jshargo/medical-interview-conversations2 huggingface dataset:
user: Yeah. 

assistant: OK OK, and then any dizziness or fainting spells that you've noticed? 

user: No fainting or dizzy spells, but he's really gassed after he has like a coughing fit and he doesn't want to stand up, he'll just be sitting down or he wants to be held. 

assistant: OK, is he more irritable than usual?
user: Yeah after he has a bad coughing fit, he wants to be soothed and he'll be crying, but it's just more of because he's worn out, I believe he's tired. 

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

assistant: OK, and then in terms of his bowel movements, have things been normal from that standpoint? 

user: Oh yeah, process of potty training him, but no, no real changes. 

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

assistant: OK and he's passing gas?
user: OK yeah I'd say so. 

assistant: Any nausea or vomiting? 

user: No. We haven't been really feeding him solid meals, it's because he's been sick, we've been trying to give him soup and liquids for the most part because his throat hurts, but he's able to keep them down. So no, no nausea, no vomiting. 

assistant: OK, and then how about changes in his appetite?
user: Yeah, he's not eating as much but still, we're trying to force food into him to keep his energy up. Most of time he always will be asking for snacks in the afternoon, but now not so much. 

assistant: OK. Alright and any anything else that I missed that he's been experiencing over the past few days? 

user: No, just the cough. 

assistant: OK, and then he otherwise healthy? Does he have any longstanding medical conditions?
user: No longstanding medical conditions. Yeah, nothing really. We had a little bit of stay in the NICU, just because he was a little bit underweight, but no, nothing really. 

assistant: OK. And then his mother's pregnancy with him? Any complications at that point? 

user: Yeah he's a little pre term. 34 weeks I think. 

assistant: OK, was he also underweight too?  You mentioned just a little bit.
user: Yeah. 

assistant: OK, and any complications during the actual delivery?
user: Yeah, not that I remember like she started going to labor early, like earlier than we expected. We thought it was just a regular contraction and that it will just resolve but she wound up proceeding when we showed up at the hospital 

assistant: OK and then in terms of growth, weight and head circumference, has he been hitting all those milestones for the past 2 1/2 years?
user: Yeah, we we bring him to the family doctor every couple of month for his regular checkups and nothing has been brought up to be concerning for his vaccines. He has been doing well. 

assistant: OK and then how about other milestones like speech, movement, fine movement, all of that, like have those been normal? Is he on par with his peers?
user: Yeah, this is our first kid, but compared to his cousins he seems to be doing well. He's speaking, he's got little sentences, now he has good eye contact. He's a good kid. 

assistant: OK, good good. Any hospitalizations or surgeries aside from when he was born? 

user: No no. 

assistant: OK good and is he on any medications?
user: No, OK we give him like a flintstone gummy. 

assistant: OK, is he up to date with all his immunizations?
user: Yeah. 

assistant: Any allergies?
user: Not that we know of. 

assistant: Any family history of lung conditions?
user: So my grandfather, so his greatgrandfather I suppose passed away from lung cancer. He was a heavy smoker though. On my mom's side there's some breast cancer. No,  nothing really that comes to mind for lungs. 

assistant: And any heart conditions?
user: No, not that we know of. 

assistant: And how about other cancers?
user: No, not that I know of. 

assistant: OK, how about asthma, eczema or allergies in the family? 

user: You know, I think my sister is allergic to peas, but she was never sick from them like go to the hospital.  I don't think there are any allergies in the family. 

assistant: OK, good, has he been in contact with anyone who's been sick recently?
user: You know, like 5 days ago we had a playdate with his cousin. And we kind of thought that that's where he got the cold from. Like the runny nose, but it just turned weird, you know. 

assistant: OK and how's this cousin doing? 

user: Last time I talked to Charlotte, Hank seems to be doing well so. 

assistant: Alright, and has he traveled to anywhere recently? Have you any of you traveled anywhere recently?
user: No, with covid and everything, we have just been keeping to ourselves. 

assistant: And with who and where does he live? 

user: He lives with me and his mother in a house 

assistant: OK. Any old carpets or mold or concerns for asbestos? Anything like that at home?
user: I don't know when this house is built. I don't think there's any asbestos in it and it's all hardwood. So no. 

assistant: OK, good. Anyone at home smoke? 

user: No, no. 

assistant: OK, good. So those were all the questions that I had. Do you have any questions for me?
user: No, no that's it, no. 

assistant: OK, well, from the sounds of it, he most likely has some sort of viral infection. We will do a COVID swap to rule that out because some symptoms do seem to overlap with COVID and we want to make sure to rule that out. So we'll take a swab. Those PCR results should come back in about 24 to 48 hours. In the meantime, he should isolate for 14 days at home and if it's not COVID, it could be another viral infection like parainfluenza, also known as croup. So for that, for any of these viral infections, actually the best treatment is to stay at home and make sure that he's very well hydrated and eating well. If his symptoms persist for three to five days or more, or if his symptoms worsen, especially if he has like a seizure or urological issues, he should go to the ER and if his symptoms do become worse, we can also prescribe him some steroids or epinephrine just to open up his airways. And if it's really, really bad he might be hospitalised as well. So just keep an eye on on that for now. And if you have any
user: A little scary. Sounds good. OK, I'll just keep an eye on him for the next five days. 

