jshargo/medical-interview-conversations2 huggingface dataset:
user: Um it's just that I'm I'm doing my Masters of social work and I'm getting towards the end and it's just, it's very scary because I'm working on my final uh thesis and there's just a lot involved and it's it's just making me very nervous. 

assistant: OK, is there anything special about the last couple of weeks that's made you more stressed than previously? 

user: Uh I think just the the time crunch of having to to finish this. I've never felt like so, like there is so little time to do the work that I need to do. 

assistant: Got it. Have you ever felt this pain before, anytime in your life?
user: No, no, not before this. 

assistant: OK. So it comes on several times a day, not necessarily triggered by anything, and you said you smoke. When did you start smoking?
user: Um like when I was probably 18 I I sometimes smoked a little and then I smoked a little more, um maybe like 10 cigarettes a day for uh like the last two years. But then a few months ago I've been I've been cutting it in half. 

assistant: OK, now when you get this this chest pain, do you ever feel short of breath? 

user: Um I I think I I make myself nervous with it and then I kind of start breathing faster, but I don't have a hard, I don't have a hard time breathing otherwise, and it's hard to get a deep breath 'cause I'm, it makes me really nervous. 

assistant: Does your heart ever flutter? Feel like it's skipping a beat?
user: Uhm no, only if I, only if I, if I, if I'm having kind of an anxiety attack that's felt like that before, but not any other time 

assistant: OK, don't get any chest pain, all right, and just in terms of other things, so anything else you've seen a doctor for in the past? You mentioned anxiety attacks. 

user: Yeah, um like I talked to my family doctor about that when I was a teenager but I really haven't, you know, seen my doctor for it anytime in the last like eight years or so. 

assistant: Anything else you see your family
user: I don't, oh, sorry, no nothing else. I just I thought I was kind of, when I was in high school I had those and then I really haven't for a long time. But um lately I felt like this like I could maybe get them again. 

assistant: So you've never had asthma as a child?
user: Uh no. 

assistant: And you don't have asthma now? 

user: No. 

assistant: OK, do you take any medications right now?
user: Uh no, like I take like a multi vitamin but that's it. 

assistant: OK, and you live in London?
user: Mhmm, like for school. 

assistant: Got it. You're doing a Masters in social work, anyone around you been sick at all last little while?
user: No, like I live alone, I haven't really seen very many people lately. 

assistant: OK, and how do you manage stress when you do get it? 

user: Um I try to I try to like set some time aside just to read books that like I like to read instead of like school books uh at night time, and uh I do really enjoy running, it's, I've been a little bit nervous to do it lately, but usually I run like a few times a week. 

assistant: OK, and when you're pretty preoccupied, do you ever get the chest pain?
user: Um like when I'm really, when I'm work, like working with classmates or uh like thinking really like if I'm talking to someone else, I don't really get it or if I if I'm like working on a task with my hands, but it's when I'm walking and I am alone kind of with my thoughts or when I'm studying, that's when I when I get it. 

assistant: Understood and you said your father passed early from a heart attack, I'm sorry, but anyone else in your family either your parents or mum have any health issues?
user: Oh he's uh he's alive, like he had a heart attack and just now he has to see a lot of heart doctors. Um no, there's nothing else in my family like that. I don't really know like about my grandpa, like my dad's dad, but like he might have also, um he just kind of, he just passed away young from um like an accident. So yeah, I'm not really sure. 

assistant: Got it, so no one has died suddenly with no explanation when they were young or while they were swimming? 

user: No. 

assistant: No one's ever talked about arrhythmias, or is that a word familiar to you?
user: No, no, just my dad and his heart attack. That's like the only thing I know of. 

assistant: OK, sounds good. I think I've got all the information I need and I'll pass it on to the doctor who'll take a look at you, OK? Have a good one.
user: I've just been experiencing a, some pain and numbness and tingling in in just my wrist area and thumb, middle finger, and index finger. 

assistant: OK, and when did this pain start and is it the right hand or or left hand? 

user: Hum, it's the right. It's a the right hand, but I also find it so starting to happen in the left hand as well, but more so on the right hand. I feel this kind of sensation over my palms and fingers it started I would say probably 2 weeks ago. And it's been, I think it's gradually been getting worse. I'm having more difficulty at nighttime, especially. It's also waking me up from sleep, and it's yeah just affecting my daily routine, my work. So yeah, I just wanted to understand what was going on. 

assistant: OK, I see and did you have any trauma to the wrist or or any injury, or have you had an injury in the past?
user: No, I haven't had any falls, no accidents, nothing like that. 

assistant: OK. And are you right or left handed? 

user: I'm right handed. 

assistant: OK yeah, and you mentioned it was the right hand that started to hurt first and then the left one has started since then?
user: Yeah, yeah, and I don't know if it's just 'cause I use my right hand more that I feel more pain and the symptoms. But yeah, I definitely would say it's worse. 

assistant: OK, and where are you finding that the pain is specifically located? 

user: So the pain I feel like it's more like a discomfort. Just over the like palm, like near the wrist and the lower palm area is where the discomfort is and then the numbness and tingling is just like in thumb an the 1st 2 digits. 

assistant: OK, and how would you describe the character of this sensation, is it burning, is it sharp, achy or or stabby?
user: Um I would say it's more of kind of like an aching, aching pain. Um it does sometimes turn into kind of like a burning sensation with the tingling, but yeah, more so on the palmer like on the palm side of things, it's more like an aching pain. 

assistant: OK. And you have some burning as well? 

user: Yeah. 

