jshargo/medical-interview-conversations2 huggingface dataset:
user: No, I haven't had any anything like that. I mean like, sometimes I can get palpitations 'cause I have a fib or atrial fibrillation, but it doesn't really yeah, affect me that, that much. 

assistant: OK. And how about shortness, sorry, how about dizziness or fainting spells? 

user: Nothing like that. 

assistant: No. Any calf pain when you walk a lot?
user: No. 

assistant: No, OK. Any fevers? 

user: No. 

assistant: No. How about fatigue?
user: Not really, no. 

assistant: No, any rashes?
user: No. 

assistant: Smell or taste? 

user: That's been normal. 

assistant: OK. Runny nose or stuffy nose?
user: No. 

assistant: Sore throat? 

user: No. 

assistant: Uhm, changes in your bowel movement?
user: No diarrhea. 

assistant: And how about like blood in your stool or constipation?
user: No constipation and no blood in the stool. 

assistant: OK, nausea or vomiting? 

user: No. 

assistant: Uhm, appetite changes?
user: No way my appetite's been been OK, that's why I was like really shocked at the the weight loss. 

assistant: Mhmm. Umm OK, how about changes in your urine?
user: No, I mean sometimes I can have a, I mean harder time to go 'cause as an old guy have large prostate I think they said, but I mean that's been OK. 

assistant: OK. How about headaches? 

user: No headaches. 

assistant: Numbness or tingling?
user: No numbness or tingling. 

assistant: Confusion or memory loss? 

user: No. 

assistant: OK. Joint pains or muscle aches?
user: I mean sometimes I can get so like my knees will hurt, but I think that's just arthritis. 

assistant: OK, yeah. Umm, alright and are you otherwise healthy? You mentioned that you have a-fib and prostate issues. Anything else?
user: Uh, yeah like high blood pressure and uh, yeah, uh just high blood pressure. 

assistant: High blood pressure, OK. Have you ever been diagnosed with something called COPD?
user: No, I I I was tested for that with the like the breathing test, I did blow into tube but yeah, they said that I didn't have it. 

assistant: OK. OK. When were you worked up for that? 

user: I was probably like I don't know 5 to 10 years ago now. 

assistant: OK. Alright, and are you on any medications?
user: Yeah, I take one for high blood pressure and I think a beta blocker as well for that like the heart rate and uh, a-fib. 

assistant: OK, yeah. OK. and, and are you up to date with your immunizations? 

user: I am yeah. 

assistant: OK, any allergies?
user: Uh, no allergies. 

assistant: OK. Family history of lung or heart conditions?
user: Uhm, I think like my uncle had lung cancer and it, and I think I've had a couple of member family members about who had lung cancer actually, but they've well, they've all been smokers. 

assistant: Oh I see. OK. Do you know what type of lung cancer they got?
user: No, I'm I'm not sure. 

assistant: OK. No problem. And OK, so I think you mentioned that you smoke. How much do you smoke and for how long have you been smoking? 

user: I smoke about a pack per day and I guess probably even smoking now for, I mean, I, I guess like 60 years almost, maybe longer. 

assistant: OK.
user: And before that I there was a point I was smoking 2 packs a day. 

assistant: Oh wow, OK, well it's good that you cut down.
user: Mhmm. 

assistant: Yeah, alright, and do you do any other recreational drugs? 

user: No. 

assistant: No, OK. And how about alcohol? Do you drink?
user: Probably one or two beers every day. 

assistant: Every day, OK. And what's your living situation like right now? 

user: Yeah, so I live with my wife in a in a townhouse. 

assistant: OK, OK. Alright, that's good. Any reasons to think you have like old carpets, dust, asbestos, mold. Anything like that in the house?
user: No, I don't think so. 

assistant: Uh, OK.
user: Yeah. 

assistant: Alright, any pets?
user: No pets. 

assistant: No pets, OK. Have you been in contact with anyone sick recently? 

user: No, I don't think so. 

assistant: No, OK. How about travel?
user: I've been, uh, yeah we've been at been at home. 

assistant: At home, OK. OK, well those are all the questions I had for you. Did you have any questions of your own for myself? 

user: Uhm, no, I was just like, well, really worried that I I could have lung cancer. 

assistant: Yeah, for sure. So that is quite high on my differential right now just because of your age, your smoking history and just the way you're presenting. So we're gonna do a couple of things. We're going to do a Covid swab just to rule that out. You should hear back in about 24 to 48 hours, but we will do investigations for lung cancer, so we'll start by doing a chest x-ray just to look for a mass or effusions and then from there if we think there are signs of cancer, we can do a CT. Umm, as well we can like stage with the Pet CT after we take a biopsy and send it off for pathology and that should give us more answers as to if you have cancer and if you do have cancer, what type of cancer so that we can talk about treatment plans and kind of what the prognosis is with those particular types of cancers? How does that sound?
user: Hi, yes, I just brought my son to the ER. We've noticed in the last two days he's been just making these grunting noises and just seems a little bit like just not himself, just more quiet. Not really crying. 

assistant: OK, and when did you, you said last few days, when when exactly did you first notice the grunting? How long?
user: It was two days ago. 

assistant: OK, two days ago. Was it when, did you hear this sound when your baby is trying to breathe?
user: Yeah, today I was trying to pay more attention. It seems like that like this really trying to breathe more. And also I like he's like the chest I see moving a lot more. 

