jshargo/medical-interview-conversations2 huggingface dataset:
user: No, those feel fine. I can move my hip and ankle okay, and no pain. 

assistant: Okay, alright, so those are all the questions I had for you. We'll do like a full physical examination, take a look at your knee, um, and most likely, what this sounds like, is something called septic arthritis. It's uh, it's when there's like an infection that um, can go into your joints and uh, it is a pretty serious issue that we need to um, assess and treat as soon as possible. So the first thing that we will um, need to do, we'll need to do some blood work just to get some inflammation markers and just your uh, CBC, and see if you have um, an infection. However, we'll also need to do a joint aspiration of your of your um, go your knee, and we'll be taking some fluid within your joint called the synovial fluid and assess for um, we'll send in for um, culture, and look for like these crystals, and count. And then based on that, we'll understand um, the infection you have and what kind of infection you have. We will start you on antibiotics right away um, today, and so you will be um, here for a while until we get all those results back. And you may also require um, an admission today as well.
user: Okay, uh, thank you. Yeah, that, that sounds good. 

assistant: Alright, yeah, so yeah, we'll get all that done for you shortly, and uh, we'll go from there.
user: Right, thank you. 

assistant: And um, we might also need an x-ray, so just sit tight. We'll, we'll come call you.
user: Yeah, so I've had this chest tightness and and been short of breath and bringing up sputum with this uh cough. 

assistant: OK, so um lets start with the cough. When did that start?
user: So I've had a cough now for a few years, um but over this past uh three days it's gotten quite a bit worse. 

assistant: : OK, for the past three days, three three years. OK. 

user: Yeah. 

assistant: Um are there any triggers for your cough?
user: Uh, yeah, if I'm doing, um, like if I'm really active like if I run to catch the bus or uh or if I'm shovelling snow, maybe I can make, become short of breath, but um not if I'm just walking around the block or anything like that. 

assistant: OK, and what caused this cough initially three years ago? Do you know? 

user: Uh yeah, I think um I think it's just a smokers cough. I think that my family doctor told me I had like chronic bronchitis before. 

assistant: OK, OK. How often were you coughing before it got worse recently?
user: Uh I would usually cough every day, but the cough would be, usually just in the morning, I I'd get up um, there, I would cough up some sputum and and then maybe, and then I'd usually be OK. 

assistant: OK, um and does anything make your cough better? Like do you take any over the counter cough syrup? 

user: Um yeah, I've tried some over the counter uh cough syrups in the past, but it hasn't helped. 

assistant: OK, OK, and if you were to talk about the quality of your cough, is it is it barky? Does it sound harsh? What does it sound like?
user: Uh yeah, I would say it sounds pretty harsh. You can kind of, it sounds like there's um mucus moving around, I guess with with the cough in my chest, I can I can kind of feel it 

assistant: OK, OK and you mentioned that you're producing a lot of sputum with your cough. What colour is that sputum?
user: Greenish 

assistant: Green, OK. Any blood? 

user: No blood. 

assistant: No blood, OK. And you mentioned, you've never produced sputum with the cough, especially not green sputum in the past three years, right?
user: I would bring up sputum, but it's usually clear and white. 

assistant: OK, OK, and do you have any wheeziness associated with this cough?
user: Uh, yes I do 

assistant: Yes, OK. And you mentioned you were short of breath. Were you short of breath prior to your cough or did that start um when when this cough got worse?
user: I think the shortness of breath has gotten a bit worse over the um last few days uh as the cough has gotten worse. 

assistant: OK, OK. And if you were to rate the severity of your symptoms, of how you're feeling, 1 to 10, 10 being the worst, where would you put yourself at?
user: Uh I would say an 8, it's been really tough, it's been getting really difficult to um breathe. 

assistant: OK, yeah. And have you ever experienced anything to this severity in the past?
user: No, I haven't had uh this difficulty breathing before. 

assistant: OK. OK. Um do you have any chest pain? 

user: Uh, my chest is, it feels tight. 

assistant: OK. Uh it feels tight, OK, does that, does it hurt though?
user: Uh no, no, it doesn't really hurt. It's just uncomfortable. 

assistant: OK. And do you think it's tight because of the coughing or um the shortness of breath? 

user: Yeah, I kind of feel it um with the coughing. 

assistant: OK and have you noticed any swelling in your limbs?
user: Uh yeah, maybe a little bit in my in my feet, more than usual. 

assistant: OK, and do you feel like your heart's racing?
user: Uh, no. 

assistant: No, OK. Any dizziness or fainting spells?
user: Uh I haven't had anything like that. 

assistant: OK. Um any changes to your vision or hearing?
user: No. 

assistant: No, um, do you have a stuffy nose or runny nose?
user: No. 

assistant: Um how about a sore throat? 

user: No. 

assistant: No, any changes to your smell or taste?
user: No. 

assistant: Um any fevers or chills?
user: No, I've felt OK. 

assistant: OK, any weight loss? 

user: Um yeah, maybe I mean over the last few years I've um lost a few pounds, but maybe maybe 10 pounds over the last last couple of years 

assistant: Last couple of years, OK. Was it intentional weight loss or unintentional?
user: Unintentional. 

assistant: OK, um alright, and any changes to your hair, nails or skin, like rashes?
user: No, I haven't noticed anything like that. 

assistant: OK, and how are your bowel movements? Everything normal there?
user: Yeah, that's been normal. 

assistant: OK, everything normal with regards to your urine?
user: Yeah, that's been normal. 

assistant: OK. Any confusion or memory loss? 

user: No. 

