jshargo/medical-interview-conversations huggingface dataset:
Patient: Um, she has seemed a little bit more tired than usual. 

Doctor: OK, and right now is she going to school or is right now all like virtual? Is she at home?
Patient: Uhm, she's at home right now. 

Doctor: OK, and does she have any symptoms of, any chest pain at all? 

Patient: No chest pain. 

Doctor: OK, any changes in her bowel movements, any Constipation, diarrhea?
Patient: No. 

Doctor: OK, any urinary problems?
Patient: No. 

Doctor: OK, has she been able to sleep well or does she wake up a lot more at night? 

Patient: Uhm, she's been able to sleep well, yeah 

Doctor: OK, how about her appetite?
Patient: Its been pretty normal. She's not eating as much as she used to, but she's still eating and drinking ok. 

Doctor: OK, and have you noticed any kind of weight changes at all recently has she lost any weight?
Patient: No 

Doctor: OK, and, has she had any loss of taste, of smell or sorry, loss of sense of taste or smell at all.
Patient: Uh, no. 

Doctor: Any muscle aches or anything like that?
Patient: Uh, no, nothing like that. 

Doctor: OK, any exposure to fumes, dust, animals or Pets at Home? 

Patient: Uh, no, nothing like that. 

Doctor: OK, has this happened at all in the past?
Patient: Uhm, no. 

Doctor: No, OK. Does she have any medical conditions at all that she's been diagnosed with in the past?
Patient: Uhm, no, nothing like that. 

Doctor: Any like asthma or any other conditions? 

Patient: No. 

Doctor: OK, any allergies that you know of?
Patient: I know she has seasonal allergies, but that's about it. 

Doctor: OK, and does she take any medications at all on a daily basis?
Patient: Uh, no, she just takes multi vitamins. 

Doctor: OK, and currently or previously has she had any surgeries or hospitalizations?
Patient: No. 

Doctor: No, OK. Are there any family history of any lung or heart conditions?
Patient: Uh, no. 

Doctor: Any cancers? 

Patient: There's some colon cancer on her dad side of the family. 

Doctor: OK, and is there any, so do you remember who the person is and also like when they got diagnosed with the colon cancer?
Patient: So it was her uncle. He was diagnosed when he was forty five. 

Doctor: OK, other than that, were there any developmental challenges at all while she was growing up? Did she, was she meeting her milestones? Any concerns at all?
Patient: No concerns, she was meeting all her milestones from what I remember. 

Doctor: OK, and uh, in terms of her pregnancy, were there any, or your pregnancy with her, were there any complications at all either during the pregnancy or after she was born?  P No, no complications.  And right now, where does she live, and who does she live with? 

Patient: she's at home with myself, my husband and she has one younger sibling. 

Doctor: OK and, is everyone at home well, does anyone have any of these symptoms?
Patient: No, OK. 

Doctor: Right, so, and in terms of the home environment, does anyone smoke in the house? 

Patient: No. 

Doctor: No OK, alright so I think that's all the questions I had right now. Do you have any questions or concerns?
Patient: No, no questions, but uhm, actually, what do you think she has and how can we treat her? 

Doctor: Yeah, so it seems like that the hoarseness of voice and the sore throat and her symptoms mostly align with what's called laryngitis, and this is usually caused by like just a viral respiratory infection. The hoarseness of voice will usually last more than a week and up to like ten days and it should resolve on its own. But we'll definitely take a better look and do a proper physical examination, see if I see any kind of swelling, redness, or any like white streaks or exudates around her pharynx as well. So after we take a look, we'll see what we can do. It doesn't seem like, it can also be a bacterial infection, in which case we would need to give her antibiotics, but usually it's a viral infection that should go away on its own. So we would just kind of wait and see and potentially just give her voice some rest during this period, and just go on from there. Do you have any other questions or concerns?
Patient: Uh no, that sounds great, thank you. 

Doctor: You're welcome and yeah, we'll, just do a full examination and then go from there. 

Patient: OK, sounds great thanks. 

Doctor: You're welcome.  Take care.
Patient: Yeah, so uh, just randomly like 2 days ago I just started having this chest pain when I'm breathing and it's just been getting worse and then because of that, I'm finding that I'm very short of breath as well, so I just got really concerned. 

Doctor: OK, I see. When did the chest pain start? 

Patient: So, there was some discomfort like just 2 days ago, but then just yesterday it started getting very painful when I was breathing. So yeah, I would say 1 day ago. 

Doctor: OK, and were you doing anything at the time when the chest pain started? Like did you get in a car accident maybe? Or any trauma to the chest or anything you can think of?
Patient: No, not really. I was just at home and then I noticed that when, I like, take a deep breath in, it's just, like, a very sharp pain. It's kind of like in my right side of the chest and it feels like a stabbing pain. 

Doctor: OK, and so the pain comes on when you breathe in, or yeah, when you take a deep breath. Does the pain come on at any other points or does it go away?
Patient: Uh, it's mostly, yeah, I feel the sharp pain when I breathe in. 

Doctor: OK, so the pain is intermittent then, it sounds like. And has there been anything you've tried that's made the pain better? 

Patient: Not really, just more shallow breathing, and it hurts less with that, but that's about it. 

Doctor: OK, and are there any positions that help make the pain any better like leaning forward or laying down?
Patient: Not really, it's uh, it's pretty much the same, I think. 

Doctor: OK, and uh, you mentioned you had shortness of breath as well. When does this come on? 

Patient: Since yesterday it's been pretty constant and it's more like, Uh, just uh, I'm really having trouble getting any deep breaths in, so I feel like I'm having to just breathe faster and more shallow. 

