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

assistant: Is there anything else?
user: No, no, I don't think so. 

assistant: OK, umm so, I'm going to get the attending and we'll go through a physical exam and get some investigations ordered so that we can try to figure out what's going on, ok.
user: I'm here because um I've been having some pain in my left knee for the past two months and it's not getting better. It feels stiff and um I just haven't been able to uh, you know, use it as well, as well as I was using it before um and it's just limited some of my daily activities. 

assistant: OK, um, and where, uh so it's, the pain is in your left knee. Where are you feeling this pain specifically? Is it at the front of the knee, the sides, or or the the back? Could you point to it?
user: It feels like it's mostly on the front. 

assistant: OK. 

user: Like deep within that um kneecap. 

assistant: OK, and you said the pain started two months ago?
user: Yes, well, it's always been a little like tender. Um but now it's more painful. 

assistant: OK. And so, so has it been getting worse?
user: I would say so, slowly getting worse. 

assistant: OK. Uh and when you get uh pain in the left knee, how long does it typically last for?
user: It usually hurts while I'm doing, while I'm moving it, or just after, but if I if I rest, the pain eventually goes away. Um but when I first wake up in the morning, that joint feels stiff. And then when I start using it, using it more, it's less stiff, but it becomes painful. 

assistant: OK, so you have some stiffness in the morning?
user: I do. 

assistant: OK, and how long does it last for? Like 30 minutes, 60 minutes or or longer?
user: The stiffness or pain? 

assistant: Yeah, the the stiffness.
user: Uh the stiffness goes away in like yeah 15 to 30 minutes. 

assistant: OK, and how would you describe the pain, um in terms of its character? 

user: It feels, it feels uh, I guess most of the time it's like it's like a dull kind of pain, but it can be sharp. 

assistant: OK, and is there anything that makes the pain worse?
user: Just with a lot of activity it gets worse. 

assistant: And you feel it radiate anywhere else? 

user: No. 

assistant: OK, and how would you describe the severity of your pain on a scale of 10 being the worst pain you've ever felt, and 1 being kind of very minimal pain.
user: Uhm, I would give it maybe uh 7. 

assistant: OK. And have you had any injuries to your knee before?
user: No, not that I can think of. 

assistant: No, OK. Um and have you been having any uh any weight loss recently? 

user: Uh no, weight gain. 

assistant: Weight gain, OK. How much weight have you gained over the last uh several months?
user: Over the past six months, I'd say I've gained about 20 pounds. 

assistant: OK, have you had changes in your diet and or exercise?
user: Um I guess I've been eating a little bit more, um but no changes in exercise. 

assistant: OK. Um have you been having any fevers or chills? 

user: No. 

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

assistant: OK, um have you had any changes to your vision or hearing? 

user: No. 

assistant: OK. Have you had any changes to your uh sense of smell or sense of taste?
user: No. 

assistant: OK, have you had a runny nose or or a sore throat?
user: No. 

assistant: Have you had a cough or or any shortness of breath? 

user: Uh no nothing like that. 

assistant: OK, how about any uh wheezing?
user: No wheezing. 

assistant: Alright, any chest pain or heart palpitations?
user: No. 

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

assistant: Alright, and any confusion or memory loss? 

user: No. 

assistant: Alright, and have you had any changes in appetite, like a loss of appetite?
user: Uh no, I, if anything, had a gain in appetite. 

assistant: Alright, uh have you had any nausea or vomiting? 

user: No. 

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

assistant: Alright. Um and how about any urinary problems? 

user: Uh no urinary problems. 

assistant: Um any changes to your bowel habits, like diarrhea or blood in the stool?
user: No. 

assistant: Alright, and have you had any rashes or skin changes or changes to your hair or nails? 

user: No, nothing like that. 

assistant: OK, and any other joint pains? Or have you or do you have any joint swelling?
user: Uh I have some joint um swelling. It's it's not very visible, but it's it appears slightly more swollen than my left, sorry, than my right knee. 

assistant: OK. So just a little bit of swelling in your left knee, but no other joints?
user: No. 

assistant: OK, um and have you been diagnosed with any medical conditions before? 

user: Um I have um diabetes, high blood pressure and high cholesterol. And I'm overweight. 

assistant: OK, do you take any medications for any of those conditions?
user: I'm on insulin for diabetes. Um I'm on Ramipril for high blood pressure and I'm also on a statin for the cholesterol. 

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

user: No. 

assistant: Alright, and uh, have you had any surgeries in the past?
user: No. 

assistant: Alright, and um are your immunizations up to date? 

user: I think so. 

assistant: Alright, uh, and could you tell me a little bit about your living situation currently, like like who you're living with and whereabouts?
user: Um I live with my husband in a house downtown. 

assistant: OK, um and are you working currently? 

user: No, I retired early. 

assistant: OK, um do you drink alcohol?
user: Um I'll have a glass of wine every night. 

assistant: OK, so about 7 drinks per week? 

user: Yes. 

assistant: OK, and um, do you smoke cigarettes?
user: Uh no, I don't. 

assistant: Alright, how about the use of any recreational drugs like cannabis or uh or anything else?
user: No. 

assistant: Alright. Um and is there any, uh, like musculoskeletal or like autoimmune conditions that run in the family? 

user: Uhm no musculoskeletal issues uh that, I know diabetes runs in the family. 

