jshargo/medical-interview-conversations2 huggingface dataset:
user: Um no pain at the ankle. 

assistant: OK, so the metatarsals are not having any pain and then the joints of the 2nd 5th digits are pain free along with the ankle as well. Um and when it comes to range of motion, are you able to flex your toes downwards and extend them upwards towards your nose?
user: Yes, I can do that. 

assistant: OK, and how about your ankle, are you able to um move your ankle on a full range of motion. 

user: I can. 

assistant: OK, and are you having a limping with, walking or otherwise called an antalgic gait?
user: Somewhat because I'm trying not to put too much weight on my right big toe. 

assistant: OK. Alright, and so I think that was everything that I wanted to ask and check today. So did you have any other questions or anything that I maybe forgot to ask about you wanted to mention today?
user: Um no just what can I do for my foot how do I make the swelling go down? 

assistant: Yeah, for sure it's so right now with having a like a red, warm and swollen joint that that's extremely tender and has limited range of motion. It's important to rule out a septic arthritis, however. Based on several of the risk factors such as diabetes, and obesity, as well as your family history of arthritis and gout. Taking the most likely thing is that this is a gout flare, and in particular in the toe like that it could be called podagra and so we will need to get a aspiration of the joint fluid just to send it off and make sure that it's not not an infection and that we're treating the right thing. If this is, gout and it comes back that this way it's treated with that high dose, high doses of anti inflammatories. I will start with medication called colchicine to help with this flare, and in the meantime, important things for preventing this in the future are diet and kind of lifestyle related with reducing things like red meats, alcohol, weight loss and um just trying to improve the diabetes management as well.
user: I've been having difficulties breathing over these last few days. 

assistant: When did it start? 

user: It started about, like, three or four days ago. 

assistant: OK, and since then, has it gotten any better or worse?
user: It has, maybe gotten a little bit worse, but not, maybe, a little worse. 

assistant: And are there certain times when you feel that you're more short of breath than other times? Anything in particular that you're doing that makes it worse?
user: Uhm, not really, it's kind of, I just feel like, it's just more difficult to breathe, uh, most of the time. 

assistant: And, has this happened to you before?
user: Uhm, not like, no, nothing like this has happened before. 

assistant: OK, do you have a history of any lung problems?
user: No, I don't, I've been healthy. 

assistant: So no COPD, no asthma, nothing like that,  right?
user: No, nothing like that. 

assistant: OK, so you're just having difficulties breathing for the past three-four days. Do you have any, uh, do you have a cough? 

user: I did have a, uh, yeah, I've had a cough as well, over these last few days. 

assistant: And has it been a dry cough or wet cough?
user: I've been bringing up, some, like, uh, whitish sputum. It's like, yeah, whitish or clear. 

assistant: And you haven't seen blood anytime right? In your sputum? 

user: No. 

assistant: OK, and has the cough gotten any worse overtime?
user: Uh, it's been about the same. 

assistant: And have you had fevers or chills?
user: I have felt hot but no chills. 

assistant: OK. What about, any redness in your eyes or any congestion in your nose? 

user: Uh, I haven't noticed anything like that. 

assistant: OK, have you had a sore throat?
user: Uh, it's felt a little itchy I guess but no pain with swallowing. 

assistant: And do you have any chest pain or chest pressure?
user: Yeah, when I like, uh, take a deep breath or after after I cough I've been having some chest pain. 

assistant: To give it a number from one to ten, what would you say in terms of how severe it is with ten being the worst pain ever.
user: I would say, maybe six. It feels pretty sharp when it happens and it goes away after a few minutes. 

assistant: OK, and where exactly is it, is the pain?
user: Uh yeah, I kind of feel it, Yeah, just over on the right side of the sternum. 

assistant: OK. Alright, and does it radiate anywhere? Does it go anywhere other than that one location? 

user: No, I feel it just in the one spot. 

assistant: OK, uhm, and has that pain gotten worse overtime?
user: No, that pain started, I guess like two days ago. More recent than the cough or shortness of breath. 

assistant: I see, I see, OK. And so you said that coughing makes it worse and sometimes breathing in. So is it just normal breathing or when you're doing like, deep breathing? 

user: Deep breathing. 

assistant: Deep breathing hurts? OK. Alright, and you've never experienced this before, right?
user: No, I haven't had a pain like this before. 

assistant: OK, when you sort of touch that area over your chest, does touching it make it worse? 

user: Uhm, no, I haven't noticed that, touching it doesn't make it worse. 

assistant: OK. Uhm, alright, have you had a headache?
user: Uh, no. 

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

user: I've been fatigued. No muscle aches. 

assistant: OK, any pain in your belly?
user: No. 

assistant: Any diarrhea? 

user: No. 

assistant: Constipation?
user: No. 

assistant: Any changes in your, uh, any changes when you pee? 

user: Uh, nothing there. 

assistant: No. OK. Any rash that you've noticed on your skin?
user: No. 

assistant: OK. Any changes in your sense of taste?
user: No. 

assistant: Changes in your sense of smell? 

user: No. 

assistant: OK, alright. So sounds like for the past three-four days you've had difficulties breathing and a cough with this whitish sputum, whitish or clear sputum. You've also been feeling a little bit feverish. Have you checked your temperature?
user: No, I haven't. I don't have a thermometer at home. 

assistant: Yeah, no problem and your throat's been a little bit itchy and then two days ago you also started having this pain in your chest. Is there any other symptom that I have not mentioned that you have been experiencing over the past couple of days?
user: No, that's everything. 