Doctor: I see, OK, and has anything like this happened to you before?
Patient: No, never. 

Doctor: OK, and have you been experiencing any headaches? 

Patient: No. 

Doctor: How about any viral symptoms, like eye redness, nasal discharge, or nasal congestion or cough?
Patient: I have been having a little bit of a cough, but that's it, like, it kind of started today, but it's nothing too significant. 

Doctor: OK, alright, is the cough dry or have you brought up sputum? 

Patient: It is dry. 

Doctor: OK, and have you had a sore throat?
Patient: Uh, no. 

Doctor: How about a loss of taste or a loss of smell?
Patient: No. 

Doctor: OK, how has your appetite been? 

Patient: My appetite's been pretty good. It's like, definitely with the pain, I don't really feel like eating today, but I don't think it's changed. 

Doctor: OK, so has your weight been stable over the last several months.
Patient: Yeah, weight has been stable. 

Doctor: OK, and have you had any fevers, chills, or night sweats?
Patient: Uhm, Nope. 

Doctor: OK, and have you had any episodes where you feel like your heart is, like, racing or beating out of your chest? 

Patient: No, I don't think so. 

Doctor: Any dizziness or Lightheadedness?
Patient: No. 

Doctor: OK, and have you had any wheezing? 

Patient: No, I don't think so. 

Doctor: OK, and with the cough, have you brought up any blood?
Patient: No. 

Doctor: OK, and have you had any, Uh, like urinary problems?
Patient: No. 

Doctor: Any bowel problems like diarrhea or Constipation?
Patient: No, nothing like that. 

Doctor: And any abdominal pain? 

Patient: No. 

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

Doctor: OK, and have you had any muscle aches, joint pains or skin changes? 

Patient: No. 

Doctor: OK, and uhm, in the past have you been diagnosed with any medical conditions?
Patient: No, I've been pretty healthy. 

Doctor: OK, so do you take any medications regularly? 

Patient: No, nothing at all. 

Doctor: And do you have any allergies?
Patient: No, no allergies. 

Doctor: Any hospitalizations in the past or any surgeries? 

Patient: No. 

Doctor: OK, and currently, can you tell me just a little bit about your living situation?
Patient: Yeah, so I just live with uh, a couple of my roommates. I'm going to University. 

Doctor: OK.
Patient: I live in like a student housing situation. 

Doctor: OK, has anybody in the house been sick or anybody that you've been around been sick?
Patient: No, we've been all pretty healthy. 

Doctor: OK, and do you smoke cigarettes or use any like vape products or anything like that? 

Patient: No, I haven't ever smoked. I do smoke weed like, I would say, once or twice a week. 

Doctor: OK, and how much would you say? Like 1 gram or less or?
Patient: 1 gram probably lasts like 2 weeks. 

Doctor: OK, and do you drink alcohol?
Patient: Yeah, just a couple of beers maybe on the weekend. 

Doctor: OK, and are you currently sexually active? 

Patient: Yeah, just one partner, my girlfriend. 

Doctor: OK, and, do you use condoms?
Patient: Yeah, we use condoms, we're pretty safe. 

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

Doctor: OK, any concerns right now or anything like that? 

Patient: No, uh, we've been pretty safe and we've both been tested before and everything, so I'm not really concerned. 

Doctor: OK, great and has anybody in the family had like a similar presentation before, like any lung problems or heart problems?
Patient: No, I think my sister, she has asthma, but that's about it. 

Doctor: OK, and uh, any cancers that run in the family? 

Patient: Not that I know of. 

Doctor: OK, so it sounds like you had this uncomfortable feeling in your chest about two days ago, but the pain really came on yesterday and it's really painful when you have a deep deep breath. So, in conjunction with your symptoms of not being able to take a deep breath and being short of breath, it sounds like you possibly have what's called a pneumothorax and so we'll do a physical exam and do a chest X-ray as well to examine this and check vitals as well to make sure that you're work of breathing is OK and we can do some blood work and go from there.
Patient: OK, yeah, sounds good. Should be like, worried at all? 

Doctor: I think right now, you're speaking in full sentences and you're not short of breath at rest, typically, when this this happens, if it's small enough, it'll usually resolve on its own and so we'll get some more information from the imaging and the lab results, but it's reassuring that you haven't been getting worse since it happened.
Patient: Sure I have had this cough for the past five days and it doesn't seem to be getting any better so I'm just here to ask you what it what it possibly could be. 

Doctor: Has the cough been getting any better, staying the same or getting worse over these last five days?
Patient: I think it's getting worse. 

Doctor: Are you bringing up any any phlegm? 

Patient: No. 

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

Doctor: OK, have you been coughing at night time as well? Is it interfering with your sleep? Or is the cough just during the day? 

Patient: Um, it is mostly during the day and in the evenings, it doesn't wake me up from sleep. 

Doctor: OK, and any triggers that you've notice 5 days ago or anything that changed at that time to bring on the cough?
Patient: No, nothing. 

Doctor: OK. And have you been having any other symptoms with the cough? 

Patient: I have a sore throat and I feel like I can't taste things the same. 

Doctor: OK, um, are you having any pain with swallowing either liquids or food?
Patient: Um, mostly with foods. 

Doctor: OK, and when did the sore throat start? 

Patient: It started up around the same time as my cough. 

Doctor: OK, and you can't taste your food as well, and when did you notice that?
Patient: That was two days ago. 

Doctor: OK, have you noticed any any loss of smell? 

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

Doctor: OK, and have you had any difficulties breathing or short of breath?
Patient: No. 

Doctor: OK. And have you had any symptoms like this before? 

