jshargo/medical-interview-conversations2 huggingface dataset:
user: No, no, I checked for those very carefully. He used to get rashes when he was a child, but no, he doesn't, he doesn't have anything right now. 

assistant: Alright, and has he had any muscle aches or joint pains?
user: Uh, he's just been, he's just been not, he's not been as active as he usually is, so I don't, he hasn't said that any anything in particular about muscle pains, but I don't know if he knows how to, you know? He's just been, yeah. 

assistant: OK, and two days ago, can you think of any triggers like, was there any exposure to dust or smoke or maybe even pets that could have brought this on?
user: Yeah, you know, if I think about it, he did go outside to play with his brother and, I don't know he might have got something out there maybe. 

assistant: Yeah, uh, certainly possible and was it like a particularly cold day? 

user: Yeah, it was a very windy, little bit chilly too. 

assistant: And when, like, during the winter time, does cold air trigger attacks for Dave?
user: Oh yeah. 

assistant: OK, and how about exercise? 

user: No, I don't think, well, they went outside to play, so I mean he was, uhm, exercise does make it worse sometimes, so it could be that too. 

assistant: OK, and so, has dave been experiencing any other symptoms besides the the wheezing and the irritability and what you've described so far?
user: No, I don't think so, that's, I think that's it. 

assistant: OK, you tried some inhalers, how often have you been using them?
user: Yeah, we used his blue inhaler about five times yesterday, and another two or three times earlier today. 

assistant: OK, and do you use a spacer?
user: Uhm, no we don't. I have to go get that and learn how to use it. 

assistant: OK, for sure we can go through, Uh, the proper technique, throughout this visit as well, just to review that again.
user: I would love that. 

assistant: That's great, and has he been using any other medications to help over these last couple of days besides the inhalers? 

user: No, just the inhalers, we've also kept it the usual one, the one that he takes, the other inhaler. 

assistant: OK, does he have one that he uses, once, like, he uses daily?
user: Yeah, yeah the one that he uses, I think the orange one. 

assistant: OK, so he does use a steroid inhaler?
user: Yeah. 

assistant: OK, and does he have any allergies?
user: Uhm, no he doesn't. 

assistant: OK, and does he have any medical conditions that have diagnosed previously?
user: Just the dermatitis and asthma? 

assistant: OK, and when was his last asthma exacerbation? 

user: Last year. 

assistant: OK, has he ever needed to be hospitalized for one?
user: Oh no, no, nothing like that, he's a healthy kid. 

assistant: OK, that's good, has he had any surgeries before?
user: No. 

assistant: OK, and in regards to birth history, were there any complications throughout pregnancy or with delivery? 

user: Oh no, everything was normal. He was born via vaginal delivery and no complications. He was a healthy baby. 

assistant: OK, and have you had any concerns with growth or developmental milestones?
user: No, no, the doc was pretty happy when he did the regular, the checkup and yeah things are good with him, he's a good kid. 

assistant: Awesome, OK, and could you tell me a little bit about the living situation, like who's the main caregiver and who he's living with? 

user: Yeah, so he lives with me, his dad and his brother who is 2 years older and he's not going to school right now. We're just keeping him at home due to Covid and trying to do some home schooling. I'm a homemaker, so I do have enough time to spend time with him and his older brother and, yeah. 

assistant: OK, has anybody in the home been sick, either his brother, yourself, or father?
user: Uh, no. 

assistant: OK, and anybody, at work or any other places that you maybe traveled to, that, uh, been around anybody who's been sick? 

user: Uhm, no, I don't think so. I don't think there was anyone that was sick. 

assistant: OK, and have you traveled anywhere recently?
user: No, no. We're just staying at home. 

assistant: OK, and are there any pets in the home? 

user: No. 

assistant: Alright, any carpets or like, uh, curtains or anything like that, covering the windows?
user: No, we got all those removed when he had his big exacerbation last year. 

assistant: I see, OK, and does anybody smoke in the home, either cigarettes or marijuana?
user: Uhm, my husband smokes, but he smokes outside, he never smokes in front of the kids. 

assistant: OK, I see, and uh, does anybody in the family, have any heart or lung conditions? 