assistant: No, OK. Any fatigue?
user: Yeah, I've been feeling well, really tired these last three days. 

assistant: Yeah, OK. Any joint pains or muscle aches? 

user: No. 

assistant: No, OK um and are you otherwise healthy?
user: Um, well, I use uh these inhalers um and I think I've been told I have COPD before. 

assistant: OK, Um other than your COPD, do you have any other longstanding medical conditions like high blood pressure, diabetes, anything like that? 

user: Um yeah I have uh high blood pressure and um I had my gallbladder taken out uh a few years ago. 

assistant: OK. OK, any other surgeries or hospitalizations?
user: Uh I had an ACL repair like when I was a teenager. 

assistant: OK, and besides the inhalers, are you on any other medication? 

user: Yeah, there's one for blood pressure um and I take vitamin D, um and that's it. 

assistant: OK, which one, which um medication are you on for the blood pressure?
user: Uh amlodipine. 

assistant: Amlodipine, OK. When did you start taking that? 

user: About uh seven years ago. 

assistant: OK, and then for your uh COPD, which inhalers are you on?
user: Uh, there's one that's for, um, like short acting. And then there's one that I use everyday, uh Spiriva, I think. 

assistant: OK, yeah. And how long have you been on these inhalers? 

user: Uh it's been a couple of years for well, for the the short one that I I use for rescue therapies been for like a long time, but Spiriva's been the last several years. 

assistant: OK, OK, and do you find that your inhalers are helping?
user: Yeah. They um, I definitely notice a difference when I, if I miss a dose or something. 

assistant: Yeah, OK. And um, do you have any allergies?
user: Uh no, I don't think so. 

assistant: No, OK. How about um immunizations, are you up to date? 

user: Yeah, I believe so. 

assistant: OK. And in terms of family history, uh are there any lung conditions or heart conditions that run in the family?
user: Um, uh no. 

assistant: No, OK. Um do you currently smoke? 

user: Uh I do, yes. I've been trying to quit, I um I smoke about a pack of cigarettes per day now. I used to smoke like 2 packs per day. 

assistant: OK, well it's it's good that you've cut down, um if you need any additional help cutting down we have resources that we can refer you to.
user: Yeah, that would be great. 

assistant: Yeah, um how much, for how long have you been smoking? Like how many years?
user: Uh well, I started when I was a teenager, so probably like 35. 

assistant: OK. Um and do you do any marijuana? 

user: Uh no. 

assistant: No, OK, OK, um how about alcohol? Do you drink alcohol?
user: Yeah, a few beers on the weekend. 

assistant: OK. Um and then where do you live currently? 

user: I live in an apartment by myself. 

assistant: OK. Um and any reasons to think that there are any old carpets, mold, or um asbestos or anything like that that could be exacerbating your symptoms?
user: Uh I mean I do have a carpet in the bedroom so, but I mean that that's the only carpet in the apartment. 

assistant: OK. Um and do you live with anyone? 

user: No, it's it's just me and my dog. 

assistant: OK. Uh have you, have you been around any sick contacts recently?
user: Um maybe, I mean I I usually will see uh, a couple of friends, we'll meet up to grab some coffee in the morning in the morning um but I feel like they have been uh OK. 

assistant: Yeah OK, how about um travel, have you traveled anywhere recently?
user: No. 

assistant: No, OK. OK, well I think those were all the questions that I had for you. Did you have any questions or concerns or anything that I missed that you wanted to discuss?
user: Um no, I just wanted to, um, yeah, come in because it's been really difficult to breathe. 

assistant: Yeah, so OK, well we'll do a physical exam on you um to try to understand um how bad your COPD exacerbation is. Um we'll also try to get an um oxygen saturation on you, and we do want that reading
user: Yeah, so I've been feeling just really down recently in the last week. I started off by having this sore throat which started around 5 days ago and then I also noticed I've been getting some chills over the last few day. And on top of all of that, within the last three to four days I've been getting muscle aches all over my body. 

assistant: OK, alright so the sore throat started 5 days ago and then the fever started when?
user: So the fever. I think I haven't measured it, but I started having chills like 3 days ago. 

assistant: Three days ago, OK, and the muscle aches started two days ago?
user: I would say 3 days ago as well. 

assistant: Three days ago, OK. OK, are you having any trouble swallowing foods or fluids? 

user: A little bit with solids with a sore throat but liquids, I'm doing OK right now. 

assistant: OK. And is it hard for you to like, are you having issues vocalising at all?
user: No, I think my voice has been the same. It's just when I'm not talking, especially if I'm swallowing my own like spit, it still hurts sometimes, but mainly with solid food. 

assistant: OK, OK and then, are you having any issues with taste or smell? 

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

assistant: OK, how about hearing or vision?
user: No, no changes. 

assistant: Any weight loss over the past few weeks? 

user: No, I probably have gained weight. 

assistant: OK, any fatigue or exhaustion?
user: Now that you mention it, I do feel pretty tired over the last few days, I don't know if it's just because of my muscles aching all the time, or I don't know. I have definitely felt very tired. 

assistant: OK, how about changes in your hair, nails or skin like rashes?
user: No, nothing like that. 

assistant: Do you have a cough at all?
user: No, I haven't really noticed the cough. 

assistant: How about shortness of breath or wheezing? 

user: No, no shortness of breath or wheezing. 

assistant: OK chest pain or you feeling like your heart's racing?
user: No. 

assistant: No, and how about dizziness or fainting spells? 

user: Uh, no, I haven't had any of those. 