assistant: OK. And is the does it radiate anywhere, are you feeling this in in your neck, shoulder, or down your arm at all?
user: It kind of goes from the palm, along, so it goes from the palm it goes upwards like to my fingers, but also backwards like into my lower arm as well. Like my forearm. 

assistant: OK, and do you have any pain in the neck? 

user: In my neck? 

assistant: Yeah.
user: No. 

assistant: OK, an anything that you've done that makes the pain worse?
user: Uh. I I just have to like I work as an accountant. There's a lot of work I do on the computer with a keyboard mouse, so I feel like it's hard to really do that all day right now. So I think if I do that, I'll make it worse. But if I take a rest and kind of just shake my hands a little bit, then it gets better. 

assistant: OK, um so kind of like flicking your wrist sort of thing, so kind of shake out the?
user: Yeah. 

assistant: OK, um an anything that you do that makes it better besides those moves like have you taken any medications or tried any like wrist splints or anything like that?
user: No, I haven't tried any medications or splints. 

assistant: OK, and what is the severity of the pain on a scale of 1 to 10, 10 being the worst you've ever felt and do you feel this pain at any particular time of day more than than others? 

user: The pain is probably like a, a 5,  and I feel it more during the night as well as like when I'm working, I feel it's definitely more as I continue to do more work. 

assistant: I see OK. And. Have you had any like numbness and and that tingling in the hand or anywhere else?
user: No, just in the areas that I described nowhere else. 

assistant: OK, and have you had any muscle weakness?
user: Uhm no, I don't think so. 

assistant: OK, and how about any issues with like gripping objects, dropping objects or like opening jars? 

user: Yeah, I I do I do have like when I'm lifting things and opening jars opening lids like I do have the similar discomfort, pain as well as the numbness and tingling. 

assistant: OK, alright and have you had any fevers or chills?
user: No. 

assistant: Have you had any night sweats?
user: No. 

assistant: Have you had any unexpected weight loss? 

user: No. 

assistant: OK. Have you had any headaches?
user: No. 

assistant: How about any like sensory changes such as changes to your vision or hearing? 

user: No, no, nothing like that. 

assistant: How about a loss of your sense of taste or sense of smell?
user: No. 

assistant: Have you had any runny nose or feeling congested?
user: No, nothing like that. 

assistant: How about a sore throat or a cough? 

user: No, OK. 

assistant: Have you had any shortness of breath or wheezing?
user: Uhm no, nothing like that. 

assistant: Have you had any chest pain or feeling as though your heart's racing? 

user: No. 

assistant: OK, have you had any dizziness or or lightheadedness?
user: No. 

assistant: Alright, and have you had any of nausea or vomiting?
user: No. 

assistant: And any abdominal pain?
user: No. 

assistant: OK. Have you had any diarrhea or constipation or blood in the stool?
user: No. 

assistant: Alright, have you had any urinary problems like pain or frequency?
user: No. 

assistant: Alright, have you noticed any skin changes or like rashes or anything like that?
user: No. 

assistant: OK, and. Have you had any like muscle aches or or body pains? 

user: No. 

assistant: OK, and any confusion or memory loss?
user: No. 

assistant: OK, uh, and have you been diagnosed with any medical conditions in the past?
user: No, I've been fairly healthy. 

assistant: OK. And so do you take any medications regularly, either prescribed or over the counter?
user: No, I I've been pretty healthy. Sometimes I take some Advil for headaches and stuff or Tylenol, but that's it. 

assistant: OK. Uhm and do you have any allergies?
user: Uhm, nope. 

assistant: And have you had any prior hospitalizations or surgeries?
user: No, I haven't. 

assistant: Alright, and can you tell me a little bit about where you're living and and who you're living with?
user: I'm living with my husband and two kids in a small townhouse. 

assistant: I see and you mentioned you're an accountant. Are you working right now?
user: Yeah, I. I am in, I'm an accounting, time off and just taking a little bit easy before I find out like what this is and how this will really impact my work. 

assistant: I see OK. And have you been around anybody who's been sick recently?
user: No. 

assistant: Have you traveled anywhere?
user: No. 

assistant: Do you smoke cigarettes.
user: No. 

assistant: OK, and how about smoking marijuana? 

user: No no, no drugs. 

assistant: OK, so no recreational drugs?
user: No. 

assistant: OK, and are you currently sexually active?
user: Yes, just just with my husband. 

assistant: OK, uh, and any concern for sexually transmitted infection? 

user: No. 

assistant: OK, um and do you drink alcohol?
user: Uh, just maybe some wine every other day. 

assistant: OK, um and in the family are there any musculoskeletal or like neurological conditions?
user: No. 

assistant: OK, and how about autoimmune conditions like rheumatoid arthritis or like hypothyroidism or type one diabetes?
user: In my family history? I think there is. 

assistant: Yeah. 

user: Some, there's definitely some diabetes on my father's side. But other than that, I think one of my aunts on my mother side had um a hysterectomy for cancer. 

assistant: OK, alright and was it endometrial cancer?
user: Not sure actually, but she I just know that she had her uterus removed. 

assistant: I see alright and um so next I wanted to just move to the physical exam portion and so just first inspecting the hand and wrist do you see any swelling or redness?
user: No. 

assistant: How about any changes to temperature, do any of the joints feel warm? 

user: No. 

assistant: And are you seeing any muscle atrophy or any deformities of any of the joints in the hand?
user: Uhm, maybe like just a little bit like I feel like I've lost some of like the fat pad just right near my thumb. 

