jshargo/medical-interview-conversations2 huggingface dataset:
user: So I've had a fever that I measured this morning and I had a cough.  I've had a cough these last several days. Yeah, today is Friday so it started Monday, so I guess like yeah the cough started four days ago. 

assistant: OK, and the fever started four days ago as well? 

user: Well, I've been feeling hot this week, but I checked my temperature this morning and it was the first time I checked it and it was 38.5. 

assistant: OK, so that's definitely a fever, so we can take your temperature today as well. Umm, so have your symptoms been the same or getting worse, or be getting better over the past few days?
user: They are getting worse. I've been starting to feel really fatigued and, uh, tired as well and the cough has gotten worse too. 

assistant: OK, have you ever felt like this before? 

user: I mean, maybe a really long time ago when I was a kid or something like that. Maybe I had the flu, but nothing recently. 

assistant: OK. And do you have a sore throat at all?
user: No sore throat. It does get a little scratchy with my cough but hasn't been sore. 

assistant: OK, and do you have any issues swallowing food? 

user: No, but I haven't been as hungry. 

assistant: OK, you haven't been as hungry. Um, have you had any changes to your taste?
user: No, I feel like I've been tasting my food OK. 

assistant: OK, how about smell? 

user: I feel like I've been able to smell. 

assistant: OK, do you have a runny nose or a blocked nose? Do you feel congested?
user: Maybe a little runny, but not too bad. 

assistant: OK, how about your hearing or vision? Any changes there?
user: No, I haven't noticed anything. 

assistant: OK, any pain or discharge from either your ears or eyes?
user: No, nothing like that. 

assistant: OK, so let's go back to the cough. Um, are you producing any sputum?
user: No sputum. 

assistant: OK, so it's a dry cough?
user: Yeah it is. 

assistant: OK, any blood associated with the cough? 

user: I haven't seen any blood. 

assistant: OK, do you feel wheezy at all?
user: I haven't noticed any wheezing. 

assistant: OK, how about shortness of breath?
user: Usually well, after some of my coughing fits, I can be a little bit shorter in breath, but otherwise they've been. 

assistant: OK, any chest pain?
user: No, I haven't had any chest pain. 

assistant: Do you ever feel like your heart's racing? 

user: No, I don't. 

assistant: OK, and any night sweats or chills?
user: I have felt a little chilly at night, but I haven't had any night sweats. 

assistant: OK, and how about weight loss? Have you had any weight loss over the past few months?
user: No, it's been about the same. Maybe down a few pounds over this week as I just haven't been eating as much. 

assistant: OK, yeah. Umm, does anything make the cough better or worse? 

user: Umm, no, I can't think of anything. 

assistant: OK, and how have your bowel movements been?
user: They've, I would say they've been normal. 

assistant: OK, and any abdominal pain?
user: No pain, but I have been a little nauseous. 

assistant: Nauseous, OK. Have you thrown up?
user: No, I haven't vomited, but I've certainly felt like it a few times. 

assistant: OK, and any triggers for your nausea?
user: Oh I can't think of anything. It just sort of came on. And it really went away on its own pretty quickly, but uh I don't know, maybe it was when I had my headache. 

assistant: OK, when when did your headache start? 

user: Um, so it's been on and off these last several days so I've been kind of resting a bit more too. 

assistant: OK yeah, you said past several days, have you ever had headaches before that?
user: Yeah, I've had, I think they're called tension headaches. I get those every so often and will take Advil or something like that for them, and they usually go away. 

assistant: OK. Do these headaches feel like the same headaches? 

user: Yeah, they they feel about the same, kind of like a pressure or vice grip on my head. 

assistant: OK, so it's not like the worst headache you've ever experienced?
user: No, I think it's just been a part of how I haven't been feeling well these these last few days. 

assistant: OK, yeah. Do you feel fatigued or tired at all? 

user: Yeah, for sure. I haven't really had any changes, but just haven't been really getting my work done throughout the day because I have just been feeling so tired. 

assistant: Yeah, umm, and do you feel any sort of body aches that go along with your fatigue?
user: Maybe a little. 

assistant: OK. Umm, can you think of anything that may have caused your symptoms? You know, have you been in contact with anyone who's been sick recently?
user: I can't think of anybody I've been around who's been sick, but last weekend I went shopping in the mall so I went into quite a few stores. 

assistant: OK, and you were wearing your mask? Everyone else was wearing their mask? 

user: Yeah, everybody far as I could tell. 

assistant: OK, have you traveled anywhere recently?
user: Uh, no, I've just been home. 

assistant: OK, I just want to ask you a few more questions. Any memory loss or confusion? 

user: No. 

assistant: Any dizziness or fainting spells?
user: Nothing like that, no. 

assistant: OK. Are you otherwise healthy?
user: Um, yeah I've well, I've been told I had high cholesterol so I've been taking Rosuvastatin for that the past few years. 

assistant: OK, and is it helping with the cholesterol levels?
user: Yeah, the last time I was at the family doctor I was told they were at a good level. O 

assistant: OK, good. 

user: I'm sorry I'm pre-diabetic as well. 

assistant: OK, when was the last time you had blood work done?
user: : I think, uh six months ago. 

assistant: OK, and that's when you were told you were pre-diabetic? 

user: Yeah, I think my A1C was like 6.2% so uh, on the cusp. 

