jshargo/medical-interview-conversations2 huggingface dataset:
user: Uh, the knee I can feel a little bit of I would say it's more of a discomfort then tenderness. 

assistant: OK, so some discomfort on the patella palpation. Uhm, alright and then when you palpate those areas, do you feel like there is a grading sensation? How, does it feel warm?
user: No. 

assistant: No, OK. And then I'm gonna get you to, can you flex your hips all the way so bend so from a sitting position stand up first? Does it hurt when you extend your hips like that? 

user: Not right now. I think, I'm pretty sure my hips are pretty well rested right now, but there is still a little bit of stiffness. 

assistant: OK. OK, so some stiffness on hip extension. How about when you bend your hips all the way?
user: Yeah, that's a I can't really go down that far. But yeah, even bending, as much as I can, there is some discomfort there. 

assistant: OK, so some discomfort and some pain on hip flexion as well as limited range of motion. 

user: Mhmm. 

assistant: OK. Alright, and when you do both of those, do you hear any like what's called a crepitus or like a grating sensation where you feel like bone maybe hitting bone?
user: No, not really. 

assistant: No, OK. Alright, and I'm going to get you to, uh, extend your knee, so straighten it out. Yeah, does that hurt? 

user: Uhm, yeah, a little stiffness in my knees. I feel like I feel more of the grating sound in my knees. 

assistant: OK, OK. And then how about when you bend your knees all the way backwards? You can do one at a time.
user: Uh, yeah I, yeah I definitely feel some discomfort there as well. 

assistant: Yeah, OK. Alright, and how about when you point your toes to the ceiling? 

user: No, that's fine. I can do that. 

assistant: And then how about when you point your toes to the ground?
user: Yeah no issues. 

assistant: OK, so no pain or limited range of motion with plantar flexion or dorsiflexion. OK, so those were all the test that I want to do with you today. Did you have any questions or concerns?
user: Uh, no, not really. 

assistant: No, OK, uhm, so it sounds like what you may have is something called arthritis, which basically happens, uhm, when the cushions at the ends of your bones and your joints kind of degenerate over the years, and so bone can eventually rub on bone, which causes like the grading sensation and causes the pain. Uhm, and it's it happens in old age, it happens with wear and tear so to diagnose it, we we'll, yeah, we did the physical exam. We can also get an x-ray of your hips and knees which can have some findings that align with osteoarthritis and basically for now we'll try to manage it conservatively so you can take and sets like ibuprofen for the pain or acetaminophen for the pain. We'll also refer you to physiotherapy to strengthen those muscles around your joint and to increase flexibility and reduce that pain. Uhm, and another thing that may be worth considering is occupational therapy because they can help you find ways to do everyday tasks without putting too much stress on an already painful joint. And if these things don't work in the future, we can also discuss things like steroid injections or joint replacement. Does that sound like a good plan?
user: I'm not so good, these last few days I haven't benn able to reallykeep anything down and not feeling so good. 

assistant: OK, I'm sorry to hear that. Um, when you say last few days, did you mean the past two days? 3 days? 

user: Well, I feel like maybe the last five days I just haven't been feeling so good and I haven't really felt like eating. But these last two days I've been really nauseous and I've thrown up a few times. 

assistant: OK, when you say you haven't been feeling good for the past five days, is it that you feel achy? Do you feel hot like you have a fever, or do you feel weak?
user: Yeah, I do feel hot and um, yeah, maybe a bit tired. 

assistant: Tired? OK. And nausea and vomiting. Are you throwing up or just feeling nauseous? 

user: Mostly nauseous, but yeah, yesterday I threw up like three or four times and then again today I threw up like two or three times. 

assistant: OK, are you throwing up any blood?
user: No, I didn't see any red. It was mostly like yellow and umm, liquidy beacuse I haven't been eating much solids or like just like food. I've been mostly just having drinks. 

assistant: OK, um, and so mostly fluid you said?
user: Yeah. 

assistant: OK, and what color is it? 

user: Uhh, yeah, usually usually kind of like yellowish clear. 

assistant: OK. Are you having any abdominal pain?
user: Maybe like after I vomit it kind of feels like squeezing a little bit. But I think, yeah, I think yeah that's just really just with when I'm heaving. 

assistant: Right, um, are you, do you have any changes in your bowel movements? 

user: Umm, no, I haven't noticed anything there. 

assistant: OK. And so no diarrhea, no constipation?
user: No, nothing like that. 

assistant: OK, no blood in your stool? 

user: No blood, I haven't seen any red. 

assistant: OK, and how about issues swallowing food?
user: Oh yeah, no problem swallowing. Just haven't felt hungry. 

assistant: OK, so you don't have much of an appetite then. 

user: No, not not really. 

assistant: OK, alright, so um, any changes in in taste?
user: Um, maybe I mean, yeah, I think I might not be really tasting things the same. 

assistant: OK, how about smell?
user: Now that you say it, I might, uh, yeah I think my smell has been impacted as well. I can't really smell anything. 

assistant: OK.
user: I thought that was kind of weird, but didn't think anything of it actually until you just asked me. 

assistant: Yeah for sure. And how about any changes in your vision or hearing? 

user: No changes to vision or hearing. 

assistant: OK, any discharge?
user: Uh, nothing like that that, but I mean my eyes were a bit, they've been a bit red these last two days. 

assistant: OK, have they been in any pain? 

user: Nope, no pain and I've been able to see everything OK. It's just I just noticed they were a little bit more red. I just thought maybe I don't know I was, I've just been tired. 