assistant: I see OK. And is there any areas of your hands over like any of the joints or over the rest that if you press you feel pain? 

user: Um no. 

assistant: OK and are you able to to move your wrist or the full range of motion?
user: Yeah, I can move it. 

assistant: OK, uh. And is there any, uh, so that then the next test I'll just ask you to just tap on the the kind of base of your palm there with your index finger and middle finger of your left hand, and when you do that, do you feel any burning or tingling? 

user: Yeah yeah. I definitely do. 

assistant: OK, so that would be, yeah, positive Tinel sign and do you get any, so if you flex both of your wrists so that the back of your hands are pressing against each other. And if you hold that position, do you start to get symptoms of the burning and tingling?
user: Um yeah, I do feel it as well there. 

assistant: OK, alright so that was everything I wanted to ask about and check today um did you have any questions? 

user: No, I just wanted to know how I can fix this. 

assistant: Yeah, certainly so it's sounding like a carpal tunnel syndrome which that the differential would be something like radiculopathy coming up up from the neck, which you're not having any neck symptoms and the positive Tenel sign and positive Phalen sign are highly suggestive of carpal tunnel syndrome, along with the nighttime symptoms and the burning and tingling sensation you're experiencing. And so to help with this one of the first things that that can be done is trying to use like wrist splints at night to try to keep your hand in a neutral position, but also, uh depending on like if there is inflammation there NSAIDs might help a little bit like ibuprofen or or things like that. But the majority of the therapy will be kind of an activity modification, and if symptoms don't improve over a period of time, then surgery could be a potential option as well.
user: It's nice to meet you as well. My name is Jenn and I'm here with my son Joey here, who he's had a sore throat now for the last couple of days. 

assistant: OK, how old is he, Joey?
user: Uh, he is 3 years old. 

assistant: He's three years old, OK. And you said for the past couple days, so about 2-3 days?
user: Yeah, probably yeah about 3 days ago he he didn't go to school for the last two days because, or I mean daycare I should say because the pains but was bugging him so bad. 

assistant: OK, yeah um. So how long has he been going to daycare for? 

user: He started this year, so, um, he's been going for about six months. 

assistant: OK? Is he having issues swallowing food? Does it hurt when he swallows food?
user: Yeah, he's, uh, he's definitely the last couple of days hasn't been eating as much like solid food. He's drinking cold liquids okay but yeah, he hasn't been eating as much. 

assistant: OK. 

user: He says it's hard to. He does say it hurts to swallow as well. 

assistant: OK, and does does he ever clutch to his neck like his neck hurts?
user: No, he hasn't said anything like that. I mean nothing about his neck. 

assistant: OK, um, have you taken his temperature at all?
user: Yeah we did and it's uh, it's pretty high actually, it was like 39.4. 

assistant: OK wow, yeah that's pretty high. Have you noticed any swollen areas on his neck?
user: No, not I haven't noticed anything on his neck. 

assistant: OK, any rashes that you've noticed?
user: No rashes. 

assistant: No, OK. And has he been having chills or night sweats?
user: Um, nothing like that that we've noticed, no shaking or or sweaty bed. 

assistant: OK, and how about like a stuffy nose or runny nose? 

user: Uh, no, nothing like that. 

assistant: OK, and coughing?
user: No cough. 

assistant: No, and how about is he complaining of any body aches?
user: No, it's mostly just been is his throat his throat that he's complaining about. 

assistant: OK, how about headaches? 

user: Uh, He hasn't mentioned anything with his head. 

assistant: OK, and has he been around anyone who's been sick?  Maybe at his daycare?
user: I, I mean, his sister has had had some colds. She's also in his daycare. So I mean, maybe her. 

assistant: OK, how old is she? 

user: Um she's 2. 

assistant: She's two. OK, so she's younger.
user: Yeah. 

assistant: OK, any nausea or vomiting?
user: Ah no vomiting. 

assistant: OK, how about um, diarrhea, constipation? 

user: Haven't noticed anything like that, his his bowel movements have been normal. 

assistant: How about urinating, has that been normal?
user: His usual amount is as, as far as I know. 

assistant: OK. And OK, any issues with his eyes? Any like pus or bleeding or redness?
user: No, his eyes of have looked normal to me. 

assistant: OK, how about his ears? 

user: Those have also been normal. 

assistant: OK, any sores on his mouth or inside?
user: Um no, it does kinda look like there. It's pretty red in the back of his throat when I was able to look, but yeah. 

assistant: OK, and has he ever experienced any of these symptoms before?
user: Um, he's had sore throats before, but I think this one is a bit more severe. He hasn't complained this bad before. 

assistant: OK, OK. Um has he tried anything for it? Have you given him any over the counter medications? 

user: Yeah, we we did use some Tylenol and it brought the fever down so that was part of the reason why we we didn't come in 'cause he's had sore throats before but the fever bounced back and and the pain seems to have continued so we came in. 

assistant: Ok, OK. And is he otherwise healthy? Does he have any medical conditions?
user: Uh, yeah, he's otherwise healthy no medical conditions, um hasn't been, had a reason to see a doctor before. 

assistant: No, OK. And then just how was pregnancy with him? Was it normal? Any complications? 

user: Um yeah there, so had um gestational diabetes, but it was treated, it was treated with diet. Um and blood sugars have been fine now, but no complications to the pregnancy from that regard as far as I know. 

assistant: OK, any alcohol or recreational drugs used during the pregnancy?
user: No, nothing like that. No. No smoking either. 

