maybe medications or any ice packs or anything like that?
Patient: Uh, not really. I do take some painkillers, so just some Advil, which seems to help a little bit. 

Doctor: OK. And. And um. OK, is the pain worse at any particular time of the day, like do you have morning stiffness? 

Patient: Yeah, usually with my normal this arthritis I do get some morning stiffness but this is completely different, it's throughout the day pretty much. 

Doctor: OK, and did you have any trauma or any injury to the knee?
Patient: No, I didn't. 

Doctor: OK, uh.
Patient: I I did have like a steroid injection to the same knee just a week ago, but no, I I haven't fallen on it. I haven't had any operations. 

Doctor: OK. Anne. And. Have you had any fevers or chills?
Patient: No. 

Doctor: OK, have you had any changes to any of your senses like vision, hearing or your sense of smell or taste? 

Patient: No, nothing like that. 

Doctor: Have you had a runny nose or sore throat?
Patient: No. 

Doctor: Have you had any cough or shortness of breath?
Patient: No. 

Doctor: How about any wheezing? 

Patient: Nope. 

Doctor: Have you had any chest pain or yeah, have you had any chest pain?
Patient: No. 

Doctor: How about any lightheadedness or dizziness?
Patient: No, 

Doctor: OK and have you had any nausea or vomiting?
Patient: Um nope. 

Doctor: Alright, have you had any loss of appetite? 

Patient: No. 

Doctor: And have you had any abdominal pain?
Patient: No. 

Doctor: Have you had any changes to your bowel movements such as diarrhea or constipation, incontinence? 

Patient: No. 

Doctor: Any urinary problems like painful urination or frequency.
Patient: No, not really. 

Doctor: Have you had any skin changes like rashes anywhere?
Patient: No. 

Doctor: OK, and any other painful joints or muscle aches or body pains? 

Patient: Yeah, I just got my general like I havee osteoarthritis, so I like It's been a pretty long time though but I get some pain in my hips sometimes my knees, so it's it's that's been going on for awhile, but this is something I've never experienced though like this significant pain and swelling and redness. 

Doctor: OK. And have you had any changes to your memory or any confusion?
Patient: Nope. 

Doctor: OK, and have you had any unexpected weight loss? 

Patient: No. 

Doctor: And how about any night sweats?
Patient: No. 

Doctor: OK, Um in the past have you been diagnosed with any medical conditions?
Patient: I do have. So I have a couple conditions. I have osteoarthritis in both my knees and hips. I have high blood pressure. I did have a heart attack four years ago and I also have had heart failure. And also I'm just a bit on the overweight side. 

Doctor: OK, are you currently taking any medications?
Patient: Yeah, so I am taking just um Furosemide then Ramipril for my blood pressure. But yeah, that's that's about it right now and like just painkillers over the counter.  DL OK, uh. And any allergies to medications?  Um, just to have a penicillin allergy. 

Doctor: OK, and what's the rash, or sorry what's the reaction?
Patient: I don't really remember I was a child at that time. I don't remember what reaction I really got. 

Doctor: I see OK and have you had any prior hospitalizations or surgeries? 

Patient: Surgeries I did have my appendix removed when I was young and also I was hospitalized after my heart attack a couple years ago. 

Doctor: OK, did you have any surgeries on your on your heart like a cabbage or?
Patient: I had a couple a couple of stents put in. 

Doctor: OK, and you take aspirin for that? 

Patient: Um yeah. 

Doctor: OK. Uhm, Alright, and could you tell me a little bit about where you're living and who you're living with?
Patient: Yeah, I live with my wife and daughter. And kind of live in a small little townhouse just, in the city. 

Doctor: OK, uh, are you currently working or uh, are you retired?
Patient: I I kind of had to retire after just my past medical history like the heart attack and then. There was just too much stress at work. It was too much for me. But yeah, I'm just at home right now. My wife still works. Yeah, I'm taking it more easy now. 

Doctor: OK. And with being at home, are you able to manage the majority of activities of daily living on your own, or are you receiving help? 

Patient: Oh you're not receiving any outside help. I can do most things myself. My wife does most of our shopping and cooking though. 

Doctor: OK. And do you drink alcohol?
Patient: Yeah, I I do. I do drink probably drink like three or four beers a night. 

Doctor: OK, Ann, and at the smoke cigarettes?
Patient: I used to I I forced myself to quit after my heart attack. 

Doctor: OK, well that's good. I'm glad that you quit and how long did you spoke for and how much were you smoking during that time? 

Patient: Probably smoked for more than 30 years and I was smoking only one to two packs a day at most. 