assistant: Yeah for sure. Any coughing?
user: Uhh, yeah I haven't had a cough but um, I've had a cough for a few years now, so yeah, that's not really a change for me. 

assistant: Alright, so no change in your cough. Is it a dry cough or a wet cough? 

user: It's uh, oh, a dry cough usually. 

assistant: Dry cough, OK. Any blood that you produce?
user: No blood, no blood. 

assistant: OK, any shortness of breath?
user: I'm not really able to exercise and stuff like that. 

assistant: OK, have any wheeziness? 

user: : Um, no, I haven't had a a wheeze. 

assistant: OK, how about any fatigue or tiredness?
user: Yeah, I've definitely felt a little bit more kind of groggy and tired this last week, really. 

assistant: OK, and muscle aches to go along with that? 

user: Yeah, bit in my like kind of upper arms and legs a little bit. 

assistant: OK, you said you've been feeling groggy. Do you feel dizzy at all?
user: Not dizzy, just maybe that I'm like moving in slow motion. 

assistant: OK yeah, any confusion or memory loss?
user: No, I think I've been OK. 

assistant: OK, any rashes?
user: No, I haven't noticed any rashes. 

assistant: OK, how about headaches?
user: Yeah, these last few days I've had a bit of a headache as well.It hasn't been very intense, so, um, I'm not worried about it too much. 

assistant: Right, OK. It hasn't been intense you said? So have you had headaches like this in the past?
user: Yeah, I had similar headaches before I think. They come like this. Like if I didn't get a good sleep or from not drinking enough water or something, I'll kind of get a headache like this. Kind of feels like it's squeezing. 

assistant: Yeah, that's understandable. But it's not like the worst headache you've ever had?
user: No, no, it's pretty similar to headaches that I've had before. 

assistant: OK, OK, good, and are you otherwise healthy?
user: Yeah, well I have high blood pressure and also, high cholesterol, so I do take medications for both of those. So yeah, I take a statin and Amlodipine I think. 

assistant: OK, OK, good. It's good that you're on both of those. Do you take any other medications like over the counter medications or herbal supplements? 

user: Yeah, I've been taking vitamin D and also a multivitamin. I heard that that we don't get enough vitamin D throughout the winter. 

assistant: Yeah, it's a great idea to take that, especially as we get older and if we live in a country where we don't get a lot of sun exposure like Canada, so that's good. And sorry before I move on, I forgot to ask you earlier if you have experienced any weight loss or night sweats recently?
user: No, my weight's been, uh, about the same unfortunately and I haven't had any night sweats. But I mean now that you asked if I felt more hot than than usual, maybe. 

assistant: OK, and did you take your temperature?
user: Uh, I did and the last time I checked it was a few days ago and at that time I didn't have a fever, but I mean, I'm still feeling hot so I'm not sure. 

assistant: Yeah, OK. Alright, so I'll go back to your past medical history. Have you been hospitalized or have you ever needed surgeries in the past? 

user: Um, no. Like the last time I was in the hospital with, it was for a colonoscopy a few years ago which came back normal. 

assistant: OK, that's good. Um, are you up to date with all your immunizations?
user: Uh, yeah, actually got the shingles vaccine a few months ago. 

assistant: OK. 

user: Probably closer to a year ago now, actually. 

assistant: Oh great, OK, that's awesome and are you allergic to anything?
user: Just peanuts. 

assistant: Peanuts, OK. Do you know if you have a family history of any lung or heart conditions?
user: Yeah, my son has asthma. But nobody in my family's had a heart problem, though. 

assistant: OK, how about any stomach problems or liver problems? Colon problems? 

user: Yeah, my dad actually had colon cancer. He was 70 and so that's why we went and decided to get a colonoscopy instead of just doing the immunohistochemistry test. 

assistant: OK, yeah, that's a good idea. Um, so it sounds like you're, you know, preemptive with your health, which is good. Any other cancers that run in the family?
user: No, just my dad had colon cancer. 

assistant: OK. And do you smoke at all?
user: No, I don't. 

assistant: OK, how about marijuana? 

user: Um, no, I don't smoke marijuana. 

assistant: OK, how about other recreational drugs?
user: I mean, I briefly like dabbled in the past at parties and stuff like that but that was when I was way younger, like in in my college years. 

assistant: OK, what kind of drugs? 

user: I think maybe we used cocaine a few times and MDMA, uh, but that was like a long time, probably like 30 years ago. 

assistant: OK, were any of these drugs injected IV?
user: No, no, I've never done that. 

assistant: OK, OK, that's good. Do you drink alcohol? 

user: I have like maybe I don't know a couple of drinks a week. 

assistant: OK, that's good. What kind of drinks do you have and how much of it do you have?
user: Usually, it'll just be one or two glasses of wine at a time and maybe two nights a week. 

assistant: OK. 

user: And I usually stick with red wine. 

assistant: OK, great, and who do you live with?
user: So um, it's just me and my son. 

assistant: How old is your son? 

user: Uh, he's 18. 

assistant: OK, and do you live in a house or an apartment?
user: Um, yeah, we live in an apartment. Yeah, on the 8th floor. 

assistant: On the 8th floor, OK, any issues in terms of like old carpet or mold or asbestos in the apartment?
user: It's a newish building so there isn't really any carpet actually in the unit, so yeah, it's pretty clean that way. 

assistant: OK good. That's good. So those were all the questions that I had for you. Did you have any questions or concerns that you wanted to bring up before we ended the interview? 

user: Well, I'm just hoping to to get this sorted out and feel better. 