assistant: OK, OK, good um and how far along were you when when you delivered him?
user: Um it was a vaginal delivery just after 38 weeks. OK so he was full term. 

assistant: And you said vaginal delivery? Did they have to induce you at all?
user: Um no no. 

assistant: OK and was he a normal birth weight?
user: Yeah he was. Yeah, I think he was like just over 3 kilograms. 

assistant: OK, good and was he healthy after birth? Did he have any breathing issues? Jaundice? Anything like that?
user: Um, no breathing issues or or jaundice. He came home with us right away. 

assistant: OK, OK and then after that point to now has he been normal in terms of his weight, height, head circumference? 

user: Yeah yeah. He's been growing normally and eating well up up to this point. 

assistant: OK, and I should ask um has he been hitting all his milestones like, is he doing the things that his peers are doing?
user: Yeah, I would say he's keeping up with his his peers in daycare and no concerns with his development. 

assistant: OK, good. Is he on any medications?
user: No medications. 

assistant: No. OK, and is he up to date with all his immunizations?
user: He is yes. 

assistant: OK, and any allergies? 

user: Not that we're aware of. 

assistant: OK, any family history of lung conditions?
user: Um no, no family history of any lung conditions. 

assistant: OK. And So who does, who does he live with at home?
user: So he lives with my myself, and his father and then sister. So there's just the four of us at home. 

assistant: OK, and what's the relationship like between all of you? Any domestic issues? Or are things OK?
user: Oh, things are are great at home. It's a really supportive environment. 

assistant: OK, good and does anyone smoke at home? 

user: No one smokes at home. 

assistant: No, OK. Um, any carpets at home? Old carpets?
user: I think there's there's a few area rugs around, but most of the carpets are gone. 

assistant: OK, OK Um alright, so it sounds like, um grom what you're telling me, he ohh sorry, I should have asked you this earlier. Has he had any issues breathing?
user: Um no problems breathing, but his voice does sound a bit, a little bit off. A bit Husky. 

assistant: A bit Husky, OK. Um alright and nothing like a seizure like a febrile seizure, right? 

user: No, I haven't seen any like limb jerking or anything like that. 

assistant: OK, so um, just roughly doing from the sounds of it, it sounds like he has a sore throat that's been persistent and we do this thing called the Centor score. So it sounds like he's had a fever, no cough, a sore throat. So the first thing that we want to check to see or to rule out would be a strep throat and then well if that comes back negative we will go from there and think about other viral causes versus strep throat as well.
user: Um, no. We were thinking that it could be, uh, maybe strep throat. So um, yeah, thank you. 

assistant: OK, great, thank you.
user: I've had this cough that started four days ago uh that that's been getting worse and um just started having some some diarrhea yesterday as well. 

assistant: OK um sorry, how long did you say your cough has been going on for? 

user: Last four days. 

assistant: Last four days, OK, and do you feel that um it's getting worse, better, or staying the same?
user: Uh it's getting getting worse. 

assistant: Getting worse, OK. And how often are you coughing? 

user: Oh, now it's uh well, at least the last two days, it's been happening all day. Um yeah, at least every hour I've been coughing. 

assistant: OK, um have you noticed any triggers for your coughing like environmental causes like the cold, uh time of day whether that's morning or night, um old carpets, anything like that?
user: Um yeah, smoking definitely makes it worse. I I haven't smoked the last few days 'cause each time I lit a cigarette it it brought it on. 

assistant: OK, well that's good that you're taking a little break from smoking. Um how would you describe the quality of your cough, is it, does it sound harsh? 

user: Yeah, the cough's like, yeah, harsh. 

assistant: Harsh, OK. And in terms of severity, 1 to 10, 10 being the worst, how bad is it?
user: Uh I'd say it's a 7. I just can't stop coughing. 

assistant: Yeah, have you ever experienced anything like this in the past?
user: Uh yeah, nothing like this really before. 

assistant: OK, uh is the cough a dry cough or is it, or do you have sputum coming up as well? 

user: It's it's dry. 

assistant: Dry, OK. So no blood?
user: Yeah no no blood, just yeah, it's been mostly dry. 

assistant: OK, and any shortness of breath?
user: Uh not really, I mean I well I guess I've been short of breath after I cough, so yeah. 

assistant: OK, um any wheeziness? 

user: Uh no. 

assistant: How about chest pain?
user: No chest pain. 

assistant: OK, um any feelings of um feeling like your heart's racing?
user: No, nothing like that 

assistant: Um, swelling in your limbs?
user: No. 

assistant: No, how about uh pain in your calves when you walk a few blocks?
user: No 

assistant: Um dizziness or fainting spells? 

user: Uh yeah this morning I had it, I felt dizzy um when I when I got when I, yeah when I got up. 

assistant: OK, but no fainting, right?
user: No. 

assistant: No fainting, OK. Any um pain in your throat?
user: Uh no, my throat's felt OK. 