assistant: OK, yeah, that's understandable. Um, have you made any sort of lifestyle changes to get your blood glucose under control?
user: Well, I have been walking the dog more. he weather is getting better and trying to eat out less often. Yeah, I've been trying to lose weight, but it it's been yeah, relatively stable still. 

assistant: OK, we can review some options with you later on in the visit if you would like. 

user: Yeah, certainly we can talk about that later. 

assistant: OK, sounds good. Have you had any surgeries or hospitalizations in the past?
user: Yeah I had an inguinal hernia repaired about five years ago. 

assistant: And are you on any medications?
user: Just Rosuvastatin right now. 

assistant: OK, and any over the counter medications or herbal supplements?
user: Just a multi vitamin. 

assistant: OK, umm, do you have any allergies? 

user: Penicillin. I break out in hives. 

assistant: OK, and did you need to be treated with any sort of antibiotics recently?
user: No, no, I haven't had any antibiotics for a long time. 

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

assistant: OK, good. An yeah, that's really good. Um, do you know if you have any family history of any lung conditions or heart conditions? 

user: No, I don't think so. 

assistant: OK, how about cancers in the family?
user: I think my grandfather had bladder cancer, but, uh, I'm not sure. 

assistant: OK, and I forget if I asked you earlier, but have you had any changes to your urinary habits, any changes in your urine itself or voiding frequency?
user: No, I haven't had any changes there and I haven't noticed any like blood or color changes. No pain. 

assistant: OK, great. And do you smoke?
user: Um, no I do not. 

assistant: OK, how about marijuana?
user: Nope. 

assistant: Any other recreational drug?
user: No, I just have a few beers on the weekend. Like probably I don't know two or three on Saturday and Sunday. 

assistant: OK, and where do you live?
user: I live in a like duplex and rent the basement in a house nearby. 

assistant: OK, do you live with anyone?
user: Yeah, I live with my girlfriend. 

assistant: OK, and um, any concerns for you know old carpets or mold or asbestos in the duplex that you're living in? 

user: Not in our unit so I mean, maybe upstairs, but if it's anything like our place, then no. 

assistant: OK. I think those were all the questions that I had for you. Did you have any questions or concerns that you wanted to bring up before we end the interview?
user: Uh, no, well  I guess I was just concerned about about COVID. 

assistant: Yeah, you know that's the top on my list of differential diagnosis for you. So what we'll do is a COVID swab and that should come back in a day or so, but we do encourage isolation for 14 days and that includes from your girlfriend as well. So even if the COVID swab comes back negative, sometimes it can be false negative, so as long as you're having these symptoms, and these symptoms are common in COVID,  we do ask that you isolate for 14 days if the swab comes back positive. We will also notify public health so that they can get in touch with you and do some contact tracing to see where you may have gotten COVID from, but other than that, if it's not COVID, it could likely be another upper respiratory viral illness because of this time of year. A lot of different viruses are going around like common viruses or the flu, you know, so it could be one of those. And then if you're still sick or your symptoms change, we can reassess to make sure it's not a bacterial infection or bacterial pneumonia, in which case we can prescribe antibiotics.
user: I've just been having this this cough over the last few days and I also notice that I'm getting like these headaches and chills as well at night. So I was just a bit concerned. 

assistant: OK, so the cough started a few days ago. Have you been bringing up any phlegm?
user: No, not really. It's been pretty much like a dry cough. I did feel like a tickle in my throat before it started, but no, I'm not producing any phlegm. 

assistant: OK, um is the cough any worse at any particular time of day, like when you first get up or or at night when going to bed? 

user: No, it's pretty much just been there over the last, at least like 2 days. It's been getting worse, more frequent. 

assistant: OK, so um and are you coughing all throughout the day?
user: Pretty much, at least for the last few days. Just it's been pretty nonstop. 

assistant: OK, anything that's made the cough worse?
user: Uh, no, not really. It's uh, pretty much been the same for the last few days. 

assistant: Anything you've tried to make the cough go away? 

user: Just like Tylenol cold. And then I think there was another over the counter medication that I took, but nothing really helping. 

assistant: OK and uh, the cough has been been getting worse. Have you been experiencing any other symptoms?
user: Um, I did just just last night, actually. I thought that I had some shortness of breath as well. I don't know if that's being caused by all the coughing, but yeah, I got pretty scared, so that's why I'm here today. 

assistant: OK, um has anything like this happened to you before?
user: No, like I've been pretty healthy otherwise completely so this is this is completely new for me. 

assistant: Ok, and yeah, you mentioned you had a fever but did have you checked your temperature? 

user: No, I haven't I I just had like chills over the last two nights. Just had to put on like 3 three blankets just to get to sleep, but I haven't really checked my temperature. 

assistant: OK, I have you had night sweats?
user: No, not really, just mostly chills. 

assistant: OK, and how has your energy been the last few days, have you have you had a lot of fatigue?
user: Yeah, I just feel completely just sick like what it feels like I have the flu or something and I just feel really tired too. 

assistant: OK, have you had a runny nose or sore throat? 

user: No, not really. I did have like a I don't know if it was soreness, but just like a tickle in my throat just a few days back before the coughing started. 

assistant: OK, yeah. And have you had any loss of smell or or loss of taste?
user: Yeah, now that I think of it, I I I I can't I can barely taste taste the food that I'm eating. I don't know about smell I I'm pretty stuff stuff stuffy right now so that might just be because of that. I definitely notice I can't really taste my food. 

assistant: Alright. Uh, and uh, have you been having any wheezing? 