user: No, uhh, I have some, I have high blood pressure but that's it 

assistant: OK, any, like, congenital diseases that run in the family?
user: No. 

assistant: Or how about any genetic diseases? 

user: No 

assistant: Cystic fibrosis or anything like that?
user: No no, no. 

assistant: OK, uhm, so was there any other, anything else that maybe I forgot to ask about or I'm missing that you'd like to add today? 

user: No, I'm just worried that he's going to have a big asthma attack like last year, I just also want to make sure nothing else is going on and if he can be taken care of and he's just, he's feeling awful. 

assistant: For sure, yeah, we'll, uh, check his his vital signs and do a physical exam. And it does sound like it could be an asthma exacerbation, and so we can trial some inhaler medications, a little bit different than what you use at home. But also using Ventolin as well and we'll assess the need for potential, uh, antibiotics and also steroid if necessary and if his breathing gets worse or you're starting to hear that the wheezing is getting worse or his work of breathing is becoming more intense then certainly we'll need to add on some oxygen and possibly, some other therapies.
user: Um so I'm here because my shoulder has been really painful for the past week um and any movement of that shoulder, of my right shoulder, causes a lot of pain. 

assistant: OK, and how long have you been having uh this pain for?
user: For the past week, 

assistant: Past week, OK. Um and did you injure your shoulder at all recently? Any trauma to the area or anything like that?
user: Um so about like, a couple of months ago, I um was do, I I work in construction so um I was moving around some heavy objects and um I guess like the repetitive motions caused some sort of rotator cuff injury. But I had that um, like I got that treated and everything was fine for a couple of months. But this pain just started a week ago. 

assistant: OK, and where is this pain located exactly?
user: Um it's it's just like in my shoulder, like at the joint between my upper arm and um shoulder. 

assistant: OK, and uh is it an aching pain or is it a sharp stabbing pain? 

user: So at rest it seems to be like achy and stiff, but um but when I move my shoulder, when I try to move it, it it causes more of a sharp pain. 

assistant: Sharp pain, OK and what kind of movements cause the sharp pain? Or is it just any movement?
user: Uh any movement. 

assistant: OK. Are there any uh movements that are worse in particular? 

user: Um I think um, like no, anything hurts. 

assistant: OK. OK, and how much would you rate this pain out, on a scale of zero to 10, 10 being the worst pain you felt in your life?
user: I'd give it about a 7. 

assistant: Seven, OK.
user: Yeah. 

assistant: And are you having uh, is this pain moving to any other uh joints or any other part of your body?
user: No. 

assistant: OK, so just just in the area that you described? 

user: Yes. 

assistant: OK, and do you notice any kind of um, just looking at your shoulder outside, from the outside, any swelling, redness, any masses or deformities?
user: No, I don't see anything like that. 

assistant: OK, alright and um is there anything that you've tried that has helped with your pain?
user: Um I've tried some ibuprofen, some ice. It seems to help temporarily. 

assistant: OK, and earlier when you had the rotator cuff injury, did you get physiotherapy? 

user: Um I did. But not, but I didn't finish the full course. I just went for a week or so and then um I had to go back to work, um so I stopped doing that. 

assistant: I see, um yeah, so that's something definitely uh it's very important and we'll need to consider going forward as well. Other than that, are you having any symptoms of any fevers or chills?
user: Uh no, nothing like that. 

assistant: OK, and have you been sick recently at all or met with someone who was sick?
user: No. 

assistant: OK, any any weight loss um or loss of appetite? Anything like that?
user: Uh no, nothing like that. 

assistant: OK, any numbness or tingling?
user: No. 

assistant: Any weakness in your extremities? 

user: No. 

assistant: Any um any just symptoms or anything else like diarrhea, constipation, urinary changes? Anything else is going on?
user: No. 

assistant: No, OK. So it's mainly just the shoulder pain?
user: Yes. 

assistant: OK, um alright, and does rest help at all, like when you're lying down, just not moving your shoulder. Does that help with your pain? 

user: Uh, yeah I would say so. 

assistant: OK. And is is this stiffness there just throughout the day, or is it there in the morning and then gets better during the day?
user: It's pretty much there all day. 