Doctor: OK. And. OK, and then I about your um family history. Is there anybody in the family that has any heart or lung conditions?
Patient: Yeah, so heart disease runs in my family. My brother, my dad, they both both have had heart attacks. But yeah, my on my mom side everyones pretty healthy though. 

Doctor: Oh OK, that's good, and Alright, so I just wanted to the I guess physical exam piece you've already mentioned that it's red, it's swollen and is warm to touch compared to the other knee and um painful to move. Are you having any limping with your gait? 

Patient: Yeah, I barely like I can't really put too much away or move that knee around. So yeah, if I stood up I would have a limp. 

Doctor: OK, uh, and is there any instability to either varus or valgus stress?
Patient: Uhm, no, I don't think so. 

Doctor: OK, and any instability when testing the ACL or PCL with the anterior and posterior kind of translation test. Pulling and pushing it? 

Patient: Uhm, no. 

Doctor: OK. And any I don't think I asked this any muscle weakness?
Patient: No. 

Doctor: And any numbness, tingling? 

Patient: No. 

Doctor: Or burning sensations?
Patient: No. 

Doctor: OK. Alright, so that was everything that I wanted to check. Was there any anything that I may be missed or any final questions? 

Patient: No, yeah no, I was just I I just don't know if like this is serious and if I need surgery or something because it's been really painful. 

Doctor: Yeah, certainly so right now the top thing on top two things on the differential would be gout or pseudogout they do have some risk factors for that, including a diuretic medication as well as alcohol and obesity are all risk factors for it. However, you also had a knee injection a week ago, which could predispose to an infection. So gout and septic arthritis are the two things that I am thinking about an, so we'll do a knee aspiration and send that off for some investigations and that will help us determine which what the cause is and we can choose the appropriate appropriate treatment.
Patient: Hi, I was just really worried. My son just yesterday night I noticed that he was making these grunting noises and I did notice that he was a bit warm yesterday as well, and today I, he just hasn't been himself, just very, very irritable, crying a lot. Yeah, I just got bit worried. 

Doctor: Yeah, for sure. What started first?
Patient: I would say the there was a little bit of coughing earlier, like yesterday. But then later on during the night, it kind of turned into this grunting noise, and he's kind of like his chest is moving a lot more when he's taking a breath in and all that. 

Doctor: OK. Uhm did you measure his temperature at home? 

Patient: Yeah, so I think it was 38.5 degrees Celsius. 

Doctor: OK, and did you do that orally or rectal or under armpit?
Patient: I did it under the armpit. 

Doctor: OK. OK, uhm so you mentioned that he's had a fever, he's been grunting and he just seems a little bit more fussy. Is that right?
Patient: Yeah. 

Doctor: OK is he coughing at all? 

Patient: He was yesterday but not really now. 

Doctor: OK and was it a dry cough?
Patient: I think so. I mean, not-nothing really came out. 

Doctor: OK, that's good. So no blood, no sputum?
Patient: No. 

Doctor: OK, and did he seem wheezy?
Patient: Uh, no. 

Doctor: No, OK. So there's no wheezing with the grunting?
Patient: Maybe a little bit like that, just a little bit of a noise, but it's mostly the grunting. 

Doctor: OK. Has he had any weight loss?
Patient: No, not that I really, we haven't really weighed him now since his last appointment. 

Doctor: OK. Does he seem excessively tired or fatigued? 

Patient: Uhm, moreso today I would say he's like earlier, he was very fussy, but now he seems a bit more tired. 

Doctor: OK. Any rashes that you've noticed?
Patient: No. 

Doctor: No, OK. Uhm any changes in his vision or hearing? 

Patient: Uh, no, not that I can tell. 

Doctor: No, OK. So he's responding to like sounds and he's still looking at you and things like that?
Patient: Yeah. 

Doctor: OK. Have you noticed a runny nose or stuffy nose? 

Patient: Uhm, no, nothing like that. 

Doctor: No, OK. And he said he hasn't had any like fainting spells?
Patient: Uh, no, I don't think so. 

Doctor: No, OK. And how many wet diapers is he producing in a day now?
Patient: Probably 5 or 6. 

Doctor: 5 or 6 OK. Has that changed from before? 

Patient: No, it's pretty much the same. 

Doctor: OK, and uhm any changes to his bowel movements?
Patient: No. 

Doctor: No. How about his urine?
Patient: No. 

Doctor: No, OK. OK. And then you said he was fussy, is he still eating and drinking OK?
Patient: Uh no, today he's not really taking anything in, like very fussy, very hard to feed him today. 

Doctor: OK, is he crying a lot?
Patient: Earlier today was crying a lot, but now has calm down and just I guess tired himself out. 