user: No, no wheezing. 

assistant: Alright, and shortness of breath, were you at rest when that that happened or were you exercising or exerting yourself? What, how did the shortness of breath come on?
user: I was actually just laying down and I was sleeping and I just noticed that I couldn't really take deep breaths, so I kind of just got back up and it was just during last night. It hasn't happened after that, but I'm scared it will happen again. 

assistant: OK, and have you, how many pillows do you usually sleep with? 

user: Just one. 

assistant: Have you noticed any swelling in your feet or ankles?
user: No, nothing like that. 

assistant: Alright, have you had any chest pain?
user: No, no chest pain. 

assistant: Any feeling, any episodes where you feel like you were gonna faint?
user: No. 

assistant: Feeling like your heart's racing? 

user: No. 

assistant: Alright, um, have you been having any abdominal pains?
user: No abdominal pains. 

assistant: Alright, how about urinary problems? 

user: No, nothing like that. 

assistant: Any bowel problems like diarrhea?
user: No, it's pretty regular. 

assistant: OK, have you noticed any rashes anywhere? 

user: No. 

assistant: Alright, and then how about like muscle aches or or joint aches?
user: No, nothing like that, just feeling tired. 

assistant: OK and then have you had any changes to your vision? 

user: No. 

assistant: Like blurred vision or things like that?
user: No, nothing like that. 

assistant: Any changes to your voice, like it sounds more hoarse to you or? 

user: No, not really. 

assistant: Oh, OK, and any nausea or vomiting?
user: I did feel a bit nauseous over the last two days, but I haven't vomited. 

assistant: OK and have you been diagnosed with any medical conditions in the past?
user: No, I've been pretty lucky. No medical conditions. I don't even take any medications either. 

assistant: OK, anything over the counter like supplements or herbal?
user: No, just just the cold medications over the counter, nothing else. 

assistant: OK, any allergies to medications?
user: Not that I know. 

assistant: Any hospitalizations?
user: No. 

assistant: Have you had any prior surgeries?
user: Nope. 

assistant: OK, um, and could you tell me a little bit about your living situation now?
user: Oh yeah, so I just live in a townhouse with my wife and two children. And yeah, currently, working as an engineer. Yeah, pretty everything else is pretty good. 

assistant: OK, um have you had to miss work over the last few days? 

user: Yeah, I actually didn't go to work yesterday, just felt terrible yesterday. 

assistant: OK how have the wife and kids been feeling at home?
user: They're actually completely fine now. They don't seem to have any any symptoms of like coughing or anything like that. 

assistant: Anybody at work that's been sick? 

user: There was actually like just we work in the same kind of office setting. One of my coworkers was coughing just last week and like you know, my boss told us, told him to like, go home and get some rest and he was away for a couple days. 

assistant: OK, uh, do you know what um what he had or anything like that?
user: No, I'm not really sure. Now that I think of it, like I I don't I haven't seen him since. Uh, so I haven't really asked him. Yeah, I'm not really sure. 

assistant: OK. Has have you traveled anywhere, or has anybody in your office been been traveling anywhere? 

user: No, not really. Not that I know, everything is pretty strict right now with with the pandemic going on. 

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

assistant: Do you drink alcohol? 

user: Just rarely, maybe a couple times a month. 

assistant: OK, do you use recreational drugs like IV drug use or opioids or crystal meth, anything like that?
user: No, nothing like that. 

assistant: OK, and are you currently sexually active? 

user: Yep. 

assistant: OK, could you tell me a little bit about your your partner or partners?
user: Just my wife, no other sexual partners. 

assistant: OK and have you had a sexually transmitted infection before? 

user: Nope. 

assistant: OK, and so in regards to your family history, has anybody had similar symptoms before?
user: No, not really. Not nothing like this. 

assistant: OK, any heart attacks or strokes in the family? 

user: No. 

assistant: OK, and then how about so any cancers in the family?
user: Hi there, yeah I've had this pain in my knee that's been going on for a few weeks now and it hasn't gone away and and so I thought I would get checked out. It's been really impacting my running. I just haven't been able to run as often as I would like to and so that's why I wanted to get this looked at. 

assistant: Yeah, for sure. You said it started a couple of weeks ago. Was that two weeks ago, three weeks ago? Or more than that? 

user: Yeah, I would say maybe it's been going on for the past four weeks, for the past month. 

assistant: Past month. OK. And is it a constant type of pain or does it come and go?
user: It comes and goes, yeah, and it depends on what I'm doing. 

assistant: OK. Uhm, alright and what kind of makes it worse or better?
user: So if I'm out while running, what will bug it, but I think like that the main things that hurt are if I'm walking down stairs or if if I'm squatting. I like to lift weights as well, and yeah, I could barely even do body weight now 'cause if I I'm squatting down it causes a lot of pain, it's a sharp pain. 

assistant: OK. OK, and if you were to describe the quality of your pain, would you say it's achy, throbbing, dull, sharp, burning? 

user: Uh, it's a sharp pain. 

assistant: Sharp pain, OK. And one to 10, 10 being the worst pain you've ever had. How bad is this pain?
user: It's about a 7. 

assistant: 7. And have you ever had pain like this in the past? 

user: Uh, no, I haven't. 

assistant: OK, and do you feel like your pains getting worse over the past four weeks?
user: Uh, yeah it has gotten, has gotten a bit worse. 

assistant: OK, uhm, alright, and do you, are you experiencing any sort of muscle weakness? 