assistant: Give us a call if his symptoms are becoming worse or if they're not resolving and we will try to do an assessment on him. Of course we will do a physical exam today and will let you know how severe his symptoms are. Most children will get over their infection on their own and he likely won't need any additional treatments.
user: Not so well I I feel like I've been having just worsening breathlessness and a cough for it's been going on for two years now and I just can't seem to get rid of it. 

assistant: OK, the cough and breathlessness both started two years ago? 

user: Yeah, I would say approximately around the same time. 

assistant: OK, OK. Um, do you always have the breathlessness, or does it come and go?
user: Um, I think it's, I feel short of breath most of the times, but it's mainly just gets worse when I'm exerting myself when I'm walking more than usual or just working in the garden. 

assistant: OK, OK, um and same thing with the cough? It gets worse when you're walking around? 

user: Yeah, I would say so. 

assistant: OK. And was there any sort of trigger for this two years ago? Anything that you remember?
user: Um, no, it kind of just started gradually on its own. No, no real triggers that I can remember. 

assistant: OK, and, does anything make it worse or better besides the exertion? 

user: Uh, no, I think that's pretty much the only thing that really makes it worse. 

assistant: OK, and how would you describe your breathlessness? Is it that you're breathing too fast or you can't catch your breath?
user: It's I think it's more so just I can't catch my breath and sometimes I just have trouble being able to take like a full breath. 

assistant: OK, OK. Um, and out of 1 to 10, 10 being the worst, how bad is your breathlessness?
user: It can get up to I would say like an eight sometimes when I'm doing a lot of work. 

assistant: OK, and have you ever experienced this before?
user: Not before the two years, before I I never felt anything like that. 

assistant: OK, and you mentioned it's gradually been getting worse, right?
user: Yeah, I would say so. 

assistant: OK, and the cough, um, do you ever cough up any blood?
user: No, it's uh, it's usually just a dry cough. No, no I don't produce any mucus or blood. 

assistant: OK. OK. Um, and do you feel like you're wheezy? 

user: No, I haven't heard any kind of wheeziness at all. 

assistant: OK. Any issues with your breathlessness when you're laying down?
user: No, I'm completely fine laying down. 

assistant: OK and it's not waking you up at night, right?
user: No. 

assistant: OK um, have there been any changes to your taste recently?
user: No, not that I know. 

assistant: Any changes to your smell? 

user: No. 

assistant: Have you experienced a sore throat?
user: Nope. 

assistant: Runny nose or stuffy nose?
user: Nope, not that I know of. 

assistant: OK, changes in your hearing or ear pain? 

user: No. 

assistant: Changes in your vision or eye pain?
user: No, nothing like that. 

assistant: OK, and have you noticed any fevers? 

user: Um, maybe some chills here and there, but not not really a fever, no. 

assistant: OK, and you mentioned chills. How about night sweats?
user: Um, just a few times per week I would maybe have to take off my blanket sometimes I notice a lot of my sweat covering the bed sheets. That's been going on for about, say a couple months now. 

assistant: OK, OK um any weight loss? 

user: I think over the last few months I may have lost like around 3 three kilograms. 

assistant: OK, OK, any rashes on your body?
user: Not that I know, no. 

assistant: OK. Um, how about uh like feeling you're like you're tired?
user: Um, yeah, I feel pretty tired sometimes, but I just thought it was because I'm getting older. 

assistant: OK, fair enough. How about chest pain?
user: No chest pain, no no. 

assistant: Any swelling in your arms or legs? 

user: No, not that I've noticed. 

assistant: OK and how about feeling like your heart's racing?
user: No heart has been fine. 

assistant: OK. And how about changes to your bowel movements? 

user: No, I go pretty regularly. 

assistant: OK and urine, any changes there?
user: Nope. 

assistant: OK, how about nausea and vomiting?
user: Uh, no. 

assistant: Headaches? 

user: Uh, no. 

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

assistant: No? Ok, um how about confusion or memory loss?
user: Not that I know of, no. 

assistant: OK, and are you otherwise healthy? Do you have any other medical conditions?
user: I do have high blood pressure and I think they said like my prostate is larger than normal. Um, but nothing else. 

assistant: OK, and have you been sick in the past?
user: Uh, in terms of like breathing, I think maybe as a child like I may have had like a pneumonia but nothing else. 

assistant: OK, and are you on any medications?
user: Just ramipril for my high blood pressure. 

assistant: OK, um how long have you been on that medication for? 

user: Uh, for a pretty long time, I would say more than 10 years. 

assistant: OK and no issues, side effects with that, right?
user: No, and my blood pressure is pretty well controlled on that medication. 

assistant: OK, good, um, any allergies?
user: No. No allergies. 

assistant: Are you up to date with all of your immunizations?
user: Yeah I got my shingles and my pneumonia vaccination everything like that. 

assistant: OK, and uh, in terms of family history, um, are there any heart or lung conditions that run in the family? 

user: Uh, so yeah, my dad had quite a few problems. He had type 2 diabetes then he suffered from 2 strokes and then he also had a heart attack uh, in I think when he was like 56. But then he actually ended up dying of bowel cancer in his 70s. 

assistant: OK. How about your mother? Is she alive? Is she healthy?
user: Um, my mom is alive, but she suffered from Type 2 diabetes and high blood pressure as well. And she also had, like hypothyroidism. And she also suffered from depression as well. 

assistant: OK. Um OK, so do you live by yourself and where do you live? 

user: I live on an apartment and in apartment by myself right now. I do find it difficult getting out of the house recently just because of my shortness of breath, but other than that I feel that I'm pretty independent. 

assistant: OK, and do you smoke?
user: No, I've never smoked in my life. 

assistant: No? Um, how about other recreational drugs?
user: No no marijuana, no cocaine, nothing like that. 