assistant: Yeah, OK. And you mentioned that you don't have a history of asthma or COPD. Do you have any other medical conditions? 

user: I have high blood pressure. And I take Amlodipine, for that. 

assistant: OK any other over the counter medications or any other medication that you're on?
user: No. 

assistant: Any allergies? 

user: No allergies. 

assistant: OK, and where do you currently live?
user: In a townhouse just outside of the city here. 

assistant: I see, do you live alone? 

user: No, I live with my wife and daughter. 

assistant: And have your wife and daughter been sick recently or have either of you had contact with someone who's been sick?
user: I've been working from home, uhm, but my daughter has recently started going back to high school and she's had a runny nose recently and a sore throat, but that's about it. 

assistant: And what about your wife?
user: She's been fine. Yeah, she's been healthy. 

assistant: OK, good. Other than your daughter, have you been in contact with anyone else who might have, who might be sick or might have symptoms similar to what your daughter has? 

user: I don't think so. 

assistant: OK, alright, and do you, have you traveled anywhere recently?
user: No, I've been just, uh, working from home. 

assistant: OK, and do you smoke? 

user: No. 

assistant: Ever smoked in the past?
user: No, I've never smoked before. 

assistant: Marijuana? 

user: I mean, I'll have a joint sometimes with friends at a party or something, but that's maybe once a month? 

assistant: Sure, and any street drugs?
user: Nope, nothing like that. 

assistant: OK, and do you drink alcohol? 

user: I have a beer a couple of times per week. 

assistant: Alright, and you told me about your medical history, but do you have, have you ever had any surgeries or any hospitalizations in the past?
user: Uh, I've had a hernia repair, about seven years ago. I haven't had any issues since. 

assistant: Alright, OK, uhm, and are there any medical conditions that run in your family? 

user: Uhm, my grand-father had a heart attack, in his seventies. And, I think my dad has high blood pressure as well, but, I think that's it. 

assistant: Alright, well, so, I think that's all that I wanted to know. I can see that you haven't been feeling well over the past couple of days and I'll go back to my attending and we will come back and chat with you little bit more and do a physical exam and go from there.
user: Uh, yeah, so I, I just came in because I've been having, for the last, I would say 2 weeks, just a lot of congestion in my nose and then I've also been feeling a lot of pressure in my head as well as just, around my jaws and my face overall. 

assistant: Okay, and um, you said it started two weeks ago. Has it gotten better or worse, or been the same since then? 

user: Um, I'd say it's pretty much been the same, except like the pressure's getting worse. 

assistant: Okay, and do you find that the pressure is worse when you're bending down, or um, yeah, when you're like squatting or sitting down?
user: Um, when I'm sitting down, I don't think so, but like sometimes I do feel like, for example, when I'm lying on one side, it gets really bad on that one side and I have to kind of switch over to the other side. 

assistant: Okay, alright. And uh, when did your headaches start?
user: Um it's, I guess it's not so much as a headache as just kind of um, just pain in and around the cheeks and just going up to my head. And it started about, I would say around 2 weeks ago. 

assistant: Um, and do you have a stuffy nose? 

user: Yeah, I definitely have a stuffy nose and it started, um, it sometimes gets like, like a runny nose as well. 

assistant: Yeah, okay and what's the discharge like?
user: Uh it's usually clear. 

assistant: Okay, and do you have a cough?
user: No, no coughs. 

assistant: Sore throat?
user: No. 

assistant: Um, and do you have any difficulties breathing?
user: Um, no, not that I've noticed. Sometimes when it gets really stuffy, I, uh, have to breathe through my mouth. 

assistant: Yeah, I see. Do you have any difficulty swallowing?
user: Uh, no. 

assistant: Any chest pain or any heart, um, palpitations?
user: Nope. 

assistant: Um, any pain in your belly? 

user: Uh nope. 

assistant: Nausea or vomiting?
user: No. 

assistant: Changes in your bowel movement? 

user: Nope? 

assistant: Any urinary symptoms?
user: No. 

assistant: Any muscle aches? 

user: Nope. 

assistant: Um, any fevers or chills?
user: No, not that I've noticed. 

assistant: Any weight, changes in your weight recently? 

user: No, no changes. 

assistant: Any uh, night sweats?
user: Uh, no. 

assistant: Okay. Um, alright so, have you had any contact with anyone who could have been sick in the past two weeks or before that?
user: No, no, I'm very like careful. Um, I barely go out. 

assistant: Good, that's very good. Um are you, have you traveled anywhere outside the province? 

user: No. 

assistant: Okay and um, do you currently work?
user: I work from home right now, um, I'm an accountant. 

assistant: Okay and do you live with anyone else, or do you live alone? 

user: Uh, so I live with my family. I live with my husband and um two daughters. 

assistant: Have any of them been sick recently?
user: No, they've been fine. 

assistant: Okay, good. Um, and do you smoke? 

user: No, not at all. 

assistant: Do you smoke marijuana or consume any recreational drugs?
user: Probably the last time was in college, um for marijuana. 

assistant: I see. Um, what about alcohol?
user: Alcohol, I'll probably have a glass of red wine a day. 

assistant: Alright, okay. And um, have you, do you have any, um I guess carpets or, or um curtains or any sort of animals around, anything that might cause any kind of environmental allergies?
user: Uh no, nothing like that. 

assistant: Okay, um alright. And do you have any medical conditions that you've been diagnosed with?
user: No, I've been completely healthy. 