assistant: Yeah for sure. So you know, right now we're thinking it could be a viral GI viral infection because of your complaints of nausea, vomiting, loss of appetite and fever. But it could also be COVID and we are going to have to do a swab for you and run that test because you have a lot of symptoms that overlap with those symptoms. Um, and then, so just going off of that, we'll wait for the swabs to come back. If they come back positive, we will notify public health and they'll do a trace to see where you could have gotten this infection from. And then meanwhile, we do suggest that you isolate for two weeks so that you don't spread the illness, and even if the swab comes back negative, there is still a chance that you may have COVID and it's a false negative test. So we'll start there. If it turns out you don't have any of those viral illnesses and you have more of a, you know, bacterial picture, we can work you up for that and prescribe antibiotics. So that's where we will start. How does that sound?
user: So like I don't really feel sick. I just I lost. I can't. I for the past two days I can't smell anything. I can't taste any of my food. It's super weird I like live with my boyfriend and he was like here take a bite of this onion and I like bit into it and I literally didn't taste anything. Otherwise, like I feel totally fine. I just heard that this happens sometimes like with COVID and. I'm just kind of worried that I have COVID. 

assistant: OK, for sure I will we will, um definitely look into that today and you are right, it is a symptom that can occur with with covid. But we will want to make sure that it isn't something else, and so I wanted to just ask you a few more questions about how you've been feeling. So you said you haven't felt sick, so have you been experiencing any other symptoms?
user: I mean, I may be even a bit tired, but really. Otherwise no. I guess maybe I felt like a little dry, but I haven't actually been coughing. 

assistant: OK. So no cough have you felt a like short of breath at all? 

user: No. 

assistant: OK, and have you brought up any like, sputum or any blood?
user: No. 

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

user: No. 

assistant: OK, any feeling like your heart is ready racing?
user: No. 

assistant: Alright, um, any nausea or vomiting. 

user: No. 

assistant: Any diarrhea or constipation?
user: No. 

assistant: OK, any changes to urinary habits. Any painful urination or needing to go more often? 

user: No. 

assistant: Alright, and have you had any headaches?
user: Mmm no. 

assistant: Uh, how about any fevers? 

user: I don't, like I don't have a thermometer, I like maybe felt a little hot, but like like I don't really know. 

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

assistant: Alright, or how about any night sweats?
user: No. 

assistant: And recently, over the last several months, have you had any changes to your weight? 

user: Uh, no. 

assistant: OK. And in the last several days, have you had a sore throat?
user: Like I said, it felt like dry, but I don't think it's been sore. 

assistant: OK um. And have you had a runny nose? 

user: No. 

assistant: Or felt congested at all?
user: No. 

assistant: OK, and then any eye pain or ear pain?
user: No. 

assistant: OK, and then any rashes on your skin?
user: Like I have eczema, but nothing new. 

assistant: OK, and in regards to your past health do you have any medical conditions that you're followed for,
user: Like the eczema, like I have like a peanut allergy. That's it. 

assistant: I see OK, do you have an EpiPen?
user: Yeah. 

assistant: OK, do you keep that with you regularly?
user: Yeah, yeah, always. 

assistant: OK, excellent um, and do you take any other medications or?
user: I take birth control. An like sometimes like I had, I had like eczema cream like the the steroid one for when it's really bad. 

assistant: OK, and when did you start birth control? 

user: Maybe like three years. 

assistant: OK, and how often are you using the cream?
user: It's kind of like goes in like flares, so like this, 'cause it's winter I've been using it like maybe a couple times a week. 

assistant: OK, um and. Any allergies to medications? 

user: No. 

assistant: And have you had any surgeries in the past?
user: Nope. 

assistant: OK, any reason reason for hospitalization?
user: Nope. 

assistant: OK.
user: Sorry I went to the Emergency Department like when I had my peanut like the first time I realized I was allergic to peanuts. But that was it. 

assistant: Oh, did you have an anaphylactic reaction?
user: Yeah, like I was a kid. So. I don't really remember that much, but that's when they told me I was allergic. 

assistant: I see OK, so important to have the EpiPen then for sure. 

user: Yeah 

assistant: And so you mentioned that you're living with your boyfriend?
user: Yeah. 

assistant: OK, anybody else?
user: No, just us. 

assistant: OK, and as your boyfriend been sick at all? 

user: No. 

assistant: OK. And at like have you been around anybody who's been sick at work or school?
user: Um no like all my classes are online, so I don't really see anyone besides him right now like we don't even officially like together. He's just been essentially staying at my apartment, 'cause like we don't see anyone else. 

assistant: OK. Um, and do you smoke cigarettes? 

user: No. 

assistant: Do you smoke marijuana?
user: Like occasionally we will like. Do an edible or something, but I don't smoke it. 

assistant: OK, and any other recreational drugs like cocaine, MDMA? 

user: No. 

assistant: OK, um and uh are you currently sexually active?
user: Yeah, just like with my boyfriend. 

assistant: OK, and um. Any sexually transmitted infections in the past? 

user: No. 

assistant: OK um. And then do you drink alcohol?
user: Like maybe a couple of beers on the weekend. 

assistant: OK, and in your family, has anybody ever lost their smell before?
user: I don't think so. 

assistant: OK, anybody in the family have a heart condition or a lung condition?
user: No. 

assistant: Alright and then I have anybody in the family had cancer before?
user: Like my like my Uncle um had like prostate cancer. 

assistant: OK, do you know, breast cancer, ovarian cancer? 