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

user: No. 

assistant: OK, and do you still work?
user: Uh, no, I actually worked at just the hospital I used to volunteer, but now I just can't get out of the house. I feel just tired and short of breath all the time so just staying in my house most of the time. 

assistant: OK, and has anyone around you been sick? 

user: No, not that I know. 

assistant: No um, and have you traveled anywhere recently?
user: No, No. 

assistant: OK, um, have you been worked up for this in the past two years? Like have you had any chest X-rays or pulmonary function tests or anything like that?
user: No, I've never really had this issue before, so no investigations. 

assistant: OK, OK, well those were all the questions that I had. Did you have anything that you wanted to add that I maybe missed?
user: Uh, no, I just it's been going on for two years and I feel like it's getting worse and worse. And yeah, I'm just scared of having to, you know, go on oxygen or like just not being able to breathe at one point. 

assistant: Yeah, for sure. So we will try to do a good job working you up for everything that we think it may be. And right now, it sounds like it could be pulmonary fibrosis either like you know an autoimmune process or triggered after like an infection that you may have had in the past. We will definitely also look into see if it's perhaps a lung cancer, asthma and you mentioned you don't smoke so we don't think it could be COPD but we'll also test for that in case all everything else comes back negative.
user: Yeah hi, I'm I I have a pain in my belly. It started a couple hours ago. 

assistant: OK, and where exactly in your belly do you have this pain?
user: It's mostly up here on the right side. 

assistant: The right side, OK and can you describe what kind of pain is it? Is it like a dull pain or sharp pain, an aching pain? 

user: Oh I guess it's a, it's an aching pain I'd say. It kind of just, um, it would initially just come and go, but now it's just it's staying. It's not going away. 

assistant: OK, and so it's in the right area and does it travel anywhere elsewhere besides on from the right side?
user: No. 

assistant: OK. And on a scale of 1 to 10, one being the least amount of pain you felt in your life, and 10 being the worst, how much would you rate it right now?
user: It's about to a 10, an 8 maybe. 

assistant: An 8, OK and so just to clarify, when did it start?
user: About 8 hours ago. 

assistant: 8 hours ago, OK. And were you doing anything before? Like, did you have a meal or how were you sleeping before it woke you up, what was going on before you had the pain? 

user: I was just about to go to sleep. I wasn't doing anything in particular at the time. 

assistant: OK. And has it been getting worse since it first started?
user: Oh yeah, definitely it would come and go, but now for the past I'd say five to six hours, it's been constant, just there all the time. 

assistant: OK. And have you had any similar pain like this in the past?
user: Yeah, uh I I have the same pain that sort of comes and goes after I eat. Usually after I've had something like a something fatty, something from outdoors, maybe like a burger or fries or something. I initially thought it was indigestion, but I don't I don't know what's going on now. 

assistant: OK, and does it, does anything make it better or worse or anything that you've tried?
user: Well, I guess eating sometimes makes it worse, um, but I don't I don't think there's anything that's making it better. 

assistant: OK, have you tried any medications at all?
user: I tried Tylenol but that didn't do anything. 

assistant: OK. And besides, uh, the pain that you're having, do you have any nausea and vomiting? 

user: I am a little nauseous, but no, I didn't, haven't had I haven't vomited yet, no. 

assistant: OK, and have you been having any fevers?
user: I don't think so. I haven't checked. I don't feel feverish. 

assistant: Any sweats or like chills?
user: No,  I don't think so. 

assistant: OK, any changes in your bowel movements like constipation, diarrhea? 

user: No. 

assistant: OK. Have you traveled anywhere recently?
user: No, I haven't. 

assistant: Have you been feeling at all, very tired, not your usual self, fatigued? 

user: Well the pain is making it difficult for me to do things, um, but I I guess I'm not, uh a little fatigued  maybe. 

assistant: OK. Um, have you been having any changes in your urinary patterns?
user: No. 

assistant: No? Any changes in your skin and you rashes, any yellowing of your skin? 

user: Nothing that I've noticed, no, I don't think so. 

assistant: OK. Any changes in your urine color?
user: No. 

assistant: OK, have you noticed blood in your stools at all?
user: I have not, no. 

assistant: OK, and how about your appetite, has this changed at all?
user: Well, I guess because it's this thing happens usually happens after I eat, I think I've been eating less than usual, just because I don't, I don't want to, you know, I don't like the pain. 

assistant: Any significant weight loss recently? 

user: I don't think so. 

assistant: OK, any recent infections recently at all?
user: No. 

assistant: Um, and otherwise are you, do you have any other medical conditions like diabetes, high blood pressure or anything else? 

user: I do have diabetes but that's about it I think. 

assistant: And you take anything for your diabetes?
user: I take metformin. 

assistant: OK, um do you take any other medications at all? 