assistant: Any hospitalizations or surgeries?
user: I did have a, um, c-section with both my, both my children. 

assistant: I see. Any complications after? 

user: No complications after. They were both healthy, I, I didn't have to stay in the hospital. 

assistant: Great, great. Um and any allergies uh to medications, foods or environmental allergies?
user: Nope, not that I know of. 

assistant: Any medications, including over the counter herbal medications? 

user: I have uh, I do take uh, Tylenol cold in bed sometimes, to relieve some of the pain and pressure. 

assistant: That's good, that's good. Is there anything else that makes the the pressure and the pain better?
user: Um, I have done those like, kind of those steam um, therapies. That sometimes helps. 

assistant: Okay good, good, good. Um, any uh, anything that makes the, that makes it worse? I know that lying on one side, you said, makes things worse for you. Anything else that's made the pressure worse?
user: Um, no, I would say that's, that's about it. 

assistant: Okay, any changes in your sense of smell? 

user: Yeah, definitely. Uh when I get really stuff, stuffy, like I don't really smell anything. 

assistant: What about sense of taste?
user: Um taste, I guess, like with the smell gone sometimes like the taste feels weird too, but like not, not really. 

assistant: I see, okay. Um, and any family history of any medical conditions?
user: Um my, my father did have a heart attack in his uh, I think it was late 50s, but he's well and alive right now, so he's fine. 

assistant: Good. Alright, well that's all the questions I had for you given the symptoms that you've shared with me, it sounds like you might have something called um, rhinosinusitis, uh which is basically inflammation of the sinuses and of the uh, of the nasal cavity or the area inside your nose, and uh, often it's just treated with conservative management, so just continue to take um, Tylenol if that seems to help you, and do the steam therapy. It will take time to get better, um, but if you feel that it's um, it's not getting better in the next week or so, give us a call again and we can maybe see if it's a bacterial infection and see if um, if antibiotics might be needed but oftentimes it's usually a viral infection, and antibiotics are not needed, and sort of just resting and taking care of yourself, um, and trying to manage the symptoms that way can help. Um, but also check your temperature here to see if you have any fevers and uh, go from there. We'll also, I guess, we'll also do a COVID swab because your symptoms do overlap with some of those symptoms. Um, and we'd recommend that you quarantine until at least uh swabs, swab results are out and then public health will let you know what to do. 

user: Okay. 

assistant: Do you have any questions for me?
user: I've just had a real like a real bad cough. Umm, it's been going on for 4 or 5 days now umm, and I'm just, I'm having some trouble breathing. I'm coughing up like gunky green stuff. Uhm, yeah, it's just really bad. I haven't had anything like this before. 

assistant: OK, so when did the cough start? 

user: About four or five days ago. 

assistant: Four or five days ago. OK, and, uhm OK. So for 5 days, did you do have any shortness of breath with that?
user: Yeah, it's uh, I'm just I feel like I can't, can't quite like breathe fully. 

assistant: OK, uhm you can't quite breathe fully, so like when you take a deep breath in, you can't expand your lungs fully. Is that what you mean?
user: Yeah, yeah, I just overall I just feel like yeah, I'm I'm short of breath. I guess that's the best way to put it. 

assistant: OK, so you're short of breath. And how about wheezing? Do you have any of that? 

user: I don't think so. 

assistant: OK. So when did this start again? You said if a couple days ago or a few weeks ago.
user: I think it was four days ago. 

assistant: Four days ago, OK, and did you have like a runny nose or stuffy nose at that point? 

user: Maybe a little bit. I wasn't really thinking about it too much. 

assistant: OK, uhm sore throat?
user: No, not a sore throat. 

assistant: Not a sore throat, OK. Uhm, how about changes in your taste or smell? 

user: No, none of those. 

assistant: OK. How about changes in your vision or hearing?
user: Uh, no. 

assistant: Fever, weight loss? 

user: I feel like I've I've probably had a fever the last couple nights. I've just been really hot in the evenings. 

assistant: OK.
user: Yeah, I feel like I've had a fever. I don't know bout my weight. I don't weigh myself all the time. 

assistant: Mhmm. 

user: But nothing like major. 

assistant: Any chest pain?
user: Feels a little like it hurts a little bit, like when I when I breathe in. 

assistant: OK. Uhm, do you ever feel like your heart's racing? 

user: No, I don't think so. 

assistant: Alright, And any changes in your bowel movements?
user: No, no, that's all the same. 

assistant: No bellyaches?
user: Nope. 

assistant: No bellyaches? 

user: Nope. 

assistant: OK, how about changes to your urine?
user: Uh, no. 

assistant: No, any dizziness or confusion? 

user: No, uh no, not dizziness or confusion, but I have just been feeling very weak and tired. 

assistant: When you say weak, have you like lost any of your like motor movements like your arms, legs?
user: No, no, not like that kind of weak. I just have felt like very rundown. 

assistant: OK. 

user: Just like just fatigued like more than usual, yeah. 

assistant: OK. Are you otherwise healthy or do you have any longstanding medical conditions?
user: Uhm, I don't I don't have too much luckily, knock on wood. Uhm, I, I take a medication for my reflux. 

assistant: Mhmm.
user: And I did, I did have a knee replacement, five years ago. 

assistant: OK. 

user: Other than that, like I don't, I haven't really been to the doctor for much. 

assistant: OK. Uhm alright. Do you have something called COPD?
user: No. 

assistant: No, OK. Uhm, are you on any medications?
user: Just that one for the reflux its uhm oh, it starts with an R. Uhm, Rabeprazole? 