user: No muscle weakness. 

assistant: No, OK. How about numbness or tingling?
user: No numbness or tingling. 

assistant: Headaches? 

user: No. 

assistant: Confusion or memory loss?
user: Nope. 

assistant: Any joint pains or muscle aches outside of the area of this left knee?
user: No, just, just the left knee. 

assistant: And whereabouts on the left knee, is it?
user: It's on the anterior aspect. Like on the front of it, but I I could, it feels like the pain is right behind my like right underneath the kneecap. 

assistant: Right underneath the knee, OK.
user: Yeah. 

assistant: OK. Alright and otherwise like have you had any weight loss? 

user: No, my way it's been the same. 

assistant: OK, how about fevers or chills?
user: No fevers or chills. 

assistant: OK. How about fatigue? 

user: No fatigue, energy's been good. 

assistant: OK. Changes in your hair or nails like rashes?
user: No, nothing, nothing like that. 

assistant: OK. Changes in your vision, hearing, smell or taste? 

user: Nope, that's all been normal. 

assistant: OK, alright. How about coughing, shortness of breath, or wheezing?
user: Uh, no, not not-nothing like that. 

assistant: OK, chest pain or heart palpitations? 

user: Nope. No chest pain or or anything like that. 

assistant: OK. Any changes in your bowel movements?
user: Nope, I haven't had any diarrhea or any blood. 

assistant: OK, any changes in your urination? 

user: No. 

assistant: No, OK. Alright, and are you otherwise healthy or do you have any longstanding medical conditions?
user: I do have, ah, asthma, so I I do take a, an inhaler. I have a daily, a daily one that I'll use and then, just a, like rescue one. So like the blue one that I'll use sometimes, but I haven't needed that one for for awhile. I've been pretty good. I don't even need it when I'm going or runs anymore. 

assistant: OK, OK that's good. And are you on any medications? 

user: Yeah, just the just the inhalers and then I took uh, birth control as well. I've been taking that since I was 16 so, yeah, so for like 6 years? 7 years? 

assistant: OK alright. And are you, have you been hospitalized or had surgeries in the past?
user: No, I haven't had any. 

assistant: OK, how about immunizations? Are you up to date? 

user: I am, yes. 

assistant: OK, how about allergies? Do you have any?
user: Uh, I, uhm, I don't, no. 

assistant: No allergies, OK, good. And any family history of musculoskeletal issues. 

user: Uh, no, ah, well, I think my grandparents have like osteoarthritis or something like that. They, but, that's it. 

assistant: OK. Uhm, how about longer heart conditions?
user: No, nothing like that. 

assistant: OK. And any autoimmune conditions? 

user: No, I don't believe so. 

assistant: No, OK. How about cancers?
user: Uh, no, no cancers in the family. 

assistant: OK, And, and do you smoke?
user: No, I I try to stay away from that with all the running and stuff that I'm doing. I'm uh, I want to make sure that I'm able to to improve. 

assistant: Yeah, for sure. And how about marijuana? Do you consume that in any form?
user: No, I don't. 

assistant: No, OK, and how about recreational drugs?
user: No, I stay away from that stuff too. 

assistant: OK, OK, good. And who do you live with and where do you live right now?
user: So I live with a couple of roommates at school, just finishing up my undergraduate degree. 

assistant: OK, OK. Uhm, have you been in contact with anyone sick recently? 

user: No, I don't, I don't think so. Everybody's been been healthy. 

assistant: OK, OK, and travel anywhere?
user: No, we've been at, been at home. 

assistant: OK. OK, uhm, alright, so I think those are all the questions that I have for you. Let's move on to the physical exam part of this interview, if that's OK with you. So I'm going to get you to take a look at both your knees and let me know if you see more redness or swelling in your left knee compared to your right. 

user: Uh, no, I'm not noticing any swelling. 

assistant: Do you see any redness?
user: No, no redness. 

assistant: No, OK. How about any atrophy, deformities, or skin changes in your left knee compared to your right knee? 

user: No, nothing like that. 

assistant: No, OK. I'm gonna get you to press down and palpate on your quadriceps on both knee. Sorry, on both thighs. Do you feel any pain there?
user: Uh, no pain there. 

assistant: OK, how about when you press down on your knee caps?
user: Yeah, I do get some pain when I push on the on the kneecap, uhm, on my left knee. 

assistant: OK, how about just below that where your shins start?
user: No pain there. 

assistant: No pain there, and then how about on the lateral aspects of your knee? 

user: Ah, no pain there. 

assistant: And then the medial aspects of your knee?
user: No pain there. 

assistant: No pain there. OK, good. When you are palpating, was there a difference in temperature between the left and right knee? Was the left knee a little bit more warm than the right knee? 

user: No, the temperature feels the same. 

assistant: OK, OK, good. So now I'm going to uhm, are you sitting down?
user: I am yes. 

assistant: OK, so from a sitting position I'm going to get you to stand up uhm, and you let me know if that is painful. 

user: It is, yeah. 

assistant: Yeah, OK. Uhm, and then how about when you bend your knees?
user: Uhm, no, no pain with just bending. 

assistant: OK, how about when you, uh, when you flex your hips so you can do one leg at a time, does that hurt? 

user: Oh no, that doesn't hurt. 

assistant: OK. And how about squatting down?
user: That does hurt. Yeah, squatting hurts. 

assistant: Squatting hurts OK. OK and then how about when you point your toes towards the ceiling?
user: No pain. 