assistant: OK. And so you've been hearing this grunting sound, and he's been trying to breathe. And you see that his chest is moving more than usual and he's crying. Has he been sleeping well or no? 

user: Uh yeah, so last night it was really hard to get him to sleep. He did sleep, I would say like around like 4 hours last night, but it was really difficult. 

assistant: And what about feeding? Does he take a formula or is he breastfed?
user: So he's, uh, he takes formula and today it like yesterday he was feeding. Today it's been really hard to get him to feed. Maybe he fed for like one or two times, but not much. 

assistant: It happens when you try to feed him? 

user: Uhm, Kind of just uh after awhile, just pushes it away, not really, uhm, yeah, uhm not really too excited about feeding. 

assistant: OK, and what about diapers? How many wet diapers has he had over the past, or yesterday and today?
user: Probably around the same like usually has like five to six weight diapers and it's around the same. 

assistant: OK. OK. Uhm and did you try anything? I know that he's six months old. Did you try feeding him anything new or anything different?
user: Uh, no, it's just been the bottle feeds. 

assistant: Nothing new right? No solid foods yet?
user: No. 

assistant: OK. And uh in terms of his activities, you mentioned that he's not as he's not moving and, as active as he usually is? 

user: Yeah, today I also thought I felt that it was a bit warm, warmer than usual, but I didn't have a thermometer at home. 

assistant: OK. Uhm have you noticed, has he been drooling at all?
user: Drooling? 

assistant: Mhmm. 

user: No, I haven't noticed that. 

assistant: OK. What about coughing?
user: Uhm, I haven't heard any, any coughing, no. 

assistant: OK, Sorry, is he is able to sit up on his own?
user: Uhm, up against like a sofa or chair, but not really on his own. 

assistant: Have you ever been has been left alone over the past two days at some point? Do you feel like you might have taken something in his mouth accidentally? 

user: Uhm no I I tried checking his mouth like I was there with him like all all the time. 

assistant: No, OK nothing like that? OK, how has his immunizations been so far? Has he as he received them?
user: Yeah, he's received all his immunizations, up to date. 

assistant: Uhm, did he have, it has he was vaccinated anytime recently? Because sometimes you said he's warm and sometimes, sometimes just getting vaccinated can cause a reaction. 

user: Yeah, no. He was vaccinated like I think more than two or three weeks ago. 

assistant: OK, alright. And you said no diarrhea or anything like that, right?
user: No. 

assistant: OK, any, is he does he have any nausea or not nausea but is he vomiting? Is he bringing anything up? 

user: No, not really. Like he was just pushing away the bottle. But like he didn't bring anything up. 

assistant: OK. Has he been limp and lethargic?
user: Uhm no, I don't think so. 

assistant: OK, has you said that he hasn't had his formula much? But what about drinking? Like has he had anything to drink? Any milk or anything like that, or no?
user: No, I don't think so. 

assistant: No, she hasn't had much to eat and or drink over the past or today? 

user: Yeah mostly. 

assistant: So he might be a little bit dehydrated.
user: Yeah. 

assistant: OK. Uhm, OK, well uhm, I, I, OK, so that's all I wanted to do know in terms of his current status, I would obviously want to examine him very carefully and see what's going on. Uhm, how has uh, how is he like just going back, how was your pregnancy?
user: Pregnancy was uh, OK, no complications, but he was premature by two weeks, so I think he was born at 35 and four days. 

assistant: OK, and were there any complications at that time, including complications related to the lung, something like respiratory distress syndrome? 

user: Yeah, so when he was born there was they needed to do, I forgot what it was, but they told me that initially he wasn't breathing, but then right afterwards after like within 5 minutes, he was fine. 

assistant: Hmm, uhm, OK, uhm, was he kept in the hospital in the NICU after being born?
user: Yeah, just because of that scare, they kept him for three more days, but like he was growing while there were no more episodes of the breathing issue, so they let him go after. 

assistant: OK. Uhm, has, how has he been since then over the past six months? 

user: Since then, he's been fine. No, we didn't have to go to the hospital or anything, and during our routine visits he's been growing well, no normal issues. 

assistant: Any issues because development?
user: No, he's been pretty, like he's been meeting his milestones according to like the family doctor. 

assistant: Has he had any surgeries or any, or no hospitalizations you said, and no, uhm no diagnosis, right? He hasn't been diagnosed with any condition?
user: No. 

assistant: Alright. Can you tell me about allergies? Is he allergic to anything that you're aware of? 

user: No, not that I know. 

assistant: OK, is there uh, can you tell me about his family history? Anything that you might have or uhm his dad or anyone else in the family?
user: Uh, no, him, his dad and I are pretty healthy, yeah. No medical conditions. 

assistant: Anything like cystic fibrosis in the family? 

user: No, not that I know of. 

assistant: OK. Alright, well we'll examine the child and look at his vitals, listen to his lungs, look, look inside his mouth and that's this sounds serious, so we'll keep you, we'll keep you updated and we'll let you know what needs to be done. He might need, potentially need antibiotics. He might need potentially, to be intubated, but we will have all these discussions after the baby's been seen and we'll draw some labs and go from there.
user: OK, sounds good. 

assistant: Alright.
user: Hi, so yeah I I'm really worried. I started coughing up blood this morning, and for the last two days I've been having some, like on my right calf, just a lot of swelling and tenderness. Uhm, I just actually got out of the hospital just last week. I had a knee replacement surgery on my right leg. So yeah, I was just really concerned about this blood that I'm coughing up. 