user: No. 

assistant: OK. So that that was all I wanted to ask about on, uh, the history today. Was there anything else that I maybe forgot to ask about?
user: Mmm I don't know that's it. 

assistant: OK, so, uh, yeah with, uh, the symptoms of losing your smell over the last day or so we will certainly look into. Whether or not this is caused by COVID and so that will require a nasal swab test for that. Usually the results are coming back now within 48 hours hopefully, but still will be required to self isolate now for the next 14 days after your symptoms are gone, so we will let you know when the results come back from this test though.
user: OK. OK, geez OK. Thank you. 

assistant: Alright, you're welcome.
user: Um, I'm just, I'm here because I've had this cough for the past two weeks and uh, it's just not going away. 

assistant: Okay, and um, is it getting worse at all really?
user: Not really, it's just been the same. 

assistant: How would you describe the cough? Is it a wet cough or a dry cough? 

user: It's a dry cough. 

assistant: Okay, are you bringing up any uh, sputum or blood at all?
user: Uh no. 

assistant: Um, would you describe it as like a, a barking cough, a harsh cough, or a muffled cough?
user: Not really. 

assistant: No, okay. Um, before you started uh, coughing, did you have any other symptoms, like runny nose, congestion, sore throat, anything like that? 

user: Uh, no. 

assistant: Okay, so it's just the cough?
user: Yeah. 

assistant: Okay. Any fevers or chills? 

user: Nope. 

assistant: Okay, and is the cough constant, or does it come and go?
user: It, uh, I guess it's just, it's there throughout the day. 

assistant: It's there throughout the day, okay. And is it brought on by any activities or, or does it just come on by itself? 

user: It comes on by itself. 

assistant: Okay, and has it gotten any better at all or stayed around the same?
user: It's stayed the same. 

assistant: Okay. Has this happened to you before, where you had a cough for a long time?
user: No. 

assistant: No, okay. Um, do you have any other symptoms like chest pain, sore throat?
user: No. 

assistant: Okay. Um, any recent travel or contact with anyone that's been sick? 

user: I don't think so, no. I just went to my, I went to see my family doctor um, for some prescriptions. 

assistant: Okay.
user: Um, three weeks ago. 

assistant: Three weeks ago, okay. Any headaches at all?
user: No. 

assistant: Okay, nausea or vomiting? 

user: No. 

assistant: Any night sweats?
user: Um, no, nothing like that. 

assistant: Any fatigue at all?
user: No. 

assistant: No. Any shortness of breath? 

user: No. 

assistant: And no chest pain?
user: No. 

assistant: Any diarrhea or constipation?
user: No. 

assistant: Okay. Um, any wheezing at all? 

user: No. 

assistant: Okay, any changes in your weight recently?
user: Um, no, no, I don't think so. 

assistant: Any changes, sorry, any issues with your urination?
user: No. 

assistant: Are you sleeping well or does the cough keep you up at night? 

user: Um, it's, it's not so, it hasn't interrupted my sleep. 

assistant: Okay, and how's your appetite been like?
user: No, everything's okay. 

assistant: Okay, and any uh, loss of your sense of taste or smell? 

user: No. 

assistant: No, okay. Um, any exposure to any fumes or dust within your environment, or animals or pets?
user: No. 

assistant: Um, and otherwise, do you have any medical conditions like asthma, COPD, anything like that?
user: Um, I went in for, I went in for a checkup three weeks ago, and uh, I found out I had high blood pressure. You know, who would have thought and then my doc started me on this pill called ramipril and uh, I've just been checking my blood pressure on a regular basis, and it's yeah, it's been good. But other than that, I'm very healthy. 

assistant: Okay, and no asthma? 

user: No asthma. 

assistant: Okay. And any allergies to any medications or any environmental allergies?
user: Um, just penicillin. 

assistant: Just penicillin. And have you taken any antibiotics or penicillin recently?
user: No. 

assistant: No, and um, what medications are you on? 

user: Just, just that one. 

assistant: Just the ramipril?
user: I also take, I also take a multivitamin. 

assistant: Multivitamin, okay. Have you been hospitalized before or had any surgeries?
user: No. 

assistant: No, okay. Um, any family history of any lung or heart conditions?
user: Um no, no, I don't think so. 

assistant: Okay. Any cancers? 

user: Yeah, uh, pancreatic cancer and colon cancer runs in the family. 

assistant: Okay, and is that uh, any direct relatives, like your mom or dad or kids?
user: My, my grandparents on my mom's side. 

assistant: Um, and currently, do you work um, or are you retired?
user: I'm a lawyer. 

assistant: Okay. And, uh, do you work from home right now? Or do you go in person?
user: Yeah I've been working from home. 

assistant: You've been working from home, okay. Um, and what's your home situation like right now? Do you live with anyone? Do you live in a house or an apartment? 

user: Um, I live, I live in an apartment. I, um, I live alone I just got, I had a divorce two years ago and since then I've been, I've been living alone. 

assistant: Okay, I'm sorry. Um, and is, in your home environment, is there any kind of allergens like dust or any mold or anything like that?
user: No, nothing like that. 

assistant: Okay, and currently do you smoke at all? 

user: Um, sometimes. 

assistant: Sometimes, how often would you say you smoke?
user: Um, maybe uh, two or three cigarettes. Maybe three or four days a week. 

assistant: Okay, and how long have you been smoking for?
user: Um, so I, I used to smoke a lot when I was young and then I quit. And then I started again two years ago. 

assistant: Okay. Um okay, and do you use any recreational drugs like marijuana?
user: No, I don't. 