assistant: OK. 

user: Yeah. 

assistant: Alright and are you up to date with all your immunizations?
user: Uh, yeah. 

assistant: Including like the pneumovax vaccine and the shingrix?
user: I had the shingrix the pneumo I think the doctor said we were going to look at that the next time I came in. 

assistant: OK, sure. 

user: So I I'm not sure I I know that I always say yes to these things, but I'm not sure because of Covid and stuff if I've been getting everything exactly on time. 

assistant: Mhmm. OK, and how about uh, how about allergies? Do you have any allergies?
user: Oh, like uh, just seasonal. Not to any medications or anything. 

assistant: OK. Uhm, have you been in touch with anyone sick recently around you?
user: No, like the only person I see is my husband. I guess him, and so he has a PSW that comes in to take care of him. He has a couple more problems than I do. So basically, we see I see him and her and we see we see our kids, but just like outside. 

assistant: OK. OK and alright and then, uhm, have you traveled anywhere recently? 

user: No, no 

assistant: No, OK. Dietary wise, are you like eating healthy?
user: Yeah, yeah, I think so. I try to, you know, cook, you know, whole foods for us like lots of veggies and you know fish and good meat. Although in the past you know few days, I just 'cause I felt really rundown and fatigued, I haven't been eating as much as I normally do. 

assistant: OK. 

user: Otherwise, I think we pretty healthy I try to, you know, follow healthy recipes and find them online. 

assistant: Yeah, for sure. Yeah, that's good. Do you, do you smoke?
user: No, no. 

assistant: No, OK, and any other recreational drugs?
user: No, never. 

assistant: OK. Do you drink alcohol?
user: I'll have the occasional glass of wine on a special occasion, but not frequently and not, not heavily. 

assistant: OK. And where do you live and who do you live with right now? 

user: Uh, just me and my husband. We live outside of town. We live in the country on a little farm. 

assistant: OK. Any old carpets or dust or mold or asbestos in the, in the home?
user: No, no we renovated probably 15 years ago, and there's no no more carpet, and there were never any asbestos problems or anything. 

assistant: OK. OK, well I think those are all the questions that I had. Did you have any questions for myself? 

user: I don't think so. I just I hope you know we can get this figured out. 

assistant: Yeah, for sure. So we'll start with doing a Covid swab because you have some symptoms that overlap with it, so you should hear back in about 24 to 48 hours with those results. But it does sound like what you're telling me with the wet cough and you know a little bit of shortness of breath, I think it's worthwhile to get a chest x-ray to see if you might possibly have a pneumonia, and if you do, if there is some consolidation we'll probably prescribe some antibiotics for that. Umm, how does that sound to you?
user: Sounds great to me. Yeah, I just you know, hope there's nothing serious going on. 

assistant: Yeah, yeah, and it shouldn't be. It's probably 1 something that's been going around in the community and you haven't had any recent hospitalizations or surgery, so I wouldn't worry about like any of those atypical bugs just yet.
user: OK, OK, that's good to hear. 

assistant: Yeah, for sure. Well, uhm, thank you.
user: Yeah, I'm just coming in with my son, he's been having, he's been complaining of just, seems like pain in his right ear for the last I would say three to four days. And it seems like he's just more irritable, just not himself right now. 

assistant: Yeah OK, so, how long did you say he's had this ear pain? 

user: I would say four days now. 

assistant: Four days, OK. Have you noticed any hearing loss?
user: Uh, no, he still responds when I call his name. 

assistant: OK and, have you noticed any fluid coming out of his ears? 

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

assistant: Is it more like one side of his ears or is it both ears?
user: It's just his right ear. 

assistant: Just his right ear, OK. And have you noticed that it's like, swollen, red or warm? 

user: Uh, no, I don't see any swelling or redness at all. 

assistant: OK, OK, good, and have you taken a look inside his ears?
user: Yeah, I tried to take a look with a flashlight. I couldn't really see too much. 

assistant: OK, yeah, that's fair. And you mentioned he's had a runny nose too, When did that start?
user: Yeah, so that, kind of like last week he was recovering from, I think it was just a cold and he had a runny nose and just was a bit congested. But then over the last week it kind of just resolved. But then this week he started having just this ear pain. 

assistant: OK. Any fevers? 

user: Uh, no, not that I, I haven't measured anything and he hasn't mentioned any, like he hasn't felt cold or anything like that. 

assistant: OK, any weight loss over the past month or so?
user: No. 

assistant: No, any change in his hair or nails, like rashes or, sorry, or skin? 

user: Yeah, no, I haven't seen any changes in the skin. 

assistant: OK, any changes in his vision or smell or taste?
user: No. 

assistant: No, OK. His runny nose, what color is it? 

user: It was mainly, uh, it seemed to me like it was mainly clear when it was happening, like he wasn't bringing up any yellow or green material. 

assistant: OK, good. Does he have a sore throat at all?
user: No, not that he's told me. He's still eating things and I don't think he's having any trouble with eating anything, so I don't think so. 

assistant: OK, that's good. Has he had a cough?
user: Uhm, actually he did. He did start coughing like yesterday, but just a few times a day. I don't know if it's because of this or like, what else might be going on. 

assistant: OK, and you said for the past few days, he's had the cough?
user: Yeah, I think just maybe started yesterday. 

assistant: Started yesterday, OK. Is it a dry cough or is it, is he bringing up any phlegm?
user: No, it seems to be just dry. I think I just noticed it like three or four times during the day yesterday. 