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

assistant: No worries. Do you have any allergies to any medications, any environmental allergies?
user: No no, no, I don't. 

assistant: OK. And have you been hospitalized in the past? 

user: No, no I haven't ever. I've been very uh healthy. No hospitalizations. 

assistant: Any past surgeries?
user: I got my wisdom teeth removed when I was a teenager. 

assistant: OK. Have you been in contact with anyone who has been ill recently?
user: No, I don't think so. 

assistant: OK. Hmm, and in terms of your family history, has anyone had any cancers or um any err um IBD like Crohn's disease or ulcerative colitis? 

user: No, not that I know of. 

assistant: OK. And anything that runs in the family at all?
user: My dad had a heart attack when he was in his 60s. But that's it. 

assistant: OK. And um, currently right now do you work? 

user: Oh no, I'm I'm laid off because of COVID. 

assistant: OK. And currently, what is your home situation like?
user: What do you mean? 

assistant: So do you live in an apartment, house and do you live with anyone? 

user: I I I live in an apartment, I live alone. 

assistant: Um, and in terms of your daily routine, do you feel that you get enough exercise? Do you go outside for walks or runs or anything like that?
user: I usually go out for a run, especially when it's a little bit warmer, which it now is. 

assistant: And do you do you drink alcohol?
user: Uh, sometimes. 

assistant: How much would you say you drink in an average week? 

user: One to two drinks a day. 

assistant: OK, and what do you usually drink?
user: I'll just drink a glass of wine at night, just helps me relax. 

assistant: OK. And do you smoke cigarettes? 

user: I don't, no. 

assistant: OK. And do you use any recreational drugs like marijuana?
user: Yeah, so I've had this cough, ongoing now for the last three days and I found I've had a more difficult time breathing as well. 

assistant: OK, and So what came first? did the cough come first?
user: Yeah, the cough started first. 

assistant: OK and so it started three days ago?
user: Yeah. 

assistant: When did the shortness of breath start?
user: That started probably about two days ago. 

assistant: OK, and the cough, can you describe it a little bit? Is it like a wet cough, a dry cough? How would you describe it? 

user: Yeah, I brought up a little bit of sputum. It's been clear, mostly clear and sometimes dry as well. The cough's been getting worse over the last couple of days as well and hasn't really stopped either, it's just kind of ongoing all day. 

assistant: OK, so it's it's pretty constant?
user: Yeah, it's been constant. 

assistant: OK, and how much sputum would you say you're bringing up? 

user: I would say, uh, maybe like two teaspoons a day. It's only like a little bit in the tissues and I'm not bringing up sputum every time. 

assistant: OK, and is your sputum at all yellow, green? Or does it have any blood tinge content in it?
user: No, I haven't noticed anything like that. 

assistant: OK, so it's mainly just white or clear. 

user: Yeah, it's mostly, yeah, like whiteish or clear. 

assistant: OK, uhm, and have you had anything like this happen before?
user: No, I haven't. 

assistant: OK, and how would you describe the shortness of breath? Are you having trouble taking deep breaths or are you having trouble breathing when exerting yourself, like how would you describe it? 

user: Yeah, I have like, a chest tightness. I find when I exert myself it gets worse and after I cough, I have a little bit of trouble catching my breath as well. 

assistant: OK, When do you have the chest tightness, when did that start?
user: Uh, yeah, that's started within the last two days as well, with the cough. 

assistant: OK, so is it just the tightness when you cough or is it there just throughout?
user: Yeah if I take like a deep breath in, like, it just feels tight, like I can't get a deep breath. 

assistant: OK, and have you had any kind of, like swelling in your calves, or pain in your calves at all?
user: No, I haven't had anything like that. 

assistant: OK, and have you had any surgeries recently or have you been immobilized for a long time or admitted to a hospital or anything like that?
user: No, I haven't had anything like that, I've been healthy. 

assistant: OK, and have you had anything like a blood clot, either in your legs or traveling up to your lungs in the past before?
user: No, I haven't had anything like that. 

assistant: OK, and have you been diagnosed with cancer or any other medical conditions?
user: No, I haven't. 

assistant: OK uhm, so would you say the coughing and the shortness of breath is getting worse, or it's about the same? 

user: I'd say it's gotten a little bit worse over these last couple of days. 

assistant: OK, and is there anything that makes your symptoms better or worse?
user: Yeah, if I exert myself it does make it a bit worse. It'll bring on the cough more, and shortness of breath. 

assistant: OK, and how about any positional changes? Like, does lying down help? Does resting help relieve some of that tightness, cough and shortness of breath? 

user: No, nothing like that has helped. 

assistant: OK, and have you tried any kind of medications at all, over the counter?
user: No, I haven't tried anything. 

assistant: OK. Alright, so it seems that your shortness of breath, is it, uh, mainly when you're breathing in or breathing out? Or are you having shallow breaths? How would you describe it? 

user: I would say it, yeah, I kind of go back to the chest tightness, it just feels like I'm not able to, like, breath in all the way and catch my breath after I exert myself or coughing. It's easy Uh, like if I rest I'm not short of breath. 

assistant: OK, do you have any other symptoms? like a runny nose, sore throat? Anything like that?
user: Uhm, nothing like that. 

assistant: OK, and any headaches?
user: I have had a little bit of a headache over the last day. Usually I get headaches like this when I haven't slept well. 

assistant: OK, and is it like a different type of headache and is it on one side of your head or both? 

user: Yeah, I feel it on both, kinda like right up into my forehead there. 

assistant: OK, and is it kind of like a pressure like pain? Is it pulsating pain? How would you describe it?
user: I would say it's more of a pressure, yeah. 