assistant: OK, um alright, so that was everything I wanted to ask on history. So next I just wanted to do a physical exam, and just looking at the left knee, are you seeing any um swelling or redness uh on the knee?
user: Um it appears slightly more swollen than my right knee. 

assistant: OK, but are you seeing any redness? 

user: No redness. 

assistant: OK, and are there any temperature changes? Like does the knee feel hot or or warm?
user: No. 

assistant: OK, and if you um press along the uh joint line, do you feel any pain? 

user: Uhm yeah, it feels a little tender. 

assistant: OK. And how about pain over any of the muscles, like the thigh muscles or the hamstrings or the calf muscles?
user: No, those are fine. 

assistant: OK, and then how about any pain over the patella or kneecap? 

user: That that's a little bit more painful. 

assistant: OK, and are you able to bend your knee uh like like flex it, straighten it?
user: Uh I can do that, it's just painful when I do that. 

assistant: OK. Um and uh and then how about walking, are you um, do you have an antalgic gait or or or a limp?
user: Uhm no, no, well, I guess I'm I'm putting more weight on my right knee so it might appear to some people that I do have a slight limp. 

assistant: OK. And any issues with moving your hip or your ankle? 

user: Uh no. 

assistant: OK, um so I think that was everything I wanted to ask and check today. Did did you have any questions?
user: Um yeah, so um how do you, how can I treat my knee? 

assistant: Yeah, certainly, so it it sounds like um this could be most likely osteoarthritis um of the left knee, which uh is something that would be best treated with uh trying to stay as active as you can, but but also pacing your activities as well, so that you're not um doing so much that the next day you're in significant amount of pain, but it's important to remember that um activity will help um with keeping your knee mobile, but also um actually help with reducing pain as well, and then also uh you could use Tylenol um as a medication for it. I wouldn't recommend ibuprofen or NSAIDs on a long term basis, although you could take those if you're having like an acute flare up of your pain. Um and then also like topical agents such as um like Voltaren or something like that you could put on your knee and um if it's really bad and it keeps um continuing on, we can consider something like a steroid injection as well.
user: Yes, I just came in here today. I I've just been. Really getting like the soreness in my throat for the past, I would say four days and I also had a fever for the last two days as well. 

assistant: OK. So the sore throat, have you been having  pain with swallowing foods or liquids? 

user: Uhm maybe a little bit with solids, not so much with liquids. But yeah, I definitely been feeling more sore. 

assistant: OK. Have you noticed any changes to your voice?
user: Uhm, no, not really, not. I haven't really notice any changes. 

assistant: OK, uh, have you noticed any redness in the back of your mouth? 

user: Yeah, I've noticed some redness and then I also feel like there's like some material, like whitish material coming up from the back of my throat. 

assistant: OK, this could be a uh, what they call a tonsillar exudate possibly, we'll look on physical exam. OK, does it look like there's swelling in the back of your mouth?
user: Yeah, it definitely looks angry. 

assistant: OK, have you noticed any swelling in your neck as well like either on on the sides, like, or any lumps there?
user: Yeah, definitely like more on the front side of my neck on both sides. I feel kind of like some swelling and lumps. 

assistant: OK. And you've had a fever as well these last couple of days, so have you had any chills?
user: Yeah, I've had chills and then also been feeling warm during the day. I think yesterday I took a temperature at night and it was 38.4 degrees Celsius. 

assistant: OK, so yeah, certainly a fever. Have you had any night sweats?
user: No. 

assistant: OK. Uhm, and have you had any headaches?
user: No headaches. 

assistant: Have you had any eye redness or eye discharge?
user: No. 

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

assistant: OK, any ear pain? 

user: No. 

assistant: Have you had a runny nose or felt congested?
user: Last week I did have a little bit of a runny nose and a little bit of a cough as well, but this week I'm not really having any cough or runny nose, it's just a sore throat. 

assistant: OK, so the running nose and cough have gone away completely? 

user: Yeah. 

assistant: OK, and how long did those last for?
user: Uhm probably like 5 days so it's I think it started two weeks ago. 

assistant: OK. And you're an are you having a cough now?
user: No, no cough right now. 

assistant: OK, uhm, and uh, OK, and have you had any changes to your sense of smell or sense of taste?
user: Uh, no they've both been the same. 

assistant: OK, and have you had any loss of appetite? 

user: Uhm, no, my appetite's been pretty much the same I, I still try and I I do get hungry and I try to make sure, even though it hurts a little bit, to keep eating. 

assistant: OK. Uhm, and when you did have a cough, or during this time as well, have you coughed up any sputum or any blood?
user: No, nothing like that. 

assistant: OK, uh, have you had any wheezing? 

user: Uhm, no wheezing. 

assistant: OK, now have you had any shortness of breath?
user: No, no shortness of breath. 

assistant: OK, and then how about any chest pain?
user: No, no chest pain. 

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

assistant: OK. Have you had any heart palpitations? 

user: Uh, no. 

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

assistant: Have you had any diarrhea? 

user: No. 

assistant: Have you had any constipation?
user: Ah no. 

assistant: OK and have you had any urinary problems like pain with voiding or urinary frequency? 

user: No, nothing like that. 

assistant: OK, and have you had any abdominal pain?
user: No. 