assistant: Yeah, certainly. So when, so you had a knee surgery last week, were you like immobilized afterwards for periods of time? 

user: Yeah, I've been just taking some rest, not really doing too much. And even in the hospital, like I was there for a day and was pretty immobilized. 

assistant: OK, and have you had any pain in your calf, and if so, which which one?
user: It's just the right calf and it's it's pretty swollen right now and I was having a lot of pain over it for the last two days. 

assistant: OK is it, can you feel the pain at rest, or or is it with uh like with movement? Or if you press on it? 

user: It's yeah, it's pretty tender when I press on it. I haven't really been moving around, and it's still like painful right now, but it doesn't really hurt when I'm like, like I've been trying to keep myself rested just because of the surgery, but when I press on it, it is pretty tender. 

assistant: OK, and is the is the swelling in kind of one spot of your leg, or is it most of the of the leg?
user: It's just the calf, I would say more like just the lower leg area. 

assistant: OK. Have you noticed any skin changes, like redness or or or temperature like it feels hot to touch. 

user: Maybe a little bit. I haven't really noticed it too much. 

assistant: OK, and do you have a history of like varicose veins or anything like that?
user: No, nothing like that. 

assistant: OK. So uhm when did the coughing up blood start?
user: Just this morning actually. So just uh, like I would say a couple hours ago. 

assistant: OK, and how much blood are you coughing up? 

user: Just some on like I just notice on the tissue like just some spots that I noticed every time that I'm, like, I would have to cough it up. Maybe like in the last couple hours, I've had three episodes of that where I've noticed blood on the tissue. 

assistant: I see and did you ever cough prior to this?
user: No, not really. 

assistant: OK, uhm, and have you been experiencing any infectious symptoms like red or runny eyes, runny nose, sore throat?
user: No, nothing like that. 

assistant: Have you been having any chest pain or or shortness of breath? 

user: No chest pain, but I do feel like I do have to take like a deeper breath. Like I've just been feeling it this morning a little bit. It's just kind of a bit of uneasy breathing. 

assistant: OK, so it has been more difficult to breathe. And is that is that at rest as well, do you feel that kind of sensation?
user: Yeah, even right now, just a little bit, like it's it's not anything that I'm too worried about, but it is there. 

assistant: OK, do you have any pain if you have if if you take a deep breath in.
user: Uh, no I don't, no I don't really have any pain. 

assistant: OK, and do you feel like your your heart's racing or beating really fast.
user: I I do feel like my heart is beating like faster, especially today. But yeah, I don't know. 

assistant: Alright, and how about your breathing? Do you feel like you're breathing faster.
user: No breathing, I feel like it's around the same. 

assistant: OK, and have you had any lightheadedness, or dizziness, or or feeling like you're going to pass out? 

user: No. 

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

assistant: Alright, uh have you had any abdominal pain? 

user: Uh no, no abdominal pain. 

assistant: Any nausea or vomiting.
user: Nope. 

assistant: Have you had any diarrhea?
user: No diarrhea, no. 

assistant: How about any urinary problems, like pain or frequency. 

user: No. 

assistant: Have you had any skin changes or or rashes?
user: Uh, no. 

assistant: OK, and how about any other like joint pains, muscle aches?
user: No, nothing like that. 

assistant: Alright. Have you ever had a a DVT before?
user: No, I've never had anything like that. 

assistant: OK, or yeah, like a deep vein thrombosis or have you had a pulmonary embolism before?
user: No, I've never had anything like that before. 

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

user: I do have uh, so with my with my knee and then I do have high blood pressure, uh I have diabetes. 

assistant: OK, then was it a knee replacement you had done?
user: Yeah. 

assistant: OK, and do you take any medications for the blood pressure and diabetes?
user: Yeah, so for the blood pressure I'm taking medication called Ramipril, and then for diabetes I'm taking Metformin. 

assistant: OK, have you needed like insulin for diabetes before? 

user: No, I've never had to use insulin. 

assistant: OK, and and do you take any other medications, either prescribed or over the counter?
user: No, nothing else. I actually I do take some multivitamins, but besides that nothing. 

assistant: Alright, and do you have any allergies to medications? 

user: Not that I know of. 

assistant: OK, and any hospitalizations or surgeries in the past besides the the knee surgery last week?
user: No. 

assistant: Alright, so you've been healthy otherwise. I I'm not sure I I ask this, I'm wondering if you had any fevers or chills. 

user: No, not really. 

assistant: OK, and uh how about any night sweats?
user: No. 

assistant: Alright and uhm has your weight been stable over the last several months or have you had any changes?
user: Yeah, it's been pretty stable. 

assistant: OK, thank you, just wanted to clarify a few things there. And uhm, currently, can you tell me about where you're living and who you're living with? 

user: Yeah, so I'm living with my wife in a house. I do have two kids, but they're off to college right now so it's just us 2. 

assistant: OK, and and what what do you do for uh for work?
user: Yes, so I actually work as a mechanic, and right now I'm kind of off of work with, I just need to recover and kind of get that physiotherapy done and then I can return, hopefully in a month or two. 

assistant: OK, yeah we need to recover after the knee surgery. OK, and do you smoke cigarettes? 

user: I used to, but I quit when I was in my thirties. I used to smoke like probably a pack a day between my 20s and 30s. 

assistant: OK, but it sounds like yeah, you quit, about 20 years ago then?
user: Yeah. 