assistant: OK. How about when you point your toes towards the ground? 

user: No pain. 

assistant: No pain. So no pain on dorsiflexion or planter flexion, OK. Do you hear any like popping or crackling sounds in your knees when you climb stairs or when you're standing up after sitting down for a long time?
user: Yeah, yeah, sometimes I will hear, uhm, some, some like yeah, crackling sounds. 

assistant: OK, alright and yeah, you mentioned that you do a lot of running. Do you do any other sorts of exercises? 

user: Yeah, I'll do some weight lifting and like cycling as well. I mean, all kinds of different stuff. We just, like staying as active as I can. 

assistant: OK, alright yeah, given your young age and the fact that you do a lot of running and a lot of physical activity like cycling and lifting weights, what you have is most likely something called a Patellofemoral syndrome and that is basically a nerve. Uh kind of pain and then in the in the soft tissues and bone around your kneecap. Uhm, and it's basically happens because of overuse, so vigorous physical activities that put repeated stress on your knees, like running and cycling, uhm, can cause that or just like improper sports training techniques. Uhm, we can do a few things that that'll help with the pain. So for a little bit, if you could hold off on the running that would be good. So, in the meantime, while you while you switch to like low impact activities, whether that's like riding a stationary bike or swimming, you can also try something called the RICE method and so that stands for resting, uhm, so avoiding putting any strain on that knee using ice packs for several days, compression, so wrapping your knee in like an elastic bandage, as well as elevating your knees higher than your, then the level of your chest can help. And then with the sharp pain you could also also take ibuprofen for pain management. Uhm, yeah, so we can start there if it doesn't get better we can also order an x-ray just to rule out other things that could have caused this pain in your knee. And if none of those nonsurgical treatments work, oh sorry, I also forgot to mention will also refer you to physiotherapy to help you with the range of motion and strength and endurance. But of those non surgical treatments work we'll also refer you to like am arthroscopy or some sort of surgery that may be able to fix the issue more permanently. Does that sound OK?
user: It does, yeah, thank you. 

assistant: OK, yeah, no worries.
user: Yeah, that sounds great. Thank you. 

assistant: Can you tell me about what brought you in today? 

user: Yeah, I've had this cough for the past four or five days and it doesn't seem to be going away or getting better, so I thought I should get it checked out. 

assistant: OK, are you here with your mom today?
user: I am. 

assistant: Hi mum. Um OK. You got a cough you said I'm sorry, you said for five days?
user: For, yeah, four to five days ish, yeah? 

assistant: OK. And, uh, has it you said it was a dry cough? Is that right? 

user: Yeah, that's right. 

assistant: OK, so at no point were you bringing up on gunk with your cough?
user: Yeah. No, no, nothing like that. 

assistant: OK. Since it started, do you think it's gotten worse or has it kind of stayed the same? Gotten any better? 

user: It's kind of stayed the same. 

assistant: OK. OK, uhm. Along with the cough have have you been having any other new symptoms?
user: Uh no. 

assistant: OK, have you had a sore throat? 

user: No. 

assistant: Do you feel like you can taste and smell things normally?
user: Yeah, I think so. 

assistant: OK. OK, have you been having a runny nose? 

user: Oh yes, I have had that for the past couple of days as well. 

assistant: And is it a runny nose with kind of clear stuff? Is it watery or is it thick? Does it have a color to it a yucky the color?
user: It's pretty clear. 

assistant: OK, OK. Uhm. And uh have you had any fevers? Your mom might be able to answer that one better.
user: Yeah, um. He has had uh like he's had fevers in the past, but I I didn't really check this time. He didn't seem hot. He didn't have any chills. 

assistant: OK, well that's good. Uhm. OK, have you had any back or muscle pain?
user: No. 

assistant: OK. Have you had any chest pain?
user: Uh no, no chest pain. 

assistant: OK. Any, any nausea or vomiting?
user: Uh no, no nausea or vomiting. 

assistant: Have you ever had any pain in your belly? 

user: No, nope that no pain in my belly. 

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

assistant: OK, have you been around anyone that's been sick?
user: No, not that not that I can remember. 

assistant: OK. Uhm, have you traveled anywhere recently? 

user: Uh nope. 

assistant: Are you going to school right now or staying home?
user: I’m going to school and they're doing these half days. 

assistant: OK. OK uhm, and has anyone in your school been sick? 

user: Ah, Nope, not recently. 

assistant: At least not that we know of. OK.
user: No. 

assistant: OK, have you ever had anything like this before?
user: No. I've been pretty healthy otherwise. I've never had like I've never had like a dry cough like this. I've had runny nose in the past, but they never lasted this long. 

assistant: OK, have you ever been in the hospital?
user: No. 

assistant: OK. Did you see your family doctor for anything? Any health problems?
user: No, no. 

assistant: Do you take any medicines? 

user: No. 

assistant: OK. This may be a tricky one to answer, so Mom can definitely help us. Do you have any family history of respiratory problems?
user: Um uh his grandparents had um asthma, but he's been worked up for that and he doesn't get short of breath or wheezing or anything like that with even with physical activity. So yeah, so he doesn't have that. 

assistant: And what else? 

user: Pardon me. 

assistant: I said just some some asthma in the family.
user: Yeah. 

assistant: OK. And so you live, you live with your mom. Do you live with anyone else in your family? 

user: I have a four year old sister. 