assistant: Okay, um, and do you drink alcohol? 

user: Yeah. 

assistant: How much would you say you drink on an average day?
user: More than I would like to mention. I, yeah, I, maybe 5 or 6 beers a day. 

assistant: Okay, and um, is this something that's new for you, or has been going on for years now?
user: Again, that started about two years ago, so. 

assistant: Um, and uh, do you use, so no other recreational drugs, right?
user: No, nothing else. 

assistant: Yeah, so we can definitely talk more about alcohol usage definitely, especially when there's uh, people going through stressful times. There can be increasing substance use, including alcohol, so we definitely have a lot of resources that we can um, discuss today if you would like. 

user: Yeah, I would really like that. Thank you. 

assistant: You're welcome. Um yeah, but those are all the questions I had for today. We'll definitely do like a physical examination, but it seems you've just been having a cough for the last two weeks.
user: Yeah. 

assistant: Without any other symptoms. Um, okay, so do you have any questions at all for me?
user: Um no. 

assistant: So what we'll do is, since you've had this cough for the last two weeks, we definitely want to do a COVID swab, just in case. You've been uh, working from home, but if there was any potential contact, they usually, it comes back in 24 to 48 hours.
user: Okay. 

assistant: Other than that, sometimes uh, with a history of smoking, you can have something called uh, COPD. We can, like after the physical examinations and everything, we can potentially discuss doing pulmonary function tests as well. Um, and yeah, but other than that, it can also just be like a dry cough, can be just a viral upper respiratory tract infection that takes two or more weeks to resolve. In that case we wouldn't really. 

user: Sure. 

assistant: Um, yeah, so we'll do the physical examination and then go from there.
user: Hi, umm, so I've had a sore throat for the past three days and it doesn't seem to be getting any better, and I've also had a fever. So, I thought I should get it checked out by you. 

assistant: Yeah, for sure. So you said that the sore throat started three days ago. Has it been getting any better or any worse? 

user: Neither, it's been the same. 

assistant: OK, is it painful to swallow food or liquids?
user: It's painful to swallow solids, yeah. 

assistant: OK, uh, and how is your, umm, have you had any voice changes like a hot potato voice or sound like muffled or any voice changes at all?
user: No, not really. No. 

assistant: OK. And have you noticed any like neck swelling? 

user: No. 

assistant: OK. And how about your appetite? Has that changed?
user: Uhm, I'm still hungry, I just don't eat as much 'cause my throat is sore. 

assistant: Right, OK, that makes sense. And so you mentioned that you also had a fever. When did that start? 

user: That started two days ago. 

assistant: OK, OK and did, did you check it?
user: It was 38.8. 

assistant: OK. Alright, so yeah, certainly a fever. OK, and have you had any, uh, like any runny nose? 

user: No, not that I've noticed. 

assistant: How about any red eyes or itchy eyes or eye discharge?
user: No. 

assistant: OK, how about any loss or changes to your sense of smell or taste? 

user: No. 

assistant: OK. Have you had any any headaches?
user: Um, no headaches, no. 

assistant: OK. How about any cough?
user: No cough. 

assistant: No coughing, OK. And how about any shortness of breath? 

user: No. 

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

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

assistant: Any fainting or dizziness? 

user: No. 

assistant: OK, and have you had any heart palpitations?
user: Uh, no. 

assistant: OK. And so you don't you haven't had any cough, but have you had any instances of bringing up any sputum or or any blood?
user: No. 

assistant: OK. And have you had any nausea or vomiting? 

user: No. 

assistant: Have you had any abdominal pain?
user: No. 

assistant: You had any diarrhea or, or constipation?
user: Uh, no. 

assistant: OK. How about any urinary problems?
user: Um, no, nothing like that. 

assistant: I see, OK. And any skin changes or rashes? 

user: No. 

assistant: Alright, any muscle aches or body pains?
user: No. 

assistant: And any, and how's your energy been? Have you had fatigue? 

user: I have been, yeah, I've been tired. 

assistant: OK. And have you had any, have you been diagnosed with any medical conditions in the past?
user: Um, I have type one diabetes. 

assistant: OK, and uh, insulin wise, do you use a pump or is it like, how do you manage diabetes? 

user: I use an insulin pump, yeah. 

assistant: OK, excellent, and do you see an endocrinologist for that?
user: I do. 

assistant: OK. Well that's good and have you had any complications or have things been stable?
user: Things have been pretty stable. I had, when I was younger, I had a few episodes of like hypoglycemia. But now things are pretty stable. 

assistant: OK, and you can recognize those signs like feeling jittery and sweaty might, maybe a little anxious when that comes on?
user: Yes, I'm an expert now. 

assistant: OK, that's great that you can recognize that those signs. It's important. And have you had any allergies?
user: Uhm, no allergies. 

assistant: Any, and all your immunizations up to date? 

user: Ah, yes. 

assistant: OK. Uhm, and any hospitalizations or surgeries before?
user: No. 

assistant: OK, uh, and uh currently, are you in, in school or working?
user: I'm in school. I'm in Grade 10 and we're doing half days now. 

assistant: OK. Err, half days like in person?
user: Yeah half in person and half online. 

assistant: OK. Have you been around anybody who's been sick?
user: No, no one at schools been sick actually. 

assistant: OK. Uhm and have you traveled anywhere? 

user: Ah, nope, not not since COVID. 

assistant: OK, I see an are you ah, who are you living with?
user: I live with both my parents and three of my siblings. 