assistant: OK, and do you drink alcohol? 

user: Uh no. 

assistant: OK, how about using any other recreational drugs?
user: No other drugs. 

assistant: Ok, and in the family, are there any heart conditions or or lung conditions?
user: No, not that I know of. 

assistant: OK, and anybody in the family have a bleeding disorder or or a clotting disorder? 

user: No, not not that I'm aware of. 

assistant: OK, have you heard of anybody in the family having, I know you said you haven't had had this before, but anybody in the family having a deep vein thrombosis or or PE.
user: Not that I know, not really. 

assistant: OK. So that was everything that I wanted to ask about on history today. We'll do physical exam and I'll listen to your chest and have a look at your leg. We'll also order some imaging studies, with a CTPA it's called. Uh but before we go ahead with that, was there anything else that that you wanted to add?
user: No, I think that's that's all. 

assistant: OK, so we'll get the lab work started, as well as the imaging ordered. It will look for, to see if there is any pulmonary embolism present, because with the surgery last week and being immobilized for a period of time, it is a risk factor for it, and leg swelling with uhm coughing up blood can be symptoms of this. So we'll wanna make sure to to do, to investigate for a pulmonary embolism.
user: Hey I I came in here today I I just was feeling just a bit short of breath over the last few days and I've had a so I normally have a cough, but I've just been coughing a lot more over the last week and I don't know if it's if it's something else. I I do have a COPD diagnosis which I was diagnosed with like a couple years ago, but this is this seems to be much worse. 

assistant: OK, you said you were diagnosed with COPD couple years ago. Was that two years ago? Three years ago?
user: It was almost, probably five years ago. 

assistant: Five years ago, OK, and have you always had this cough since then?
user: Yeah I’ve probably had a cough for the last 10 years, I think. 

assistant: OK.
user: Yeah. 

assistant: And you you’ve mentioned that this cough has gotten worse over the last week? 

user: Yeah, I've been coughing a lot more. Even just walking down the stairs from my bedroom to even the kitchen I just have to take a little bit of a breather, just start coughing. 

assistant: OK. And is it a dry cough or are you bringing up any phlem?
user: No, I'm bringing up like this. It's usually before this week. It was like kind of a clear to yellow. Sorry clear to white material, but this past week it's been more yellow in color. 

assistant: OK, any blood in there? 

user: No, I mean notice any blood. 

assistant: OK and you said you were also short of breath, uhm when did that start?
user: So that's just in the last few days. But just to clarify, I do get short of breath here and there sometimes I have to use puffers, but the last few days I've just been really short of breath, even even if I walk a little bit after like sit down and, can't really catch my breath. 

assistant: OK. Alright, and do you get short of breath when you're laying down? 

user: Uhm no, not really, it's mainly just when I'm moving around and doing stuff. 

assistant: OK, how about when you're asleep? Does it wake you up and kind of make you gasp for air?
user: No. 

assistant: No OK. So no orthopnea or PND. Alright, and the puffers that you're on, can you remind me which ones you're on again? 

user: So I'm on this one called Ventilin for the which I’ve been using a lot more recently just for relief and then, I'm on this other puffer thing. It's called spiriva. 

assistant: OK, how often? How? How many times this week have you had to use your ventilin?
user: Uhm, Ventilin are probably used. Probably almost like 10 times this past week. 

assistant: OK. Alright, any chest pain? 

user: Uhm? Just when I'm having like those coughing fits in with the breathing, I feel some discomfort, but that's it. 

assistant: OK, OK. Alright and then any palpitations or feeling like your heart's racing?
user: Uh no. 

assistant: OK. Alright, and do you ever feel like your calves hurt after you walk awhile?
user: No, not really. 

assistant: No OK, any dizziness or fainting spells?
user: Uhm, No, no, not that I know. 

assistant: OK. Numbness or tingling?
user: No. 

assistant: Headaches? 

user: No. 

assistant: Changes in your bowel movements?
user: No. 

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

assistant: Changes in your appetite? 

user: No, not really. Eating about the same. 

assistant: OK, changes in your urine?
user: No. 

assistant: Runny nose or stuffy nose? 

user: Uh, no. I don’t have that. 

assistant: OK, sore throat?
user: No. 

assistant: Any changes in your vision or hearing?
user: No. 

assistant: Changes in your smell or taste? 

user: No, not really. 

assistant: OK, how about weight loss?
user: No, my weights been pretty steady. 

assistant: OK, chills?
user: Uhm, maybe a few times this, like from that last couple days I've been feeling a bit chilly. But I I don't know if I have a fever or anything like that. 

assistant: OK, so you haven't actually measured your temperature right? 

user: No. 

assistant: OK, we can do that today. Any rashes?
user: Uh no. 

assistant: Fatigue?
user: No. 

assistant: OK, um and besides the COPD do you have any other longstanding medical conditions?
user: Uhm. I I have a like high cholesterol. 

assistant: OK.
user: And. Just I, I used to take blood pressure medications but I don't right now. 

assistant: OK. And what kind of blood pressure medications did you use to take, and how come you stopped?
user: I was on like a diuretic. Then the doctor said, like my blood pressure was really well under control, so I just stopped taking it. 

assistant: OK, OK, and the doctor was OK with that. 

user: Uh no, I just stopped taking it. I didn't really like ask the doctor. 