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

assistant: Have you had any muscle aches or or joint pains? 

user: Uh, no not that I know of. 

assistant: OK. Uhm, have you had any confusion or memory loss?
user: No. 

assistant: OK and have you had any changes to your energy? Like any fatigue or malaise?
user: Uhm no, I don't think so. I'm still I still feel like pretty energetic. 

assistant: OK. In the past have you been diagnosed with any medical conditions? 

user: No, no, I've been pretty healthy. 

assistant: Alright, and do you take any medications regularly, either over the counter or prescribed?
user: No. 

assistant: OK. And do you have any allergies?
user: No, not that I know of. 

assistant: OK, and do you have any? Are your immunizations up to date?
user: Yeah, as far as I know. 

assistant: OK. And, can you tell me a little about your living situation? So like where you're living and who you're living with? 

user: Yeah, I I live with my parents right now in a, in a house just in the city. And I also live with my older brother. 

assistant: OK, have you been going to school?
user: Yeah, right now it's online school right now due to the pandemic. 

assistant: OK, and has anybody at home been sick or have you been around anybody who's been sick?
user: My brother did have like similar sore throat symptoms, I think maybe two weeks ago and he did get some medications from the doctor. 

assistant: OK, so did he get antibiotics?
user: I think so. I think he got some antibiotics. 

assistant: OK. Have you traveled anywhere recently?
user: Uh, no. 

assistant: Alright and, I know if some people in your age group might experience with smoking or or alcohol. Have you or any of your friends tried anything like that before? 

user: No, no, nothing like that. 

assistant: OK, and everything that we talk about is always confidential, so you can feel safe sharing with me, and so has there been any concerns with physical or emotional violence at home?
user: No, I feel pretty safe. My parents are pretty caring and loving. 

assistant: OK, well that's excellent. And are you sexually active?
user: No. 

assistant: OK, have you been sexually active in the past? 

user: No, not at all. 

assistant: OK. And now in the family, are there any conditions such as heart problems or lung problems that run in the family?
user: Uh, no. Like my parents are pretty healthy. 

assistant: OK, uhm, and any cancers that run in the family?
user: No. 

assistant: OK, and how's school going?
user: School is going pretty well, no real issues. It took some time and adjusting to the new online curriculum, but it's going pretty well now. 

assistant: OK, well that's good. I'm glad that you been able to, uh, adjust. So I think that was everything I wanted to ask about on history today. Did you have anything else that you maybe wanted to add? Or that I maybe forgot to ask about?
user: No. I think that those are all the questions I had. 

assistant: OK, so with your current symptoms right now with no cough, tonsillar exudate, a fever, also your age and the like swelling and redness that you notice in the back of your throat is likely a group a strep pharyngitis that's causing this. And with your exposure to your brother who also received antibiotics, could be potentially be a sick contact for you that you were around, so this would require antibiotics as well for yourself and we'll do a rapid strep antigen test to check for this and wait on the result for that because it it still could possibly be a viral illness and so that passes negative and we're thinking it's a viral illness then we might hold off on antibiotics for now and monitor symptoms. And if at any point things get worse like you start to get shortness of breath or your fever's getting worse and it's not, not being controlled, then we'll reeassess the situation.
user: OK, sounds good. Thank you so much. 

assistant: Thank you.
user: Hi so I brought my 6 year old son in today because yesterday during soccer practice, he he developed this pretty severe cough and he couldn't catch his breath. 

assistant: OK, so this happened yesterday, you mentioned? 

user: Yeah, it happened yesterday afternoon. 

assistant: OK, uhm so you mentioned a cough. Is it a harsh barky cough, or is it more like a muffled cough?
user: I would say it's more muffled. 

assistant: OK, and is it a dry cough or is it bringing up any phlegm?
user: Dry 

assistant: Dry OK. So no blood in the with the coughing?
user: No blood. 

assistant: And does he sound wheezy to you?
user: He does, yeah, he's still sounding a little bit wheezy now. It's it's better than last night. He was a bit more wheezy last night. 

assistant: OK. Uhm how about shorter breath? Does he sound short of breath at all? 

user: No, that that's gotten a bit better, that resolved about an hour. Like after he stopped playing but he was, he was short of breath yesterday. 

assistant: OK, and have you tried anything for his cough, for his shortness of breath or wheezing?
user: No, we haven't 

assistant: No OK. Does he have a fever at all?
user: No, he doesn't mention anything about feeling hot or or or having chills either. 

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

user: No 

assistant: No, weight loss over the past few weeks?
user: No, he's been gaining weight well. 

assistant: OK good, has he had a stuffy nose or runny nose? 

user: Well, sometimes he will get a runny nose. He takes like Reactin or Claritin or some sort of allergy pill for that sometimes, but that's usually like the changing of seasons that will happen more often. 

assistant: OK OK. Does he have any allergies?
user: Yeah, to mostly environmental triggers. I'm not sure if the specific things are, but I just know it gets worse. Maybe in the spring, springtime? 

assistant: OK. And does he have asthma?
user: He's never been diagnosed, but he has had uhm or his sister has asthma. 

assistant: OK, OK. And has he? Have you noticed any changes in his vision or hearing?
user: No. 

assistant: No, OK. How about change in his smell or taste?
user: No 

assistant: No, how about like does he seem like he has any chest pain?
user: No, he hasn't mentioned anything like that. 

assistant: Any dizziness or fainting spells? 

user: No 

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

assistant: OK, Uhm how about confusion or sorry you said no headaches?
user: No headaches. 

assistant: No, OK, any joint pains, muscle aches? 