Patient: No, nothing like this. 

Doctor: OK. And how has your energy level been? Have you been fatigued?
Patient: A little bit, yes. 

Doctor: OK. Have you had any changes to your vision or or hearing?
Patient: No. 

Doctor: Any mucous or pain or discharge from either your ears or nose?
Patient: No. 

Doctor: OK, so your nose hasn't been runny, but has it felt congested? 

Patient: umm, no. 

Doctor: OK, have you had any fevers or chills?
Patient: I don't know about fevers. I guess I was feeling a little bit hot last night, but I didn't take my temperature. 

Doctor: OK, so possibly a fever. I will certainly check your temperature today to investigate that. Have you had any night sweats?
Patient: Umm, no night sweats. 

Doctor: Alright. And have you had any weight loss in the last few months? 

Patient: No. 

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

Doctor: Have you noticed any heart palpitations or heart racing? 

Patient: No. 

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

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

Doctor: OK, how about any urinary problems? 

Patient: No. 

Doctor: Problems like diarrhea or constipation?
Patient: No. 

Doctor: OK, and any muscle aches or or body pains?
Patient: No. 

Doctor: Have you had any rashes? 

Patient: No. 

Doctor: OK, so the cough started 5 days ago, you had a sore throat, you've been feeling a bit more tired and haven't been able to taste your food for the last couple of days.
Patient: Yes. 

Doctor: OK. Have you been diagnosed with any medical conditions before?
Patient: Um, no, I don't think so. 

Doctor: OK, nothing you see a physician regularly for?
Patient: No. 

Doctor: Alright, do you take any medications?
Patient: No. 

Doctor: Alright, do you know if you have any allergies to medications?
Patient: Umm, possibly penicillin. 

Doctor: OK, do you know what the reaction was?
Patient: I think I had a rash. 

Doctor: OK. Are your immunizations up to date? 

Patient: I think, yeah, I think so. 

Doctor: Excellent and any surgeries before?
Patient: Umm, no. 

Doctor: And have you been in the hospital for any reason?
Patient: Umm, no, no. 

Doctor: OK. And are you in school now?
Patient: I'm in grade 6. 

Doctor: OK, cool, what's your favorite class?
Patient: I would say it's math. 

Doctor: Awesome and has there been anybody in your class who's been sick? 

Patient: No, everything's virtual right now. 

Doctor: OK cool, so have you traveled anywhere?
Patient: Umm, no. 

Doctor: Alright, and who are you living with?
Patient: I live with two of my younger siblings and my mom and dad. 

Doctor: OK, and is there any physical or verbal abuse in the home?
Patient: No. 

Doctor: OK, so you do feel safe in the home? 

Patient: Yes yes. 

Doctor: OK. And do you smoke cigarettes?
Patient: I don't. 

Doctor: OK and I know some people in your age group might even start using other types of substances. Have you noticed anything like that, or have you used anything like that? 

Patient: Umm, no. 

Doctor: OK. And so do you drink? do you drink alcohol?
Patient: I have had a sip of wine, but that's that's about it. 

Doctor: OK, great. And has anybody in your family had had similar symptoms?
Patient: No, I don't think so. 

Doctor: OK, um and anybody in the family have asthma or lung conditions? 

Patient: I think my aunt has asthma but I was I was checked for asthma when I was younger and it turns out I don't have it. 

Doctor: OK, and any diseases that run in the family like genetic or congenital?
Patient: I think Crohn's disease. 

Doctor: OK, and umm, who in the family has that?
Patient: My father. 

Doctor: OK, so that was everything that I wanted to ask today, was there anything else you wanted to tell me? 

Patient: No, that's it. What do you think I have? 

Doctor: Well, it is sounding like it could be most likely an infectious type of process going on with the possibility of having a fever with a cough and sore throat. So we'll do a physical exam and also some investigations which will include a covid test today. Because some of these symptoms do overlap, but it could be something like the common cold. I don't know the virus that's bringing this on but it's not necessarily covid. But because we're doing the test, it will require 14 days of self isolation. We'll get back to you with the results as quickly as we can.
Patient: This afternoon, I'm just here because I've been experiencing some breathlessness as well as a bit of cough. 

Doctor: OK, when did it start? 

Patient: So I think it's a it started around three months ago and I believe it's just been getting worse. 

Doctor: OK. Um, how often are you experiencing the shortness of breath?
Patient: I feel it like a lot of the time, especially outside when I'm in the cold or at at night when I go outside at night, my chest feels a little tight too at the same time. 

Doctor: OK, and how long does it last?
Patient: I would say it lasts up to an hour every time I'm out in the cold and then once I come back in. So I'd say it lasts at least one hour. 

Doctor: OK, does anything else make it worse, like dust? You know, laying down anything like that?
Patient: Sometimes when I'm near dust, sometimes when I'm running during gym class, increased activity does make it worse. 

Doctor: OK, OK. And if you were to describe the quality of your breathing difficulties, is it more like a burning kind of feeling? Is it like you can't catch your breath? What does it feel like? 

Patient: I think it's more just a I can't catch my breath and it feels like my my throat is just kind of like closing off and I can't take deep breaths. 

Doctor: OK, yeah, that's scary. And one to 10, 10 being the worst, how bad is your shortness of breath?
Patient: It can get up to I would say like an 8 at times. It can get pretty scary. And sometimes, like I feel like heaviness in my chest too when it happens. 

Doctor: Yeah, and the coughing, has it been going on for as long as your breathlessness? 

Patient: I would say around the same same time frame like 3 months, but I'm not always coughing. It comes and goes. 