assistant: OK. Alright um and have you been diagnosed with any medical conditions in the past? 

user: Uh, I have um, I have diabetes, but that's about it. 

assistant: OK, and do you take any medications?
user: I'm on metformin. 

assistant: OK. Um and do you have any allergies to any medications? 

user: No, no allergies to medications. 

assistant: Have you been hospitalized or had any surgeries in the past?
user: No. 

assistant: No, OK. Um any family history of any musculoskeletal or rheumatological conditions? 

user: No. 

assistant: OK, and currently right now, so you said you work as a construction worker, right?
user: Yes. 

assistant: And are you off of work right now, or have you been off work um due to your previous injury and pain, or are you still working?
user: I'm still working, but modified, um so I am not uh lifting any heavy objects or anything like that. I'm just doing some like groundwork. 

assistant: OK, that's good. Yeah, I mean, um we might also need to, if you're doing any kind of overhead like work where you're raising your arms above your shoulders, that might uh, cause further problems as well, so we'll look into some of those modified duties as well.
user: OK. 

assistant: Um yeah, and what is your living situation like right now? Who do you live with? 

user: Um I live by myself right now. 

assistant: Do you live in a house or apartment?
user: Um I live in an apartment. 

assistant: And, uh, uh, in terms of your daily life, do you smoke at all? 

user: Um I don't smoke. I used to smoke before, but that was like 20 years ago. 

assistant: OK, that's good, and do you use any recreational drugs like marijuana or any other drugs?
user: Uh no, no. 

assistant: How about smoking, you smoke cigarettes? Sorry, you said you you quit. Um do you drink alcohol? 

user: I'll drink like a glass of wine here and there. 

assistant: OK. Alright, um yeah, and those were some of the questions I had for you. In terms of just a physical examination, uh when you press on the area that you describe, um when you press around the area, does it hurt?
user: I have to press pretty hard for it to hurt. 

assistant: OK, but otherwise it's not tender? 

user: No. 

assistant: OK, and again, no swelling, redness, or anything like that, just it's mainly just on the inside?
user: Yeah. 

assistant: OK, and um and any kind of movement hurts, right? There's no particular movement that, like if you were instead of um trying to raise that shoulder by itself, if you were to just move it with the other arm. Does it hurt?
user: The other arm? The other arm doesn't hurt at all. 

assistant: Or like if you were to use your left arm to to passively move your right arm and shoulder. Does that hurt or is it when you just try to move the right arm by itself? 

user: It's, oh, it still hurts, any any moving of the shoulder hurts. 

assistant: OK, alright, so yeah, so based on what um you've told me so far in your recent shoulder cuff injury, what can sometimes happen is uh with those injuries, you might get some um inflammation and what might happen is something called uh adhesive capsulitis, or just commonly knows as known as a frozen shoulder. And there's different stages, so that might happen, so in the initial stages like freezing um and then there's stiffening in stage two, and then usually after 6 to 12 months it starts uh getting better.
user: OK. 

assistant: Um and it might also affect your other shoulder as well. So what we'll um end up doing today is see if um we can get some um imaging done so we can do an X-Ray of your shoulder. I'm sure you've had X Rays before, so we'll kind of compare them to your shoulder X Rays from before. We, if we need to, we can also get an ultrasound if um we don't, uh we can't really tell from the X Rays. And then from there, um we can get some blood work as well. Um just your normal blood work as well as inflammation markers, and then um from there we'll need to uh, really um discuss some management strategies. So you've already tried some physiotherapy, but now we need to make sure that's uh, it's it's consistent because this is something that has a high recurrence rate and we will definitely need to finish the full course of physiotherapy, whatever it may be, um because if physiotherapy doesn't work, we may have to consider like other options like um corticosteroid injections right into your shoulder.
user: OK. 

assistant: For some relief.  But yeah, so first we'll just try some conservative methods like physiotherapy, pain management, uh and then go from there. How does that sound? 

user: That sounds pretty good. Thank you. 

assistant: Welcome, alright, so we'll call you for the X-Rays and then we'll go from there.
user: Uh yeah, hi, I just came in here today cause uh, lately, for the last couple of months, I've been getting these coughing fits. They don't really seem to be going away and I was a bit concerned. 

assistant: So you've had this, when did this start? 

user: Uh, I would say probably during the winter uh it, it kind of started, where I started having um, just coughing fits when I'm walking to school and then also during like gym class I started having these coughing fits and sometimes I also felt like I couldn't breathe. 