Doctor: Yeah, OK. Alright, and is he an otherwise healthy child?
Patient: Yeah he was, he was premature by three weeks so, Other than that like I remember when he was born they did have earlier some issues with his oxygen not being high enough and they had to like keeping, keep us in the hospital for a bit longer. 

Doctor: OK.
Patient: But yeah, after that, like there haven't really been too many concerns. 

Doctor: OK, so he's hitting all the developmental milestones like in terms of motor movements, ah speech, behaviour, all of that?
Patient: Yeah, no issues there so far. 

Doctor: OK, and how about medications? Is he on any?
Patient: No. 

Doctor: No medications, OK. And is up to date with all his immunizations? 

Patient: Yeah, oh he had all his immunizations so far. 

Doctor: OK. How about allergies? Does he have any?
Patient: Not that I know of. 

Doctor: No, OK. Any family history of lung or heart conditions?
Patient: No. 

Doctor: OK, and does anyone at home smoke? 

Patient: No, no one smokes. 

Doctor: OK. Has he been in contact with anyone sick recently?
Patient: Uh, no, not that I know of. Uhm his older sister does go to school though, but I don't know if she might have carried something home. 

Doctor: OK, how old is she? 

Patient: She's six years old. 

Doctor: Six, OK. And is she healthy or is she having similar symptoms?
Patient: No, she's healthy. No, no symptoms. 

Doctor: OK. Any travel recently? 

Patient: No. 

Doctor: No, OK. And who does he live with at home?
Patient: Uh, so his older sister, me and his mother. 

Doctor: OK, any reasons to believe like you have old carpets, dust, mold, asbestos, pets, anything like that that could worsen his symptoms?
Patient: Uh, no nothing like that. 

Doctor: OK, so I think those are all the questions that I had for you. Did you have any questions or any concerns? Anything that I missed that you wanted to add?
Patient: No, I think that was all. 

Doctor: OK, uhm so for him we'll do a Covid swab just to rule that out because some of his symptoms do overlap with that. But it it's really sounding like a picture of like community acquired pneumonia, so we'll do a couple of things for him. Uhm, we can get his temperature, get his oxygen oxygen saturation right away we'll get a chest x-ray. We'll do some blood work as well and uhm, he might need to be admitted depending on uhm, the oxygen, oxygen saturation and the fact that he's grunting. So if he's admitted will give him some extra oxygen and keep monitoring him and keep him hydrated. Uhm we'll also give him some antibiotics if, if it turns out he has pneumonia. Yeah, does that sound OK?
Patient: That sounds good. Thank you. 

Doctor: OK yeah, no worries.
Patient: Yeah, I've had uh, a cough that's been um, bugging me for the last several months now, and more recently I've noticed that I've started to bring up a bit more, or a little bit of blood as well. 

Doctor: Okay, well that's not good. So you said the cough started several months ago, how many months ago do you think, like three, four, five?
Patient: Uh, yeah I would say, yeah, maybe like, like five or six, and it kind of started um, it was really infrequent and so it didn't really, well I thought it was just the usual smoking, but it's been getting worse over these last, over these past six months. 

Doctor: Okay and um, the blood in the cough, when did that start? 

Patient: So that started about, uh, about two weeks ago. 

Doctor: Two weeks ago, okay. Um, how much blood are you coughing up like, if uh, like is it the size of your palm, is it more than that, less than that?
Patient: Uh, I would say less than that, like each time there's maybe to about the size of I don't know, uh, like a looney. So like inside of the palm. 

Doctor: Okay, sure. Um, and are you experiencing any shortness of breath along with your cough?
Patient: Yeah, now that you mention it, I have been. It's uh, you know, I thought that was just kind of me getting older and the smoking, but I've certainly been able, I haven't been able to walk as far and even uh, to the end of the driveway getting the mail now is, is pretty, I'll get short of breath. Before I used to be able to walk a lot further than that, just a couple of years ago. 

Doctor: Yeah, for sure. Um, and sorry you said, you mentioned, you mentioned you had some wheezing as well, right? 

Patient: Um, I haven't really had any, noticed any wheezing. 

Doctor: No, okay. Um, and have you had a fever recently?
Patient: No. 

Doctor: Weight loss? 

Patient: Um yeah, now that you mention it, maybe, maybe a little bit, like 5 to 10 pounds over the last, the last month. 

Doctor: Last month, okay. Um, any chills, fever, sorry, chills, or night sweats?
Patient: No um, no, I haven't had anything like that. 

Doctor: Okay, any rashes? 

Patient: No. 

Doctor: Changes in your vision or hearing?
Patient: No. 

Doctor: Um, how about a stuffy or runny nose?
Patient: No, I haven't had any symptoms like that. 