user: No. 

assistant: OK, and how about changes to his bowel movements?
user: No, everything's been normal there. 

assistant: OK, how about nausea or vomiting? 

user: Nothing like that. 

assistant: OK, OK, so you mentioned he has asthma. He might have asthma. He was never formally diagnosed. Does is he otherwise healthy or does he have any longstanding medical conditions?
user: He's been healthy. Yeah, I know he did have like he would get some itchy skin when he was a bit when he was like a baby, but he hasn't needed any creams for that for a long time. 

assistant: OK so he might have something like eczema, you think?
user: Yeah, yeah I think he did. 

assistant: OK, OK and is he on any medications right now?
user: No, he doesn't take anything right now. 

assistant: OK, Uhm during his mom's pregnancy with him, were there any complications? 

user: No, she was uhm healthy and he was born at term with a normal weight and able to go home relatively quickly, so there weren't any concerns. 

assistant: OK, that's good and was he healthy like after birth?
user: Yeah, so he's he's done well. There weren't really any concerns with development or or growth, and he's doing well in school. 

assistant: OK, OK, good. How about uhm so was he a full term baby and was it a vaginal delivery?
user: Yes. Yes for both 

assistant: OK, any complications during the delivery?
user: No, 

assistant: OK, and he didn't need any hospitalizations like right after birth as an as a newborn?
user: No 

assistant: No, OK good. Uhm Is he up to date with all his immunizations? 

user: He is, yeah 

assistant: OK. And you mentioned that he may have some seasonal allergies. Any other allergies that you know of?
user: Not that I know of. 

assistant: No, OK. You mentioned that his sister has asthma. Any other lung conditions or heart conditions that run in the family?
user: No, nothing like that. 

assistant: No, OK. OK. Uhm and does anyone at home smoke? 

user: No 

assistant: No OK. Any old carpets? Does mold, asbestos, anything like that at home?
user: We we took out the carpets and stuff when his sister was diagnosed with asthma, so it's good from that perspective. 

assistant: OK, good, and who lives at home with him? 

user: So it's myself, his mom and then his sister. 

assistant: OK, OK, any pets at home?
user: He's got a fish. 

assistant: A fish, OK. And has he has come into contact with anyone sick recently?
user: No, I don't think so. I mean when at school, they've been pretty diligent with I mean covid and everything right now, so I think he's been OK. 

assistant: Ok, uhm has he traveled anywhere recently? 

user: No. 

assistant: No, OK. OK, those are all the questions that I had for you today. Did you have any questions of your own for me?
user: Yeah, I was just wondering if if my son had asthma as well and if like you need a prescription for inhalers. 

assistant: Yeah, so we're gonna since he's never been diagnosed before, we're gonna do some investigations for him just to start so we can do, we can start by doing a pulmonary function test for him to see what his lung activity is like uhm so we'll start there and then we'll also, because you're saying he's short of breath, we'll take his oxygen saturation as well, and maybe even do some like some basic blood work for him, and if it turns out he has asthma, which in this case I do strongly suspect, we'll prescribe him some bronchodilators like a short acting beta agonist as well as an inhaled corticosteroid because his symptoms do seem somewhat severe this time around. And then I should also mention because some of his symptoms overlap with that of COVID, he will also get a covid swab and you should hear back about that in 24 to 48 hours. How does that sound?
user: Hi, um my son has just been sick over the past uh couple of days. He's just had this cough and uh stuffy nose and uhm, yeah. He's also had this uh rash that just started. 

assistant: OK, and so can you tell me a bit more about the cough, so it started um?
user: Yeah, so the cough started about a week ago and um his stuffy nose, he's sort of had a stuffy nose since around the same time and then um, those symptoms um so it continued and got a little bit better over the past few days and then he started um having this rash on his face that then kind of went down to his neck. 

assistant: OK, and is the rash still uh there right now? 

user: Yeah. 

assistant: OK. Um and is the cough uh productive, is he bringing up sputum?
user: No. 

assistant: OK, um has he brought up um any blood?
user: No. 

assistant: OK. Um and uh, you told me about the the runny nose, what um, can you describe the discharge?
user: Yeah it's just uh it's just uh watery discharge. his eyes are also red and kind of um he's been teary. Or I guess just yeah, it's just been like very watery and red and uh yeah, it's clear discharge. 

assistant: OK. Um has he had a sore throat?
user: Um no. 

assistant: Alright, um how about any changes to his sense of smell or or taste? 

user: Uhm he, uh, he hasn't really, uh yeah, he hasn't said anything about that. 

assistant: Alright and has he had any problems with breathing.
user: No. 

assistant: OK. Has he mentioned anything about chest pain?
user: Uh no. 

assistant: Alright, um has he had any fevers or chills? 

user: Uh yeah, he does have a fever, um 39.5 I checked yesterday. 

assistant: OK, uh is that is that the first time that um he was noted to have a fever yesterday?
user: Um he has had a fever for the past few days. Um it was around, it was less, between 37.5 to 38.5, um but then yesterday was just uh it just kept going up so I got concerned and thought I should bring him in. 

assistant: OK, I see. Yeah well it's good that you brought him in. Um has he been having any night sweats? 

user: No. 

assistant: And um how has his weight been over the last several months, has he been gaining weight OK still?
user: Oh yeah. 

assistant: Alright, that's great. Um and has he had any any any wheezing? 

user: No. 