assistant: OK, do you live with your dad too?
user: Yes. 

assistant: Do you guys have any pets? 

user: Um no, no pets. 

assistant: And does anyone smoke in the home?
user: Nope, no. 

assistant: OK, and what do you like to do for fun? 

user: Um I like playing with my friends, I like playing video games. 

assistant: Oh cool. So what's your favorite game?
user: I am playing Rollercoaster Tycoon. 

assistant: Oh cool, that sounds like fun. OK well, hopefully we can get you back to feeling healthy so you can continue to play lots of roller coaster Tycoon. So I’m going to go get the doctor that I'm working with. I'm, uh, I'm wondering, you know, he might want to do a chest X Ray and get a better look at what's going on there. Have you ever had an X Ray before?
user: I don't think so, no. 

assistant: Do you know what an X Ray is?
user: A little bit, yeah. 

assistant: Yeah it's like taking picture of your body on the inside. It's pretty cool so it gives us an idea of what's going on in the inside. Also, this really this part is kind of not so much fun, but I think we should probably do a covid swab because we're doing that with anyone that comes in with these symptoms lately and that's not a lot of fun. We gotta stick something up your nose, but I think that you're really brave and I think that you'll be just fine with it, OK? 

user: OK. 

assistant: So we're going to arrange for these things and then I will come back with the doctor that I'm working with and we'll kind of talk about where to go from here.
user: OK, that sounds good. 

assistant: Thank you guys for chatting with me. 

user: Yeah, thank you. 

assistant: Thanks.
user: Hi, I just came in uh, I just had this sudden, just this morning after I woke up, this sudden shortness of breath and like each time I take a deep breath I'm getting this chest pain. 

assistant: Okay, and this just started this morning, you said?
user: Yeah. 

assistant: Were you absolutely fine last night?
user: Yeah, I didn't have any trouble last night. 

assistant: I see, I see, okay. Um, any other, does the chest pain only occur when you're taking a deep breath in? 

user: Yeah, mainly it's during that time. 

assistant: Okay, um, have you had any other symptoms such as a headache or cough, or runny nose, congestion, sore throat?
user: Um, no. No, nothing like that. 

assistant: And changes in your bowel movement? Any pain in your belly? 

user: No. 

assistant: Any urinary symptoms?
user: No. 

assistant: Any um, any pain in your legs?
user: Um, I did notice last, last night and for the last few days that my right calf like, just feels um, painful and it seems a bit more swollen. 

assistant: Um, was there anything that you were doing a couple of days ago? Any, say, any flights or periods um, where you might be sitting still or lying still for awhile? Any surgeries, anything like that?
user: I was, I was just discharged from the hospital um, last week after a hip surgery. 

assistant: Um, okay. Were you moving around at home after the hip surgery? 

user: Um not, not really. Like I was, I was told I should move around a bit, but it's been quite hard. 

assistant: Um, alright, and do you have any medical conditions that you've been diagnosed with?
user: Yes, I have uh, high blood pressure, and um, I also have this thing like, like varicose veins. 

assistant: Um, do you take any medications? 

user: I, I take this medication called um, lisinopril. 

assistant: And any new medications that were started after your hospital stay?
user: Um, no, they gave me like some pain medications I seem to, uh, um I got hydromorphone medication. I've been trying to stay away from it though, just taking Tylenol instead. 

assistant: Is your pain controlled well with Tylenol?
user: Yeah, I tried to suck it up. I just don't wanna go on those other medications. I've heard like, you can get addicted to them. 

assistant: Yeah, that's fair, that's a fair point. But it's also, I guess it's important that you move around at home. Um, so maybe try to, maybe we can increase your Tylenol dose, or maybe um, see if there's another pain med that you can be started on if you're not interested in opioids, just to make sure that you're moving around 'cause that's very important. At the hospital, did you receive an injection in your, in your tummy. 

user: An injection in my tummy, um. 

assistant: Every day, once a day?
user: I think so, yeah I did. 

assistant: Okay, okay. Um, alright. And do you have any allergies?
user: Uh, no allergies. 

assistant: Okay, um, and who do you live with? 

user: I live alone. Yeah, right now I live alone in an apartment. 

assistant: Were you discharged with any support?
user: Yeah, I do have a nurse coming in, like every, everyday, but I don't, they, they didn't come like yesterday. 

assistant: Okay, okay. Um, and do you smoke, or did you ever smoke in the past?
user: I used to smoke in, probably in my 20s and 30s, but then I stopped when I had kids and stuff. 

assistant: Do you drink alcohol? 

user: Um, yeah, probably uh, a glass, once or twice um, every couple days. 

assistant: Um, and sorry. just going back, how much did you smoke in your 20s and 30s and for how many years?
user: Probably smoked for, probably, 15, 15 years, probably like, like half a pack a day. 

assistant: Alright um, and do you consume any marijuana or any recreational drugs? 

user: No. 

assistant: Okay, alright. Well given your symptoms, um, with the, with the swelling and the pain in the right calf and the difficulties breathing, it's very likely that you have um, and your recent hospitalization and hip injury, um it sounds like you might have something called, or pulmonary embolism, basically, which is a blood clot inside your lungs, and so we'll do a scan of your lungs to see what's going on. We'll also do an ultrasound of your leg, and then um, we might have to treat, uh, this with blood thinners. And we definitely have to hospitalize you, and we'll be measuring your vitals and seeing if you need any oxygen to help you out.
user: Okay, I'll be, I'll be here for a while then? 