assistant: OK, so no blood that he's bringing up right?
user: No, no. 

assistant: OK, and does he have any shortness of breath?
user: No, no. 

assistant: No, OK, any wheezing? 

user: No, no wheezing. 

assistant: No chest pain?
user: No. 

assistant: OK, uhm, any nausea or vomiting? 

user: No nausea or vomiting. 

assistant: Any changes to his bowel movements?
user: No. 

assistant: No, OK and, how about urine, is that normal?
user: Yeah, Uh, no changes at all. 

assistant: Any headaches?
user: Not that he's told me about. 

assistant: OK, dizziness or fainting spells? 

user: No. 

assistant: Feeling like he's off balance or lost coordination?
user: No, I don't think so. 

assistant: No, OK, no numbness, no tingling?
user: No. 

assistant: Has he had any contacts with sick people recently?
user: Uhm, no, I don't think anyone's been sick around him. 

assistant: OK and has he traveled to anywhere recently? 

user: Uh, no, like, he's mainly just been inside his home. 

assistant: OK. has he ever had ear pain before?
user: He did have a similar pain, I think when he was like around three years old, but it happened with his left left ear, not the right one. 

assistant: OK, was he prescribed any medications?
user: Uh yeah, he was given a, like a course of antibiotics at that time. I forgot what it was called, but I think at that time it was much worse, like he, I don't know if he was just younger and couldn't tolerate it but I think he also had a fever at that time. 

assistant: OK, OK, and then any other ear infections outside of that one time. 

user: No, I think that, only that one I can recall. 

assistant: OK, alright, is he otherwise healthy?
user: Yeah, otherwise he's healthy. No, other conditions or anything like that. 

assistant: No hospitalizations or surgeries?
user: No. 

assistant: And is he on any medications?
user: No medications. 

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

user: Yeah, all his immunizations are good. 

assistant: OK, any allergies?
user: Not that we know of so far. 

assistant: And any family history of lung conditions or heart conditions. 

user: No lung or heart conditions. Just, his father does have like celiac disease, so I don't know if that's related at all. 

assistant: OK, how old was he when was diagnosed with celiac?
user: Fairly young I would say, in his 20s. 

assistant: OK, OK, uhm, alright, we'll keep an eye on it in him, like if he has any changes in his bowel movements or if he's getting severe abdominal pain after eating certain foods with gluten you can get him checked up for that as well.
user: OK. 

assistant: Yeah and then, in terms of where he lives, does he live with you and your partner? 

user: Yeah, so it's just, he's an only child, lives with me and my husband, and also we have like a pet dog. 

assistant: OK, do you live in an apartment or in a house?
user: We live in a, it's like a condominium. 

assistant: OK, OK, any old carpet, mold or asbestos in the building? 

user: No, no, nothing like that. It's fairly well kept. 

assistant: OK, And is he other-wise like developmental-wise, he's OK? There's no past history of like developmental disorders, anything like that?
user: No, no issues from like when he was younger like no complaints at all. I Think he was doing the same as every other child. 

assistant: OK, no complications during your pregnancy with him, no complications during the actual delivery and then when he was a newborn? 

user: Uh no, no complications, it was just a vaginal birth at 39 weeks and we didn't need to stay in the hospital at all afterwards. 

assistant: OK, good. So those were all the questions that I had for you today. Did you have any questions of your own?
user: Yeah, I don't know if, uh, like last time we did get some antibiotics. I don't know if he needs them right now or what would you recommend? 

assistant: Yeah, uhm so I'm gonna have to take a look into his ears first before I can come up with like a management plan for him. So once I do, if I see, uhm, if his tympanic membrane has been perforated or I see pus in there, we'll prescribe him like 10 days of antibiotics. We can give him either Amoxicillin, or if he has bad reactions to penicillins,  we can give him Cefuroxime and then if, uh, it doesn't seem to have any systemic symptoms, so if he has systemic symptoms like fever, which we'll check for today, and if he's like been really ill and he has like a middle ear effusion or bulging tympanic membrane, again we'll give him antibiotics for 10 days. But if his tympanic membrane is just bulging a little bit, or if he has some middle ear effusion but no systemic symptoms, like, no fevers, and he seems to be fine otherwise, we'll reassess him in 24 to 48 hours to see if he's better and if he's not, again, will prescribe him antibiotics. How does that sound?
user: I I've had this, uh pain in the right buttock area, it's been really intense, and more recently I'm feeling it like radiate just down my right leg as well. 

assistant: OK, and sorry when did you say it started?
user: So um it's been going on uh for, well, it's it's gotten really intense in the last uh like 2 days. 

assistant: OK, and before that, did you have any pain at all or was it just like sudden? 

user: Yeah, I do have a bit of pain uh down in my uh in in my buttock area. Um but um it's just gotten really uh, it's gotten more painful over these last couple of days. 

assistant: OK. Um and is it a persistent kind of pain? Or does it come and go?
user: Um it's uh persistent, it's it it does get worse though, depending on what what I'm doing. 

assistant: OK, what uh when does it get worse?
user: Um well it it gets it gets worse with walking, with sitting, um really any like any kinds of movements, like if I just gotta kind of stay still and that's the only thing that really helps it. 

assistant: OK, um have you tried anything for it?
user: Uh yeah, I'm just taking some pain medic medications over the counter for these last couple of days um like Advil and Tylenol, but that's it. 

assistant: OK, um and does, is it helping?
user: It does, I mean, uh not really, it hasn't really helped much. 