Doctor: OK, and for your coughing, is it kind of like the same triggers, the cold, dust, things like that?
Patient: Yeah, I would say so. 

Doctor: And do you ever have do you ever cough up blood?
Patient: No, I don't. It's mostly just a dry cough. I don't cough up anything. 

Doctor: OK so no sputum or phlegm, no? OK, do you ever feel wheezy? 

Patient: I I I do hear like a like a weird sound when I breathe out sometimes, I I think it might be wheeziness. 

Doctor: OK, OK. Do you have a sore throat?
Patient: Uh, no I don't have a sore throat, no. 

Doctor: No? Um, how about a runny nose or stuffy nose?
Patient: No, nothing like that. 

Doctor: Any changes in your smell?
Patient: No, no changes in my smell, no. 

Doctor: OK. How about hearing? 

Patient: Uh, no hearing is fine. 

Doctor: OK and like no pus or liquid's coming out of your ear or anything like that, right?
Patient: No. 

Doctor: No ear pain? 

Patient: No. 

Doctor: OK, and how about your vision, everything OK there?
Patient: Yeah, everything is OK. 

Doctor: OK, any fevers? 

Patient: I don't know about a fever, I haven't checked, but some nights I do, especially in the last week I have woken up feeling a bit chilly. I haven't really checked. 

Doctor: OK, so you woke up feeling chilly, any night sweats?
Patient: Uh no. 

Doctor: OK, any weight loss? 

Patient: No no. 

Doctor: How about changes in your skin? Like have you noticed a rash anywhere?
Patient: Uh, not that I've really noticed no, no rashes. 

Doctor: OK and any chest pain at all?
Patient: No, just sometimes when I I'm coughing a lot I feel a little bit of just tension and heaviness in there. But that's just when I'm like really coughing a lot. 

Doctor: Yeah OK, and any any feelings like your heart's racing?
Patient: Nope. 

Doctor: No? OK. And how about swelling? Have you noticed swelling anywhere in your body?
Patient: No, nothing like that. 

Doctor: No? OK um, OK, how about um, does your shortness of breath get worse when you're falling asleep? 

Patient: No, nothing like that. I think it's mainly just worse if I go out in the cold or I'm like running around, doing more activities. 

Doctor: Does it ever wake you up at night?
Patient: No never. 

Doctor: OK and any nausea or vomiting? 

Patient: No, no nausea or vomitting. 

Doctor: OK, how about changes in your in your bowel movement?
Patient: No, bowel movements are normal. 

Doctor: How about in terms of urinating, any changes there? 

Patient: No no. 

Doctor: OK any headaches?
Patient: No. 

Doctor: No? Any dizziness or fainting spells? 

Patient: No. 

Doctor: Confusion, memory loss?
Patient: No, nothing like that. 

Doctor: OK, good are you otherwise healthy?
Patient: Yeah, I don't have any other condition, I I do remember my doctors saying I have hay fever before, but that's about it. 

Doctor: When was that?
Patient: I think that was like more than three years ago. 

Doctor: OK, um, any recent surgeries? 

Patient: No. 

Doctor: No? Are you on any medications?
Patient: I just take some Tylenol sometimes for the like Tylenol cold, sometimes for the symptoms. I don't think it has really helped. 

Doctor: No? OK, do you have any allergies? Not just to medications, but to anything else?
Patient: Uh just like hay fever but nothing, nothing else that I can think of, no. 

Doctor: OK. Um, are you up to date with all your immunizations?
Patient: As far as I know, yeah everything's up to date. 

Doctor: OK, any family history of lung conditions?
Patient: Uh, don't think so. My sister, I think she they were saying she might have asthma and she also has eczema. No one else in the family has any other conditions. 

Doctor: Not not even like heart conditions, cancer? 

Patient: No, uh no, not that I know. 

Doctor: OK, OK, have you been in contact with anyone who's been sick recently?
Patient: No. 

Doctor: No, OK, and any travel recently?
Patient: No, I've been here in Ontario. 

Doctor: OK, and where do you live?
Patient: So I currently live in London, but I just recently moved into a new flat around two months ago. 

Doctor: Two months ago, OK. Um, is it more is it an older flat?
Patient: Uh, no, it's fairly new. But one thing I did notice, I don't know if this has anything to do with it, but my flatmate actually smokes. Sometimes that can really irritate and make me cough more sometimes at night. 

Doctor: Yeah, any any pets?
Patient: Oh no, I don't have any pets. 

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

Doctor: OK. And do you smoke marijuana?
Patient: Nope, never tried marijuana. 

Doctor: OK, any recreational drugs?
Patient: No, I don't smoke marijuana or cigarettes. 

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

Patient: Um, just like, maybe sometimes at parties, but very rarely. Maybe I would say once a month. 

Doctor: OK, OK. Um, and is there anything that you wanted to discuss today that I missed?
Patient: Uh, so no, I think that that was all like just the shortness of breath was scaring me a lot. But yeah, just the coughing, but other than that I just want to know what's going on. 

Doctor: OK, yeah, and you mentioned you are otherwise healthy so you don't have any history of asthma or anything like that, right?
Patient: No, no ones ever told me that, but my sister has asthma, so I was wondering, maybe? 

Doctor: Um, have you ever experienced shortness of breath when you were younger with like exercise?
Patient: Uh, not really. Just maybe like the normal amount. Like if I'm running around too much, I feel shortness of breath, but I think it just got worse over the last few months. 

Doctor: OK and then have you ever had any imaging done in the past like a chest X-Ray or investigations like a pulmonary function test? 

Patient: No, I don't recall having any of that done. 