assistant: OK, well, we'll keep checking your blood pressure and that's something you should keep an eye on as well, just in case ou have complications with your kidneys. Does that sound OK?
user: Yeah. 

assistant: OK uhm? And are you on any medications other than the puffers? 

user: Just a Torva Staten. 

assistant: For your cholesterol OK, and are you up to date with your immunizations?
user: Yeah, not even a vaccine. 

assistant: Pardon me?
user: I even got the coronavirus vaccine. 

assistant: OK, good Congrats. Did you also get the shingles vaccine and the pneumococcal vaccine?
user: Yeah I got them. 

assistant: OK, OK good, any allergies? 

user: Uh, no, not that I know. 

assistant: How about a family history of lung or heart conditions?
user: Uhm? My father had lung cancer but he smoked a lot, I also smoke so I sometimes worry about that, but he had cancer and my mother, she was perfectly healthy. Yeah, so just my father. 

assistant: Just your father OK. How much do you smoke? 

user: Probably half a pack a day. It used to be one pack, even 2 packs at one point in time, but right now it's half the packaging. 

assistant: OK, alright, well, it's good that you're cutting down. And if you need more resources to help you do that, we have some available that we can refer you to. Do you take any other recreational drugs like cannabis, heroin, cocaine?
user: No, nothing like that, no. 

assistant: OK. And do you drink alcohol?
user: Um just probably maybe like a couple times a month. 

assistant: Couple times a month OK. And are you currently married?
user: Yeah, I currently live with my sorry, wife, in an apartment. 

assistant: OK, and any reason for you to believe you have old carpets, mold, dust, asbestos, pets, anything that could be triggering your symptoms?
user: No, nothing like that. We live in like a fairly new apartment. 

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

user: No, not not really. Wie’ve been just to ourselves. 

assistant: OK, and have you traveled anywhere recently?
user: No, just been on our house. 

assistant: OK. Alright, well those were all the questions that I had. Did you have any questions of your own?
user: Uh, yeah I was just wondering what this can be. 

assistant: Yeah, you know it sounds like you have a cough and shortness of breath, and both of these things you've had for a while, but now they're getting worse and based on your past history of COPD I would say this sounds like a COPD exacerbation. So for that we will start off with some basic blood work like CBC, electrolytes, your kidney function, ABG’s, as well as like a chest X Ray. And basically we should treat it we're going to take your oxygen saturation an give you some extra oxygen if you need. We’ll continue to use your bronchodilators an and in addition to both of that will also give you some steroids as well as antibiotics. And just to prevent any infections or if you already have it then it can help with that as well. And because your symptoms somewhat overlap with those of Covid will also do a covid swab just to make sure it's not that. And you should hear back about those results in 24 to 48 hours. How does that sound? 

user: That sounds good. Thank you. 

assistant: OK, yeah, no problem.
user: So my back has been killing me it's been hurting for the past two months, but recently it's gotten worse. I'd say over the past week or two weeks it's gotten really bad and no over the counter medication is helping with the pain. It's I'm finding it hard to walk. I can't feel anything in the groin area and I'm having so many bladder accidents. 

assistant: OK, and so this pain started two months ago, but it's progressed to like these other symptoms as well?
user: Yes, that's right. 

assistant: Where did the pain start?  Uh, it started in my lower back.  Started your lower back OK and does the pain, how would you describe the pain, is it like aching. sharp? 

user: It's sharp. 

assistant: OK and did anything happened prior to the pain, any injuries at all that you experienced?
user: Two months ago I was in a motor vehicle accident um an I think my back started hurting then but they did some imaging it's and turned out like one of the discs there was a slip in a disc or something, but at that point the pain was just achey and I don't really have any in any of these other issues. But over the past two weeks it's gotten sharp and I'm having all these other symptoms. 

assistant: OK, um and. So you're having the set like what's called, some numbness in your groin. Is that unilateral, like on one side or both sides? 

user: Uhm, it seems like it's both sides. 

assistant: OK, and. So and then you're also having the urinary incontinence. How long is that been going on for?
user: The past week. 

assistant: OK, and what about the numbness in your groin area?
user: That's been going on for the past week as well. 

assistant: OK, and OK, and how would you describe your pain right now on a scale of 1 to 10, 10 being the worst pain you've felt?
user: Um I would say it's like an 8 or 9. 

assistant: Eight or nine OK, and does it get worse with any, any motions at all? 

user: I think it's worse with um, I don't know like, it's worse with anything, anytime, anytime I tried to move it, it hurts. 

assistant: OK, so you just improved with rest complete rest.
user: Yeah. 

assistant: OK. Does it travel in, does the pain travel anywhere else, does it shoot down your legs at all?
user: Yeah, so it does shoot down my legs and I'm having a hard time walking because of that. 

assistant: Is it both legs or just one?
user: It's mostly on my right, but the left one isn't the same as it used to be either. 

assistant: OK
user: Yeah, I'm having a hard time like getting up from a chair and things like that. 

assistant: OK, and anything that you've tried that has helped relieve some of your symptoms.
user: I've tried like over the counter counter and ibuprofen. I've tried some topical analgesics and nothing seems to be working. 

assistant: OK. And. Have you experienced any trauma? So you mentioned you had a car accident rate two months ago? 

user: Yes, that was. Yeah, that was two months ago. 