Doctor: Okay um, and then change in your smell or taste? 

Patient: No, that's been normal. 

Doctor: Okay, and how about chest pain?
Patient: No, I haven't had any chest pain. 

Doctor: Okay. Um, and do you ever feel like your heart's racing? 

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

Doctor: Okay, how about calf pain when you walk, like more than a block or two?
Patient: No, I haven't had any symptoms like that. 

Doctor: Okay, any changes to your bowel movements? 

Patient: No things have been normal there. 

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

Doctor: Uh, changes to your urine?
Patient: No. 

Doctor: No. Uh, headaches?
Patient: Every once in a while, I'll get a headache, but it's, they're pretty mild. Usually I'll take an Advil and they go away. 

Doctor: Sure, um, how about dizziness or fainting spells? 

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

Doctor: Okay, um, any confusion or memory loss?
Patient: Uh, I guess I um, forget things a little more easily now, but, that's just part of getting older. 

Doctor: Okay, sure. Um, and then other questions I have for you, are um, are you otherwise healthy? Do you have any major medical, medical conditions? 

Patient: Uh, I have arthritis um, in my knees and uh, hands, um so I have a lot of pain from that sometimes, and I also have high blood pressure and um, GERD. 

Doctor: Okay.
Patient: Or acid reflux, yeah. 

Doctor: Sure. Do you take any medications for these things?
Patient: Um, yeah, I'll take Tylenol um, for the arthritis, and sometimes use some like, topical creams for my knees. Um and uh I, I take amlodipine as well, I think, for the blood pressure. 

Doctor: Okay. Okay, and um, are you up to date with all your immunizations?
Patient: Yeah, yeah, I remember getting one not too long ago, actually. Well, seven years ago I guess now, but I didn't realize, that we uh, had to get anymore. 

Doctor: Um, so yeah, after you turn 65, they should've given you the Shingrix for shingles and pneumococcal vaccine, does that sound familiar? 

Patient: Yeah it does. Yeah, I just didn't know about them until that time. 

Doctor: Okay yeah, sure. Any allergies that you have?
Patient: Uh, I don't think so. 

Doctor: No. How about family history of lung or heart conditions?
Patient: My uh, grandfather had, had lung cancer. And he was in his uh, 70s when he, when he passed away, I remember. 

Doctor: Okay, okay. And do you currently smoke? 

Patient: I do, yes. Yeah, I, I smoke um, I don't know, maybe half a pack a day now, which is, it's a lot less than I used to. I was smoking two packs a day at one point. 

Doctor: Okay, well congratulations on cutting down. Um, yeah, if you need help cutting that down even more, let us know, we have resources that you may be able to use.
Patient: Yeah, absolutely. Thank you. 

Doctor: Yeah, no problem. Do you do any other recreational drugs like marijuana, cocaine, heroin, anything like that? 

Patient: Yeah since I, oh CBD drops, I, at night I find that helps with uh, sleep and, and the pain in my knees. 

Doctor: Oh okay, are those prescribed drops?
Patient: Um. well I do buy, I get them from uh, like the uh, the OCS store, I think they're called. 

Doctor: Okay yeah. Okay, that's good that you're getting them from, like an official store.
Patient: Yeah they're for, they were, uh, my friend said that they worked for her, and so I just gave them a try and I, I found that they've helped. 

Doctor: Okay, good. Um, and where do you live right now? And who do you live with?
Patient: Yeah, so I live in uh, in an apartment with my, with my husband. 

Doctor: Okay, And any like, old carpets, dust, mold, or asbestos in this apartment?
Patient: No, I don't believe so. It's relatively new. We just moved out of our house, uh, just to make it a little easier on us. 

Doctor: Okay yeah, for sure. Um, have you been in contact with anyone sick recently? 

Patient: No, I don't think so. I've been spending a lot of time at at home uh, with my husband, and he's been okay. 

Doctor: Okay, good. How about travel?
Patient: No, we've been pretty scared with uh, COVID and all that, so we've been staying, staying home for the most part. 

Doctor: Okay, okay, good. Um, those were all the questions that I had for you today. Did you have any questions of your own for me? 

Patient: No, I was just really concerned when I started to see um, the blood coming up more recently, and so I was just hoping to get this figured out. 