assistant: OK, uh, have you tried any medications for it? 

user: Uhm, Yeah, I took an Advil this morning. It's taken the edge off a little bit. I will use that sometimes when I get headaches. 

assistant: Are you having any nausea or vomiting?
user: No, I haven't had anything like that. 

assistant: OK, and have you traveled outside of the country or outside of the province at all? 

user: No, I haven't. 

assistant: Have you been in contact with anyone that's been sick recently?
user: I don't think so. I work at the Toyota factory and there have been a few people that have been sick who worked there? But I don't think I've been in contact with them. 

assistant: OK, and are you having any fevers or chills at all?
user: I have felt pretty hot, yeah, I was sweaty last night, I didn't check a temperature, but I felt feverish. 

assistant: OK, were you having night sweats? 

user: My bed wasn't drenched or anything but I was sweating. 

assistant: OK are you feeling like you have lost any sense of taste or smell at all?
user: Uhm, Yeah, I haven't been able to smell very well. 

assistant: OK, and when did that start?
user: That may be within the last two days as well. 

assistant: OK, and are you congested at all? Like, do you have a runny nose or anything like that?
user: No, I don't have anything like that. 

assistant: OK, yeah, any changes in your bowel movements, like any Constipation or diarrhea?
user: No, I haven't had anything like that. 

assistant: OK, any muscle aches?
user: Yeah, I have felt a bit sore. 

assistant: Where would you say you feel sore? 

user: Just kind of all over, my whole body just kind of feels a bit achy. 

assistant: OK, and when did this start?
user: Yeah, probably like last night, this morning when I was laying down and just felt a bit tired and achy? 

assistant: OK. Has your sleep or appetite changed at all?
user: I didn't sleep very good last night. I just don't feel very rested this morning. And yeah, I haven't felt very hungry either. 

assistant: OK, uhm, alright, do you have any medical conditions that you take any medications for? 

user: No, I don't take any medications. 

assistant: OK, and have you had any surgeries or have been hospitalized before?
user: I did have tubes in my ears when I was little, but that's it though. 

assistant: OK. Any family history of any heart or lung conditions? 

user: Yeah, my dad had a triple bypass surgery done last last year. He was sixty-three at the time and that's about it. 

assistant: OK, and you don't have any high blood pressure or anything like that, right?
user: No, not that I know of. 

assistant: OK, and do you have any allergies? 

user: Uhm, just environmental stuff I think, just, like in the springtime, I'll get itchy eyes or a runny nose. 

assistant: OK, and currently do you work?
user: I do, yeah I work at a car factory nearby, just on the assembly line. 

assistant: And have you been off of work right now, with your symptoms? How is that going? 

user: Oh yeah, just like these last two days I called in and I let them know and I left work early yesterday when I realized that I was feeling sick and didn't go in this morning. 

assistant: OK, uh, and what's your living situation like?
user: So I live with my girlfriend, and we have a son who's four years old. 

assistant: OK, and any one of them having any similar symptoms?
user: No, they've been good. My wife works from home and my son, he's been his playful self. 

assistant: OK, that's good. OK, last few questions. Do you smoke at all? 

user: No, I don't. 

assistant: Do you use any recreational drugs like marijuana?
user: Uh, no, I don't. 

assistant: OK, and do you drink alcohol?
user: Yeah, I've had this cough and it's just not going away. 

assistant: OK, and how long have you been having this cough for?
user: I think it started about a month ago. 

assistant: OK, and is it a dry cough or is it a wet cough? 

user: I I'm bringing up some phlegm if that's what you mean. 

assistant: Yeah, so you're bringing up phlegm when you cough?
user: Yeah. 

assistant: And is it, what color is it? 

user: I it looks pretty dark and and sometimes red. 

assistant: OK, so do you think there's blood in your phlegm?
user: Yeah, the dark it does kind of look like blood, so that's what scared me and wanted me to come in today. 

assistant: OK, and, how much phlegm would you say you're putting out like per every time you cough?
user: I'd say every time I cough, I'm bringing up at least a teaspoon of of the dark sputum. 

assistant: OK. And so this started four weeks ago. It has it been a constant like you've been constantly coughing or does it come and go?
user: I it it's there pretty much all the time, but especially bad in the morning. 

assistant: OK. And do you remember if anything changed or you did something differently, or anything that happened before you started having this cough? 

user: Uh, I had a cold a few weeks back, but, it was just a runny nose and it seems that the cough has been kind of lingering around. 

assistant: OK. And do you find that it's been getting worse at all?
user: Yeah, the cough has been getting worse. 

assistant: And have you had any previous episodes of this? 

user: I I've had a smokers cough now for several for several years, but it's really just this past month that that it's gotten really bad and I have it all day long. 

assistant: OK. And, uh, are you coughing every day or every other day? Like, how often would you say you're coughing?
user: Uh daily. 

assistant: Daily? OK, is there anything that makes your cough go away or get worse?
user: Uh, nothing that seems to really make it any worse or better. 

assistant: OK, and do you have any other symptoms like shortness of breath or runny nose, sore throat, anything like that? 

user: Uh nothing I can think of, just just this cough that's been bugging me. 

assistant: OK. And have you traveled outside of the country at all recently?
user: Yes, I've been working in the Philippines for the last three years. 