assistant: OK, how about changes to your bowel movements?
user: No, I don't think so. I go regularly once a day and I haven't noticed any watery stool or diarrhea. 

assistant: OK, that's good. Any changes in your appetite? 

user: Yeah, with a sore throat I tend to like eat softer foods right now. I can't really, I don't really feel like eating. 

assistant: Yeah, OK. How about nausea or vomiting?
user: No, no, nothing like that. 

assistant: OK, OK, and any issues with joint pain? You said your muscle aches, but how about joints?
user: Um, no, I don't think it's specifically my joints. I think more so I would say like around in my thighs. Then I would say just my upper arms hurt a lot. And even, uh, my upper back area hurts a lot as well, so it's kind of just everywhere. But those are some areas that hurt the most. 

assistant: OK, OK, are you otherwise healthy?
user: Um, yeah, I do have a couple of things on my list. I do have high blood pressure. I have diabetes and other than that, I also have like high cholesterol. 

assistant: OK.
user: Yeah, that's just some of the things that I've been diagnosed with. 

assistant: Yeah, OK, and do you take medication for any of these things?
user: Yeah, so I take for the blood pressure, I take this medication called the Ramipril. 

assistant: OK yeah.
user: And then for diabetes I'm taking Metformin. And then for the cholesterol I'm taking this medication called Crestor, yeah. Yeah, but other than that, just like vitamin D and multi vitamins. Those are some of the medications that I'm taking. 

assistant: Sure yeah, are you up to date with all your immunizations? 

user: Yup. 

assistant: OK, do you know if you got a vaccine called Shingrix for shingles and Pneumovax for pneumococcal infections?
user: Yeah, I actually think I got them just this past season. Uh, with all this COVID going on, I just wanted to make sure I got all those vaccines as well. So yeah, I recently just got them. 

assistant: OK, good. And and how about any allergies?
user: Uh, no, I don't have any allergies. 

assistant: OK, how about family history of lung conditions or heart conditions?
user: Uhm, no lung conditions and uhh heart conditions, both my mom and dad suffered from like high blood pressure. My dad also had a heart attack when in his 60s. Now there is some heart conditions that run in the family. 

assistant: OK, OK. And then any cancers in the family? 

user: Uhm, m son actually got diagnosed with colorectal cancer just a few years ago. 

assistant: Oh, I'm sorry to hear that.
user: He's doing OK though. Like it was pretty scary at the time. 

assistant: How old was he when he was diagnosed? 

user: I think he was, yeah in his forties, 46. 

assistant: OK, well he's yeah, that's young. Have you had a colonoscopy?
user: Yeah I had it done. Everything came back normal so yeah, I'm not sure where he got it from. 

assistant: OK. Have you had any sick contacts recently?
user: No, no sick contacts that I know of. I've been mainly in my house. I do go outside for groceries and some things like that, but other than that I'm retired. I don't really go out too much. 

assistant: Yeah, OK, and you said you're retired. Do you live alone? Do you live with anyone?
user: No, yeah, I live alone now. And I live in London in an apartment 

assistant: OK, any old carpets? Mold, dust, asbestos?
user: No, nothing like that. It's a pretty safe building. 

assistant: OK, good, and do you smoke? 

user: I used to. I used to smoke, probably in my 20s to late 40s, but then I quit. 

assistant: OK, good, good for you. How much did you smoke before you quit?
user: Probably one to two packs a day, I would say. 

assistant: OK, that's good, that's good that you quit. Do you drink any alcohol?
user: Uhm, I just stick to some red wine, maybe a couple times a week. 

assistant: OK, couple times a week so two to three times?
user: Yeah, I would say two to three times and, uh, I probably go through maybe 1 bottle every two weeks. 

assistant: OK, OK. And then any marijuana?
user: No, no, I've never had any marijuana or any recreational drugs, no, nothing else. 

assistant: OK, good, well those were all the questions that I had for you today. Did you have any questions of your own for me?
user: Yeah, uh, with all this COVID and the pandemic going on, I don't know, I like, I've been mainly at my house, but like I said I do go to do my own groceries. Of course I wear a mask, but I don't know if I might have caught COVID,  so that's something I was worried about. 

assistant: Yeah, for sure. I think just because your symptoms do overlap with those of COVID, we will be doing a COVID swab today and you should hear back about your results in 24 to 48 hours. But you should still self-isolate for 14 days because you do have similar symptoms and if it's not COVID, it's probably another viral illness that's going around these days and for that you don't need any medication, like prescribed medications, but just keep an eye on that, on your symptoms. Stay hydrated, eat well. If you need to lower your feve, you can use Tylenol. And if your symptoms worsen or you start getting neurological symptoms like weakness or seizures or anything like that, you should seek help from the ER. How does that sound?
user: Sounds good. I just had another quick question. I did get the shingles and the pneumococcal vaccine back then but I didn't get the flu vaccine, like should I get it? Is it recommended? 

assistant: Yes, it's definitely recommended. So we won't give you the vaccine right now because you have symptoms. But once you are healthy again, you should definitely get the get the flu vaccine and you should get it once a year. 

user: OK, I just never took those vaccines, but I'll do that from now on. 

assistant: Yeah, it's a good idea, and even if you get the flu, your symptoms won't be as severe if you have the vaccine, so it's definitely something to consider.
user: Sure, I've had this terrible headache for the past four days. Doesn't seem to be getting any better, and I feel hot like I have a fever. I've been coughing a lot so I am I'm worried I have COVID, so I'm here. 

assistant: OK. So I'll start with the headaches. When did when did that exactly started? 