Doctor: Yeah, for sure. Um, so they're a couple of things we're gonna work you up for. Um, because some of your symptoms overlap with COVID, we'll start by getting a COVID swab and you should hear back in about 24 to 48 hours. Um, we will also do a chest x-ray um, to look for any signs of lung cancer. Um, and then if we see consolidation or anything that would indicate um, like a mass in your lungs, we will discuss options for like biopsies which is the gold standard for diagnosing lung cancers. Also, I know you haven't had any recent travel or anything like that and your symptoms have been going on for a long time, but uh, it may also be worthwhile to uh, also check for things like TB, which could also cause you to cough up blood. Um, so we'll start, we'll start from there, and then if those come back negative, then we'll work you up further for other things that you may have, but are like more rare. How does that sound?
Patient: Hey, I've just been feeling kind of ill over the past two days and uh, I thought I'd just come in to see what's going on. So I've had um, um, I was feeling very achy and I had a cough and then I think yesterday night I developed a fever. 

Doctor: OK, and so um, last night you developed a fever. What, uh, did you check your temperature?
Patient: Um, I didn't, but I'm pretty sure I have a fever and like I can feel it. 

Doctor: OK. Have you had any chills or night sweats? 

Patient: I had chills last night. 

Doctor: OK. Uh, so you mentioned you've had a cough as well, and when did that start?
Patient: Two days ago. 

Doctor: And is the cough been, um producing any phlegm or sputum? 

Patient: No, it's kind of dry cough nothing 

Doctor: alright. How about any any blood?
Patient: No. 

Doctor: OK. And you've had muscle aches. Has this been like a whole body type of feeling, or is it any particular muscles that hurt?  P : It's all over.  OK, have you had any headaches? 

Patient: No. 

Doctor: Alright. And have you had a cough before or is this a new cough?
Patient: It's a new cough. 

Doctor: Have you had any wheezing with the cough? 

Patient: A little bit. 

Doctor: Yeah, so you've had wheezing as well. Are you able to to hear it?
Patient: Yeah, it's just like I can kind of like tell, when I'm breathing like it just, yeah. It sounds different. I don't know what a wheeze sounds like, but it just sounds different. 

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

Patient: Uh, uh, sorry, can you say that again? 

Doctor: Sorry um, did you have any chest pain?
Patient: Uh, no. 

Doctor: OK. Um, have you had any, uh, um, symptoms such as red eyes or or itchy eyes or runny nose?
Patient: No. 

Doctor: OK, have you had a sore throat? 

Patient: No. 

Doctor: Any nausea or vomiting.
Patient: No. 

Doctor: OK, how about a loss of taste or loss of smell?
Patient: Uh yeah, I kind of just foods have just been tasting little bland, since yesterday. 

Doctor: OK, so yeah, I lost of taste today. Have you had a runny nose at all?
Patient: No 

Doctor: OK. Any abdominal pain or diarrhea? 

Patient: No. 

Doctor: Any urinary problems like uh pain or frequency.
Patient: Uhm? I uh, I I've had that for a while like it's just I think my prostate's kind of large so it's it's hard for me to, like I pee very frequently. 

Doctor: OK. And OK. Have you noticed any skin changes or rashes? 

Patient: No. 

Doctor: Uh. And how is your energy been?
Patient: I've been feeling a little tired. 

Doctor: Alright, so you've had this dry cough that started two days ago. Been feeling feverish, have had some muscle aches, been tired and also a loss of taste. Have you been experiencing any other symptoms?
Patient: No, that's I think that covers it all. 

Doctor: OK. Oh sorry, I asked about chest pain, but have you had any like dizziness or feeling like you're going to faint or even like your heart's racing really fast?
Patient: No. 

Doctor: OK, have you been diagnosed with any medical conditions in the past? 

Patient: Um, just a large prostate. It's not cancer or anything, it's just kind of large. 

Doctor: OK so I have you heard of BPH before?
Patient: Yeah, I think that's what the DOCTOR: said. 

Doctor: OK, and do you take any medications for that or for any other reason?
Patient: Yeah, I do. I do take a I think a medication for that. Uhm? It's called tamsulosin. 

Doctor: OK yeah call me what is like Flomax or or tamsulosin, but there are there are others for sure. 

Patient: Yeah I think I think it's called Flomax. 

Doctor: OK yeah it's the brand name for it but lots of yeah lots of different namings can be hard for the medication sometimes. And have you had any surgeries or hospitalizations?
Patient: Nope. 

Doctor: Do you have any allergies? 

Patient: Nope. 

Doctor: OK um, and can you tell me a little bit about where you're living and who you're living with?
Patient: I just live with wife in an apartment. 

Doctor: OK. And has she had any symptoms or been sick at all?
Patient: Oh no, she's feeling good. 

Doctor: Have you had any sick contacts? 

Patient: I don't, no I haven't. I don't think so. I mean potentially. I was. I was actually out with my friends, but no one was sick. 

Doctor: OK. Have you traveled anywhere?
Patient: Nope. 