assistant: Um how about any like changes to his appetite?
user: Um he's just been eating less since he's been feeling unwell. 

assistant: OK.
user: Yeah, but he still he still he manages to eat about um half the plate. So I guess it's not too bad. 

assistant: And that's been the last few days? 

user: Yeah, yeah. 

assistant: OK and um has he had any muscle aches or body pains?
user: Uh, no, not really. 

assistant: OK, and um is, are there any exposures that um could've possibly caused a skin rash like changes in like laundry detergent, or um like coming into contact with with anything on his skin or or taking um, or any anything that he was allergic to that he's been around? 

user: Um I don't think so. He was playing outside with the neighbours, um with the neighbour's kids, but I don't think he came into contact. I'm not sure. 

assistant: OK, uh, has he been diagnosed with any medical conditions before?
user: No, he's pretty healthy. 

assistant: OK and sorry, just to to go back to the symptoms, I missed a few questions here. Did he have uh, does he have any nausea or vomiting? 

user: No. 

assistant: How about any diarrhea?
user: Uh no. 

assistant: OK, and any abdominal pain? 

user: Um nope. 

assistant: Or or any urinary problems?
user: No, no. 

assistant: OK. Um And and so he hasn't been diagnosed with any medical conditions before. Um does he take any medications regularly, like prescribed or over the counter?
user: Um no he doesn't. 

assistant: Alright, and any allergies to medications or uh environment that you're aware of? 

user: Um no. 

assistant: OK, and um are his immunizations up to date?
user: Um well, no, I don't. I don't I don't vaccinate my kids. I'm just I'm I'm worried that they'll uh get autism. 

assistant: OK, yeah, that's uh well, it's important to know um today that he's not vaccinated, because certainly that will influence um what we're thinking about in terms of what could be causing the symptoms. Um and we can uh discuss the, I guess more about the vaccination procedures and what not later. Um but OK, so he's not currently vaccinated, and have there been any um concerns with his growth and or development? 

user: No. 

assistant: He's meeting all of the the milestones and doing well at school?
user: Yeah. 

assistant: OK, um and in terms of the pregnancy, uh were there any complications during the pregnancy like gestational diabetes or or um high blood pressure? 

user: Uh I did have gestational diabetes. 

assistant: Uh sorry yeah, did that require insulin or?
user: Uh yeah, I did have to take insulin. Um he was he was also a pretty big baby when he was born, um we had to, I had to give, get a C-section done. 

assistant: OK, were there any complications with the with the procedure, with the surgery? 

user: No no, no complications at all. 

assistant: OK, did he have any um like breathing problems or jaundice or any reasons to stay in the hospital when when he was born?
user: No, he didn't. 

assistant: OK, um that's good. And uh who's he living with and who's the primary caregiver currently?
user: I'm the primary caregiver. Um he's got an older brother who's seven years old and his dad, it's the four of us. And we also have a dog. 

assistant: OK. Any allergies to the dog or to pets at all? 

user: No. 

assistant: OK, um and um any reasons or concerns for um uh physical or emotional abuse in the home?
user: No. 

assistant: OK, and um any family history of any heart or or lung problems?
user: No. 

assistant: How about a family history of any bleeding disorders or or clotting disorders or cancers? 

user: Um no. 

assistant: OK. Um so that was everything that I think I wanted to ask about on history. Um so it sounds like um he's had a cough, um a runny nose, um some red eye red eyes that, with some tearing as well as a rash that that started and and a fever. Was there any other symptoms?
user: No. 

assistant: Alright. Um so next we'll go on to the physical exam. We'll want to have a look um at the rash and get the vitals, um but there is a concern that this is, could be, uh Measles and so um it'll be important to um, supportive management and um ensure that um it's not passed on to um anybody else. That reminds me, yeah, he was out playing with other children, were any other kids experiencing similar symptoms? 

user: Um I'm not sure I I guess I need to talk to their their parents now. 

assistant: Yeah it would be um a good idea to uh yeah contact um and see, just to make sure that we're treating everybody appropriately.
user: Hi, um so I've had this terrible fever for the past three days um and just before that I had a stuffy nose um and I had a sore throat, well I still do, um and it's just not going away, so I thought I should just come in and see if I have covid or what it is. 

assistant: OK, so if I understand, it started with a stuffy nose?
user: Yes. 

assistant: OK and that kinda progressed to a fever?
user: Yes, that's right. 

assistant: OK, have you been feeling any other symptoms aside from the fever? 

user: No. 

assistant: Nothing really, have you had any nausea, any vomiting at all in the last little while?
user: No. 

assistant: Any pain anywhere else in your body?
user: Uh, no. 

assistant: OK, do you have any neck stiffness? 

user: No. 

assistant: Any headaches?
user: Um no, no headaches. 

assistant: OK, and have you been able to eat and drink during this time period? 

user: Yes. 

assistant: Excellent. OK, you've had a cough at all?
user: No cough. 

assistant: No cough, OK and then how about abdominal pain, any pain in your tummy?
user: Um no. 

assistant: Nothing like that, what about other changes in your body? Have you noticed any fevers or any rashes, any skin changes?
user: Uh no, nothing like that. 

assistant: OK. What about any pain in any of your joints and your knees, hips?
user: Oh, actually um not in my joints, but I've just, there there has been some muscle ache. 

assistant: OK, how long has that been going on for?
user: Uh for the past two three days. 