assistant: OK. Um alright, and if you were to describe the quality of the pain, would you say it's sharp, dull, achy, throbby?
user: Uh it um, kind of like a sharp pain in the in the buttock and um it it um it's kind of like burning uh down the leg. 

assistant: OK, OK, so a radicular kind of pain then. Um OK, and if you were to rate the severity of your pain 1 to 10, 10 being the worst pain you've ever felt, what would you rate it? 

user: 8. 

assistant: OK. And does this pain radiate elsewhere, I know you said it starts on your buttocks, kind of goes down your legs, does it go up your back or down into the other leg at all?
user: No, I feel it just uh just in the buttock and down the leg. 

assistant: OK, uh have you ever experienced this kind of pain before?
user: Uhm I have, yeah um I'm a a truck driver, and so I do a lot of uh a lot of sitting and I've had kind of sciatic pain um in the past. 

assistant: OK, and have you ever had any like trauma or anything that could have triggered this initially um in the past? 

user: No, I don't think so, I don't, I haven't really done much, just kind of work and um ueah, I haven't had any trauma to the back or anything like that. 

assistant: OK, and are you experiencing any sort of weakness with your legs?
user: Uh no no weakness, just um well, yeah, maybe I guess, maybe yeah, maybe a little bit of uh, leg weakness, I've had I've had a little bit of difficulty walking, been limping. 

assistant: Oh I see, OK. OK, and just in your right leg, right?
user: Yeah. 

assistant: Any urinary or um stool incontinence?
user: No, I haven't had anything like that. 

assistant: OK, um any numbness or tingling?
user: Yeah, I've I've had some numbness and tingling down the the right leg. 

assistant: OK, how about in the groin area?
user: No, it's just kind of down the back of my leg. 

assistant: OK, um alright, and otherwise do you have any other symptoms?
user: No, it's just been just been, uh, this pain. 

assistant: OK, alright. Um and I'll just kind of go through some questions with you. Do you have any joint pains or muscle aches elsewhere?
user: No. 

assistant: No weight loss?
user: No weight loss. 

assistant: Fevers or chills?
user: No fevers or chills. 

assistant: Uh rashes?
user: No rashes. 

assistant: Changes to your vision, hearing, smell, or taste? 

user: No. 

assistant: Um are you coughing, having shortness of breath, or wheezing?
user: No, I haven't been any, having any symptoms like that. 

assistant: OK, any chest pain, palpitations, uh or dizziness or fainting spells?
user: No, nothing like that. 

assistant: Any changes to your bowel movements?
user: No diarrhea or constipation. 

assistant: And no bleeding in the stool? 

user: No blood in the stool. 

assistant: OK. And then how about nausea or vomiting?
user: No, I haven't had any nausea or vomiting. 

assistant: OK, changes to your urine?
user: Uh no, no changes to the urine. 

assistant: OK, and are you otherwise healthy? Do you have any longstanding medical conditions? 

user: I do have um high blood pressure and uh high cholesterol and I take medications for those, I take amlodipine and um a statin. 

assistant: OK, do you have any other medical conditions, are are you on any other medications besides those?
user: Just a multivitamin. 

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

user: I am, yes. 

assistant: OK, any allergies?
user: Uh no, I don't believe so. 

assistant: No, uh family history of um musculoskeletal or neurological issues? 

user: Uh no, nothing like that. 

assistant: Uh autoimmune conditions?
user: No, nothing like that. 

assistant: Cancers?
user: No. 

assistant: No, OK. And do you smoke?
user: Um yeah, I smoke uh about um half a pack of cigarettes per day. 

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

user: Uh for uh yeah, about 40 years. 

assistant: 40 years, OK, have you ever thought of quitting?
user: I have, yeah, I've cut down over the years, um I used to smoke more, it's just the culture with uh, I don't know everybody's driving a truck and smoking. 

assistant: OK, yeah, that's hard. If you ever need any resources, we have some that we can refer you to.
user: Thank you. 

assistant: Yeah, no worries. And do you um consume marijuana? 

user: No, I don't. 

assistant: OK, how about other recreational drugs?
user: Uh nope, nothing like that before. 

assistant: OK, do you drink alcohol? 

user: Um yeah, I'll have a beer or two on the weekend, so maybe a couple of drinks per week. 

assistant: OK. Um and how about um do uh, sick contacts, have you been in touch with any recently?
user: No, I haven't been around anybody who's been sick. 

assistant: OK, um any travel recently? 

user: Uh just for the drop offs that I that I make um driving, I do have to make some pretty um long hauls uh back and forth um, the, yeah. 

assistant: OK. Um and where do you currently live?
user: So I live in a house with my um with my wife uh yeah and son. 

assistant: OK, alright and, OK so now I'm just going to move on to the physical exam part of this um and I'm going to ask you to do a few things, OK? So, well just by looking at your legs, or if you have a mirror um and you can look at your right buttock area, um do you see any swelling or redness?
user: Um no, I don't see anything like that. 

assistant: OK. And does it feel hot? 

user: No, it doesn't feel hot. 

assistant: OK. And do you see any skin changes?
user: No skin changes. 

assistant: Um any atrophy or deformity in the area? 

user: No. 

assistant: No, um has your gait changed, like does it, are you limping, hobbling, anything like that?
user: Um yeah, I feel like I've been limping a little bit, uh yeah. 

assistant: Are you putting more um pressure on the left foot then?
user: I am, yeah, yeah, I guess there's like an antalgic gait. 