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

assistant: OK, um have you had a stuffy nose or runny nose?
user: Uh nothing like that. 

assistant: Um changes in your taste or smell? 

user: Uh ueah, I feel like I've um had problems with both taste and smell. 

assistant: OK, um, when did that start?
user: Um I think this morning, um, yeah, I really noticed that when I was I was trying to have some breakfast, but um I thought it was my lack of appetite that was that was causing issues, but I haven't really been able to smell or taste food. 

assistant: Yeah, that's unfortunate. Um have you noticed any weight loss over the past few weeks? 

user: No, weight's been stable. 

assistant: OK. How about fevers or chills?
user: Um I I felt hot but no chills. 

assistant: No chills, OK. Have you taken your temperature? 

user: No, I haven't. 

assistant: OK, well we can do that today in the clinic and we'll let you know. Um, and changes to your hair, nails, or skin, like rashes?
user: Uh, no. 

assistant: No, OK. How about fatigue or muscle aches? 

user: Um ueah, I mean maybe I've had a bit of uh muscle aches um and fatigue. 

assistant: OK. Um and you mentioned you've been having diarrhea. How long has that been going on for?
user: Uh maybe the last like two days. 

assistant: Two days, OK. And how often are you having a bowel movement? 

user: Uh every well, it kind of changes so um maybe every few hours. 

assistant: OK, and is it mostly fluid or is it semisolid?
user: Uh I, mostly fluid, it, um, yeah, it's been pretty pretty loose. 

assistant: Pretty loose, OK. And how much um how how much stool are you producing every time you go? Is it filling the toilet bowl or um is it uh relatively little? 

user: Uh at first it was a lot, but um now it it just hasn't been much. It's relatively um little. My stomach's just been killing me. 

assistant: OK, so you have some abdominal pain associated with that too?
user: Yeah. 

assistant: Yeah, OK, and then any blood in your stool? 

user: No, no blood. 

assistant: OK um have you noticed any malodours, well I guess uh out of the ordinary?
user: Uh no, I haven't noticed anything like that. 

assistant: OK.
user: But I haven't been able to smell so, who knows? 

assistant: Right, OK, true. Um in terms of your abdominal pain, when did that start? 

user: Uh I I think around the same time as the diarrhea, so the last two days. 

assistant: OK, um any nausea or vomiting?
user: Um no vomiting, but I've I felt nauseous. 

assistant: OK. The abdominal pain, is it, where is it located? Is it pretty central? Is it general?
user: Yeah, it's pretty like central or general I guess you could say, there isn't really one specific spot that I feel it. 

assistant: OK, and what makes it worse? What makes it better?
user: Uh nothing, I'm not really too sure, nothing really makes it better or worse. 

assistant: OK, and if you were to describe the pain, is it sharp, dull, or achy?
user: Uh I'd say it's pretty achy. 

assistant: OK. And out of 1 to 10, 10 being the worst, how bad is the abdominal pain? 

user: Uh probably like 4. 

assistant: OK. Um and is your abdominal pain getting worse, staying the same, or getting better?
user: About the same. 

assistant: OK. Um, any memory loss or confusion? 

user: No. 

assistant: No, OK. Are things normal with your urine?
user: Yes. 

assistant: OK. So, are you an otherwise healthy person?
user: Uh yeah, I haven't um had anything, any reason to see a doctor for a while. 

assistant: OK, well that's good. Uh you don't have any longstanding medical conditions like uh high blood pressure, diabetes, anything like that? 

user: Um, no, nothing like that. 

assistant: OK, any hospitalizations or surgeries in the past?
user: Um I did have a surgery, um yeah I had my meniscus repaired, but that was it. 

assistant: OK and when was that?
user: Oh about 10 years ago. 

assistant: OK so I just wanna, before we move on, I'm just gonna recap kind of the symptoms that you have. You've had uh for the past four days more or less, you've had um a possible fever, um this cough, um loss of smell and taste, um diarrhea, uh abdominal pain, and nausea. Is that correct?
user: Yeah, that's correct, yeah. 

assistant: OK.
user: The cough started first and then uh yeah, started to get some more of the abdominal pain and nausea, and yeah, the diarrhea the last few days. 

assistant: OK OK, are you on any medications?
user: No, I don't take anything. 

assistant: OK, not even over the counter medications or vitamins or herbal supplements?
user: No, nothing like that. 

assistant: OK, any allergies? 

user: Uh no allergies. 

assistant: OK, are you up to date with all your immunizations?
user: I am, yeah. 

assistant: Um, any family history of lung conditions or heart conditions? 

user: Um no, nothing like that. 

assistant: OK, how about GI conditions like stomach issues, colon issues, liver?
user: No, I haven't heard of any issues like that in my family. 

assistant: OK, any cancers that run in the family? 

user: Uh no, no cancers. 

assistant: OK, um any um, OK, well I'm going to ask you, uh do you smoke? You mentioned you did.
user: Uh yeah, I I I do, um I smoke maybe about a half a pack of cigarettes per day, probably less, um yeah. 

assistant: OK, how long have you been doing that? 

user: Uh for the last uh 10 years. 

assistant: OK, have you ever thought of quitting?
user: Yeah, I've I've been slowly cutting it down. I was smoking a pack a day before and now under half a pack, so I'm trying. 

assistant: OK. Well congrats, that's a big feat, um if you need additional resources to try and help you quit, please do let us know. Um I will ask you my next question then, um, do you do marijuana at all?
user: Uh no. 

assistant: No, OK, how about other recreational drugs? 

user: Uh nope, nothing like that. 

assistant: Do you drink alcohol?
user: Yeah, I'll have a glass of um wine on Sundays, but that's about it. 

assistant: OK, how about um, where do you live?
user: Uh so I live in a townhouse um with my wife um and daughter. 

assistant: OK, are any of them sick? 

user: Um my my wife was talking about being really fatigued and uh she did mention a cough coming on. 

assistant: OK um, have you been around anyone else who's been sick recently?
user: Uh, no. 

assistant: No, OK. Um have you traveled to anywhere recently? 

user: Um no, I haven't. 