assistant: So around the same time that you've had this fever?
user: Mhmm. 

assistant: OK.
user: That's right. 

assistant: Now have you had any contact with anyone who's been sick in the last little while?
user: Um no, not that I can think of. 

assistant: OK, have you had any recent travel anywhere else?
user: No, I did go hiking um last weekend, um and it was about 2 hours away, um there were some people on the hiking trail that I passed by, but um other than that, no travel outside the province. 

assistant: OK. Does anyone around you or in your immediate circle come down with anything similar recently? 

user: Um my husband has also been experiencing similar symptoms for the past week. 

assistant: OK, how's he doing?
user: Uh the same as me. 

assistant: OK. And have you had any covid swabs recently?
user: No. 

assistant: OK, and aside from the weekend hike, have you been mainly self isolating or?
user: Uh yeah, just me and my husband at home. 

assistant: OK, and do you leave the house for work at all?
user: No, I work from home. 

assistant: OK, sounds good. So you have some muscle aches, little bit of fever, stuffy nose, sore throat, do you have any difficulty swallowing? 

user: Uh no, it just hurts. 

assistant: OK, so you're still able to swallow food, swallow liquids?
user: Yes, that's right. 

assistant: It doesn't feel like anything is going down the wrong way or have any coughing after you swallow?
user: No. 

assistant: OK. And just in terms of coming back to this sore throat, do you feel like you have any swelling around your neck? Does it feel inflamed or swollen?
user: No. 

assistant: Nothing like that? 

user: No. 

assistant: OK, alright, excellent. So you're eating well, doing well, any changes to your bowel movements recently?
user: Uh no, no. 

assistant: OK, alright, I'll just kind of go into other things, just in terms of anything else that you might have had in the past, uh have you ever been hospitalized for any reason in your life?
user: I had my gallbladder taken out five years ago. 

assistant: OK, so that was around when you were 50 years old?
user: Uh yes. 

assistant: OK. And any other surgeries you've had in your life? 

user: Uh no. 

assistant: No, anything you've had to see a doctor for?
user: Um I, in the past couple of years uh just for things like like this I guess um colds, um I'm pre diabetic, so I've been checking my glucose levels, yeah other than that nothing else. 

assistant: So no high blood pressure? 

user: No. 

assistant: No cholesterol issues?
user: No. 

assistant: OK, so it sounds like you've been pretty healthy otherwise.
user: Yeah. 

assistant: Excellent, OK. Do you have any allergies? To medications or otherwise.
user: Penicillin. 

assistant: Penicillin, what happens when you take penicillin? 

user: Um I get a rash. 

assistant: OK. Any trouble breathing?
user: No. 

assistant: And what medications, if any, are you on? 

user: Um I'm, I just take multivitamins, that's it though. 

assistant: And you said you lived with your husband in a house, um in London?
user: Um yes, that's right. 

assistant: What do you two do for work? 

user: So I work from home as a digital marketing agent and my husband is a computer programmer. 

assistant: OK. And do you smoke?
user: No. 

assistant: Do you drink alcohol? 

user: Uh I drink once once in a while. 

assistant: OK. And when you drink, how many drinks do you have?
user: Um about one or two glasses of wine. 

assistant: Got it. Any other recreational drugs, substances?
user: Um no, 

assistant: So no marijuana, heroin, cocaine? 

user: I've tried marijuana before, just like edibles, but not, not regularly. 

assistant: Understood. And have you ever used IV drugs?
user: No. 

assistant: OK, and when was your last menstrual period? 

user: It was um a year ago. 

assistant: A year ago?
user: Mhmm. 

assistant: OK. And then otherwise, so we talked a little bit about recent travel. It sounds like you have the hiking trip last week and you passed some people, but it sounds like your husband also has kind of similar symptoms that you do right now. 

user: Yeah. 

assistant: Sounds good, now we've already talked about kind of past medical issues. Moving on, I think what we'll do next is move on to a physical exam. But before I do that, do you have any questions for me? Anything else you feel I should know?
user: No, do you think I have covid? 

assistant: It's a possibility. It's always good to rule these things out, so we'll be ordering a covid swab no matter what. Obviously with any presentation where we have someone come in with a fever and sore throat, we want to rule out anything infectious. So it sounds like if your husband got it, and you have it, covid would be our first thing that we want to rule out. So just while we're trying to investigate, work this up further, I want to have you and your husband self isolate. The other question I suppose I should ask is, have you gotten your flu shot this year? 

user: No, I haven't. 

assistant: So it's also a possibility it might be influenza, just the seasonal flu. But until we, I suppose rule out covid, it'd be best just to keep to yourself just in case you are infectious for the meanwhile.
user: Hi, I just was brought in here today. I had a fall just waking up coming down the stairs. I fell off the last few stairs and just fell onto the right side and on, right onto my head and now, uh I couldn't even I could barely stand up and put any weight on my hip. It's the right hip. 

assistant: OK, Uhm, so what caused you to fall in the 1st place? Did you just lose balance, were you dizzy?
user: I think I just I missed, I wasn't dizzy or anything. I just missed one of the steps and just slipped, slipped down the stairs. 

assistant: OK.
user: But it was just the last few stairs I didn't have like I didn't hit my head or anything like that. 

assistant: OK, and when was this?
user: This was a so I guess now two hours ago. 

assistant: Two hours ago, OK. Has a pain been constant since? 