assistant: OK, alright, and then um if you press down on your hipbone, do you feel any pain there? On your right hip bone. 

user: No, I don't. 

assistant: OK, how about when you press down on your buttocks itself?
user: Um yeah, there is uh a little bit of tenderness um over the buttock area. 

assistant: OK, how about the back of your legs? 

user: No. 

assistant: OK, how about the front um of your legs, thighs?
user: No. 

assistant: No, OK. Alright, um and then I'm gonna just get you to do a few movements um with me as well. Would you uh OK, so are you sitting down right now? 

user: Yeah. 

assistant: OK. Would you mind standing up from a sitting position?
user: Yeah, for sure. 

assistant: Does that hurt? 

user: It uh yeah, that that that causes pain. 

assistant: OK, so that causes, so um hip hip extension uh that causes some pain, um and as well as knee extension, so would you mind um kicking your right leg up in front of you all the way up as far as you can go?
user: Mhmm, oh yeah. 

assistant: Does that hurt?
user: It does, yeah. 

assistant: OK so right hip flexion um also causes pain, and then would you mind uh folding your knees backwards um and just sort of flexing it? Does that hurt?
user: Uh no. 

assistant: OK, so no pain at knee flexion. And how about when you point your feet um and toes up towards the ceiling?
user: Uhm yeah I I do get some pain with my um, yeah when that's all straightened out, yeah. 

assistant: OK, so some pain on um planter flexion of the right foot. And how about if you um point your feet and toes towards the ground? 

user: No pain there. 

assistant: OK, um alright and how about when you uh kick your legs uh to the side and upwards?
user: Oh uh no pain with abduction. 

assistant: OK so no pain on right hip abduction, and then how about when you bring it back down?
user: No. 

assistant: OK and no pain on hip adduction. OK, well those are all the questions that I have for you. Do you have any questions for myself?
user: Uh just wondering about possibly like what it could be. 

assistant: Yeah, um so it sounds um right now like you may have some sort of uh sacral nerve radiculopathy um or or like a lower lumbar, lumbar um radiculopathy, um basically uh that's known as sciatica, uh where your nerve roots can be compressed, causing some of these symptoms. Um and to diagnose these things, usually it's just done by history and physical exam um but if after we try out some management things, it doesn't go away or you're having some red flags, including um numbness in the groin area, bowel or bladder incontinence, then we can look at some um imaging for the for the spine, including MRI. Um and so in terms of management of this, um we can try a couple couple of like conservative approaches first, so that includes taking NSAIDs uh for the pain um and then like activity modification. So if you're sitting down um all the time, um perhaps like taking little breaks, uh stretching out your legs, doing some physio as well um during those breaks can help um, and as well, I'm going to give you a referral for physical therapy and they'll do some exercises with you and um slowly increase those exercises. Um and if those still don't work, we can try um steroids, steroid injections, um as well, we talked about the imaging if it doesn't go away in about 6 to 8 weeks. Does that sound OK?
user: I've had this like, pain in my knee. It started within the last few hours and my knee's swollen, it's painful. Um, I can barely move it. 

assistant: Okay, were you uh, did you injure yourself at all before the last few hours or anything? Any trauma to um, is it the right knee or the left knee? 

user: It's the left knee, an no, no trauma uh, or anything like that. I've never hurt this knee before in my life. 

assistant: Okay, and has this ever happened to you before?
user: Uh. Um, no, nothing in my joints. I've had other infections before, like in my skin, um, like cellulitis, but I, I've never had a knee, knee problem like this before. 

assistant: Okay, I see. And have you ever had cellulitis in that area?
user: Uh, I, I had it over, kind of my, uh, like over my foot before. 

assistant: Okay, and um, where would you describe the pain is? Is it like on the kneecap, is it above the kneecap, below? Where would you describe it?
user: I would say it's like my whole knee, it's like uh, I don't know, it looks like it's going to explode. 

assistant: Okay, is it like um, so, it's swollen, is it red and warm?
user: It is, yeah, it's really red. 

assistant: Okay
user: And warm as well. 

assistant: Okay, and how would you describe the pain? Um, is it like a sharp, stabbing pain, or is it an aching pain?
user: It's a, a stabbing pain. 

assistant: Okay, and uh, are you mainly having the pain with movement of your knee, or um, when you're pressing on it? 

user: Uh, I would say both, I can't um, I can't really move it, it'll give me pain. And even pressing on it, it's, it's quite painful. 

assistant: Okay. And on a scale of uh, 1 to 10, sorry 0 to 10, with 10 being the worst pain you've felt in your life, how much would you rate this pain?
user: Uh, it's a 9. 

assistant: A 9, okay. Um, so it just started a few hours ago. Is there anything that makes the pain better or worse? 

user: Um, I mean just trying to stay as still as possible is all I've been been doing so far, uh because, um, like any type of movement is really bad. 

assistant: Okay, and are you able to weight bear, are you able to stand and walk by yourself?
user: Uh, I, I was pretty much like hopping on one leg to, to get in here and as soon as I could, I got in a wheelchair, just because it uh, hurts so bad. 

assistant: Okay, and um, do you have any pain or symptoms in any other joints or muscles of your body? 

user: No, just, it's just my left knee. 

assistant: Just your left knee, okay. Um, do you have any other symptoms like fevers, chills, nausea or vomiting?
user: Um, I have felt uh, uh feverish, yeah. But then, yeah, I, I felt feverish and um, but I haven't had any chills, though. 

assistant: Okay, when were you feeling fevers?
user: Uh, just like, today, it's kind of, yeah, it started within the last day. 