Doctor: OK alright well those are all the questions I had for you. If you didn't have anything else to add, I guess we will conclude by saying that what you have, we have a differential diagnosis for this. Um, it sounds like what you have is asthma. Since your symptoms started three months ago when you moved into a flat with your friends, and it seems like this smoking and cold is triggering that and so we'll work you up with a pulmonary function test to start and we'll see if bronchodilators will help with your symptoms. And if it doesn't, we'll also rule out other things like pneumonia or like allergic rhinitis. How does that sound?
Patient: Yeah, that sounds good. 

Doctor: OK, sounds great. Well, we'll see you soon then.
Patient: Alright, thank you. 

Doctor: Take care.
Patient: Yeah, I've had a shortness of breath, and even at at rest. Really, feeling like it's difficult to breathe, and when I take a deep breath I get a chest pain. 

Doctor: When did this start?
Patient: This started yesterday. 

Doctor: How bad is your shortness of breath? 

Patient: Like, I don't know. I feel like I'm OK, like n terms of being able to breathe, but I mean if I exert myself at all, there's no way I would be able to. It's, I just feel like even at rest it's hard to breathe. 

Doctor: OK, has it gotten worse since yesterday or better, or kind of been the same?
Patient: It's mostly been that been the same or actually sorry it's got, got a little bit worse at first. It was more more with exertion, and now it's, at rest as well. So yeah, it's got worse. 

Doctor: I see, OK. Are you able to talk in full sentences or do you need to take a deep like stop to take a breath? 

Patient: I could talk in full sentences. 

Doctor: And the chest pain, does it only occur when you take a deep breath, or are there other times as well?
Patient: I pretty much yeah only when I'm taking a deep breath and say, I mean, maybe that's why part of the I can't take a deep breath so it's making me feel it's making the breathing more difficult making me feel more short of breath. 

Doctor: OK. Any other symptoms that you've had? A fever or headache?
Patient: No, nothing like that. 

Doctor: Any cough? 

Patient: Yeah, I, I've had a cough as well over that the same same time period. 

Doctor: Is it a dry cough? Are you bringing something up?
Patient: It's dry, yeah, I haven't brought up any sputum or any any any blood. 

Doctor: OK any other flu like symptoms, runny nose, stuffy nose, sore throat? Anything like that? 

Patient: No, I just had um, yeah, the shortness of breath and chest pain. 

Doctor: OK, uhm. And have you, I guess I just invited more general questions about others potential symptoms. Do you feel like your heart is racing or do you feel like you have, uhm, do you have any belly pain or any changes in your bowel movements?
Patient: No belly pain or changes to bowel movements, but I do feel like my heart is beating really fast really fast though. 

Doctor: Yeah, OK. Uhm, you said this started yesterday. Were you like completely fine the day before?
Patient: Uh I was yeah. 

Doctor: Anything that's happened recently that's different or new? 

Patient: I'm well it like uh, about two weeks ago I had a hysterectomy 'cause I, for abnormal bleeding. Yeah I had surgery 2 weeks ago. 

Doctor: What have you been doing these past two weeks in terms of sort of physical activity? Have you been moving around or no?
Patient: It's it's certainly been less I I've been moving a little bit, but I've had a lot of pain so I just haven't been doing as much activity, that's for sure. 

Doctor: I I see and have you had any, I guess any pain in your legs. Or swelling in your leg? One or the other? 

Patient: Yeah, I have had actually, yeah my right my right calf is pretty sore. 

Doctor: Definitely have a look at that. Have you noticed that it's been bigger or more red or warm?
Patient: Um, no, I don't notice anything like that, just I, just really hurts. 

Doctor: Uh, OK. Any medical conditions that you've been diagnosed with? 

Patient: Um, yeah, yeah and I have a high BMI. Type 2 diabetes and anxiety. 

Doctor: Do you have any bleeding disorders?
Patient: Um other yeah, no. I think you're right. It said fibroids. 

Doctor: OK, OK. And do you take any medication?
Patient: Yeah, so uh insulin, well metformin. And then that's it. 

Doctor: OK. 

Patient: I'm sorry and then an SSRI. Like I said, low pram for anxiety. 

Doctor: Alright. And do you have any allergies?
Patient: No, I don't. 

Doctor: And, who do you.. do you currently live alone?
Patient: Uh no, I live with my husband and and our two sons. 

Doctor: OK and, do you, have anyone sort of come in to help you out over these past two weeks? Are you getting any outside help from nurses etc. Or are your are your family members being supportive and helpful?
Patient: Yeah, it's been mostly the the family members. My husband's been working from home and the kids have been helpful as well. They are 10 and 12 so they are able to do some things on their own so yeah they've been supportive. 

Doctor: That's great. That's great. OK, and you smoke at all? 

Patient: I do yes I I smoke about a half a pack per day. 

Doctor: For how long?
Patient: Um, yeah, but I I started in my, yeah, after the kids were born actually, uh so like 10 years ago. 

Doctor: OK, have you tried cutting it down at all? 

Patient: Yeah, I have. I've kind of gone through spurts of quitting and restarting, quitting and restarting. So yeah, I've tried before. 

Doctor: OK, and what about marijuana or recreational drugs?
Patient: No, don't use anything like that. 

Doctor: And alcohol?
Patient: Yeah I'll have some wine on the on the weekends, but maybe that's like a glass or two. 

Doctor: OK, OK uhm, and do you have any medical conditions that long run in the family?
Patient: Just, uh, yeah, my father actually had a stroke when he was 68, and that's it. 

Doctor: OK OK uhm. You haven't ever had one, have you?
Patient: No, I I haven't had anything like that. 