assistant: OK, and anybody at home have any sore throat or cough, or or anything like that? 

user: Uhm, so my younger sister had a sore throat like a week back, but that's all she had. She never had a fever and her sore throat went away in like 2 days. 

assistant: OK. Uh, OK and does she need any treatment?
user: No. 

assistant: OK. Uh, and uh, and I I know people around your age might experiment with drugs or alcohol. Have you used anything like that or your friends?
user: Oh no, no, nothing like that. 

assistant: OK. And do you smoke cigarettes or have you tried? 

user: Uhm, I tried once but I don't ever do it regularly. 

assistant: OK. And uh, and do you smoke cannabis or use cannabis products?
user: Um, no, I never have tried. 

assistant: OK. And and is there a family history of any heart or or lung conditions?
user: Uhm, I know my grandfather had lung cancer, but he used to smoke. 

assistant: OK, I see. How old was he? Roughly?
user: Uhm, he was in his late 60s. 

assistant: OK, I'm sorry to hear that, and thank you and oh sorry, I forgot to ask her are you currently sexually active?
user: No. 

assistant: OK. Have you been sexually active before?
user: Uh, no. 

assistant: OK, so umm, OK. Uhm, so that was all the questions that, uhm that, that I wanted to ask, was there anything else that you wanted to umm, mention today?
user: Uh no, I don't think so. Is it, when you asked me if my neck was swollen, my necks not swollen but I feel like inside the back of my throat, my tonsils feel a little bit swollen. 

assistant: OK. And have you looked? Does it look like you have like redness in the back of your, back of your mouth? 

user: Yeah, it looks pretty red and angry. 

assistant: OK, and it's sore?
user: Yeah. 

assistant: OK, so it's just to kind of summarize, this happens like this sometimes you been having so the sore throat, like the redness and swelling of the tonsils in the back of your mouth, as well as a fever and being pretty tired over these last few days. 

user: Yes. 

assistant: OK, yeah. Um alright, so it's sounding like most likely this would be strep throat or, or Group A strep pharyngitis with, because you have no cough, and with a high fever and swelling that you've been redness that you notice in the back of your mouth. And so we'll do a rapid strep antigen test and it will require just a throat swab. To see, to to detect for that, however with a, uh, umm, yeah, I guess that's it. That's what I yeah, well, we'll start with with that now and it could potentially be something like uhm, a viral illness, but that's lower on the on the differential then the bacterial infection is right now. And because of COVID it will be, we'll do a swab as well because people can get fever and sore throat with with COVID as well.
user: Ok. 

assistant: So just to make sure that we're being comprehensive. 

user: OK. That sounds good. Thank you so much. 

assistant: Thank you.
user: I've had a cough that started like 4 days ago, um and it's just been getting worse, so I I wanted to come in. 

assistant: OK yeah, it's good that you've come in. Um, so the cough started four days ago, has it been constant since? 

user: Yes it has. 

assistant: OK, and how often are you coughing?
user: I um, I'd say a few times an hour now. Uh when it first started, it was a bit more intermittent, but now it's happening um all day long and throughout the night as well, it interrupted my sleep last night. 

assistant: Oh OK, um is it a dry cough or are you producing sputum? 

user: It's it's mostly dry. 

assistant: OK, so no sputum, no blood?
user: No blood. 

assistant: OK. Um do you find that there are any triggers to your, to this cough, like um, environmental triggers, like the cold weather, um any old carpets at home, or um you know a particular time of the day, or exertion, anything like that?
user: No, interestingly, nothing like that seems to really make it worse. It's just been um kinda coughing all day. 

assistant: OK, and um has anything made it better? Have you tried anything for this cough? 

user: Uh I tried um drinking some uh like tea and some other cough syrups and it didn't didn't help. 

assistant: OK, um how about, ah, OK. And if you were to describe the quality of this cough, would you say it's it's, it sounds barky, it sounds harsh, um how would you describe it?
user: Uh harsh. 

assistant: Harsh, OK. And if you were to rate your symptoms 1 to 10, 10 being the worst, how bad is it?
user: Uh, 6. 

assistant: Six, OK. And and have you found that your symptoms are getting worse, staying the same, or getting better over the past four days? 

user: Getting worse. 

assistant: Getting worse, OK. And have you ever experienced anything like this in the past?
user: Uh no. 

assistant: No, do you feel wheezy at all?
user: No, I haven't heard any any wheezes. 

assistant: OK, how about uh shortness of breath? 

user: Yeah, I've definitely noticed some difficulty breathing, um yeah. 

assistant: OK, and uh, when when did, when did your shortness of breath start?
user: Right around the same time as the cough or maybe shortly after, um yeah, shortly after. 

assistant: Shortly after, OK. Do you find that there are any triggers for shortness of breath, like exertion? 

user: Yeah, yeah exertion. Um as well as like the cough itself, I'm finding that I'm coughing so much throughout the day that I'm having a hard time catching up and catching my breath afterwards. 

assistant: Yeah, for sure. Um OK, and any chest pain?
user: No chest pain. 

assistant: OK. Um How about feeling like your heart's racing?
user: No, nothing like that. 

assistant: No, any swelling in your legs or arms?
user: No. 

assistant: OK. Do you ever feel like you have uh pain in your calves after walking um a few blocks?
user: No. 

assistant: No, any fainting spells or dizziness?
user: Uh, no. 

assistant: No, um have you had a sore throat? 

user: No. 