assistant: And, uh, have you been experiencing any fevers or chills or night sweats? 

user: I felt like, uh, a little bit hot. I might have a fever now so yes, no chills though. 

assistant: How about night sweats?
user: I have been sweating more at night too. Yeah, I have to get up and  change my pajamas sometimes. 

assistant: OK. And how often has this been happening?
user: Um, I'm changing my pajamas and it's sometimes the sheets, uh, maybe a couple of times per week. 

assistant: OK, and have you been feeling more more tired, more fatigued at all recently?
user: Yeah, my energy has just been really down. I've been really fatigued. 

assistant: And do you find that you ever have any chest pain or shortness of breath? 

user: I sometimes I do have some pain over on the right side of my chest. 

assistant: Is this pain, what kind of pain is it?
user: I'd say it's kind of like a, uh it's a stabbing kind of, uh, uh pain and I only really notice it when I take a deep breath. 

assistant: OK. And how about shortness of breath, have you been experiencing anything like that? 

user: I only really get short of breath when I'm going for a hike or up to my 4th floor apartment. 

assistant: Any changes in your skin that you've noticed, like any rashes at all?
user: No rashes. 

assistant: And how about your sleep? Have you been getting enough sleep on a daily basis? 

user: Uh just the, uh sweating at night has been annoying because it wakes me up sometimes, but other than that sleep has been OK. 

assistant: OK, and how about your appetite?
user: I feel like I've been eating OK. Regular diet. 

assistant: And have you had any significant weight changes recently? 

user: Uh yeah I'm down like 15 pounds over the last few months and I haven't really made any changes to my diet or exercise, so I haven't really been trying. 

assistant: OK. Um, any recent infections at all?
user: Just the cold that I was talking about it a few weeks ago, and that's where the runny nose kinda went away. 

assistant: OK, um, and have you at all, either here or when you were working in the Philippines have been exposed to someone with tuberculosis? 

user: I believe some of the, uh people I was helping over there did in fact have tuberculosis. 

assistant: OK, and have you had a TB skin test done at all?
user: I've had one in the past, but I can't really remember the last time and it was normal though, when when I had it a few years ago. 

assistant: OK, but nothing since you've been back at all?
user: No, the last test must be at least a few years ago. 

assistant: OK. And in terms of just in your environment, at work and at home, are you exposed to any mold or any pets? 

user: No pets at home, and, uh, I don't think there's any mold in the home either. 

assistant: Do you notice any kind of tingling or numbness in your limbs or any muscular weakness?
user: I I, I mean, I'm really tired all the time and kind of feel weak that way, but, no muscular weakness. 

assistant: And have you previously been diagnosed with any medical conditions like high blood pressure, diabetes, anything else? 

user: Uh just a chronic bronchitis with a smokers cough. 

assistant: OK. And do you take any medications?
user: Yeah, I take, uh, a beta agonist inhaler, an inhaled corticosteroid and another type of anti muscarinic inhaler. 

assistant: OK, and do you have any allergies to any medications?
user: No allergies. 

assistant: Any allergies at all to any environmental exposures? 

user: I don't think so, no. 

assistant: Any hospitalization in the past?
user: No. 

assistant: And any surgeries in the past?
user: No surgeries. 

assistant: And have you been in contact with anyone who is ill? I know you mentioned in the Philippines, you were exposed to some people with TB, but anything since then?
user: Not that I can think everybody's been healthy. 

assistant: OK, and and in your family, has there been any history of any cancers or heart attacks? Any any medical conditions?
user: No heart attacks, but uh my father died of lung cancer when he was 67. 

assistant: And currently do you live in an apartment building? Is there anyone you live with? 

user: Yeah, I live with my girlfriend in an apartment. 

assistant: OK, and do you work currently?
user: Yeah, I've been doing some housing work in the Philippines, the last seven, several years. 

assistant: OK. And do you currently drink? 

user: Uh no I don't drink alcohol. 

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

assistant: Uh, any and you smoke cigarettes at all?
user: Yeah, hi, I'm so I have been very wheezy for the past week um and I'm also like consistently coughing all the time and it's not getting any better. Um I do have asthma and I think it's it's acting up. 

assistant: OK, and how long have you had asthma for?
user: Since I was like 5. 

assistant: OK, and are you using any puffers?
user: Yes, so I am on a short acting. As well as an inhaled cortico steroid. And I only take the short acting like when I have the symptoms 

assistant: OK. And so how how long have you been symptoms worsening for?
user: For the past week I would say. 

assistant: OK, and how how often have you used the ventilin? 

user: The ventilin that I use is almost every day like a couple times a day. 

assistant: OK, so would you say more than 10 times?
user: Yes. 

assistant: OK. And have you had to do you have y to miss any school or anything like that over the past week?
user: I missed two days. 

assistant: Two days, OK. And are you just getting daytime symptoms or are you waking up from sleep or not being able to sleep because of your symptoms? 

user: I woke up twice last week. 

assistant: OK. OK, so yeah, definitely seems like your symptoms are really acting upon and so you're getting some wheezing and you say you're also getting a cough.
user: Yes, that's right, 

assistant: OK. And what kind of things would you be doing that you get these symptoms? Is it mostly exertion or is it exposure to dust or any other environmental factors?
user: Uh, but, it's mostly exertion, but things like cold air can trigger it too. 

assistant: OK, I see. OK, any have you been exposed to any new environments where there is, you know, dusty carpets, mold, new animals, anything like that? 

