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

assistant: OK, have you ever had anything like this before? 

user: Um no not I mean if I I get a call from time to time when I get sick, but I've never really felt short of breath. 

assistant: OK, is this cough a dry cough or are you bringing up any sputum?
user: Um it's a dry cough. 

assistant: OK. OK, have you had any fevers? 

user: Um yeah, I checked it this morning. I was like it was kind of mild, so 37.4 I think. 

assistant: OK. That was just this morning?
user: Yeah. 

assistant: OK. OK, uh. Have you had any chest pain?
user: No. 

assistant: OK Um. Have you felt at all like you're going to faint?
user: No, no. Although I I should let you know and maybe I don't know if it's related um, but I had a seizure last night. And, I was fine after and then I went to bed. Um I don't know if that's related, but I thought I should let you know. I do have a seizure disorder I have epilepsy. 

assistant: OK OK, thank you for sharing that with me. Have you ever had any issues like this following seizures in the past?
user: No, I usually don't get seizures very often. Um I kind of forgot to take my med. I think that might have yeah. 

assistant: Alright, OK. No worries um. OK, is there anything, in terms of this shortness of breath and this cough, is there anything that makes it feel worse?
user: Um I. 

assistant: In any position?
user: Yeah, I. I mean, I haven't really been in a lot of positions like it, just started three hours ago or so, so I haven't really. 

assistant: That's a hard question. 

user: Yeah I haven’t done much since then. 

assistant: Have you had any nausea or vomiting?
user: No. 

assistant: Any belly pain
user: Uh no. 

assistant: OK, any diarrhea?
user: Uh no, no I don't. 

assistant: OK, have you been in contact with anyone that's been sick lately? 

user: Uh no, I haven't. 

assistant: OK, have you traveled anywhere?
user: No, I've just been at home. 

assistant: OK, anything else you wanted to tell me that I didn't ask you about? 

user: Um no no. I. 

assistant: Have lost any of your sense of taste or smell?
user: No, I haven't. 

assistant: Have you had any sore throat?
user: No. 

assistant: Runny nose? 

user: No. 

assistant: OK, uhm. So in terms of your overall health you said that you have epilepsy. Any other chronic conditions that you've been diagnosed with?
user: No, that's it. 

assistant: You said you take a medication. What medication or medications are you currently taking?
user: Um I'm taking Keppra. 

assistant: OK. And normally, are you having any difficulty remembering taking it, or was it just kind of a brain fart? 

user: No, it just kind of happened, it was, it was my daughter's birthday and we kind of just, I usually sort of have it with dinner time, but we did things a little bit differently and had like a celebration earlier on and so I completely forgot because I didn't have dinner later. 

assistant: Oh yeah, that makes sense. It happens for sure. K, do you have any allergies?
user: No. 

assistant: Do you have any family history, any any diseases that run in your family?
user: Yeah, epilepsy runs in the family. My mom had it. 

assistant: OK. And in terms of your lifestyle, you said that you have a daughter. So do you live with your family? Do you live with your daughter? 

user: Yeah, yeah, I live with my daughter and my wife. 

assistant: How old is your daughter?
user: Pardon me. 

assistant: How old is your daughter?
user: She's 16 years old. 

assistant: Oh wow sweet 16 

user: Yeah. 

assistant: Right, OK, so are you currently working?
user: I I am yeah. 

assistant: What do you do for work?
user: I’m an accountant. 

assistant: OK cool, are you working from home or still working out? 

user: I’m working from home yeah. 

assistant: Nice and thats sounds great. OK, and uh. Do you smoke?
user: I don’t, no. 

assistant: Do you drink alcohol?
user: On the weekends, one or two class says a wine. 

assistant: OK. And did you use any other substances?
user: No, I don't. 

assistant: OK, I think that about covers my questions for now. So I'm gonna take everything we talked about. I'm going to go over it with the doctor was working today and now we'll come back shortly and talk to you about the next steps if there's any tests we want to do or how we want to move forward with this so. 

user: Yeah, thats great. 

assistant: OK. Sure see you shortly.
user: I have been having this, pains in my in my joints that's been ongoing now for the last several months and it's been getting worse over this period of time. 

assistant: OK, so several months, is the pain, so where, where exactly is the pain? 

user: So I get it in some of the joints in my hands. And then also my feet as well. So yeah my. Yeah, really in my feet and my hands. 

assistant: OK, and what kind of pain is it, is it like an aching pain, is it sharp pain?
user: It'll be a bit at achey when it's there, but I if I move the joints at all when it's really sore, I can get a sharp pain as well. 

assistant: OK, and is this pain worse at all at any particular time of the day?
user: Yeah, I would say in the morning time or if there's any period of time where I I'm like sitting and resting for awhile and I get up to move. I have a lot of stiffness and it takes me over an hour, sometimes to just get moving. 