Doctor: OK, alright. So. I guess come to in terms of smoking, you said that you've tried to quit a couple of times in the past. Do you intend on trying again? I know it can be very hard to, to quit smoking.
Patient: Yeah, it's only something that is always kind of in the back of my mind. 

Doctor: OK, if there's I'm happy to assist you and share resources and problems like medications and things like that that could help you if you're interested so we can talk more about that. talking about your I guess you mentioned that your weight is a little higher than or, its outside the normal range, is that something that you would like to cut down?
Patient: Yeah, I really try to eat more vegetables and have been trying to do that sort of thing. I've lost a few pounds, but not enough, definitely want to keep going. 

Doctor: OK, good good, as long as you feel that you what you're currently doing is helping you and is helping you reduce weight. That's great. But also I'm here for you if you need more education or guidance on that. So, given what you've told me so far, it sounds like you might have developed a clot in your leg somewhere, simply because you had a surgery and you were not moving around very much. Sometimes that causes the blood to kind of, not move around your body is as as much as it usually does, and kind of stays in one place and get turned into a clot and that clot can sometimes get dislodged and settle into your lungs, and that can make it difficult for you to breathe. So, we'll do some tests that that's what my understanding is. Given what you've told me so far, but we do have to confirm it using a test. Also, the fact that you smoke and your weight, and your BMI is high, increases your risk of developing a clot, so I would definitely strongly recommend that you continue to try to reduce both and try to quit smoking. And so we'll do an ultrasound of your leg and we'll do a scan of your chest and see what's going on and then decide if we need to give you any medications, like any blood thinning medications.
Patient: OK, yeah, that sounds really good. Thank you. 

Doctor: Welcome.
Patient: I just came in here today, I've been having a lot of shoulder pain that's just kind of left me not doing any of my activities recently. Just in my left shoulder. 

Doctor: OK and when, when did this pain start? 

Patient: It started 5 days ago but it became pretty bad and I've been kind of having like a somewhat of a pain for the last couple weeks, but it got really bad just this week. 

Doctor: OK, did you have any trauma to the shoulder like any any injuries or triggers that could have caused the pain?
Patient: Uhm I have been just going to the gym more frequently over the last few months and lifting weights and things like that. But just this week I wasn't even really able to do that either. 

Doctor: OK, when you were lifting weights like a few days ago like was there an episode where there was an acute onset of the pain, where it got worse kind of like right away. 

Patient: I think it was more progressive, but five days ago I do feel that there was like just. I was having some pain before that, but then I just noticed while working on I I started having more pain. But yeah I don't think there was anything like sudden that happened though. 

Doctor: Oh OK, but it yeah it was progressing and then it got acutely worse with the weight lifting. It sounds like.
Patient: Maybe like I did increase my weight like in the last two weeks. So I did feel like a little bit more pain with the increase last week. 

Doctor: OK, I see an in the left shoulder do you feel the pain at the front at the sides or or back?
Patient: It hurts, particularly like in the front part of the shoulder. 

Doctor: OK, do you feel that it's radiating anywhere else?
Patient: Just my whole left shoulder, nothing else really. 

Doctor: OK. And could you describe the character or the quality of the pain? Is it sharp, or is it a key? 

Patient: It's more achy. 

Doctor: OK.
Patient: But but certain like some movements so it can get like kind of sharp. 

Doctor: OK, and has there been anything that has made the pain worse?
Patient: Uhm, if I just if I carry anything with my left arm or if I have to lift anything or place it on my shoulder like it really hurts. 

Doctor: OK, and have you done anything that's made it better? 

Patient: I just like resting it, not carrying anything. And trying not to lie on my shoulder. 

Doctor: OK, so you're sleeping on the others on the right side then.
Patient: Yeah. 

Doctor: OK alright, how would what would you say the severity of the pain is on a scale of 1 to 10. 

Patient: Uhm, if I'm not doing it, doing anything or not doing much, it's probably like a two or three, but if I try to carry anything it goes up to like probably like a 7. 

Doctor: OK, uh, and um. Do you do any repetitive kind of like overhead activities? Things like playing basketball or just lifting things like above your head at the gym?
Patient: Um not recently just just like normal weight exercise, maybe with the bands I do some overhead exercises, but in terms of sports I I play or I used to play a lot of tennis. I did have some issues with the same shoulder, which is why I kind of stopped playing tennis. My DOCTOR: said it, I might have overused that shoulder, but that's that was like a couple of years back so I thought it must have healed by now. 

Doctor: OK, so previous overuse injury of the left shoulder? 

Patient: Mmmm 

Doctor: OK, and uh. I'm have you had any trauma to the shoulder?
Patient: Um no not that I know of. 

Doctor: OK, have you had any fevers or chills? 

Patient: No. 

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

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

Doctor: OK so even over the area you haven't noticed any redness or like soft tissue swelling?
Patient: No. 

Doctor: OK. Have you had any chest pain? 

Patient: Nope. 

Doctor: OK, how about any shortness of breath?
Patient: No, not that I've noticed. 

Doctor: OK, have you had pains and any other joints?
Patient: No, just my shoulder. 

Doctor: OK And. Um, Have you had any recent infections or or symptoms such as like a runny nose or sore throat or even a cough?
Patient: No, nothing like that. 

Doctor: OK, and how about any nausea or vomiting?
Patient: Um nope. 

Doctor: OK. And um. How has your sleep been these past couple of nights? So you mentioned you haven't been able to lay on your left side?
Patient: Yeah, it's been pretty painful like I kind of wake up every time I accidentally go on to my left side. 

Doctor: OK, so you're getting worse thing a pain at night? 