assistant: OK. Um, those were all the questions that I had. Did you have any concerns, any questions, anything that you wanted to discuss that I uh possibly missed today?
user: Yeah, so I just came in today, I actually had asthma as a kid and I used to be on the puffers and it pretty much resolved by the time I was around like 18 years old, and I've been pretty good since then. I haven't even been really using the puffers for the last five years, but just recently, just during the winter I started noticing some of my symptoms coming back and now, especially over the last few months whenever I'm doing something like going to the gym or exercising, I do get that shortness of breath and I feel my throat closing in again and recently for the last, I would say a week I've also been having some wheezing as well. So yeah, I just wanted to come back and make sure everything is alright. 

assistant: OK sure, so just to rewind a little bit. When were you first diagnosed with asthma? 

user: So I was diagnosed when I was, I think it was like when I was 13 years old. 

assistant: 13, OK, and you've been using Puffers since?
user: So yeah, in the last, I would say two months I've noticed it, similarly to when I was younger, especially when I'm on the treadmill or running, I get short of breath very easily. But at rest I'm fine, I don't have any trouble, but I've noticed it for the last few months. 

assistant: OK, so it's mostly when you're exercising or with activities?
user: Mhm. 

assistant: OK. And do you feel wheezy as well?
user: Yeah, in the last one to two weeks I would say I'm also wheezing as well. Mainly during like, if I'm running or still, with exercise, I feel myself wheezing. Yeah, so that's been an issue for the last couple of weeks. 

assistant: So once you stop activity, does your shortness of breath and wheezing eventually resolve?
user: Yeah, yeah, so I just have to kind of sit down and relax for a bit and then it goes away on its own. 

assistant: OK, how long does it last before it goes away? 

user: Probably, at least, like I would say 10 to 15 minutes. 

assistant: OK, OK.
user: Until I'm fully kind of recovered. 

assistant: Ok, Ok. Are You coughing as well?
user: Uhm, yeah, when I'm exercising, that's when all of that happens. The wheezing, the coughing, but throughout the day otherwise, I'm not coughing. 

assistant: OK. And, when you cough, do you bring up phlegm or is it more like a dry cough?
user: No, no, nothing like that. 

assistant: No, you don't feel like you're breathing a lot more than usual?
user: Uh, no, I don't think so. 

assistant: OK, Do you still have puffers at home?
user: I actually, like I haven't used them for a while so no I don't have any puffers. 

assistant: OK. Any weight loss recently?
user: No. 

assistant: No, fevers or chills?
user: No, nothing like that. 

assistant: OK, any rashes or changes in your hair or skin or nails?
user: I do, I have just, uh, eczeme, I've had it for most of my life now, so especially during the winter I do get some irritation, especially on my hands. So yeah, some rashes, but that's about it. 

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

assistant: Stuffy nose, runny nose, changes in your taste?
user: No. 

assistant: Changes in smell?
user: No. 

assistant: Chest pain?
user: No chest pain. 

assistant: Do you find you get short of breath when you're laying down or it wakes you up at night? 

user: No, just when I'm exercising, especially running. 

assistant: OK, sure, any dizziness or fainting spells?
user: No headaches. 

assistant: Any like, reflux, heartburn? 

user: No. 

assistant: Nausea, vomiting?
user: No. 

assistant: Changes to your bowel movements? 

user: Nope. 

assistant: OK, so you mentioned you were diagnosed with asthma and eczema in the past, any other longstanding medical conditions that you have?
user: Uh, no those those are the only ones. 

assistant: OK, any allergies?
user: I do have, I think like, just seasonal allergies. I don't know if I'm allergic to pollen, but during the spring time I get allergies and then during the winter now I'm getting some of these symptoms that I'm talking about. So yeah, but none to any medications that I know of. 

assistant: OK, so you're not getting any night time symptoms, and you're only getting day time symptoms with activity, right? 

user: Yeah. 

assistant: Has this prevented you from going to work or school?
user: Oh yeah, so I, just this past week, I usually do my running, like morning workout right before work, and just one of the days after I worked out, I felt just terrible, with this coughing and short of breath so I just decided to take a day off work that day. But then I realized it kind of goes away on its own, so for the other days I have been going to work. 

assistant: OK, OK, good. And, alright, and then any medications that you're on? 

user: I'm on a, Just one of those steroid creams for my eczema. 

assistant: OK, OK. Are you up to date with all your immunizations?
user: Yep. 

assistant: OK, uhm, how about family history of lung conditions or heart conditions? 

user: No heart conditions, but yeah asthma is pretty big in my family, as well as eczema, like my mom has it, my sister has it, so yeah asthma is pretty big. 

assistant: OK, how about cancers?
user: Uhm, no, I don't think anyone in the family has any cancers. 

assistant: OK, and do you smoke? 

user: No, I've never smoked. I'm pretty health focused and I can't even take if someone else is smoking, so no. 

assistant: No, OK. Do you drink alcohol?
user: No, I don't drink alcohol, no drugs, yeah, I'm pretty, I like to stay very fit and healthy so nothing like that. 

assistant: OK, and have you been in contact with any sick people recently? 

user: No, not that I know of. I live by myself in my apartment. I've been working from home. I work as a programmer and so I only go outside for runs and stuff for groceries, so I haven't really seen anyone sick around me. 

assistant: Yeah, and have you traveled anywhere recently?
user: No, I've mainly been at home. 

assistant: OK, good, and where's home?
user: Home is in Hamilton Ontario and I've just been working from home. 