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

assistant: Okay um, alright. Uh um okay, sorry, one moment. Okay um, so is there anything that makes your cough better? What do you do to make it go away?
user: Uh, I just basically have to, if I, if I'm doing any kind of activities, just take a moment, sit down for like 10 to 15 minutes and then it seems like it goes away on its own. 

assistant: And you said that sometimes you also have difficulties breathing with it? 

user: Yeah, like a couple of times it got really bad where I had to um like, it was difficult get, it was, it was like I was trying to take deep breaths for air, but uh it was, it just felt like I couldn't. 

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

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

user: Uh no. 

assistant: Um, any changes in your vision or your hearing?
user: No. 

assistant: Any confusion?
user: No. 

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

assistant: Okay, any sore throat? 

user: Uh no. 

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

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

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

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

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

assistant: Any changes in your, any nausea or vomiting?
user: No. 

assistant: Any changes in your bowel movements? 

user: No. 

assistant: Any acid reflux?
user: Uh, no. 

assistant: Okay, um, and any certain muscle aches or joint pains? 

user: Um no, nothing like that. 

assistant: Any numbness or tingling in your arms or legs?
user: No. 

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

user: It's usually uh, it's usually dry. 

assistant: Uh sorry, can you say that again?
user: It's usually dry. 

assistant: Okay um, have you ever brought up any sputum or any blood? 

user: Uh never any blood, I have like on occasion, like sometimes brought up some sputum. 

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

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

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

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

assistant: Um, and do you, so you mentioned that it's worse when you're in the cold or exercising, and smoking makes it worse? What about things like dust or pollen? Um, say when you're cleaning the house and there's also dust, does that make things worse, or is it worse in a specific time of the year when you're outdoors?
user: Uh, now that you mention it, yeah, like if we're ever in the basement or anything like that, I, I do start getting like kind of irritation um, in my throat, and that kind of, sometimes I have also coughed at those times. 

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

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

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

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

assistant: Okay. Alright, uh do you have any, um, I guess going back, were you a healthy child, growing up? 

user: Yeah, as far as I know, I, I didn't really have any concerns from like the school or home at all. 

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

assistant: Any surgeries? 

user: No. 

assistant: Are you taking any medications?
user: Uh, no medications. 

assistant: Are you still using the eczema cream? 

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

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

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

assistant: Um, have you ever seen an allergist?
user: No, I haven't. 

assistant: No. Uh, who prescribed the cream for the eczema? 

user: Um, just a, it was like at a walk-in clinic. 

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

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

assistant: Okay, okay. And things are good at home? Do you feel safe? 

user: Yeah, yeah, I feel completely safe. 

assistant: Any concerns about bullying at school?
user: No, no, not at all. 

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

assistant: What about alcohol?
user: Uh, I'll come, I've, I haven't tried it um, yet, at all. 

assistant: Okay, okay. Just wanted to mention that the conversation that we're having right now is confidential between you and me. Um, unless you mentioned anything that harms you or harms anyone else so, so feel free to discuss whatever or talk openly about um, any issues that you have. Um, okay, and um, are you sexually active? 

user: No, no. 

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

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

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

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

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

assistant: OK. It all started about five days ago. OK alright. Have you, can you tell me about your headaches? 

user: Yeah, so there, I started getting these headaches just two days ago, but like it's more than a headache, it's kind of mainly over the cheeks and then it goes and just above the nose 

assistant: I see.
user: The light kind of up into the forehead. 

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

assistant: OK. Alright, and do you have any other symptoms? Do you have a runny nose or sore throat or cough? 

user: Uhm, I don't have a cough. I don't have a sore throat. I do sometimes get a runny nose though like every every now and then. 

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

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

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

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

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

user: No. 

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

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

assistant: No. OK. Any muscle aches?
user: No, not that I know. 