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

assistant: Runny nose or stuffy nose? 

user: Not, no, but I've definitely, I feel like I've maybe noticed a change in my smell. 

assistant: OK, how so?
user: I just uh, I feel like I haven't been able to smell as well. 

assistant: Um when did you notice that?
user: The, really, these last like 2 days. 

assistant: OK, and any changes in your taste?
user: Uh I haven't really I, I thought, well, I wasn't really able to taste my food, but I thought that was because I couldn't, I wasn't smelling, um so I thought that was just going to go away, but the symptoms have gotten worse. 

assistant: Yeah, and have you had a fever or chills in the past few days? 

user: Uh yeah, I've had a fever um or I felt hot anyway. 

assistant: Did you take your temperature?
user: I haven't checked it, but um like I've been feeling pretty sweaty from how hot I've been. 

assistant: OK um so we'll take your temperature today and we'll let you know. Um have you noticed any weight loss over the past few weeks? 

user: No. 

assistant: No weight loss, how about fatigue or muscle aches?
user: Uh maybe these past couple of days, yeah. 

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

assistant: OK. Um any changes to your bowel habits? 

user: Uh, no. 

assistant: No, any nausea or vomiting?
user: Um, no, no. 

assistant: No, OK. Any abdominal pains? 

user: No. 

assistant: Any changes to your urine?
user: No. 

assistant: OK, and would you say that you are an otherwise healthy person?
user: Yeah, yeah, that's why, these symptoms um really surprised me. 

assistant: Yeah, um so you've never been hospitalized or needed surgery in the past? 

user: No, I haven't needed to, I haven't seen a doctor in a few years. 

assistant: OK, um, are you on any medications?
user: Uh nope, just uh take a multivitamin and uh, and that's about it. 

assistant: OK, um, OK, um any allergies?
user: Uh yeah, I'm allergic to um cats. 

assistant: Cats, OK. And have you been around any cats recently?
user: No. 

assistant: No, OK. How about immunizations? Are you up to date?
user: Yeah I am. 

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

user: Uh, no. 

assistant: How about cancers?
user: Nothing like that. 

assistant: OK, and do you smoke?
user: No. 

assistant: Um how about marijuana? 

user: Uh sometimes I'll have a joint with friends or something like that on the weekend, but um yeah, so maybe once a week. 

assistant: Once a week, OK. Um, how about alcohol, do you drink any alcohol?
user: Uh, no 

assistant: No, OK. Um and where do you live right now?
user: I live in a house um with my wife and uh 3 kids. 

assistant: OK. Is anyone else sick at home?
user: Uh everybody's been well. 

assistant: OK, um any reason to believe that you've been around any sick contacts recently? 

user: Um possibly, um I mean, I'm in sales, so meeting with clients all day, um maybe one of them were sick. 

assistant: Yeah, yeah for sure. Um, any travel recently?
user: Uh no travel, all the meetings have been in the city. 

assistant: OK, OK good. So those were all the questions that I had for you today. Did you have any questions of your own or anything that you wanted to discuss today that I missed?
user: Um no, that, I was just worried about uh Covid. 

assistant: Yeah, so that's definitely top on the list right now for things that we have to rule you out for. Um so we'll take a swab today, we'll send it off um for those PCR results, you should hear back in 24 to 48 hours. Uh in the meantime, you should isolate for 14 days, and that includes from family members when possible, and public health will get in touch with you if those results are positive and so they can they can do some contact tracing. If it's not Covid, it could be another viral illness that's going around, and I guess the best therapy for that is staying hydrated, um getting good sleep, and eating nutritious foods. Uh but if your symptoms get worse, like you're running a really high fever, um you're having neurological symptoms like you know seizures or fainting spells, um or if you're having difficulty breathing, um you should come back to the ER. So how does that sound?
user: Yeah, it's really informative. Thank you. 

assistant: Alright, take care.
user: Uh I just came in today I think I broke my leg or something, it's something that was, I heard a snap, I was in um just a dance class um and we have like these long uh dresses, it it was a traditional dance class and my foot uh slipped right onto, it got caught in my dress and it just kind of slipped and I I felt right on my, my leg kind of twisted and I fell down and I just stayed down. I knew something was not right and something was broken. 

assistant: When did this happen? 

user: Just uh I would say like an hour ago 

assistant: Hour ago, OK. Are you able to bear any weight on it at all?
user: No, not really. I I had to come in the ambulance. 

assistant: OK, OK, and um if you were to localize this pain, where exactly is it? 

user: It's pretty much my whole lower leg is painful, but I think where it looks like it broke is like the middle part of my lower leg. 

assistant: The middle part, OK middle part of your lower leg, so kind of where your shins are?
user: Mhmm. 

assistant: OK, so in the shin area, OK. Um have you tried anything for it? I know it's only been an hour.
user: Uh no nothing. I just like I just want to make sure I keep it as still as possible um I didn't wanna even try anything. 

assistant: OK yeah, that makes sense, if you were to describe this pain, would you say it's um sharp, dull, achy throbbing? 

user: It's like sharp and throbbing. It's like probably one of the worst pains that I've felt in my life. 

assistant: OK, OK. And 1 to 10, 10 being the worst pain ever, how bad is it?
user: At 10 for sure. 

assistant: Ten, OK, have you, so you said you've never experienced this before, um do you feel like it's getting worse, the pain, or has it been pretty much the same since it started, or is it getting better? 

user: Uh I would say it's the same, it's like I'm in as much pain as I was earlier. 