assistant: OK, do you live in a house, apartment, who do you live with?
user: I just live in an apartment by myself. I did have a roommate, like uh, that moved out just a couple of months ago. But yeah, right now I'm just by myself. 

assistant: OK, OK, any old carpets, pets, mold or asbestos in the house? 

user: No, nothing like that. 

assistant: OK, good. So those are all the questions that I had for you. Did you have any questions of your own for myself?
user: Yeah, I was just wondering if I should go back on the puffers. I don't have any right now, I just don't know if my asthma has just uh, come back. 

assistant: Yeah so, what we're gonna do is, we're going to do a PFT, so pulmonary function test on you, cause it's been a while since you've had one of those done. And that's just to check how well your lung is functioning, so we'll do that. We'll also maybe get a chest X-ray as well for baseline and depending on what those two come back as, we'll probably get you to use your short acting beta agonist puffer again and we'll also give you a long acting.
user: OK. 

assistant: As well as an inhaled cortico steroid. So, actually, you know what, we'll give you an inhaled cortico steroid and a short acting beta agonist because you can't use both the steroid and the long, so we'll start with those two. We'll start with the short acting as well as inhaled cortico steroid. And if we find that your asthma is just based on like, exertion or like something called athletic asthma, we can also try something called Cromolyn instead but we'll discuss that more. Right now our priority is to get your symptoms under control, so we'll start with the short acting as well as the inhaled cortico steroid. How does that sound?
user: Uh, I, I'm uh, just coming into the clinic uh, today uh, my parents told me to come today. I don't know what this thing is, just mass right below, or kind of like a lump or mass below my right knee and it's not painful or anything, it's a little bit uncomfortable but I just want to check out and see what it might be. 

assistant: Yeah, certainly. Okay, when, when did you first um, notice this mass?
user: So I think I noticed it um, for the first time um probably a couple weeks ago. I would say like, two weeks ago I, I noticed it. 

assistant: Okay, and uh, where specifically is it, is it located? 

user: So it's, it's uh, below my knee uh, right on like uh, I feel it on the big big bone right below the knee. It's um, yeah, I just feel like uh, like a hard lump. 

assistant: Okay, and uh, okay Um, and uh, is it, is it associated with any pain?
user: No, it's not really, uh, that painful. It's uh, it's, if I press on it, it's a little bit uncomfortable, but it's not like, I wouldn't call it pain. 

assistant: Okay. And have you had any trauma to the, to the knee, or area, or any injuries there?
user: Uh, no, not that I can remember. I don't think I've had any injuries there, and this lump is like, probably like 2 to 3 centimetres, it's, I don't even know like, when it appeared or why it appeared. I haven't really injured myself or anything. 

assistant: Okay, um, and have you had any, uh, any fevers or chills?
user: No. 

assistant: Okay, have you had any unexpected weight loss?
user: Uh, no, not that I can remember. 

assistant: Okay, uh, and how about, um, any neurological symptoms like numbness, tingling, sensory loss? 

user: No, I haven't felt any of those. 

assistant: Okay, and how about uh, any muscle weakness in the lower extremity or upper extremity?
user: No, no weakness. 

assistant: Okay. Um, have you had any, uh, like fevers or chills? 

user: No. 

assistant: Uh, how about night sweats?
user: Uh, no night sweats. 

assistant: Okay, and have you had any infectious symptoms, like uh, like a runny nose or a sore throat?
user: No. 

assistant: Okay. Have you had uh, had a cough or shortness of breath? 

user: No, I've been pretty well recently. 

assistant: Okay, that's good. And how about any memory loss or confusion?
user: No, nothing like that. 

assistant: Okay, and any sensory changes like changes to your vision, hearing, smell or taste? 

user: Uh, no, nothing like that. 

assistant: Okay, have you had any chest pain?
user: No. 

assistant: How about any heart palpitations or feeling like your heart's racing?
user: No. 

assistant: Okay, have you had any lightheadedness or dizziness? 

user: No, nothing like that. 

assistant: Okay. Um, and have you had any nausea or vomiting?
user: Um, no, no nausea or vomiting. 

assistant: Okay, uh, have you had any changes or loss to appetite?
user: Nope. 

assistant: How about any abdominal pain?
user: Um, no. 

assistant: Okay, and how about any changes to your urinary patterns like pain or, or frequency?
user: No, no changes at all. 

assistant: Okay, and have you had any changes to your skin, like such as rashes, or, or any changes to your hair or nails? 

user: No, not anything that I've noticed. 

assistant: Alright, so then, how about your energy? Have you had any fatigue?
user: Um, no. My energy's been fine. 

assistant: Okay, and have you had any muscle aches, or body pains or uh, any joint pains?
user: No, I mean like all the other joints and other like, bones and muscles have been fine, it's just, even I wouldn't describe this as pain, it's just uh, I think my parents got a bit concerned um, since there was like a lump. They were scared and I was a little bit scared too, so I just came in to check it out. 

assistant: Yeah, certainly. Okay, um, and uh, have you had, have you been diagnosed with any medical conditions in the past? Or see a doctor for any reason?
user: Um, no, I've been pretty healthy up until now. 

assistant: Okay, uh, and do you take any medications regularly, over the counter or prescribed? 

user: Uh no, no medications. 

assistant: Okay, uh, and do you have any allergies?
user: No. 

assistant: Alright, and are your immunizations up to date?
user: Yeah, all my immunizations are up to date. 

assistant: Okay, uh, and have you had any hospitalizations or surgeries? 

user: No, I haven't had uh, any hospitalizations or surgeries. 