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

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

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

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

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

assistant: Do you take medications? 

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

assistant: Any allergies?
user: Uh, no, no allergies. 

assistant: Any medical conditions that run in the family, including any heart conditions or lung conditions or cancers?
user: Uhm, yeah, so hard conditions, both my dad and uncle have had heart attacks in their 50s. But yeah, that's that's it. That's all, that's all that I know and we also have cancer on my mothers side. My uncle from my mothers side had bladder cancer. 

assistant: OK. OK. Uhm, and do you you mentioned that you have a daughter. Do you, who do you currently live with? 

user: I live with my two daughters and my wife. 

assistant: OK, and what do you do for, do you work?
user: Yeah, currently I'm working from home. I'm an accounting clerk. 

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

assistant: Oh, that's great. It's great that you're trying to cut down. Do you intend on getting the getting down the smoking even further?
user: Yeah, that's that's the plan. If I can do that, hopefully by the end of this year, that would be great. 

assistant: That's wonderful. Do you smoke marijuana at all?
user: No. 

assistant: Uh, do you smoke any recreational drugs? 

user: No. 

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

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

user: Great sounds good, thank you. 

assistant: Uhm, also sorry before for in the call because the symptoms are started recently and they do uhm, overlap with some of the symptoms that if patient with COVID might have, it might be a good idea to get a COVID swab done as well, so we'll do that today and you would have to quarantine and stay away from the people at your home as well, until the results are out, and then if it's positive, public health will let you know what to do.
user: Hi, I've been having this back pain for the past month, so I'd just like something for it an and you know image it if possible just to figure out what it is. 

assistant: You've been having it for the last month, is this the first time you're having this back pain?
user: Yeah yes. 

assistant: OK and where exactly are you having the back pain? 

user: It's in my lower back. 

assistant: OK, and what kind of pain are you experiencing, is it like a sharp stabbing pain or is that a dull aching pain?
user: It's kind of dull and achy but sometimes I feel like I have little spasms in my back. 

assistant: OK, and how often are you getting these spasms? 

user: Um I'd say like two to three times a week. 

assistant: OK. And it is this back pain constant, or does it come come and go?
user: It's pretty constant, but it gets worse with certain things. 

assistant: So one month ago when it started before then, did you injure yourself at all or, were you doing anything that brought on the pain or did the pain come on gradually?
user: So I work in this factory where I move a lot of boxes and I think I may have like lifted a really heavy box or lifted it in an improper position because that's when, that night is when my back started hurting. 

assistant: OK, I see and how long have you worked in this role?
user: For the past 30 years. 

assistant: OK Alright. And has the pain become worse at all or has it stayed the same since it started? 

user: I'd say it's pretty. It's been pretty similar to the start. 

assistant: OK. And does the back pain move anywhere, like for example does it shoot down your legs at all?
user: No OK. Have you tried anything that has helped you?  I've tried some topical analgesics, and you know those fire and ice gels and I think sometimes that helps, but it's always temporary. 

assistant: OK. And what kind of things make your pain worse like, bending down as opposed to stretching backwards?
user: Yeah, bending down like it when I flex my back that hurts more than if I straighten it out. 

assistant: OK. Is a bending hurts more and what about bending towards the sides?
user: Um a little bit more towards my right side. 

assistant: OK. And are you having any other symptoms, like numbness or tingling in your extremities or back at all?
user: No. 

assistant: And any kind of numbness or loss of sensation in your buttocks area or just below your lower back?
user: Um no 

assistant: OK. And any fevers or chills? 

user: Nope. 

assistant: Any night sweats?
user: No. 

assistant: Any um skin changes or rashes?
user: No. 

assistant: Any, have you been ill recently at all with cough cold symptoms at all?
user: No. 

assistant: Do you feel pain in anywhere else, in any other muscles or joints at all?
user: Um no. 

assistant: Have you recently had any changes to your weight? 

user: No. 

assistant: OK. And. Any kind of changes to your bowel movements?
user: No. 

assistant: OK. Any kind of issues with urination at all? 

user: No. 

assistant: And any urinary or fecal retention or incontinence?
user: No. 

assistant: Right, so it's just this pain that's been there for the last month, stayed around the same. In terms of your medical history have you been diagnosed with the. Have any medical conditions in the past?
user: I have a high blood pressure which I take some Ramipril for. 