assistant: OK. OK and um so yeah, OK, um do you know how you felt like on the floor? Like did you uh go like leg first or was it, did your um, kind of like the mechanism of your fall, did you break the fall at all with your arms?
user: Uh no, I didn't break, it kind of, so I was kind of uh, I feel like when I was slipping it was at first my leg was hyper extended but it kind of just felt like it snapped and it went straight down, so there was some kind of twisting as well as some hyperextension. Um but it just kind of slipping on my dress and then just straight down. 

assistant: OK, OK. Um otherwise, do you have any pain elsewhere in your body?
user: No. 

assistant: How about any numbness or tingling in the area? 

user: Um I do feel some numbness, tingling just below where it happened, um but it like comes and goes. 

assistant: OK um and then how about how about any um like feelings of like losing sensation or feeling cold in that area?
user: Um no, I I can feel everything in that area. 

assistant: OK.
user: But it's hard to tell like it's just very painful right now. 

assistant: OK, yeah, that's understandable. Um how about headaches? 

user: No, no headaches. 

assistant: Uh any fainting or dizziness.
user: No. 

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

assistant: Um weight loss recently. 

user: No. 

assistant: Fevers or chills?
user: No. 

assistant: Uh changes to your hair, nails, or skin, like rashes?
user: No, nothing that I've noticed. 

assistant: No, any changes to your vision, hearing, smell, or taste? 

user: No. 

assistant: Um how about coughing, shortness of breath, or wheezing?
user: No, no, nothing like that. 

assistant: No, OK, um how about chest pain or palpitations? 

user: No. 

assistant: No, any changes to your bowel movements?
user: Uh no, not that I've noticed. 

assistant: Uh nausea or vomiting? 

user: Nope. 

assistant: Abdominal pain?
user: No. 

assistant: Changes to urinary habits? 

user: No, nothing like that. 

assistant: No, OK, um and are you otherwise healthy?
user: Yeah, I've been pretty healthy, I um don't take any medications regularly, I don't have any medical conditions. 

assistant: OK, that's good. Any hospitalizations or surgeries in the past?
user: No, um just just for like my pregnancies, I had two pregnancies, both of them delivered vaginally, but no issues with that, just after that no hospitalizations or surgeries. 

assistant: OK, OK. Um and then um are you up to date with all your immunizations?
user: Yep. 

assistant: OK, that's good. Um do you have any allergies?
user: No, not that I know of. 

assistant: OK, um and then is there any family history of like musculoskeletal issues? 

user: Um so my mother has something called osteoporosis. 

assistant: OK, yep.
user: Um but that's that's all that I can think of. 

assistant: How old was she when she was diagnosed with that?
user: Um probably in her fifties. 

assistant: In her fifties, OK. 

user: Late fifties I would say. 

assistant: Um have you been, have you ever like been tested for that?
user: No, I've never, I've never had testing. 

assistant: OK, all right. Um and then any family history of lung or heart conditions? 

user: No. 

assistant: Uh how about autoimmune conditions?
user: Uh no, not that I know of. 

assistant: Any cancers?
user: Uh, I think one of my aunts has uh ovarian cancer. 

assistant: OK, OK, um how old was she when she was diagnosed with that? 

user: Um like pretty uh recently, so probably like in her sixties. 

assistant: OK, OK, um and then have you been in touch with anyone sick recently?
user: No. 

assistant: No, OK, have you done any travel recently? 

user: No. 

assistant: OK. Um those are all the questions I had for you. Did you have any questions of your own or anything you wanted to add before we move to the physical exam component?
user: No, I just want to get this fixed as soon as possible. 

assistant: OK, that sounds good, yeah we'll, we'll try our best. 

user: Thank you. 

assistant: Um OK, so now looking at your legs like side by side, do you notice any uh redness or swelling in your right leg compared to your left?
user: Yeah, it's all, it's all swollen and red and just looks so much different than my other leg. 

assistant: OK, yeah, um do you notice any obvious like breaks in the skin? 

user: No, there's no breaks in the skin but like when I fell like I, I can definitely see like the bend, there is like a bend in the bone, so I definitely do think it's broken. 

assistant: OK, and do you notice any like bony pieces that are pushing on the skin?
user: No. 

assistant: No, OK. Uh any bruises in the area? 

user: Yeah, the whole area seems bruised up and angry. 

assistant: OK. Um does uh, besides the bruising and the misalignment, do you notice any other obvious deformities, any muscle atrophy in the area?
user: No. 

assistant: No, OK, and then uh placing your hand on one leg compared to the other, does it seem warmer?
user: Yeah, I feel like it's it's warmer. 

assistant: OK um and then I'm gonna try to get you to do some movements, um can you move your right leg at all, like can you flex and extend your knees? 

user: No, not not at all like I I'm I'm too scared to try. 

assistant: OK, and how about weight bearing, are you able to stand up at all on that leg?
user: No, I just I just got time to call the ambulance, I knew I knew it was just not possible. 

assistant: OK, alright, um I guess those were all the questions that I had for you. Um I think you may have a tibial fracture. So we'll start with some X Rays um to be sure and to try to take a look at like where the fracture is and how we can approach that. Um because everything is swollen and angry down there, we'll probably try and um apply a splint um until the swelling goes down. And then um we can uh refer you to an orthopaedic surgeon for a surgic, for the surgery itself. So that could um involve, like uh  you know them doing like and intramedullary nail, plates and screws, and um like some sort of fixation. Um but after the surgery, your fracture will probably take about four to six months to heal completely, uh so in that period um we can talk about like pain management and physiotherapy as well, just to keep the muscles in that area strong and to increase your range of motion. Does that sound OK?