user: Uh no nothing like that. 

assistant: OK, OK, and how would you describe the cough? Is it wet or dry?
user: It's dry. 

assistant: OK, and. And how about the wheezing? Are you getting it like frequently every time you have an episode, or just sometimes?
user: I I'm getting an on and off, but basically every time I cough after that I'll be wheezy for a little bit. 

assistant: OK. OK, and are you having any other symptoms like sore throat, runny nose, shortness of breath, anything like that? 

user: No, nothing like that. 

assistant: OK, and any blood in your sputum at all?
user: No, no blood. 

assistant: OK, OK and has the ventilin been helping at all? Or do you find that it's less effective? 

user: Ventilin um it's been helping temporarily, but it definitely doesn't help as much as it used to. 

assistant: OK, um. And have you traveled at all recently or been in touch with anyone who's been sick?
user: Uhm, no, nothing like that. 

assistant: OK. And, and any headaches? Nausea or vomiting?
user: He no, nothing like that. 

assistant: Nothing like that OK, any dizziness or fainting? 

user: No. 

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

assistant: No. Any fatigue?
user: Um a little bit because I haven't been sleeping too well. 

assistant: OK, any? Sensation of chest pain or racing of your heart? 

user: No. 

assistant: No. OK. Any changes in your bowel movements?
user: Uh no. 

assistant: Any changes in your appetite or weight? 

user: No. 

assistant: No, any changes in your sense of smell or taste?
user: No 

assistant: OK, OK. An other than asthma since you were five an do you have any other medical conditions at all?
user: I do. 

assistant: OK and you take that daily? 

user: Um yes. 

assistant: Any other medications that you take?
user: No, just some multi vitamins. That's about it. 

assistant: OK, any allergies to any medications that you know? 

user: Not to medication I’m allergic to like strawberries and Kiwis. 

assistant: OK, and what kind of reaction do you get?
user: I just break out in hives. 

assistant: OK, and have you been previously hospitalized for any reason? 

user: No. 

assistant: OK, any past surgeries?
user: Ah nope. 

assistant: OK and currently like who do you live with? 

user: I love with both my parents and two of my siblings. 

assistant: OK, and are any of them sick at all?
user: No everyones pretty healthy. 

assistant: OK. And. So currently right now you're 16. This is an age where sometimes your peers or yourself might experiment with alcohol, smoking or recreational drugs. Have you have you tried anything at all? 

user: No, I haven’t. 

assistant: OK. Do you have any friends or peers that have tried alcohol or recreational drugs?
user: I don't think so. 

assistant: OK, and in terms of just your home environment school. Do you feel safe or do you find yourself feeling unsafe or having been bullied at all?
user: Oh, I'm pretty, I feel pretty safe. 

assistant: OK, that's good. And any family history of any heart or lung conditions at all ? 

user: No. 

assistant: No. OK, so yeah, those are all the questions I had for you today. Do you have any questions?
user: Yeah, So what can I do about These these symptoms? Should I continue taking my puffers? 

assistant: Yeah, So what we'll have to do is re assess. So right now we will need to alleviate some of your symptoms so we will get you get you some ventilin and you mate will do like a full physical examination and get your oxygen saturation and everything an you might need some cortico  steroids as well and then we'll talk about changing your regiment for your puffers as well and whether or not we need to add something else into your therapy, so we'll do a full physical examination and then go on from there. Does that sound good?
user: Yeah, that sounds great. Thank you. 

assistant: You're welcome.
user: Yeah, I brought my son here. I'm a little bit worried about him because like yesterday he had he had this temperature of like 38.5 um so he's been feeling a little bit hot and he's not swallowing his food, like we've been feeding him some mashed up food but he's not swallowing it. He's just kind of throwing throwing it back out there. Um he's drooling now uh and he sounds kind of muffled um and he's been very short of breath. 

assistant: That doesn't sound good. Um uh yeah, I'm I'm currently looking at him and he doesn't uh look great. While the uh while the doctor's um taking his vitals and examining the baby, I'll just ask you a couple of questions.
user: Sure 

assistant: So you said that all of this started about a day ago. How was he doing before that?
user: He was fine before that, he had like a an infection, like some sort of viral infection recently, like about a week back, he had like a runny nose and a cough, but that went away. 

assistant: Um OK, so he had these symptoms about a week ago. Did he see any, did you take him to the hospital or to a clinic? 

user: I took him to our family doctor um and they just suggested some supportive treatments um which we've been doing at home like we try to keep him well hydrated, and we've been keeping an eye on his like um diapers and things like that. 

assistant: OK, has he been um has he been, how many diapers is he um, are you changing a day?
user: Usually like about 5, 6, but yesterday it was like 2. 

assistant: OK. Um and uh has he been uh irritable or agitated?
user: Uh he has been very irritable and fussy. 

assistant: Has he been sleeping OK?
user: I um no you know what last night he didn't sleep well at all. He was crying the whole night. 

assistant: Um and uh in terms of uh, so how much has he has he had to eat or drink in the past uh day or two? 

user: Uh he's had about like maybe a bottle of his milk, like of that. 

assistant: OK.
user: Yeah. 

assistant: That's it? 

user: Yeah, he's not taking. He's not he's not taking anything else like he's been so fussy and so like he's unwilling to try anything. 