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

assistant: OK and have you are using any other medications at all? 

user: No. 

assistant: Have you been hospitalized or had any surgeries in the past?
user: No. 

assistant: OK. Do you have any family history of any musculoskeletal or rheumatologic condition?
user: No. 

assistant: Any cancers in the family? 

user: No. 

assistant: And so currently are you working or did you have to take time off work?
user: I'm taking some time off work until I figure out what this back pain is. 

assistant: OK. And currently, what's your living situation like? 

user: I live in an apartment with my wife and our teenage son. 

assistant: OK. And do you smoke at all?
user: I used to smoke. I haven't smoked in over 10 years. 

assistant: OK. And do you drink alcohol at all? 

user: I drink occasionally, I'll have like a beer on the weekend. 

assistant: Any recreational drugs like marijuana?
user: No. 

assistant: OK. Alright, so I'm just gonna ask a few questions, maybe get you to do some movements and see what hurts the most. 

user: OK. 

assistant: So when you press your hand down, down your spine. Is it hurt at all in the lower back with palpation?
user: Um it kinda hurts right in the middle, uh, just above the buttocks area an where like my tailbone almost is 

assistant: I see. And, uh, any kind of pain with lying down and then raising your legs straight up without bending the knees.
user: I can try that. Um that hurts a little bit, yeah. 

assistant: And does it hurt in the lower back or near the front of your hips?
user: That hurts in my lower back. 

assistant: And any kind of redness or swelling that you've noticed at all? I know it's in the back, so it might be more difficult to see. 

user: Um no, I don't see anything like that. 

assistant: OK. And are you, has your gait, changed at all, or is it, are you able to walk without a limp or anything?
user: I'm able to walk without a limp. 

assistant: OK. Alright, so and then, uh, bending down you said hurts more than standing up or extending your back, right? 

user: Yes. 

assistant: OK. Alright, so those are all the questions I had for you today. Do you have any questions for me?
user: No, just like how can I treat this? 

assistant: Yeah, for sure. So this has been going on for the last month. It sounds more like what's called mechanical back pain and due to the nature of your work having been lifting heavy objects for the last 30 or so years it's usually something that occurs with repetitive, repetitive work, and strenuous work like that that affects your back. And what you're describing with the flexion seems more pain coming from the discs themselves instead of the facets at the back. So every time you flex you have some compression of your discs. So what we what we need to do right now is it's been one month almost and then usually we get imaging if the pain does not improve after six weeks of conservative management. So what we can try is to give you some pain management first, and some anti-inflammatory medication, and then as well as try some physiotherapy, some exercises to help you with the back pain. And then if the pain does not improve and since there is no red flags that were too worried about right now with your back pain we can wait to get some imaging. But first we would just like to try some of the conservative management. Is that OK with you?
user: I'm doing OK. Thank you. How are you? 

assistant: I'm well thanks. What brings you in today?
user: So, usually we go to my favorite pizza spot for lunch and these last couple of days I've noticed I just can't taste it. 

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

assistant: OK, so loss of taste, so you can't taste anything or you can only taste some things or you're just not getting the full depth of your taste?
user: Yeah, I really noticed it with the pizza, but with like other things too, it's just a yeah, really plain, it doesn't  really have any flavor with the food that I'm eating. 

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

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

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

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

assistant: OK, you have a cough?
user: Yeah, I've had a cough. 

assistant: OK, a similar timeline? 

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

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

assistant: OK, so no sputum, no blood? 

user: No sputum and and no blood. 

assistant: And do you feel wheezy at all?
user: No wheeziness. 

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

assistant: OK, sure, yeah. And how about any fatigue? Do you feel like you're more tired than usual? 

user: Yeah, these past few days I have definitely. I felt more tired, I've been sleeping a lot more throughout the day and just I don't know, kind of lazy. 