Patient: Yup. 

Doctor: OK. Have you had any weakness? Do you feel like you have less strength in your arm?
Patient: Um I do you feel that there might be some less strength in my left arm, but it's I'm not really using it much so it's hard to tell. 

Doctor: OK,  And how about a range of motion. Do you feel as though you could lift your left arm up to like, scratch your head and back?
Patient: It does hurt like when I try to lift my arm up. 

Doctor: OK, so it sounds like a range of motion is decreased?
Patient: Mmm 

Doctor: OK, and have you had any altered sensation of your arms being like numbness or tingling?
Patient: No, I haven't felt any of that. 

Doctor: OK. Um and have you had any changes to your bowel habits like constipation or diarrhea? 

Patient: Nope, nothing like that. 

Doctor: Have you had any abdominal pain?
Patient: Nope. 

Doctor: And have you had any urinary problems? 

Patient: No. 

Doctor: OK, and in the past have you been diagnosed with any medical conditions?
Patient: Uh. No, I've been a pretty healthy actually just just that overuse injury like two years ago. 

Doctor: OK, great and do you have any allergies to medications? 

Patient: No. 

Doctor: OK, do you take any medications regularly?
Patient: Just recently I've been taking a lot more of the Advil, but that's about it. 

Doctor: OK, I and have you had any hospitalizations or prior surgeries?
Patient: No, no prior surgeries or hospitalizations. 

Doctor: OK, and could you tell me a little bit about your living situation currently, like who you're living with, and whereabouts? 

Patient: Yeah, so I'm living with with my wife in a small condominium in downtown. 

Doctor: OK, and are you working currently?
Patient: Yeah, I'm working as a real estate agent. 

Doctor: OK, uh, and do you drink alcohol? 

Patient: Rarely just on some occasions, but not regularly. 

Doctor: No. OK. How about smoking cigarettes or cannabis?
Patient: No, I've never smoked. 

Doctor: Do you use any recreational drugs or have you in the past? 

Patient: Nope 

Doctor: OK. Um. And so so the next part, just for the physical exam. So do you have pain with shoulder AB duction.
Patient: Uhm yes. So just to yeah, I do have some pain. Especially from. Yeah yeah pain throughout AB duction. 

Doctor: OK, is there any like pain that's like parts of that that range of motion that are more painful for you? 

Patient: yeah, so probably from 60 degrees to 120 degrees is more painful. 

Doctor: OK. And. If your arm is outstretched and your thumb pointing down so your arm is internally rotated does that give you pain?
Patient: Yeah, if yeah, not not just like that, but if you were to like press down on it it the internal rotation does cause a little bit of pain. 

Doctor: OK. OK, so it sounds like a positive jobes test and a positive Neer's test as well as a painful arc for your shoulder. And is there pain to palpation?
Patient: Uh. Just to, yeah, definitely just at the front of the shoulder there is some some pain over with palpation. 

Doctor: OK, that sensation is normal, reflexes are normal and strength is slightly reduced as well. OK, so that was everything that I wanted to ask on history and check on the physical exam as well. Was there anything else that you wanted to mention today that I maybe forgot?
Patient: Uhm, so I've had this runny nose, well first it was a stuffy nose, but now I've had this runny nose for the past week and a half and it doesn't seem to be getting any better. So I was just wondering if you could give me something for that? 

Doctor: Yeah, so yeah, let's just try to first see what's going on. So you've been having this, so when did it start getting stuffy? 

Patient: Uhm, it started getting stuffy about two weeks ago. 

Doctor: Two weeks ago, and when did it start getting, like just a runny nose?
Patient: Yeah, that started a week and a half ago. 

Doctor: OK, and have your symptoms, have these symptoms gotten worse at all? 

Patient: No, it stayed about the same. 

Doctor: OK and do you have any coughing?
Patient: No, no coughing. 

Doctor: No coughing, uhm, any fevers or chills? 

Patient: No. 

Doctor: No, uhm, and the, from the runny nose, are you having any yellow or green discharge?
Patient: No, it's clear. 

Doctor: It's clear, OK. Have you at all coughed up any blood at all?
Patient: No, nothing like that. 

Doctor: OK, and do these symptoms come and go, or are they pretty constant?
Patient: Uhm, they are pretty constant. 

Doctor: OK, and is there anything that you have tried that has helped you with these symptoms? Any over the counter medications? 

Patient: No, I haven't tried anything. I've been thinking about using some nasal decongestion but I don't want to make my runny nose any worse. 

Doctor: Yeah, no, that's a, that's a fair point. And yeah, there's multiple things that you can try over the counter, but we can get into that more later. Are you having any other symptoms at all, like any, shortness of breath, chest pain, any kind of dizziness, anything like that?
Patient: No dizziness, I feel like sometimes I have a headache though, because I feel like there's a lot of fluid or something backed up into my sinuses. 

Doctor: OK, so do you, are you feeling, that pressure in your face at all?
Patient: Mhm, a little bit, yeah. 

Doctor: OK. Have you at all in the past couple weeks to a month had contact with anyone that was sick? 

Patient: No, nothing like that, that I can think of. 

Doctor: OK and any travel?
Patient: Uhm, no. 

Doctor: OK, and any symptoms of a loss of taste of, sorry, loss of sense of taste or smell?
Patient: No. 

Doctor: No, any nausea or vomiting?
Patient: Uh, nope. 

Doctor: Any night sweats? 

Patient: No. 

Doctor: How about fatigue, or do you feel tired?
Patient: A little bit, yeah. 

Doctor: OK, are you, do you work at all? 

Patient: I work from home right now. 