user: Yeah, it's, it's really excruciating. 

assistant: OK, does anything make it better or worse?
user: No, it's I'm just in extreme pain. Like I I I can't even put any weight on it. 

assistant: OK, so you can't, OK so you can't weight bear, and you can't walk on on that leg I guess. 

user: Mhmm. 

assistant: OK. Is it a sharp kind of pain or is it dull and achy?
user: It's uh, it's pretty sharp, like if I'm not putting any weight on it right now, it's like really achy. But if I put any weight on, it's really sharp. 

assistant: OK. And where is this pain exactly? Is it just in your right hip or is it radiating up into your upper anterior lower back or down to your leg?
user: It's in the right hip, mostly just on the side, but the pain is kind of like, all over the right side of my groin and I feel like there's some swelling there as well. 

assistant: OK. And one to 10, 10 being the worst pain ever. How bad is your pain?
user: I would say 10, like I've never experienced pain like this. 

assistant: 10, OK. And do you, have you ever had pain like this before? Like have you ever had a fall in the past? 

user: No, this isn't this is the first time I've had a fall. 

assistant: OK, any numbness or tingling?
user: Uhm, no, not that I can tell, no. 

assistant: Dizziness or fainting spells?
user: Uhm, after the fall out like this, I I don't know if it's due to the pain, but even in the ambulance, coming out of the ambulance I was feeling a little bit dizzy, but I don't know if that's just 'cause of the pain. 

assistant: OK, any headaches?
user: No. 

assistant: Confusion or memory loss?
user: No 

assistant: Uh, joint pains or muscle aches elsewhere? 

user: No 

assistant: Weight loss recently?
user: No. 

assistant: Fevers or chills?
user: Nope. 

assistant: Uhm, and rashes?
user: Uh no. 

assistant: Any changes to your vision, hearing, smell or taste? 

user: No. 

assistant: Any, uh, you experiencing any cough, uhm, shortness of breath or wheezing?
user: No. 

assistant: OK, how about chest pain or heart palpitations? 

user: No, not that I have experienced. 

assistant: OK, and how about changes your bowel movements?
user: Nope. 

assistant: OK, how about changes to urine?
user: No, nothing. 

assistant: OK. And. Are you otherwise healthy? Do you have any longstanding medical conditions? 

user: Yeah, so I just have a, uhm I do have some osteoarthritis and then I have, I take this medication for blood pressure. It's called uh, Ramipril. 

assistant: OK. OK, and is that the only medication that you're on?
user: Uh, yeah. And then I'm just on vitamins like vitamin D, calcium and just multivitamins. 

assistant: OK. And are you up to date with your immunizations?
user: Yes. 

assistant: Yeah, OK. Any allergies?
user: Uh, no, not that I know of. 

assistant: OK. Any family history of lung or heart conditions?
user: Uhm, I think, uh my father, he died of a heart attack in his 60s. 

assistant: OK, OK, any musculoskeletal issues? 

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

assistant: No. Uhm, how about autoimmune conditions?
user: No, not that I know of. 

assistant: Any cancers? 

user: Uh, I think, my, my mother had some skin cancer, but the ones that, she didn't need any surgery, they just zapped them off. 

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

assistant: OK, uhm, do you drink alcohol? 

user: Just maybe like a wine, what every other day, a glass of of wine. 

assistant: OK, and then do you consume marijuana in any form?
user: No. 

assistant: OK. And how about in terms of where you live? Who do you live with and where do you live?
user: I live with uhm, just my husband and and we just live in a small apartment. 

assistant: OK. And have you been in touch with any, anyone sick recently?
user: Uh. No, I've I've been like at home with my husband. We haven't really left. 

assistant: OK. And have you done any travel recently? 

user: Uhm, no, I've just stayed at home. 

assistant: OK. Alright, so let's move on to the physical exam part of this interview. So if you can, I'm going to get you to take a look at both your hips as well as your legs. Do you notice any redness or swelling in the area?
user: I do notice some swelling. It's a little bit red. I can't really see too much red. 

assistant: OK. OK. Any muscle atrophy? Any deformities or skin changes like bruises? 

user: Uh, maybe some bruising, but I, I don't notice anything else. 

assistant: OK. Alright. And then when you place the back of your hand on both hips, do you notice any temperature changes? Is one side warmer than the other?
user: It's a little bit warmer, the right side than the left. 

assistant: OK, and does one like appear to be shorter? Or does does it appear to be misaligned? Or in any sort of like strange positions like outward turning of your leg, one compared to the other? 

user: I think it's a bit, but look at it a bit, like outward turning. And then yeah, I would say it's more outward turns. 

assistant: OK, and if are you sitting down right now?
user: Uh, yeah. 

assistant: OK, are you able to stand up from a sitting position? 

user: I can try, but it's very painful. 

assistant: OK.
user: Yes, should I go ahead and try? 

assistant: Yes please.
user: Yeah. So I yeah I can barely stand up. I can't, it's kind of just, I'm just supporting myself with my left like. 

assistant: OK and so I, I guess you can't do any of the like hip flexion or hip extension, hip abduction or addduction, correct? 

user: No, I can barely move it. 

assistant: OK alright those are all the questions that I had. Did you have any questions of your own?
user: No, I think I I just don't know if I need surgery or something. 