Doctor: OK. And do you smoke cigarettes?
Patient: I used to, I quit. I quit 10 years ago. I used to smoke about two or three cigarettes a day for 20 years. 

Doctor: OK, well congratulations on quitting, that's great. 

Patient: Thanks. 

Doctor: Do you smoke cannabis or use cannabis products?
Patient: Nope. 

Doctor: Do you use any recreational drugs?
Patient: No. 

Doctor: And do you drink alcohol?
Patient: Yeah, maybe sometimes once or twice a month, maybe a glass or two at a time. 

Doctor: OK, uh. And anybody in the family have any heart or lung conditions.
Patient: Uhm? Yeah, I think it's called Hypertrophic cardiomyopathy where people kind of die early. People get like people in my family got heart attacks very early on in their 30s. My brother died and when he was 15. 

Doctor: Oh wow, sorry to hear that and uh, has that been looked into for yourself? 

Patient: Oh yeah, I see a cardiologist. I get regular checkups done. 

Doctor: OK. And. OK, and uh, so that was everything that I wanted to ask about on history today. Did you have any anything else that you wanted to mention or anything you were concerned about?
Patient: Yeah, so um I just came in because uh so I I have this cough that's been going on for the last five years, but over the last month it's really been getting worse. Um and like last week I I've just been constantly coughing. So yeah, I was just a bit concerned. 

Doctor: Yeah, OK, so you said the past couple of years you've been coughing. So how many years exactly would that be? Two, three, four?
Patient: Probably five I would say, and I was diagnosed with uh COPD around that time. 

Doctor: OK, OK, um the cough that you currently have, um is it a dry cough or are you bringing up any phlegm? 

Patient: Uh I'm pretty much always bringing up like this uh white material. 

Doctor: White, OK. Um and is it constant throughout the day or do you find it comes and goes?
Patient: It's pretty much there all the time, but uh it's definitely getting worse. Um it is, I think, the worst in the morning um when I wake up and I just feel like there's just a bunch of gunk stuck in the back of my throat. 

Doctor: OK. Um and if you were to describe the quality of this cough, would you say it's harsh, barky, muffled? 

Patient: I would say it's harsh. 

Doctor: Harsh, OK. And has the quality of your cough changed at all in the past few years? Like does it sound different than it used to?
Patient: Um I don't know if it sounds different, but uh especially for the last month I would say I'm bringing up more of the material, and it's usually white over the five years, but um I noticed uh in the last week-ish, it's had a yellowish tinge to it as well. 

Doctor: OK, OK, so it's changed a little bit. Um and are you experiencing any shortness of breath with this? 

Patient: No I I don't think so, like I sometimes when I'm walking around uh doing more stuff, uh working in the garden like I feel like I might have to breathe a little bit harder, but uh not regularly. 

Doctor: OK, OK, that's good. Um and any wheezing?
Patient: Uh, yeah. It's like usually I start coughing a lot more when I'm starting to do any kind of activities and sometimes when I start coughing more, I also start wheezing. Um but uh right now, I'm fine. 

Doctor: You're fine now, OK, uh, alright. And sorry, forgot to ask you earlier, do you see any blood in your phlegm? 

Patient: No, no, I haven't noticed any blood. 

Doctor: OK, any uh changes to your hair or on your skin, like rashes?
Patient: Not that I've noticed, no. 

Doctor: OK, any weight loss?
Patient: Um, I don't think so. 

Doctor: OK, fevers? 

Patient: No. 

Doctor: OK, exhaustion?
Patient: Um yeah, I would say like for the last few months I am a bit more tired. 

Doctor: Mhmm OK, how about changes in your vision or hearing? 

Patient: No, I haven't experienced that. 

Doctor: How about a stuffy nose? Runny nose?
Patient: Uh no, not really. 

Doctor: No, OK. How about changes to your smell or taste? 

Patient: Uh nope. 

Doctor: No, OK. Uh chest pain?
Patient: Not chest pain, but when I get into those coughing fits, sometimes it feels just really tight in my chest. 

Doctor: Oh, yeah.
Patient: But it tends to go away with uh just some rest. 

Doctor: Oh OK, OK. Um how about palpitations? Like feeling like your heart is racing? 

Patient: Uh no, I don't think so. 

Doctor: No, OK. How about some swelling in your limbs?
Patient: I I did notice, like uh a little bit of swelling in my uh both my, like right by my ankles. My shoes, like like even when I wear my socks, it like leaves little marks and then uh I just feel my like my shoes are tighter. 

Doctor: OK, OK and how long has that been going on?
Patient: Probably, uh, I've had this issue for like a pretty long time um, probably I would say the last year at least. 