user: Uh the headache started, OK so the coughing started four days ago. The headache started shortly after so I would say later on during that day and then the fever I've had for, fever I think I've had for the past two days. I haven't actually taken my temperature though. 

assistant: OK um. So, uh, the cough is started four days ago. Has the cough gotten better, worse, or stayed the same?
user: The cough has stayed the same. 

assistant: OK, are you bringing up any phlegm or sputum with the cough?
user: Um, it's not really phlegm, but sometimes I cough up, like bits of like. You know little bits that look like blood or something. 

assistant: OK, so you're seeing some like red when when you're coughing up? 

user: Mmmm 

assistant: OK, and how much of this are you seeing like, is it like a teaspoon amount or or more?
user: Oh, it's it's very little. It's like maybe a little bit bigger than like the tip of a pencil. 

assistant: Oh OK, are you, OK, are you seeing this on like kind of tissues afterwards sort of thing?
user: Yeah. 

assistant: OK, um and any triggers for the cough you can think of?
user: No, it just seems to be there all day. Um, doesn't really get better with me trying to rest or not. 

assistant: OK, and is the cough there at night time too? 

user: Yes, it is definitely there at night. 

assistant: OK, um is it interfering with sleep?
user: Ah yes, I haven't been sleeping well. 

assistant: OK, um, and with your cough have you had any difficulties with breathing? 

user: Um, no. 

assistant: Alright, and now, how about any wheezing?
user: No wheezing. 

assistant: OK. And with this headache when it first came on, did you experience a like worst headache of your life, or a Thunder clap sensation? 

user: No, it's it's not that bad, but it just seems to be there all day long. 

assistant: OK, um have you had headaches like this before?
user: No, I've never gotten headaches in the past. 

assistant: OK, uh is the headache associated with any nausea or vomiting?
user: No. 

assistant: OK, and is the headache worse in the morning when you first wake up? 

user: No. 

assistant: OK, and does it have to get worse if you lie flat?
user: No. 

assistant: OK, and has this headache been getting worse, staying the same, getting better?
user: It's it's about the same. 

assistant: OK. Um and, um and you haven't checked the temperature yet, you said, but you felt hot?
user: Yes, that's right. 

assistant: OK, any other symptoms that you've been experiencing? 

user: Not that I can think of. 

assistant: OK, there's just a few others that I wanted to ask about to be comprehensive. Have you had any eye pain or ear pain?
user: No. 

assistant: How about any discharge from either your eyes or ears? 

user: No, nothing like that. 

assistant: Alright, have you had any changes to either your sense of smell or your sense of taste?
user: No. 

assistant: Alright, and have you had a runny nose at all?
user: Um no. 

assistant: And how about a sore throat? 

user: No. 

assistant: OK, and um, have you had any chills?
user: Um no chills. 

assistant: How about night sweats?
user: Um no nothing like that. 

assistant: I see, OK and over the last few months has your weight changed? 

user: Ah no, not that I noticed. 

assistant: OK, um have you been feeling tired or fatigued?
user: No. 

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

user: Um no. 

assistant: Alright, and how about any heart palpitations?
user: None. 

assistant: Alright, in any episodes of feeling really dizzy or lightheaded.
user: No. 

assistant: OK, and how about any fainting spells or feeling like you might faint?
user: No, nothing like that. 

assistant: OK. And have you had any abdominal pain? 

user: Um no, no abdominal pain. 

assistant: Any diarrhea or constipation?
user: No. 

assistant: How about any painful urination or feeling as though you need to urinate really frequently? 

user: Ah no nothing like that. 

assistant: OK, and have you had any skin changes like rashes or anything like that?
user: No. 

assistant: OK, and how about any muscle aches or joint aches or just overall like body pains?
user: Mmm no, not that I that not. Not that I've noticed, no. 

assistant: OK, is there anything in regards to your past health that you see a physician regularly for? 

user: Um No. Ah actually I I think at one point, um, I was worked up for something called familial hypercholesterolemia because it ran in the family. But I think those results were normal. 

assistant: OK, so do you, um, do you take a statin medication then?
user: Yeah I take a low dose statin. 

assistant: OK, and when was your last lipid panel checked? 

user: I think it was two years ago. 

assistant: I see, and um do you remember if the LDL was normal at that time?
user: Ah yes it was normal. 

assistant: OK, but since the, it was about two years ago, it might be worthwhile today just to also check a lipid panel just to be safe, but that'll be something we can talk about that more so at the end if that's OK. 

user: Sure, yeah, that would be great. 

assistant: OK, and any other medical conditions?
user: No. 

assistant: OK. Have you had any surgeries before? 

user: C-section. 

assistant: How many children do you have?
user: Ah just the one. 

assistant: OK, and were there any complications with the c-section? 

user: Um no no complications. 

assistant: OK, any reasons for hospitalizations?
user: Nope. 

assistant: OK, any allergies to medications?
user: No. 

assistant: Alright, any medications besides the statin that you take?
user: Nope. 

assistant: OK, and in regards to your family history, have there been people who've had early heart attacks or strokes in the family?
user: No. 

assistant: OK, but you do have familial hypercholesterolemia, do you have family members who have that?
user: Yes OK so my Aunts had it, as well as my mother. 

assistant: OK um. And has there been any lung conditions that run in the family?
user: Um, no lung conditions. 

assistant: How about any malignancy's or or cancers?
user: Ah there was colon cancer on my dad side of the family, but I'm not too sure who had it. 

assistant: OK, have you heard of anybody having breast cancer? 

user: Breast cancer no. 