assistant: Okay, and um, did you get a chance to measure your temperature at all? If not, we can do that here.
user: Um no, no, I didn't get to uh, I, I didn't check it. 

assistant: Okay, and have you been sick at all recently, either with um, any cold-like symptoms uh, or any GI symptoms, like diarrhea, um, constipation, anything like that?
user: Uh, no, I haven't had any, anything like that. 

assistant: Okay, and have you recently had any um, sexually transmitted diseases, or exposures to uh, ticks or lyme disease?
user: Uh, I don't think so. I've been just, in well, in the city. I haven't traveled anywhere, and I uh, I haven't been sexually active for, for quite a while now, so. 

assistant: Okay, okay. Uh, have you recently, at all, had um, any procedures done on your knee, like any surgeries or any joint like um, injections or aspirations? 

user: No, nothing done to my knee. 

assistant: Okay. Okay, um, so yeah, we'll take a temperature of your uh, fever, and, so are you able to flex or extend your knee at all, or is it very painful?
user: It's really painful. I uh, the movement's really limited. 

assistant: Okay, and has the pain been constant since it started a few hours ago.
user: Yeah, it's gotten uh, like it's, it's gotten slightly worse. 

assistant: Okay, I see. Okay, um, any skin changes or rashes anywhere on your body? 

user: No, it's just the red knee. 

assistant: Okay. Um, any changes in your weight or appetite?
user: Uh no, no. I haven't had any changes there. 

assistant: Okay, and otherwise, are you having um, any symptoms of uh, dizziness, fainting? 

user: Uh, no, I haven't had any of those symptoms. 

assistant: Okay, any weakness um, in your extremities?
user: No, no weakness. 

assistant: Okay, um, do you have any past medical conditions that you've been diagnosed with? Any diabetes? High blood pressure? 

user: Uh, I've been told my, my blood sugar has been like, it hasn't been controlled, so yeah, I think I have diabetes. Um, uh, but that's, that's it. 

assistant: Okay, um, do you take anything for medicate, medication for your diabetes?
user: Uh, yeah, I, I take metformin and um, and uh, yeah, that, that's all I've been taking, but, I mean, it's really hard for me to uh, like get my medication sometimes and so um, I don't always take it. 

assistant: Okay, I see. Um, and do you have any allergies to any medications?
user: Uh, not that I, not that I can think of. And, so something that I forgot to mention is uh, like I've had hepatitis in the past as well um, and uh, yeah. 

assistant: And do you know hepatitis you've had? 

user: Um, I've had, it was uh, hepatitis C and uh, I was, um, treated, I was treated for it. 

assistant: Okay. Okay, and how long ago was that?
user: That was about uh, two years ago. 

assistant: Okay, and uh, did they tell you like how it may have been transmitted at all? Was it, uh, sexually? Um, was it through um, use of IV drug use? And did they tell you what the likely cause was?
user: Uh, well like, any, anything that I, that I can usually. But I, I guess like um, various types of opioids are kind of the, the, the main thing that I'll, that I'll use. 

assistant: Okay, and have you um, injected uh, drugs recently at all? 

user: Uh, yeah I, about uh, about two days ago was the last time. 

assistant: Okay, okay. And um, do you use any other uh, drugs? Any recreational drugs like marijuana or any, do you inject any other drugs at all?
user: Yeah, I'll smoke, uh, smoke marijuana as well and um, like, I'll sometimes like, I'll take uh, pills too like dilaudid is um, is something that I'll, I'll get my hands on, but it can be expensive so, um, just, just whatever is available. 

assistant: Okay. Um, have you had uh, when was the last time you had cellulitis? 

user: Uh, he last time was about six months ago. 

assistant: Okay, and were you admitted at all, or were you treated as an outpatient?
user: Uh, I was treated as an outpatient for that, and it did clear up. It wasn't the first time that I've, I've had cellulitis and, and um, yeah, so it was treated. 

assistant: Okay, have you had any hospitalizations or surgeries in the past?
user: Um no, I haven't. 

assistant: Okay. Uh, any family history of any conditions um, musculoskeletal or rheumatologic conditions? Uh, any rheumatoid arthritis, anything like that? 

user: Uh, I don't think so. 

assistant: Okay. And currently, right now, um, what is your living situation like?
user: Uh, so um, I just live with uh, two of my, um, or actually sorry no, I live with my uh, with my parents and uh, yeah, so it's just both my parents. 

assistant: Okay. And, um, do you currently work? 

user: Uh, I was working until like, I um, yeah about uh, about 15 years ago and now I, like I got injured on the, uh, um at work and I've had like chronic back pain and I don't know, I think that's kind of how this partly all, all started. So I've been at home receiving uh, I'm on disability. 

assistant: Okay. And do you smoke cigarettes?
user: Uh, I do, yeah I, I, I smoke um, about half a pack uh, to a pack a day. 

assistant: Okay, and how long have you been smoking for?
user: Uh, so this has been, uh, about 20 years. 

assistant: 20 years, okay. And do you drink alcohol? 

user: Um, sometimes yeah. I'll, I'll have uh, just a few beers, maybe a few beers a week. 

assistant: Okay, and yeah, we were just talking about some of uh, like the movement, but you're saying you have pain with any kind of movement at all, right?
user: Yeah, it, it's really painful, I just, I try not to move it at all. 

assistant: And it's very red and swollen and warm as well? 

user: Yeah, all of those. 

assistant: Any symptoms at all in your hips or ankle?