Doctor: OK, OK, last year. Um any uh dizziness or fainting spells?
Patient: No. 

Doctor: No, OK, any memory issues, uh confusion?
Patient: No. 

Doctor: Numbness or tingling? 

Patient: No, nothing like that. 

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

Doctor: Changes to your bowel movements? 

Patient: No, I tend to go like once a day. And yeah, it's pretty normal. 

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

Doctor: No, OK. And are you otherwise healthy? Do you have any longstanding conditions? I know you said you have COPD, anything else? 

Patient: I do have high blood pressure. 

Doctor: OK. Do you have something called congestive heart failure?
Patient: Uh no, what's that? 

Doctor: OK, it's when um your heart's not pumping as much as it should be, um so you get some backup of fluid. I ask because you you mentioned that you um were having some swelling in your legs.
Patient: Oh I yeah, I I yeah, I didn't know anything about that. I just thought that was uh, it's been going on for a while now and didn't really bother me too much. 

Doctor: OK. Um alright, and are you taking any medications?
Patient: Yeah, I have this medication uh right now I'm taking it, it's called lisinopril. 

Doctor: OK, so that's for your blood pressure? 

Patient: Yeah. 

Doctor: OK. Are you on any puffers? Sorry, go ahead.
Patient: Yes I'm on, no worries, I'm on um uh two puffers right now. One of them is like just one that I use when I really need it. And then um there's another one, so I think that's like the Ventolin puffer. 

Doctor: Yeah. 

Patient: And then the other one is called, I think it's called Spiriva. 

Doctor: OK, OK perfect. And are your puff puffers giving you any relief at all from the coughing fits?
Patient: Yeah, I've been using the Ventolin uh more and it it does seem to help. 

Doctor: OK, OK. Uh do you find they're not working as much as they used to though?
Patient: Yeah, I feel like uh before, I didn't really like, it, just last year I didn't really have to take it too much. Um like even when I use the puffer, I start getting coughing like maybe half an hour later and so it's not, I don't think it's as effective. 

Doctor: OK, yeah. Um OK. And have you had any recent blood work done? 

Patient: Uh, no, I haven't been to the DOCTOR: for a while. 

Doctor: OK. And do you have any allergies?
Patient: Um I think I have allergies to uh like um amoxicillin, I got like a rash once. 

Doctor: OK. Have you had any, uh, amoxicillin, or like penicillin type antibiotics recently?
Patient: No. 

Doctor: No, OK. Um are you up to date with all your immunizations? 

Patient: Yep. 

Doctor: OK. Um, you're not quite at this age range yet, but uh we do recommend the pneumococcal vaccine when you turn 65. And um did you get the flu vaccine this year?
Patient: Uh yeah I did, with the pandemic going on, I usually don't get it, but I got it this year. 

Doctor: OK, good good. Um any family history of lung conditions or heart conditions?
Patient: Uhm, lung conditions I don't think so. Heart conditions, uh my father did have a heart attack in his 60s, but he's fine. He's he's living right now. 

Doctor: OK OK, any cancers?
Patient: Cancers, I think my uncle from my father's side um had uh bladder cancer. 

Doctor: OK, OK. Um do you smoke? 

Patient: I used to smoke. Um I just quit a few years ago. 

Doctor: OK, congrats. Um how much did you used to smoke?
Patient: Uhm, I don't know, probably I went through a like a whole pack every day, I would say for at least 30 years of my life. 

Doctor: OK, OK um so it's good that you stopped. Um do you take any other recreational drugs? 

Patient: Uh no, nothing like that. 

Doctor: No, OK. How about alcohol? Do you drink?
Patient: Uh I drink every like, maybe a beer a day. 

Doctor: OK. Um are you um living with anyone right now? 

Patient: Yeah, it's just uh me and my wife. 

Doctor: OK, where do you guys live?
Patient: Uh we just live uh outside of the city in in a condominium. 

Doctor: OK, any uh old carpets? Mold, dust, asbestos, anything like that in the condo? 

Patient: No, it's pretty well maintained. 

Doctor: OK, good. And have you been in contact with any anyone sick recently?
Patient: No, I've mainly just been trying to stay inside. I work from home too, so haven't really been seeing anyone. 

Doctor: OK, that's good. And um travel to anywhere recently? Outside the province?
Patient: Uhm, outside of the province, no, not not for like the last year at least. 

Doctor: OK, OK. Um so those were kind of all the questions that I had for you. Did you have any questions for me? 

Patient: Um yeah, I was just wondering like what you think it might be. 