assistant: Yeah, so it sounds like you have a hip fracture from your fall. Uhm, so, the way to treat this is a combination of surgeries and rehab and medication. So we will definitely look into the surgical option first, which is done using some internal repair with screws. Or, you can do a total hip replacement or a partial hip replacement. The orthopaedic surgeon will uh, decide like which option is best for you after we refer you for a consult with them, and then after that surgery they'll likely refer you to some rehab, so physiotherapy will focus on improving your range of motion and strengthening the muscles in that area. Uhm, and for management of pain, you can take ibuprofen or any over the counter pain medications for now. Does that sound OK?
user: Yeah, so uh a couple of days ago. I just started to not feel so well and I've been having this cough and trouble breathing. 

assistant: OK, um, have you ever had anything like this before?
user: I do have a, uh, cough regularly, but I mean, I, I think that's related to maybe smoking. It's something that was going on for a few years. This coughs a little bit different. 

assistant: OK, in what way is this different? 

user: It's been happening more often throughout the day and. And bringing up more more mucus, it seems like. 

assistant: OK, and then you said it start started a couple days ago, is that correct?
user: Yeah, I think like Monday, so, uh, yeah I guess like 3 days ago then. 

assistant: OK, and since you noticed it has it gotten worse over those three days. 

user: Yeah, I would say uh today's the worst day I've continually felt um sick. 

assistant: OK. And how frequently are you coughing?
user: Uh I would say maybe a couple of times per hour. I'm I'm filling up a some tissues with sputum. 

assistant: And what does that? What does that sputum look like?
user: It's like a dark greenish yellow colour. 

assistant: OK. OK, um and. Is there anything that you've changed recently in your life or any kind of things that have provoked your cough that you know of? 

user: Ugh, no, I can't think of anything. I've been kind of sticking to my regular routines. 

assistant: OK, and is there anything that makes, uh, makes it worse, say any position or anything that you do in your day to day routine you find makes you cough more?
user: Um And not really I can't. I can't think of anything. 

assistant: OK. And, have you taken any any medicine or anything to try to help with us?
user: Um. No, I I've I I do have a little bit of pain so I was. I did take some Tylenol and some Advil over the last few days, but that's about it. 

assistant: OK, Ok. Did you find that they helped at all?
user: A little bit yeah, but it would just kind of take the edge off of the pain for a little bit and it came back. 

assistant: And what kind of pain is it that you're experiencing?
user: Um, it's kind of a a sharp pain over on the like the right side of my chest like maybe belly area. 

assistant: OK, OK um the right side of your chest and belly area. Yeah OK, so is that pain, is it, did it start around the same time as the cough? 

user: Yeah, I think it, it might have started a little bit after. 

assistant: OK, and is this a pain that you've ever had before?
user: No, I haven't had anything like this happen before. 

assistant: OK. Is the pain primarily there when you cough or is it present at all times? 

user: I would say more so when I cough or if I'm like taking a big breath. Um yeah, kind of after after I have a coughing episode I take a deep breath and I really will feel the pain then. 

assistant: OK, and and um, you said that it's a sharp pain?
user: Yeah, yeah, more of a sharp pain. 

assistant: OK, OK, and is it any worse when you're doing activity, like when you're up and walking around?
user: No, don't notice it with any any activity. 

assistant: OK. OK, um an since uh, since this coughing and this this right sided pain that you're talking about began, have you noticed any fevers? 

user: I think, yeah, I've been hot the last few days and I I checked my temperature earlier today and it was like 38.6 so that was one of the reasons why I wanted to come in actually. 

assistant: OK. OK, well I'm glad that I'm really glad that you came in because yeah, we really want to get this looked into. Have you been around anyone that's been sick recently?
user: No, but I I do some volunteer work at one of the homeless shelters at a few times a week, so I am around a lot of people. 

assistant: OK. And have you traveled anywhere recently?
user: No, I've been at home. And and doing the volunteer work. 

assistant: OK um. OK, and can you just give me an idea of any? Do you have any chronic conditions that you see your family doctor for regularly or anything you take medication for? 

user: Um yeah, I have type 2 diabetes. And I I take Metformin. Um I think an SGLT 2 inhibitor and then I use insulin for that as well. And I have some, it has affected my kidneys as well. The diabetes I mean. 

assistant: OK, do you have a history of high blood pressure?
user: I do yes. 

assistant: OK, do you take medication for that? 

user: Oh yeah, I do. It starts with an "a" I think, amlodipine. 

assistant: OK OK and do you have any history of heart problems?
user: No, not that I know. No, I haven't really had any chest pain. On the left side anyway. 

assistant: Um, So you said that you have had a cough for a really long time, a dryer cough then you're having sputum now. But is that something you've seen the doctor for? 

user: Oh yeah, I think I was called like bronchitis in the past or something. Something like that. One of the doctors, my family doctor told me it was because I was a smoker. 

assistant: OK. So just to make sure I have your list of medications, you take amlodipine, insulin
user: Um, and then yeah, amlodipine, uh, yeah, I think that that that's everything. Oh a multivitamin too. 

assistant: OK cool. I just wanted to ask you a few questions questions about your lifestyle in general. Do you live here in town?
user: I do. Yeah, I live with my wife and at a house nearby. 

assistant: OK, cool and you mentioned that you're a smoker?
user: Yeah, so I've smoked for the last 30 years or so. About a pack per day. 

assistant: OK, do you drink alcohol? 

user: No, I don't. 

assistant: Do you use any other substance?