assistant: Alright, and how about ovarian cancer?
user: No ovarian cancer. 

assistant: OK. And next I actually wanted to ask a few questions about your personal and lifestyle habits, but first, could you just tell me a little bit about your living situation right now?
user: I live with my husband and my one son. 

assistant: OK, and sorry, how old is your son?
user: He is 10. 

assistant: OK, um is anybody in the home been sick recently? 

user: No. 

assistant: OK, and how about is there anybody at work?
user: At work no. No one's been sick. 

assistant: OK, have you traveled anywhere recently? 

user: We went up to we just went to um like a, we went on a hiking trail that was outside the city recently and there were a lot of people there and and we weren't wearing masks, but we, it seemed like we were keeping a good distance between each other so that that would be my only concern. 

assistant: OK for sure. Were people pretty close to each other on the paths when walking by on the hike?
user: Ahh not like the whole time, but there would be times when you know people just kind of brushed by you to try to get ahead of you or something like that. 

assistant: I see OK. And do you smoke cigarettes?
user: No. 

assistant: Um, do you smoke marijuana?
user: Um no. 

assistant: OK, and do you drink alcohol? 

user: I don't. 

assistant: Do you use any other recreational drugs?
user: Um no. 

assistant: OK, so that was all I wanted to ask about. Oh, actually one thing that I I did want to, I forgot to ask was, do you have any neck stiffness?
user: No, not that I noticed. 

assistant: OK. So that was the last question that I wanted to ask about. Was there anything that you wanted to tell me that I I maybe forgot?
user: No, I think you covered it all.  I'm just wondering do you? Do you think it's COVID or something else? 

assistant: Well, it's definitely a possibility with the symptoms that you're having, since they can be so non- specific for covid it can be a lot of symptoms that overlap. So with having headache what sounds like you might have a fever and and this cough that sounds like it's pretty bad if you're bringing up some blood, it sounds like you might have irritated some of the bronchioles with the the coughing. So we will test for that and check a PCR nasal swab for COVID. I'm not, but we will also test for other viral illnesses and bacterial illnesses as well. It doesn't sound like you have meningitis right now just based on the symptoms where you don't have neck stiffness, but it'll be certainly something that we keep keep in mind while we are doing our investigations. 

user: OK great, thank you. 

assistant: Alright, you're welcome. We'll get those started.
user: Hi there, I brought in my here because he's been barking, well not barking, he's had this cough that sounds like a barking cough and he's having a really hard time taking in a deep breath and money does it sounds, it sounds harsh. 

assistant: OK, and when did the cough start? 

user: It started about two days ago. 

assistant: OK, is it a dry cough or wet cough?
user: It sounds pretty dry, yeah. 

assistant: Alright, so so there's been no sputum and no no hemoptysis? 

user: No. 

assistant: OK. And it it does, the cough happen at any particular time of day?
user: Uhm, I mean no, well, actually mostly at night, but also it happens throughout the day. Umm, but yeah, more so at night. 

assistant: OK. And, uh, has there been any shortness of breath or difficulty breathing?
user: Uh, no shortness of breath or difficulty breathing. It just sounds harsh when he does take a deep breath in. 

assistant: OK. Uh, and any changes to, uh, to the voice or, uhm, yeah, like this is saying does he sound any different like a hot potato voice?
user: Uhm, no. It doesn't sound like that. 

assistant: OK. And uh, uhm, that you mentioned umm, oh sorry, has he had any changes to the sound of his breathing?
user: The sound of his breathing. It sounds like it sounds harsh when he takes a deep breath in. 

assistant: OK. So that sounds like he's having some stridor. Has he been having any wheezing?
user: You mean like when he exhales? 

assistant: Uh, yeah. 

user: Uh, it's more when he inhales that I hear it. 

assistant: OK. OK. And has he had any eye redness or any eye discharge?
user: Uhm, no, I haven't noticed anything like that. 

assistant: Is the other a runny nose? 

user: No. 

assistant: OK, has he had a sore throat?
user: No sore throat. 

assistant: OK, and have you had a chance to look in his mouth, has he had any, like any redness or any swelling in the back of his mouth?
user: I took a look. It doesn't look swollen. 

assistant: OK. And, uh, no shortness of breath I think you said?
user: Yeah, no shortness of breath. 

assistant: OK. And has he had a sore throat? 

user: No. 

assistant: OK, and any changes to his sense of smell or sense of taste?
user: Uhm, not that I've noticed. 

assistant: OK. And how has his appetite been?
user: Not as great as it usually is, but he's still eating. 

assistant: OK. How is his like mood and behaviour been?
user: Uhm, he's been a little bit more fussy than usual. 

assistant: OK. And eating less as well? 

user: He's been eating less, but not like much less. I still try to get something in him. 

assistant: OK, well, that's good. And has he had any chest pain?
user: Uhm, no, I don't think so. He hasn't complained of it or anything to make me think that he has any chest pain. 

assistant: OK. And has he had any fainting, or mentioned that he's dizzy at all? 

user: No. 

assistant: OK, does he have any headaches?
user: I don't think so. He hasn't complained of that. 

assistant: OK. Any ear pain or or ear discharge?
user: No. 

assistant: Does he have any diarrhea or constipation? 

user: No. 

assistant: OK, any blood in the stool?
user: No. 

assistant: OK, and any skin rashes? 

user: No, not that I've noticed. 

assistant: OK, has he mentioned anything about muscle aches or joint pains?
user: Ah no, he hasn't. 

assistant: OK. And is he had any nausea or vomiting?
user: No. 