Doctor: OK, and has this affected your work in any way?
Patient: No. 

Doctor: OK, uhm, where, where do you live? Do you live in an apartment, a house?
Patient: I live in an apartment. 

Doctor: And do you live with anyone?
Patient: No, just by myself. 

Doctor: OK, and any mold or dust or fumes, anything in your household? 

Patient: I have some old carpets, but that's about it. 

Doctor: OK. Have you felt any changes in your sleep or appetite?
Patient: No, nothing like that. 

Doctor: OK. Any changes in your bowel movement, like diarrhea or Constipation?
Patient: No. 

Doctor: Any urinary trouble?
Patient: No. 

Doctor: Any weight loss? 

Patient: No. 

Doctor: OK. Do you have any past medical conditions that you've been diagnosed with, like asthma or anything else?
Patient: Uhm, no, I'm healthy otherwise. 

Doctor: OK, any allergies that you know of? 

Patient: Uh, nope, no allergies either. 

Doctor: OK. Do you take any regular medications?
Patient: Uh no, I don't even take vitamins. 

Doctor: OK. Any hospitalizations or surgeries in the past? 

Patient: I had an arm fracture when I was younger, but that's it. 

Doctor: OK, but other than that, nothing else?
Patient: No. 

Doctor: OK. And currently right now, do you smoke cigarettes at all?
Patient: No. 

Doctor: Have you smoked in the past? 

Patient: No. 

Doctor: Any recreational drugs like marijuana?
Patient: No. 

Doctor: OK. And do you drink alcohol? 

Patient: Once in a while I'll have like a glass of wine every week. 

Doctor: OK. And yeah, those are pretty much all the questions I have right now. Do you have any questions?
Patient: Uh, no, what can I do about this runny nose? 

Doctor: Yeah, so it seems like it's been going on for more than one and a half week. What, what is reassuring is that you're not having any other symptoms that are concerning, like you're not having any cough, you're not having any green or yellow sputum, you're not having any fevers, so it seems that you might just be having a cold, which can be caused by just a viral, uh, infection, but it should go away on its own. Just make sure that you're getting some rest, you're hydrating well, uhm, you can get some over the counter medications like Tylenol cold for example, but for now I would say we should just wait and watch. But just in case, also, since it is one of the symptoms that's for covid as well, in this time period we will just get a covid swab just in case, but most likely it's nothing to be worried about. Until you get your test, I would recommend staying isolated. And then we can go on from there, is that, does that sound good to you?
Patient: Yeah, that sounds great. Thank you so much. 

Doctor: You're welcome, take care.
Patient: So I came to the emergency Department because I've been having pain in my chest. 

Doctor: OK, where is the pain located?
Patient: I would say it's like the whole pretty much the left side of my chest. 

Doctor: OK, and when did this pain start?
Patient: So I think it started just around 2 hours ago. I actually was riding my bicycle and just fell off on, kind of just slipped and I think I fell on that side like when I the impact was right on my chest and since then it's been really painful. 

Doctor: OK I am how would you describe the pain, sometimes people will use words like burning dull, achy.
Patient: I think it's more like someone is just stabbing me and then whole left side area. 

Doctor: OK, and um. Anything that you've been doing that's that's made the pain worse? 

Patient: If I. Think I have to take really really slow and shallow breaths. If I try to take a deep breath it just really hurts like taking those small, smaller breaths helps. 

Doctor: OK, and do you feel the pain anywhere else, or is it just on the left side of your chest?
Patient: No, I would say just on the left side. 

Doctor: OK, and has the pain been getting worse, staying the same or getting better? 

Patient: I'd say over the last two hours it's been getting worse. 

Doctor: OK, and do you have any other associated symptoms?
Patient: Uh, like I think I I'm having. Also maybe it's just because I'm trying to breathe slowly, but I feel like I can't catch my breath. 

Doctor: OK, um has anything like this ever happened to you before? 

Patient: No, no. I mean, I've never had any pain in my chest before. 

Doctor: OK are you, did you have a loss of consciousness when you fell off your bike?
Patient: No, I got right back up. I just just had the pain. 

Doctor: OK, so any injuries to the head?
Patient: That's fine. I was wearing a helmet. 

Doctor: OK, excellent and any headache right now?
Patient: No. 

Doctor: OK, how about any fever chills? 

Patient: No, I feel I'm fine. 

Doctor: Any nausea or vomiting?
Patient: Nope. 

Doctor: Do you feel as though your heart's racing? 

Patient: I would say like in the last hour a little bit more so than usual. 

Doctor: OK. Any skin changes or or rashes you've noticed?
Patient: Besides, just I got some scrapes here and there on my hands, but nothing else. 

Doctor: OK, and do you have a cough? 

Patient: Nope. 

Doctor: OK, and any recent infections?
Patient: No, I've been pretty pretty healthy recently. No, no cough or no infections. 

Doctor: OK, and uh, any dizziness? 

Patient: Um no. 

Doctor: Alright, and I know you mentioned the few scratches on your hands, but any other injuries?
Patient: Oh no, I I think I got a pretty lucky. 

Doctor: Oh, OK. And any alcohol or drug intake prior to falling off your bike?
Patient: Oh no, no, I was completely sober. No no drugs or alcohol. 

Doctor: OK, and any weakness or numbness or tingling that you noticed? 

Patient: Um no nothing like that. 

Doctor: Alright, and, when was the last time you had anything to eat or drink?
Patient: I just had some cereal and, um, just some chocolate milk around breakfast time but nothing else. 

Doctor: OK, and how many hours ago was that?
Patient: I would say around 3 hours ago. 

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