assistant: Well, we'll keep you for a bit, at least the next couple of days until your, your breathing gets better. And you've, you've been started on anti, on blood thinners.
user: Okay. 

assistant: And we can be sure that you're, you're doing okay, we'll also continuously monitor your vital signs um, to make sure that you're doing well, and then we'll make sure that you're discharged. We will also get you some physiotherapy here while in the hospital to help you um, mobilize better when you get home. Um, and we'll also do a COVID swab just in case. Did you have any exposures to anyone in the past couple of days before you came, at home, after you came home? 

user: No, I've been just at home, just the nurse. 

assistant: I see, I see. Okay, well, we'll do a COVID swab just in case and go from there. Do you have any questions?
user: Yeah, I've had, I've had a cough for a number of years now, but store these past like day, it's gotten a lot quite a bit worse and I've been really short of breath. 

assistant: OK, and so how many days would you say you've been short of breath?
user: Less than a day, maybe just really kind of started last night and has carried out throughout this morning. I, I called this morning to get an appointment. 

assistant: OK, and it, was it brought on by any activities or were you doing anything at that time before it started? 

user: No, last last night I was, well, I was just doing my regular kind of routine after dinner - cleaning up and just the cough started first. And over, the over the night it got worse. I could just couldn't catch my breath and that was similar this morning. 

assistant: OK, so you've also had a cough.
user: Yeah I have. Yeah, uh, I've had a cough for a long time now, but it's been worse over this last day. 

assistant: Yeah, is it like a wet cough or dry cough? 

user: It's wet, I I'm bring up sputum most of the time, but it's been, it's usually like white or clear and it's a lot more like, uh it's a lot more greenish, yellow and, yeah. 

assistant: OK, and are you having any kind of fevers or chills anything like that?
user: Uhm yeah I, I did have some chills last night, so I'm not sure about a fever though. 

assistant: OK. And are your symptoms at all, so you do have a shortness of breath, but any kind of chest pain at all? 

user: I do have some chest pressure for sure. I just feels like I can't, can't ah, catch my breath. 

assistant: OK, so is it mostly related to your breathing or do you have it at rest? Or do you have it with any exertion?
user: Yeah, I think it, it's there kind of most of the time, like the chest pressure. I kind of feel it throughout my chest when when I'm breathing but, but also just kind of sitting here I can kind of feel it. 

assistant: OK I see. And are all of your symptoms constant? Or do they come and go?
user: They've been constant and they've got been getting worse since since last night. 

assistant: OK, and have you had this happen to you before?
user: It has, yeah, I, actually last last winter I was hospitalized for a COPD exacerbation for, for a few days. I I know I got some antibiotics and umm, I needed some oxygen. 

assistant: I see and did you go home on home oxygen at all? Like do you use oxygen at home? 

user: No, I was told I didn't need any any yet, but if I didn't quit smoking I might in the future. 

assistant: OK, and are you using any kind of puffers at all?
user: Yeah, I I do I I use I think it's called like Spiriva or something like that. I use that every day and there's another one that I'll use like if my symptoms are getting bad. My blue one. I did try that actually last night and it didn't, it helped a little bit, but, not not enough. 

assistant: OK, so have you just tried like tried it one time last night? Have you tried it after that? 

user: Yeah, we just tried it last night. 

assistant: OK, so nothing today right?
user: No, nothing today. 

assistant: OK. Other than that, so you did have an admission before for this. And you have COPD. Do you have any other symptoms right now? Like runny nose, sore throat, any cold like symptoms? 

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

assistant: Did you have it before these symptoms started?
user: Uhm no, I've been feeling, I've been feeling OK. 

assistant: OK. And have you traveled at all recently? 

user: Uh, well, I did, I just go up to the trailer not too long ago to visit some family, but that's just an hour away. 

assistant: OK. Anyone sick around you recently?
user: No, I don't, I don't think so. 

assistant: And is there, are you having any headache or nausea or vomiting? 

user: No, I haven't had anything like that. 

assistant: OK. And besides the time you got hospitalized, have you had any exacerbations after that?
user: No, I just had that, had that happen, the one time, last year. 

assistant: OK. And do you feel that your symptoms are similar, worse, or how do they compare to last time, if you remember? 

user: Pretty similar. I think last time I was worse, but I waited longer last time and so that's why I was concerned and and wanted to come in early. 

assistant: OK. OK, uh, alright, so uh, have you had any fevers at all or chills?
user: Yeah, I've I've had some chills last night like I just couldn't get warm. I was loading up on blankets and it didn't seem to help. 

assistant: OK so we'll get a temperature on you today as well. Do you feel that you're breathing faster at all?
user: Uh, not necessarily it, just it just harder to to, feel like I can't catch my breath. 

assistant: OK, do you feel fatigued at all? 

user: Ah yeah, I I have a, I mean I have been feeling just tired this morning, but I think that's more to do with the fact that I just can't really do a whole lot of exertion because as soon as I move around I'm, I can't breathe. 

assistant: I see. Uhm OK, and are you having any kind of diarrhea, constipation, or any urinary troubles at all?
user: No, I'm not. 

assistant: OK. Any changes in your sleep or appetite? 

user: That's been that's been normal. Been eating well. 

assistant: OK. Any kind of confusion or any do you feel like yourself?
user: Yeah, I do. 

assistant: OK, any confusion at all that anyone's noticed? 

user: No, I don't think so. I feel like that's been ok. 