assistant: OK. And has he been diagnosed with any medical conditions in the past?
user: Uh, no, he's been a pretty healthy child. 

assistant: OK. And sorry, just to go back and just summarize the symptoms overall, so he's had a "barky" cough that started two days ago, as well as some stridor or some noise on inhalation. And, and this reminds me, has he had any fevers or chills?
user: Uh, he has had a fever. Actually it was 38.7 yesterday. 

assistant: OK, and any night sweats? 

user: No, hasn't seemed sweaty at night, no. 

assistant: OK. And has he had any weight loss in the last, several months?
user: Uh, no. 

assistant: OK. And you said he hasn't been diagnosed with any medical conditions before, but so, has he had any reasons to be hospitalized or or any surgeries?
user: No, it's been a pretty healthy child. 

assistant: OK, that's great, and any allergies that you're aware of?
user: Uh, I think he's allergic to penicillin. 

assistant: Alright, what's the reaction?
user: Uh, he just gets a rash. 

assistant: OK. And  are his immunizations up to date? 

user: Yes. 

assistant: Alright, and currently who is he living with?
user: Ah, he lives with his, both his parents and his older sister. 

assistant: OK, and has anybody in the family been sick, or is he been around anybody who's been sick?
user: No, everyone's been pretty healthy. 

assistant: OK. Has there been any travel recently?
user: No, no ones traveled recently. 

assistant: OK, and anybody smoke in the home? 

user: Uh, no. 

assistant: Alright, then any concerns for him being exposed to any forms of physical or emotional or verbal abuse or any violence in the home?
user: Oh no, no. 

assistant: OK. And is he like going to daycare or who is the primary caregiver at home? 

user: Uhm, it's usually his, his mom, yeah. 

assistant: OK. And were there any complications throughout pregnancy, such as gestational diabetes or high blood pressure?
user: No. 

assistant: Alright, and any complications with delivery and was it vaginal or C-section?
user: It was vaginal and no, no no complications. 

assistant: Alright, and up to this point, as you better meeting is milestones for like talking, walking and and things like that?
user: Yeah, that's right. 

assistant: OK, and uh, any concerns for his vision or hearing?
user: No. 

assistant: OK, and has he been growing normally? 

user: Yeah, he's had all his milestones. 

assistant: Excellent, OK. And are there any conditions in the family such as heart or lung disease?
user: Oh, no. 

assistant: OK. How about ah, asthma or things like allergic rhinitis and allergies?
user: No, nothing like that. 

assistant: OK. Uhm, so I I think that was all the questions that I wanted to ask today on history. Was there anything else that I maybe forgot to ask about or or that you wanted to mention?
user: Uh, no, that was kind of it. What should I do for him? 

assistant: Uhm, so it's it sounds like the most likely diagnosis now is something called Croup or laryngeal tracheal bronchitis, which is basically a viral infection of the upper respiratory tract areas, and so it can cause had a barky cough and stridor and fever. And so, if so, it's really supportive care and unless he decompensate's and becomes really short of breath and worse, in which case we could, the treatment would be steroids and uhm, possibly utilizing other other things as well, depending on his symptoms, but usually it will be steroids and maybe some oxygen as well. But if he stays relatively stable, then it's mostly supportive care, just making sure he's hydrated as much as possible, you could use like humidified air. Sometimes like a hot shower. That sort of thing can maybe help relieve the cough at night. 

user: OK. 

assistant: But umm, that's about it.
user: I've had, I've had this cough for the past two weeks. I was just worried about it. 

assistant: OK, past two weeks? Have, is it a dry cough or is it? Are you bringing up phlegm? 

user: I'm it's mostly dry, but just sometimes there's like a little bit, I guess, yeah, the flat little bit of phlegm. 

assistant: OK, what colour is the phlegm?
user: It's like whitish, sometimes it's clear. 

assistant: OK, is it ever green or bloody? 

user: No. 

assistant: No, OK. Do you have any shortness of breath?
user: No. 

assistant: Any wheezing?
user: Sometimes, yeah. 

assistant: Sometimes, OK. With the cough or outside the cough as well? 

user: With the cough. 

assistant: Any chest pain?
user: Um, no not initially, but like since the past few days, especially after I've like coughed a lot, it just kind of hurts me a little bit. 

assistant: OK, OK, any, do you ever feel so it just hurts after coughing. 

user: Yeah. 

assistant: So is it kind of like a sharp pain or like a dull achy pain?
user: I don't know, it just feels like like my muscles are hurting like I'm just like coughing so much it's just.. 

assistant: OK. 

user: Dull pain. In the middle of my chest then it goes away. 

assistant: OK, OK, and do you ever feel like your heart's racing?
user: No, no. 

assistant: OK. And have you noticed any swelling in your legs, arms, or abdomen?
user: No. 

assistant: Any dizziness or fainting spells? 

user: No. 

assistant: No, OK. Any headaches?
user: No. 

assistant: Confusion or memory loss? 

user: No. 

assistant: Have you noticed any fevers?
user: No. 

assistant: No. Excessive fatigue or tiredness? 

user: Uh, no, not really. I've haven't been fatigued. I think I'm I'm fine and feel normal. Other than the cough of course. 

assistant: OK, sure. Any rashes?
user: No. 

assistant: How about changes in your vision or hearing?
user: No, no concerns there. 

assistant: Have you had a stuffy nose or runny nose?
user: No. 

assistant: No, a sore throat? 

user: Uhm, no. 

assistant: OK, changes to your smell or taste?
user: No. 

assistant: No. Have your bowel movements been normal? 