assistant: OK, um and, OK. Do you feel like he's been drowsy uh and um lethargic?
user: Um yeah, I feel like he's been a little bit lethargic. Like today, he's more lethargic. All of yesterday, he was very fussy and irritable, but today seems like, he's very slow. 

assistant: OK, and just a couple of questions about um his past medical history. Does he have any uh medical conditions uh that he was diagnosed with?
user: Uh no, he's been healthy otherwise. 

assistant: How was your pregnancy with him?
user: Normal, yeah no complications there. 

assistant: Did did you have GBS or gestational diabetes?
user: No. 

assistant: No, OK. Did you have any viral infections during that time, during pregnancy? 

user: No, no. 

assistant: Was he born via Caesarean section or uh C-section or a vaginal birth?
user: Uh vaginal. 

assistant: OK. Any complications during birth? 

user: No. 

assistant: Was he um kept in the hospital for a couple days in the NICU after he was born?
user: No. 

assistant: Did he develop jaundice?
user: No. 

assistant: OK, and and he's been OK for the past two years? Any concerns about his growth, his height and weight, and his head circumference? Has your family doctor uh said anything about that?
user: No, he's been pretty good. Um he's been growing and gaining weight OK. 

assistant: Any um developmental issues? 

user: No. 

assistant: OK, alright, and any medical conditions that run in the family?
user: Uh no, just like some heart issues. 

assistant: Um OK, and uh does he, I forgot to ask, has he had any hospitalizations in the past?
user: No. 

assistant: Any surgeries? 

user: No surgeries. 

assistant: Uh has he been on any medications? Any antibiotics recently?
user: No. 

assistant: OK. Has um has he been vaccinated? Uh has his vaccinations, immunizations up to date? 

user: Yeah, they're all up to date so far. 

assistant: OK, alright, that's that's good. Um OK, and does he have any allergies that you're aware of?
user: Pardon me? 

assistant: Any allergies?
user: Oh, uh no allergies. 

assistant: OK alright um well it looks like um I, it's great that you brought him into the emergency room. Um if he hasn't been eating, drinking well, hasn't slept well, has been fussy, and and has been lethargic and tired, uh and is having difficulty swallowing food, um that's definitely very um serious. Uh we'll have a look inside his mouth and see what's going on. It could be that he has an infection or an inflammation of some sort. Um given his fever, he probably has an infection, um and uh we'll likely start him on antibiotics and put in an IV drip just to get in get some fluids inside him, just to get him hydrated, uh and monitor him very closely. We'll also check his vitals and um we'll do uh, yeah, we'll go from there. Do you have any questions?
user: Chest pain. 

assistant: Chest pain, OK. When did the chest pain start?
user: Um so I, I guess I I don't know if I'd really call it pain, it's it's been just very uncomfortable, like it just felt a little odd for like a week and a half. It's kind of. 

assistant: A week and a half? 

user: Yeah, it's kind of like a very sharp, strong pain uh when I take a deep breath. 

assistant: OK.
user: But I don't notice it all the time, it's just, it's often when um I'm sitting and studying or when I'm walking, when I'm walking to school. 

assistant: OK, did you have any accidents or injuries around that time? 

user: Uh no, nothing that I can think of. 

assistant: OK, did it come on suddenly? Or is it more gradual?
user: Yeah, it's uh, no it's it's pretty, it's pretty well, it seems the same each time. It kind of lasts like 20 minutes or so, um and I've tried Tylenol and I've tried Advil um and I've even tried like a like an Alka-Seltzer and it hasn't really helped very much. 

assistant: OK, so it's pretty, it's not consistent throughout the day, it only happens at certain times of the day?
user: Yeah, it'll come on for like 20 minutes like here and there. 

assistant: OK, anything that you think triggers it?
user: I don't I don't really know. Uh I was kind of worried um, I was kind of worried that it could be a heart thing, I I feel like it might it might be, it could be stress uhm but I'm I'm not really sure, my dad had a heart attack last year, he was pretty young. He's like in his 50s and it it just kind of scares me because now he's having these heart problems. 

assistant: OK, so these chest pains last for about 20 minutes, it only happens when you take a deep breath in, and after the 20 minutes, do they come and go? Is it something that gradually weans off, or is it fairly sharp?
user: It seems like it kind of goes away once I, once I'm at school and like talking to people and doing other things. It's kind of when I'm, I notice it when I'm on my walks when I'm alone or like when I'm studying alone more, like maybe I have it when I'm talking to other people, but I don't really notice it. 

assistant: OK, does it get worse with exercise? 

user: Uh I don't think so. It just kind of, like when I'm walking to school, it kind of stays the same. I haven't done any strenuous exercise lately, 'cause I've just had so much uh schoolwork piling up. 

assistant: So you mainly get it at, so you can get it at rest, I should say.
user: Exactly, yeah, like when I'm studying. 

assistant: OK, any fevers? Sick at all last little while? 

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

assistant: No, you've been feeling well otherwise?
user: Yeah, I mean, besides just kind of feeling stressed, I uh like I I've been trying to quit smoking and that's been, that's been kind of hard, and school's just very, very busy right now. 

assistant: When did you stop smoking? 

user: Um so like I guess I'm trying to quit, I'm smoking less than I used to. I probably smoked 5 cigarettes a day, but it used to be a little bit more. 

assistant: OK, coming back to the stress, is there anything recently that's causing you more worries?