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

assistant: Yeah, OK umm, how about muscle aches?
user: Umm, no, just tired. 

assistant: OK and chest pain?
user: No chest pain. 

assistant: Alright, do you have a feeling like your heart's racing? 

user: No, nothing like that. 

assistant: OK, any changes in your bowel movements?
user: Umm, yeah, well, I had diarrhea this morning actually. 

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

assistant: OK, no constipation? 

user: No. 

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

assistant: OK, how about your stool seeming like it's very dark? Almost to the point where it looks black? 

user: Oh no, it it wasn't dark like that. 

assistant: OK, good, any abdominal pain?
user: No. 

assistant: Any issues swallowing food? 

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

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

assistant: OK, have you had a runny nose or a blocked nose?
user: Umm, not really. 

assistant: No, OK, any rashes? 

user: Umm, no. I haven't noticed any rashes. 

assistant: OK, and are things normal with your urine?
user: Yeah they are. 

assistant: How about dizziness or fainting spells? 

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

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

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

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

assistant: OK, good. And you mentioned no rashes, right? 

user: No rash. 

assistant: OK, any weight loss over the past couple of months?
user: : Nothing like that. No weight change, it's been the same. 

assistant: OK, how about umm night sweats or chills? 

user: I felt a bit, umm, hot but not sweaty, just hot. 

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

assistant: Sure any muscle aches?
user: Umm, no muscle aches. 

assistant: Have you been around anyone who's been sick recently?
user: Yeah there is this guy in my class who was sick in class last week. 

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

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

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

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

assistant: Oh good, OK. And do you have any allergies?
user: Possibly cats but we don't have any pets at home. 

assistant: OK, good have you been around cats recently? 

user: No. 

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

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

user: I am, yeah. I have my immunization card here actually. 

assistant: OK, good. Any family history of lung conditions or heart conditions that you know of?
user: I know my grandfather had lung cancer, but he smoked his whole life also. Also diabetes but don't know if he had any heart problems though. 

assistant: OK, I'm sorry I forgot to ask you, are you on any medications? 

user: Umm, I'm not. 

assistant: OK, and do you smoke?
user: Umm, I don't. 

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

assistant: With like marijuana?
user: No, it's like those flavored ones. 

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

assistant: OK, and is there any tobacco in there or nicotine?
user: I think there might be, but umm, I don't know. I usually just buy the flavored ones. 

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

assistant: I'll just continue on asking you some other questions. Do you drink alcohol? 

user: Umm, no. 

assistant: And who do you live with?
user: I live with my mom, my step dad, and then my younger sister. 

assistant: OK, do you guys live in a house? 

user: We live in a townhouse. 

assistant: OK, in the city you said?
user: Yeah, yeah, I live close. I go to high school not too far from here. 

assistant: Oh, that's nice. And any concerns with the living arrangements in terms of you know, like it being an old building, old carpets, mold, anything like that? 

user: No, I live in a nice place. It's usually like really clean. 

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

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

user: Yeah, that makes sense. 

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

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

assistant: OK, have you been able to maintain your appetite? 

user: I do feel like I've lost a bit of my appetite over the last three to four days. 

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

assistant: Alright, so have you notice any like neck swelling?
user: Yeah, now that you mention it, I, I do have like these two lumps on the right side of my neck, like kind of right below the jaw. 

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

assistant: I see, OK. We'll, certainly look into that on the physical exam. OK, and uh, and you mentioned that you've also been really tired over these last few days? 

user: Yeah, I've, I haven't really had much of an appetite, kind of just, I've skipped work, just trying to take it easy like just napping the whole day, as much as I can. 

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

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

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

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

assistant: OK. And have you been experiencing any difficulties, or sorry, have you been experiencing any cough? 

user: No, not really. 

assistant: OK, how about any shortness of breath or trouble breathing?
user: No. 

assistant: OK, have you had any wheezing?
user: No wheezing. 

assistant: Alright, and how about any chest pain? 

user: No, no, no chest pain. 

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

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

user: Uh, no, not really. 

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

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

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

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

assistant: Alright, did you notice this in the last couple of days as well?
user: Yeah, that, that just started yesterday. 

assistant: OK. Have you had any nausea or vomiting? 

user: No. 

assistant: How about any diarrhea?
user: No. 

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

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