user: Yeah. 

assistant: Yeah. How about urine?
user: Yep, they've been, no concerns. 

assistant: Any nausea or vomiting?
user: Uhm, no. 

assistant: No. OK. Have you ever experienced anything like this in the past? 

user: I kind of had this about, I don't know three or four years ago. I just had this cough, but then it kind of went away on its own in about a week. But now it's been like 2 weeks so I don't know what's happening. If it's something I just want to make sure it's nothing serious. 

assistant: Yeah, for sure. When you had this in the past, were you ever done given a diagnosis?
user: No, I didn't go to see a doctor. I just kind of stay at home. 

assistant: OK.
user: I thought it was just like a mild infection or something. 

assistant: Mhmm. Have you tried anything for the cough this time around? 

user: I had some like lozenges and I haven't, and those have been helping me. 

assistant: OK.
user: Yeah.  OK, good. If you were to describe your cough, is it barky, harsh, muffled, like what what would you say the sound of it is?  Uhm, I don't know. It's kind of like, like a normal cough, you know, like when you're clearing your throat or something, or when you're like when something gets stuck in your throat, just like like a normal cough. I don't think it's barky. 

assistant: OK OK, are you otherwise healthy? Do you have any longstanding medical conditions? 

user: No, I don't. I don't. 

assistant: No, OK. Have you had any hospitalizations or surgeries in the past?
user: I have my wisdom teeth removed. 

assistant: OK, when was that?
user: About 8-9 years ago, when I was 17 years of 16 years old, ah, 17 years old. 

assistant: OK, OK, and are you on any medications?
user: I'm just taking this birth control pill. 

assistant: OK, which one?
user: Uhm, yeah, it's called, uhm, I forget the name. 

assistant: Ah, no worries. And when did you start it?
user: I started three years ago. 

assistant: Three years ago, OK. And no side effects, no issues with it?
user: No, no, it's all good. 

assistant: And are you up to date with all your immunizations?
user: Uh, yeah, I think so. 

assistant: OK. Did you get the flu shot this year? 

user: No I didn't. 

assistant: No. OK yeah, we recommend getting it out once a year. Just yeah, for your safety and for everyone else's and even if you get the flu, maybe your symptoms won't be as severe and then, do you have any allergies?
user: Uh, I don't, no. 

assistant: No, OK. Any family history of lung conditions or heart conditions?
user: Uhm, My mom has diabetes. 

assistant: OK. 

user: And my dad has high blood pressure. 

assistant: OK. Uhm, and then any cancers in the family?
user: No. 

assistant: No, OK. And have you been in contact with any any sick people recently? 

user: No, I've just been staying at home. 

assistant: OK. Uhm, any travel recently?
user: No. 

assistant: No, OK. How about umm smoking, do you smoke? 

user: Uhm, once in awhile. 

assistant: OK, what's once in awhile?
user: Maybe when I'm out with my friends I might sometimes, have a cigarette or two. I used to smoke a lot more, but I'm trying to cut it down. 

assistant: OK. How long have you been smoking for?
user: I started smoking in high school, so when I was 18 years old. 

assistant: Mhmm.
user: And at that time I would have about 6 cigarettes a day, but then I like I, I knew that smoking wasn't good for me, so I'm trying to cut it down, but my friends still smoke, so sometimes when I go out with them, I'll just have a cigarette or two, maybe like once a month, I would say. 

assistant: Once a month, OK. OK. And then any other recreational drugs like marijuana or cocaine or anything like that?
user: I tried a few in high school but not since then. I had, yeah, I had cocaine once. 

assistant: OK, and do you drink alcohol?
user: Yeah I have a glass at night. 

assistant: OK. Glass of wine or beer?
user: Glass of wine. 

assistant: And, and where do you live right now? 

user: Uh, I live, I live in an apartment with my boyfriend, about 20 minutes from here. 

assistant: OK. Any old carpets at home? Dust, mold, asbestos, anything that would be triggering your cough?
user: I don't know. I have not really had a problem but been here at this place for about a year and a half. 

assistant: OK. 

user: It is an old building but it's been OK so far. No recent changes. 

assistant: OK, OK, good. So those were all the questions that I had for you today. Did you have any questions of your own?
user: No, I was just worried this cough isn't, isn't serious, right? You don't think I have Covid? 

assistant: So because your symptoms do overlap with that of Covid, we're going to get a swab on you done and you should get those results in about 24 to 48 hours. And if it's positive, public health will be in touch umm, to do some contact tracing. In the meantime, because you have a cough, it is recommended that you isolate for 14 days. And if it's not Covid, but it's probably something like acute bronchitis or some other viral infection that's going around at this time of year, so for that we can, you can just treat it with like supportive treatments. You know, like staying hydrated, uhm, good nutrition, good sleep and just keep an eye on your symptoms. If they become worse or really severe like you're having neurological symptoms and just seek help from the ER. 

user: For sure. Thank you. 

assistant: Yeah, take care.
user: Hi, uh, so I just came here today uh, I've been having this cough for um, the last two weeks and it just, is not going away. I've also been getting like, just a runny nose for the last couple, I would take the whole week, all of last week. 

assistant: Okay, um, so can you tell me about your cough? 

user: Yeah. 

assistant: Go on, sorry.
user: So, it's more of just like a dry cough. I'm not really bringing anything up. 

assistant: No blood? 

user: No. 

assistant: Okay, and the runny nose, what, what's the discharge like?
user: Uh it's, it's pretty clear. It might be light, but it's not like green or yellow or anything like that. 