Doctor: Yeah, so it definitely sounds like a COPD exacerbation, but because your symptoms overlap with those of Covid, we will take a swab and you should hear back in about 24 to 48 hours. Um and you can you can self isolate for 14 days um and if it's positive, public health will be in touch with you to um do some contact tracing, but in the meantime we'll also do a work up for the COPD exacerbation. Um it seems like you have taken the correct steps so far in like stopping like stopping your smoking and um taking your puffers as needed. Um so right now we will continue using the puffers that you have, and if you don't already have a long acting beta agonist, we'll give you that as well as, if it's like if it gets really severe, we'll also give you some inhaled corticosteroids um and we'll also check your oxygen saturation to make sure it's over uh 88% um and we'll give you oxygen if you need it. Um as well, some antibiotics to consider, you mentioned that you were allergic to amoxicillin, so we might give you like a macrolide like azithromycin for now. Um and hopefully your symptoms subside and we can get you home. How does that sound?
Patient: Um yeah hi, I brought I brought my 8 year old daughter here um because I've noticed that she's been quite wheezy um for the past four five days and now she has a slight cough, um sounds like she's a little short of breath, so I just wanted to get things checked out. 

Doctor: OK, so for the, when it first presented, about four to five days ago, what did you notice, notice first? 

Patient: Um I noticed that she was wheezy um and it's it seemed like she was having some difficulty taking in deep breaths. 

Doctor: OK, now was this with any type of activity or just at rest?
Patient: Yeah, she was playing tag with one of her cousins and she she was quite out of breath after. 

Doctor: OK, has she ever had anything like this before? 

Patient: No. 

Doctor: Nothing like that, OK, and has it been fairly steady since then? Or has it been fluctuating?
Patient: It's been fluctuating. 

Doctor: OK, but it hasn't really gone away in the sense that you're still concerned coming now four days later?
Patient: Yeah, it's just it would, she would have these these uh episodes, but it would resolve on its own and then she would, you know go back to doing some sort of activity and then she would have all these symptoms all over again, but when she rests um then it goes away, so I wasn't really sure, too sure what to think of it. But now I think it's important to get it checked out, so here we are. 

Doctor: Has she had any fevers at home? 

Patient: No. 

Doctor: Has she had a runny nose at all at home?
Patient: No. 

Doctor: Has she seemed well otherwise, does she look sick? 

Patient: Yeah, she looks fine otherwise. 

Doctor: OK. And has she had any sick contacts recently? Anyone around her or her friends been sick?
Patient: No, not that I've noticed. 

Doctor: OK. Any recent travel anywhere?
Patient: Uhm, no, no, we didn't go anywhere because of covid. 

Doctor: OK, but she's still been going to school I suppose, playing with her friends? 

Patient: Yes. 

Doctor: OK. Have you noticed any rashes? Any skin changes anywhere on her body?
Patient: Uh not that I've noticed, no. 

Doctor: OK, nothing like that, has she complained of any pain anywhere? 

Patient: No. 

Doctor: OK, and has she had any recent infections?
Patient: Uh she had, actually she had a couple of infections over the past two years. Uh they would come and go uh and we took her to the DOCTOR: each time and it just ended up being some sort of viral infection. 

Doctor: OK, so nothing really needing antibiotics in the last couple of years? 

Patient: No. 

Doctor: And in terms of how she's been doing, has she been keeping up with her peers in terms of education, and how she moves, how she acts?
Patient: Uh yeah, she's been yeah, she's been on par with her peers. 

Doctor: OK, so does she have a family physician? 

Patient: Um yes. 

Doctor: OK, so they haven't brought up any concerns about how she's growing, how she's developing?
Patient: No. 

Doctor: So her weight, her height, they've been good for her age?
Patient: Yeah, yeah. 

Doctor: Excellent. And has she gotten, has she been keeping up to date for immunizations? 

Patient: Yes, she's fully up to date. 

Doctor: Excellent. In regards to how she's doing, otherwise health, in terms of her health, has, did she see a family physician for any other medical issues that she might be having?
Patient: Uh no, she's otherwise pretty healthy. 

Doctor: OK. How was the birth? Was there any complications when she was born?
Patient: No, she was a vaginal delivery, full term, no complications. 

Doctor: OK, so nothing when you were pregnant with her, no toxic congestions? By that I mean um did you drink any alcohol, smoke at all when you were pregnant with her? 

Patient: No. 

Doctor: No, OK. And you just had antenatal care, so you saw  for ultrasounds and just for checkups?
Patient: Yep, everything was fine. 

Doctor: OK. And when she was born, she didn't have to stay in the hospital at all? 

Patient: No, no. 

Doctor: And was she born, uh what weight was she when she was born?
Patient: Uh, she was, how much was she? I think she was about 8 kilos. 

Doctor: 8 kilos?