assistant: Any wheezing?
user: Yeah I I have noticed some wheezing. It's usually I usually, uh well I've been told I have a wheeze, but I can actually hear it right now. 

assistant: OK, yeah, we'll do like a full physical examination as well. And we'll get like your oxygenation level and everything like that. Umm, do you have any, besides COPD, so when were you diagnosed with you please?
user: About 10 years ago. 

assistant: OK, do you have any other medical conditions? 

user: I do, yeah. I have a high blood pressure, type two diabetes and like and there's something wrong with my, with my kidneys as well. I think my EGFR is low or something like that. 

assistant: Oh, I see, OK. And do you take any medications besides your puffers?
user: Yeah, I I do. I I take on an ACE inhibitor, Metformin, SGLT2 inhibitor and I'm also taking a, uh, a water pill as well 'cause I, over these last couple of years I've had some more swelling in my in my feet. 

assistant: OK, I see. Do you have any swelling, increased swelling right now?
user: No, I that's been about this. Been pretty constant. 

assistant: OK. And do you feel recently at all that you're short of breath when lying down, or do you have to wake up to take a deep breath? Anything like that?
user: No, I haven't only brought issues like that. 

assistant: OK, any any kind of dizziness or fainting episodes?
user: No, I haven't had anything like that. 

assistant: OK, any increased sweating associated with your chest tight or pressure or anything like that?
user: No, no, I haven't been sweaty. 

assistant: OK. Yeah. And other than that, any previous surgeries in the past?
user: Uhm, I, yeah I had a Uterine prolapse, so I had surgery for that. I have five kids. 

assistant: OK. Any, any complications after that surgery at all? 

user: No, it helped, it actually fixed the leaking at the time I was having, so was happy with that. 

assistant: That's good. Currently right now, do you work at all or are you retired?
user: I am retired. 

assistant: OK, uh, and what is your living situation like right now? 

user: Yes, we live in a house just outside of the city with my, with my husband. 

assistant: OK. Any exposures to any dust, fumes, asbestos or anything like that in your home?
user: No, I don't believe so. 

assistant: OK. Uhm and do you currently smoke?
user: Uhm, I do, yeah. Currently, yeah, maybe half a pack to a pack per day. 

assistant: OK, and how long have you smoked for?
user: Oh, I started in my teens, so most of my life I've I've smoked. I grew up around it, it's just what my parents did and everybody smoked. 

assistant: OK, uhm, and do you use any recreational drugs like marijuana? 

user: No, I don't. 

assistant: OK. And do you drink alcohol at all?
user: Uh, very rarely, don't really drink it anymore. 

assistant: OK. Alright, so yeah, those are some of the questions I had for you today. We'll do a full physical examination, get your vitals and get your oxygenation done right now. Do you have any questions at all?
user: No, that that makes sense. Thank you. 

assistant: You're welcome and yeah so we'll, we'll also do some lab work as well. We'll get some blood work done. Want to make sure we don't miss any kind of infection. Umm, you're in, like your you can be having another COPD exacerbation. But we also want to make sure you don't have like pneumonia or anything like that so. We might have to do a chest x-ray as well, but for now I would say just sit tight. We'll get all your vitals done and then go on from there. Does that sound good? 

user: Yeah, that sounds good. Thank you. 

assistant: Alright, and if you feel at all you're very short of breath and we can give you some ventil in here as well. And then if you need like we can give you like systemic, core steroids as well to help some of your symptoms. But yeah, let's, let's do some of that, physical examinations first.
user: OK, that sounds good. Thank you. 

assistant: Welcome. Take care.
user: Bye 

assistant: Bye.
user: Hi Faiha, I've been very concerned lately. This past week I, first just started having this really bad headache and then my body, just completely all started hurting after completely rest, and then three days ago I just started having a lot of chills and I had a pretty high fever, just two days ago of almost like I think it was like 38 or 39, yeah, I was just very concerned and I came here today. 

assistant: Yeah, it's good that you came in. Lets rewind a little bit and get a full history. So you said the, what started first, the fever or the headache?
user: So, the headache started first, so that was around four days ago. 

assistant: OK
user: And three days ago, like my body just started aching all over the place and then just two days ago I noticed that I had a fever and I've been getting a fever since then, as well, like even today, I was having chills. 

assistant: OK, OK, and you said your highest recorded temperature was 39? 

user: Like 38 to 39. 

assistant: OK, so headache started four days ago. Is it persistent or constant or does it come and go?
user: It was pretty constant, the headache kind of got better yesterday but last few days it's just been constant headache Pretty much every day. 

assistant: OK, OK. Does anything make it better or worse? 

user: Just some rest and, uh, I tried to take some Tylenol to get rid of it, took some Advil as well. It did help a little bit, but it just kind of came back after the medication wore out. 

assistant: How long does the headache last when you get it?
user: If I don't take medications, it can last honestly, the whole day. 

assistant: OK, yeah, um, and if you were to describe it, is it sharp, dull, achy? 

user: It's just achy and it's kind of all over the front of my forehead. 

assistant: OK.
user: Sometimes it's just like a throbbing pain. 

assistant: OK, and, alright, and you said it's mostly at the front of your head. How about near the Crown of your head, temples? 

user: It can go to the temples sometimes, but mostly it's my forehead. 

assistant: OK, OK, and severity-wise 1 to 10, 10 being the worst headache you've ever, worst pain you've ever felt. How bad is it?