assistant: OK and then. Were you in the hospital, admitted to the hospital for for a while, or how, what happened in your treatment?
user: Yeah, I was. I was taken to the ER. They did like a full work up on me. The only thing on my back that they found was a slipped disc and then they said that should that shouldn't cause me too much pain. But if I was having any of these symptoms that I'm having now I should go back, or see a doctor at least. And and otherwise I was fine like I didn't lose a lot of blood or I didn't need any surgical interventions at that point. 

assistant: OK, I see. And have you been having any other symptoms or any any pain in any other joints or muscles? 

user: Uhm, No, no, nothing like that. 

assistant: OK, any fevers or chills.
user: No. 

assistant: Any night sweats? 

user: No rashes or skin changes.  No. 

assistant: Any kind of chest pain short of, ah sorry shortness of breath?
user: Um no. 

assistant: Any cough or cold like symptoms?
user: No. 

assistant: Uhm, any so you have some urinary incontinence, any fecal incontinence? 

user: No. 

assistant: OK, how's an any recent changes in your weight?
user: No. 

assistant: Have you been sick at all recently?
user: No. 

assistant: OK, any tingling sensation either in your back or shooting down your legs?
user: No. 

assistant: Any burning sensation?
user: Little bit of burning sensation. 

assistant: Yeah OK do you have any numbness in your lower limbs or just numbness around the groin?
user: Just numbness around the groin area but my lower limbs do seem weak. 

assistant: OK so you have muscle weakness. Is it just one like that's ah weak or both legs? 

user: So both like seem weak but the right more than the left. 

assistant: OK, I see. Uhm, and does this weakness seem to get worse, or is it around the same as it was when it started?
user: It's it's it feels like it's getting worse. 

assistant: OK, do you have any past medical conditions you have been diagnosed with? 

user: I had hypothyroid, so I've been taking Synthroid for that. 

assistant: OK, any other medications?
user: No. 

assistant: OK, any allergies to any medications? 

user: No. 

assistant: OK. Any hospitalizations or previous surgeries?
user: No. 

assistant: Any family history of any musculoskeletal or rheumatologic conditions?
user: Um no. 

assistant: OK. Currently, do you work? 

user: I do. I work from home right now, I'm a teacher. 

assistant: OK, uh. And do you, did you do any work previously that required heavy lifting or strenuous activities regarding your back at all.
user: Um no no, nothing like that. 

assistant: And what's your home and living situation like right now?
user: I live at home with two of my children. 

assistant: OK. And are you able to do things at home that you were before look like, or do you need some extra help from it, your family members, or extra help from other workers. Anything like that? 

user: Yeah, my family's definitely been helping me out a lot over these past few weeks because. Yeah, like I said, like I'm having some weakness in my legs. I can't move around as much because I'm in so much pain. Um and then like there are all these like bladder accidents so. Yeah, they've been helping me out with everyday things. 

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

assistant: OK, do you drink alcohol?
user: No. 

assistant: And any recreational drugs like marijuana? 

user: No. 

assistant: OK. I'm just getting at you to do a few things on just just as part of the physical examination.
user: Sure. 

assistant: Are you able to bend down or extend your back at all, or is it too painful?
user: Yeah, I can't do that. It's too painful. 

assistant: Do you notice any kind of redness, swelling in and around your back?
user: Um not that I can tell. 

assistant: OK, and how about if you press down on the your lower back, does it hurt? 

user: Yeah, that hurts. 

assistant: OK. And are you experiencing the numbness right now and in your groin area?
user: I am. 

assistant: Are you able to raise your legs when in a lying position with straight legs, knees not bending at all, they are able to raise without any pain?
user: No, I can't do that. It's yeah, it's too painful. 

assistant: I see, alright, so those are all the questions I had for you so it seems. It's great, it's good that you came to the emergency Department. Do you have any questions at all?
user: No, just like how can I fix this? 

assistant: Yeah, so based on your symptoms, it's something that's pretty urgent. It's seems like you may be having something called cauda Equina syndrome that may be caused by your back pain and that's why you're feeling that groin would be called saddle anesthesia and then the urinary incontinence. So this may be from the injury that you had with the car accident. And it may be due to some compression of what we call like compression of the nerves in the area which might be giving you some of these symptoms. So the first thing we do need to do is get an MRI of your lower back just to make sure there's nothing going on like for example, like any masses in the area or any kind of abscesses that might be. We may be worried about just to make sure. Well, just to see what's going on in there that's causing these symptoms. And then based on what we find, uh, we will, we will target like the cause of the symptoms, like for example if it's an infect infection that's causing this, you might need to be admitted and require antibiotics. If there is any masses causing it, you may require surgery. For example if it's mainly related to your back it is something that we will have to treat with with an admission so it's good that you came in here today. Do you have any other questions or concerns?
user: Oh, not too great I've had this cough the last few days. 

assistant: OK, umm, how old are you? 

user: I'm 36. 

assistant: OK, so for the past couple of days you said, so is that two days? Three days?
user: I think 3 three days. 

assistant: OK and is it a dry cough or are you bringing up anything?
user: It's dry. 

assistant: OK, so no sputum, no blood? 

user: No blood. 

assistant: OK and do you feel wheezy at all?
user: No, no wheezing. 

assistant: No  shortness of breath? 

user: Now I ran to catch the bus yesterday and I was a bit more short of breath than I would usually be. 

assistant: OK, and have you had a fever?
user: I've felt hot yes. 

assistant: OK, did you actually take your temperature or do you just feel hot? 

user: I just got hot. 