assistant: Okay. Um, and uh, could you tell me a little bit about your living situation currently? Like who you're living with and uh, where.
user: Yeah, so I'm living um, with my parents and older brother, um, and we live in a, just a house um, right outside of the city. 

assistant: Okay, and are you currently in school and working, or, or working? 

user: No I, I don't work. I'm currently in school right now. So yeah, too busy with school and then just extracurricular activities. 

assistant: Yeah, absolutely. Okay, um, and uh, have you been around anybody who's been sick?
user: No. 

assistant: Okay, and have you traveled anywhere recently?
user: No, we've all just been at home. 

assistant: Okay. Um, and uh, and do you smoke cigarettes or uh, or use any cannabis products?
user: No, I haven't tried um, any drugs or anything like that. 

assistant: Okay, well that's good. And um, are you currently sexually active? 

user: No. 

assistant: No, okay. Have you been sexually active in the past?
user: No I haven't. 

assistant: Okay. Um, and uh, any concerns for safety at home with either physical violence or um, verbal abuse, either to yourself or anybody in the home?
user: Uh no, we, like um, me and my brother, feel safe at home. School is going well too. Um, I'm pretty, pretty athletic at school like uh, I have good friends, so no bullying or anything like that. Feels pretty safe overall. 

assistant: Okay, now that's good. I'm happy to hear that. And uh, is there any um, conditions in the, in the family? Uh, either like musculoskeletal or neurological things that you can think of. 

user: Um, I don't think anything related to this, but um, I know my, my dad has diabetes. Um, and my mom has uh, some anxiety. 

assistant: Okay, and anybody in the family ever um, have any cancers or, or any bone tumours or soft tissue um, tumours or growths?
user: Um, I don't think anyone's had like a bone tumour or anything like that. I, I know my uncle, um he, he does have a, he had like melanoma, which he had to get surgically removed. 

assistant: Okay. Um, and any genetic diseases in the family or, or congenital diseases? 

user: Um, not that I've been told, no. 

assistant: Okay, um, so um, next I just wanted to move on to the physical exam component and um, firstly, are you having any issues with uh walking?
user: No, I've been like, uh, no, no pain, no. I can walk just fine, no issues there. 

assistant: Okay, excellent. So no antalgic gait. And when looking at um, the area, are you seeing any swelling or, or redness, or skin discolouration? 

user: No, no, nothing like that. It's just, uh, I can tell there's like a lump there, and if I press it, I can feel like the hard lump, but um, no changes in the skin above it. 

assistant: Okay, and are you seeing any um, muscle atrophy around the area?
user: No um, nothing like that. 

assistant: Okay, and are you seeing any, uh, like joint deformities or, or anything like that? 

user: Um, no, not that I can tell. 

assistant: Okay, um and, uh you don't have any, any pain, so if you press on the area or on the the knee joint, you can just feel the mass and no pain there?
user: Yeah, it just feels weird. I don't, I'm not in any pain or anything, but it's like, it's weird to look at and then weird to feel uh, as well. 

assistant: Okay. Um, and um, uh okay, then no limitations with uh, with like range of motion of any of your joints including like uh, knee and ankle?
user: Yeah no, I can move everything just fine. 

assistant: Okay, awesome and so that, that was everything that I wanted to ask today and uh, uh check on the physical as well. Um, so was there anything else that I maybe forgot to ask about or anything you wanted to add? 

user: Yeah no, I um, nothing else I wanted to add, but I, I think my parents and I were just scared about it being like uh, cancer, or like a tumour, um, so I just don't know what I should do, if I need to get any tests done, or x-rays, or anything like that. 

assistant: Okay, um, yeah, we, so um, the first thing we will want to get uh, an x-ray um, of the knee and also of the uh, long bones, so of your femur um, as well as your leg too. Uh, and because right now we, um, most likely think is called something, um, an osteochondroma, um, which is the most common uh, primary benign bone tumour. Um, however, there are other things that it, it could be, um, and so, such as like an osteoma, or um, an endochondroma, um, so we'll, we'll want to um, get that x-ray and um, kind of go, go from there.
user: Hi, yes I've had this pain in my left elbow for a couple of weeks now and it's not getting any better so. I'm just here to kind of figure out what it is. 

assistant: OK alright are you feeling this pain on the lateral side of the elbow, on the or on the medial side of the elbow? 

user: It's on the medial side. 

assistant: OK and sorry, when did this pain exactly start?
user: So it's been on going for like the past three months. But it's gotten worse over the last, I'd say three weeks. 

assistant: OK, and. Has the pain been getting worse, any better? 

user: Oh the pains been getting worse. 

assistant: Yeah, OK. Was there any triggers or precipitating events to the pain, such as like a fall or any types of trauma to the elbow?
user: No, no, not that I can think of. 

assistant: Have you had any pain or injury to the elbow in the past? 

user: No. 

assistant: Could you describe the character of the pain. Is it sharp, achey or dull?
user: It's usually achey, but it can be sharp. 

assistant: OK. Does the pain radiate anywhere? 

user: No, it's pretty. It's pretty much in that one area. 

assistant: OK, just on the medial side of the left elbow?
user: Yeah. 

assistant: OK, and is there anything that you've done to help make the pain go away, or any alleviating factors? 

user: I am taking some NSAIDs that helps with the pain temporarily. 

assistant: OK. And uh. Are there any factors that make the pain worse?
user: Um when I. I. I guess when I like extend my elbow out it gets worse. 

assistant: OK, so it's a movement OK, and straightening the elbow?