assistant: Um, and so you've had this cough for two weeks and the runny nose just started last week. Has the cough improved over the past two weeks? 

user: Uh, it has, like it was much worse last week, uh, but I just can't get like, it's better now, but it's still lasting much longer than I've had a cough before. 

assistant: Okay. Um, and uh, have you had a headache at all in these past two weeks?
user: No, I didn't have a headache, but sometimes I feel a bit congested. 

assistant: And uh, have you had any um, changes in your vision or your like uh, blurry vision, or any redness in your eyes or tearing?
user: Uh no, nothing like that. 

assistant: Okay, any um, changes in smell? 

user: Nope. 

assistant: Okay, any change in uh, taste?
user: Uh no, but uh, sorry, for smell, like when I was a bit congested I, I could smell less. I wasn't able to smell too much, but taste has been fine. 

assistant: Alright, and what about uh, sore throat?
user: No, no. No, sore throat. 

assistant: Okay. What about any difficulties with breathing?
user: Um, no, nothing like that. 

assistant: Any chest pain?
user: No. 

assistant: Any palpitations or racing of your heart? 

user: No. 

assistant: Any pain in your belly?
user: No, no. 

assistant: Diarrhea or constipation? 

user: No. 

assistant: Any aches in your, any muscle aches?
user: No. 

assistant: Any numbness or tingling in your arms or feet? 

user: Nope. 

assistant: Um, okay. Uh, any fevers or chills?
user: No, not really. Last week I maybe had a, uh, two nights, I was a bit chilly, but since then I've been fine. 

assistant: Okay, and uh, any night sweats? 

user: Uh, no. 

assistant: Unintentional weight loss?
user: No, my weight's been the same. 

assistant: Okay. Alright, and um, so it sounds like you have a cough that started two weeks ago and then you only, and then you had two nights of, uh two nights where you felt sort of cold and you had the chills um, last week, but you uh started, you developed a runny nose um, a week ago?
user: Yeah, the runny nose has been more, um, this week. It kind of like, started with a cough last week. 

assistant: It, it, sorry, so it started with the cough last week?
user: Um, so late last week, I would say the runny nose started. 

assistant: I see, I see. Okay um, alright. I, and um, are you um, do you have any medical conditions that you've been diagnosed with? 

user: No, I've been uh, completely healthy otherwise. 

assistant: Any medications that you take, including over the counter, or herbal medications, or vitamins or minerals?
user: No, no. I don't take any medication. 

assistant: Allergies, including allergies to food, or environmental allergies, and allergies to medications? 

user: Um, no. 

assistant: Um, and any conditions, medical conditions that run in the family?
user: Um, I think my dad has uh, high cholesterol. 

assistant: And in terms of your living situation, do you live alone?
user: Right now I'm uh, I usually live in a dorm going to university, but right now I'm home with my parents, uh, just doing virtual learning. 

assistant: Okay, okay. Um, and have you um, is there anyone else around in the home? Or just your parents and you?
user: Yeah, just my parents and me. 

assistant: Alright uh, have you um, have you been around someone who might be sick, or have your parents been around someone who could be sick?
user: Uh, my mom had the sniffles like last week, but she pretty much got over it. 

assistant: Um, did she get tested for COVID?
user: No, she, she didn't um, but it's not like, it's just more, she just thought it was a cold or something so she didn't really bother. 

assistant: That's fair, okay. Um, and do you um, so I see that you go to school, um, and you mentioned you, have you traveled anywhere outside the, the province?
user: No, not at all. My school is actually in Ontario, so. 

assistant: Okay, great. Um, and do you currently, or have you ever smoked?
user: Um, maybe like uh, a couple times just casually. I've tried it but nothing regular. 

assistant: And what about marijuana? 

user: Yeah, same, same thing like I've tried it probably like four or five times so far. 

assistant: Any recreational drugs?
user: Uh no. 

assistant: Any uh, alcohol? 

user: Uh, yeah, just not, not much right now, but like when I, when we were at school like we would drink on the weekends. 

assistant: That's good. Alright, um, so it sounds like you've had a cough for the past two weeks and you uh, have developed a runny nose last week, and your mom was ill the week before. It's possible that you just have a common cold uh, and that symptoms will get better over time. But just in case, we would also like to do a COVID swab, um, to make sure that you, just to rule out COVID. In the meantime, I would request that you isolate, self isolate at home. Stay away from your parents as well. Um, the test results should come back in 24 to 48 hours and public health will give you a call if your results are positive and we'll let you know what to do. Um, we will also do a physical exam here and check your temperature to see if you have a fever at all and um, yeah, does that sound good to you?
user: Yeah, and will I need any like antibiotics for my cough? 

assistant: Oh. Um, well, we, I guess, you said that you don't have a sore throat at all, right? 

user: No. It's just that, I just feel like the coughs been just going on, like it would be nice to just get rid of it. 

assistant: Well um, I'll do a physical exam, look inside your throat, look inside your mouth, sorry, and listen to your chest, and uh, ensure that nothing else is going on, that you don't have anything like, say, strep throat or mono or you don't have uh, pneumonia, uh, bacterial pneumonia, for instance. Oftentimes um, symptoms that you have are caused by viruses and don't need to be treated with antibiotics, uh, but I'll do a physical exam, and maybe have a look at your labs as well, and then decide accordingly.
user: Yeah, I woke up this morning and I was just feeling suddenly feeling very short of breath and I just wasn't sure what was going on, so I thought I would come in. 

assistant: OK, this this morning suddenly feeling short of breath. OK, and this cough was not also something that happens suddenly this morning?