assistant: OK so we can take your temperature today. Any chest pain?
user: No chest pain. 

assistant: OK, and any throat pain? 

user: Yeah, my throat's been a little sore, but I thought it was maybe just because I was coughing so much. 

assistant: OK and any issues swallowing food?
user: Umm, no problems swallowing food. 

assistant: OK, any changes in your smell? 

user: Now that you mention it, yeah I thought it was maybe just plugged up, but I haven't really been able to smell these last few days. 

assistant: OK, and how about hearing? Any changes in your hearing?
user: No changes there. 

assistant: OK any ear pain? 

user: No ear pain, no. 

assistant: OK, any changes in your vision?
user: Umm, I got glasses last year but nothing recently. 

assistant: OK and any eye pain or discharge from the eyes? 

user: No. 

assistant: OK, and have you had any night sweats or chills?
user: Nothing like that. 

assistant: Any weight loss?
user: No weight loss, no. 

assistant: OK and then how about changes in your bowel movements?
user: No, everything's been regular there. 

assistant: OK, no diarrhea, no constipation, no blood in your stool? 

user: No diarrhea, no constipation, and I haven't noticed any blood. 

assistant: OK, any changes in your urine?
user: Uh, no. 

assistant: No, OK. Um, how about muscle aches or pains?
user: I felt pretty, uh, well, yeah, I guess achy and weak. 

assistant: Did that start around the same time that you experienced your cough and possible fever?
user: :Yeah, I would say it started around the same time. 

assistant: OK, any dizziness?
user: Uh, no. 

assistant: Any confusion or memory loss?
user: No. 

assistant: OK, any fainting spells? 

user: No. 

assistant: Any rashes?
user: I haven't noticed any rashes. 

assistant: OK, so it's your cough and just in general how you feel. Does it get better or worse with anything? Have you tried you know Tylenol and any antipyretics? 

user: Yeah, I tried some uh like day and night time Tylenol at home to sleep but still, when I woke up in the morning, still not feeling very good and the cough is still here too. 

assistant: OK, yeah. Have you ever experienced anything like this before?
user: Maybe as a kid. I mean, I remember getting the flu. I had a cough and that sort of thing, but I haven't been sick for several years now. 

assistant: OK. Umm, and then since you started having this cough too, now has anything changed? How are you feeling worse? Or do you feel kind of the same as when it started? 

user: I would say I feel a bit worse. 

assistant: OK, and has anyone around you been sick recently?
user: Umm, no, not that I know of. Yeah, everybody in the house has been OK. 

assistant: OK, have you traveled anywhere recently?
user: Umm, yeah, I was visiting some cousins up North several weeks ago, but that was just traveling within the province. 

assistant: OK, and they're fine? No one is sick?
user: I haven't heard of anybody being sick. 

assistant: OK, and are you otherwise healthy? Do you have any medical conditions?
user: I've been told I had high cholesterol before. But I don't take any medications for it. I've been just trying to lose some weight and exercise more. 

assistant: Sure, OK. No surgeries or hospitalizations in the past?
user: No. 

assistant: OK and no other medications?
user: Umm, no,  I just take a multivitamin. 

assistant: Ok, and no other you know over the counter medications or herbal stuff? 

user: No, I'll use my Tylenol or Ibuprofen or Advil I guess if I get the occasional headache.  And I guess, umm, something like Reactine or Claritin for the seasonal allergies but that's about it. 

assistant: OK. And so you said seasonal allergies. Any other allergies?
user: Umm, no, just usually like in the springtime. 

assistant: OK, and are you up to date with all your immunizations?
user: Yeah I am. Yeah I get the flu shot every year. 

assistant: OK good. And in terms of family history, do any of your family members have lung conditions or heart conditions?
user: I know mom has high blood pressure, but nobody's had a heart attack or, uh, no lung conditions either. 

assistant: OK, any cancers that run in the family?
user: Umm, none, I can't think of any. 

assistant: OK, and then do you smoke? 

user: I just I smoke cannabis every once in awhile. 

assistant: OK, how much do you smoke?
user: Um, I would say maybe, I enjoy it on the weekends. 

assistant: Did you say a joint on the weekends? 

user: Yes. 

assistant: OK, so is that like 1 milligram?
user: Yeah, I would say something about that. Yeah, it's not much. 

assistant: OK. But no cigarettes though?
user: No. 

assistant: OK, any other recreational drugs? 

user: No. 

assistant: OK, and do you drink alcohol?
user: Umm, I do, yeah, I'll have like two or three beers on the weekend. 

assistant: Sure. And and where do you live? 

user: I'm just like 20 minutes down the road in a house here. 

assistant: Sure, is it an apartment complex or is it like a full house?
user: Yeah, it's a single family home. I live there with my wife and three kids. 

assistant: OK, um any concerns with your living arrangements you know, like old carpets or anything like that? 

user: Actually last year we had most of the carpets taken out, so not anymore. 

assistant: OK good good. Did you have any other questions or concerns? Anything that you wanted to bring up that I didn't touch on today?
user: Yeah, I was just really worried that this could be COVID. I mean I have a cough and just have been feeling really hot so I was just concerned about that. 

assistant: Yeah, for sure, and I think that's a valid concern. So right now I'm just going through, you know, a list of differential diagnoses that you could possibly have and COVID, it's definitely top on my list and so we will likely get a swab and run those tests and try to get that back to you as soon as we can. It could also be other respiratory infections, especially viral infections this time of the year. And so, if it comes back negative for COVID, it's probably you know something else like respiratory virus or even the flu. So we'll go from there. And if it turns out it's not a viral infection, we will likely see if it's some sort of bacterial infection in which we can prescribe antibiotics for those. But it definitely sounds like there's an infectious picture going on here because of the acuteness of the presentation, and just your symptoms. So we will do afollow up in a week or so. Until then, we will run all these labs. Does that sound good?
user: Hi. So I just brought in my son he's 5. Essentially, when he, so today is Friday when he got home from school on Wednesday, he seemed fine, but he I don’t know that night he started to have a bit of like a cough. It just seemed like a little dry cough, but obviously I just wanted to keep him home, keep him safe and not like spread anything if he was sick. So he stayed at home on Thursday and he was like having a bit of a cough. Then yesterday it seemed to get a little bit worse and he was really tired, uh sorry. Today, today is Friday. He was like his cough is like getting a bit worse and I've been taking his temp the whole time and it got like a little high today, what was it? My thermometer says it was high. I'm just like trying to remember it was it was. It was like over 100 though. 

assistant: Oh OK.
user: Uh, 101 or something or maybe 100.1 if. But anyways it was so I I just thought I should probably bring him in 'cause I was really worried about him and you know so he could have maybe got covid and like at school or something. 

assistant: Yeah for sure. Um OK, so just to clarify, he's had this cough and fever for the past five five days.
user: Mhm. 

assistant: OK, OK so let's focus on the cough. 

user: It’s Friday. Its been more like like 3 days.  Wednesday is when he came home, and then um he. And then today is Friday. So yeah, sorry. 

assistant: Today is Friday OK. And um. OK, yeah sure uh so. Is this cough a productive cough, or is it kind of a dry cough?
user: Uh I think it's dry. I haven't noticed him like spitting up anything. Yeah he yeah, its just like little cough. 

assistant: OK, And. He is he. He's not bringing up any sputum or blood? 

user: No. 

assistant: No OK good. OK, and does he sound wheezy at all to you?
user: No, no, not that I've noticed. 

assistant: OK, how about short of breath? 

user: Um I don't think so like he usually he's a really active kid and he has. He hasn't been running a lot outside in the past couple of days, so maybe he maybe he could have been having a harder time breathing. But also I think he's just been tired in general. 

assistant: OK, yeah. OK, Uhm. Is his coughing getting worse with certain times of the day? Like is it worse at night, in the morning?
user: Mm I think it kinda just there the whole day. 

assistant: OK, and it does it, how does it sound? Does this sound like a barky cough? Does it sound? Uhm? Like harsh, what is what would you say the quality of it, of the sound of the cough is? 

user: Uh, I, just sounds kind of dry. It's not like super loud. 

assistant: OK. OK, and has he ever experienced anything like this in the past?
user: Um like he's had colds before, but I haven't like. I haven't like you this time he kind of had the fever, which is different than you know, having a regular cold. 

assistant: OK. And are his symptoms getting worse?
user: I think so 'cause yeah, the first day he just seemed like a little dry and then yesterday is coughing and today he actually has a fever. 

assistant: OK, and is he complaining of anything like chest pain? Or feeling like his heart's racing?
user: No, I don't think so. 

assistant: No, OK. Does he have a sore throat?
user: Mm I don't think so. 

assistant: OK, and is he having any issues swallowing food or fluids? 

user: I don't know if he's having trouble swallowing, but he doesn't seem to have a big appetite right now. 

assistant: OK, and is he, does he have a blocked nose or runny nose?
user: Maybe a bit of like a look at runny nose. 

assistant: OK, and does he have any issues with smell or taste?
user: He, this morning he really seemed like he wasn't like into his breakfast and I wonder if he's losing his sense of taste a little bit. 

assistant: OK, how about vision or hearing? 

user: I think those are fine. 

assistant: OK, and is he complaining of any chills or night sweats?
user: No. 

assistant: OK, any changes in his hair, nails or skin like rashes?
user: No, I haven't noticed anything like that. 

assistant: Any changes in his bowel movements. Pardon? 

user: Um sorry no changes. 

assistant: OK, no diarrhea, no constipation, no blood in the stool?
user: No 

assistant: OK, any nausea or vomiting? 

user: No. 

assistant: OK, any changes in his urine?
user: I haven’t really been looking, but I don't think so. 

assistant: Any dizziness or fainting spells? 

user: No, just like fatigue. 

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

assistant: And is he and is he an otherwise healthy child? 

user: Yeah, actually he hasn't decided to like a vaccine that he hasn't had to go to the doctor like ever like. I mean, he broke his arm once, but that was it. 

assistant: OK, um so no past illnesses and I guess no hospitalizations or surgeries except for the broken arm.
user: Exactly, like nothing. 

assistant: OK, and were things normal with your pregnancy with him? 

user: Yeah totally. 

assistant: OK um. And then how about as a newborn, any complications after birth?
user: No, no, like everything is things really good. 

assistant: OK, and then did he hit all his milestones up till now?
user: Yeah totally. 

assistant: OK. Any, does he have any allergies?
user: Um. No, no, I don't think so. I mean like he hasn't really taken a lot of medicine, so it's hard to say, but like nothing. 

assistant: Is he up to date with all his immunizations? 

user: Yeah. 

assistant: Yeah OK. And. In terms of family history, are there any lung conditions or heart conditions?