assistant: OK, um so so if I understand it clearly it's. You get, do you get like morning you get morning stiffness and then when you're not very active or not doing things but then it gets better with movement? 

user: Yeah, exactly, yeah there's morning stiffness and it does get a little bit better with with movement. 

assistant: OK, do you have any of this pain or stiffness in the bigger joints in your body, like the hips or the knees or your shoulders?
user: Uh, no nothing, no. Just really the small joints. 

assistant: OK in the morning stiffness lasts more than 30 minutes you said?
user: It does, yeah. 

assistant: Yes, OK. Is is it symmetrical like is the pain symmetrical as in is it happening in both hands in the same areas and both feet in the same areas? 

user: Yeah it is actually now that you mentioned that, it is symmetrical. I'm noticing that it's the same. It's the same joints on both sides of my body that I'm seeing that are affected. 

assistant: OK now yeah, I I just have. Yeah, this one particular question. It's pretty specific, so when you look at your hands in which joints are painful. In your fingers is, do you, do you have any pain or swelling in the last joints like so just um, just, below the tip of your fingers?
user: No, actually like the those joints are all, have been fine. I can move the tips of my fingers no problem, and I haven't had any joint swelling or pain in the tips of my fingers. 

assistant: OK, and how about, have you had any pain at all in the, I guess the first joints of the finger. So when you make a fist like the first joint that bends? 

user: Oh yeah, like my knuckles, you mean? 

assistant: Yeah that your knuckles.
user: Yeah, yeah those actually. Those are the worst I can notice, those kind of on the like on my index finger, middle finger and and ring finger on both sides they they all look like they're swollen and and those hurt hurt really bad. 

assistant: OK, and in your feet, which joints would you say are hurting the most? 

user: I, I would say the like the big toe joint. On both of my feet, those bother me. Yeah, but my big my big toe on on both feet, but my right foot's worse than the other. 

assistant: OK, I see OK. And are you getting any pain in any other joints?
user: Um actually yeah my my right ankle bugs me a little bit. I'm sorry if that's considered a large joint. But yeah, my ankle hurts and then also my in my hands I have. Like the middle one. Not proximal interphalangeal joint, yeah those ones hurt too. 

assistant: OK. 

user: I think I have like more than 10 joints that are swollen and painful. 

assistant: OK, I see and has this pain been pretty constant or have there been days that you don't have the pain?
user: Yeah, there are days that are better than others for sure. It just. I'm not really too sure what the reason it is like. Maybe I'm just more rested or something like that, but. There are days that that are better, but over the last several months it's been getting getting worse. 

assistant: OK, and how much would you rate the pain from zero to 10, 10 being the worst pain you felt in your life? 

user: I would say it's probably a 6. 

assistant: OK, have you tried any medications at all to help with your, help relieve your symptoms?
user: Yeah, I've been trying. Um acetaminophen and different types of anti-inflammatories like ibuprofen or Advil and I've tried creams and stuff too but it it doesn't seem to, help. 

assistant: OK. Are you feeling any other symptoms at all, like fevers or chills? 

user: Um I do. I have felt a bit warm. 

assistant: A bit warm, OK and how long has that been going on for?
user: So it that varies as well, like some days I'll get. I'll feel like feverish for a little bit and it will kind of go away. I haven't checked my temperature, but, it I have felt warm at times. 

assistant: OK, and have you lost any movement in any of these joints at all?
user: Uh it is harder to to make a fist. Yeah I can't fully close my my fingers all the way down to make a fist. 

assistant: I see. OK. Any kind of a um night sweats at all? 

user: No. 

assistant: Any weight loss?
user: Um, well I think a few pounds, I just haven't really been as as hungry now. Yeah, my appetite hasn't been been as good recently. 

assistant: OK, any skin changes or rashes?
user: I over a couple of the joints, I do notice some some redness, but just over the the joints on my hand I can have some redness. 

assistant: OK, but you don't notice any changes anywhere else?
user: No nowhere else. 

assistant: OK, any changes in your vision or hearing? 

user: No changes to vision or hearing. 

assistant: OK. Any shortness of breath, chest pain?
user: No. 

assistant: Any changes in your bowel movements? 

user: No, that's been normal. 

assistant: OK, any changes in your urinary patterns?
user: Nope, I haven't had any pain or anything like that. 

assistant: OK, any numbness or tingling sensation anywhere, anywhere in your body? 

user: Nope, I haven't had anything like that. 

assistant: OK, have you been sick at all recently, either with like cold symptoms of any viral symptoms?
user: No, I felt OK. 

assistant: OK and any muscle weakness? 

user: I. I don't think so. I've just I I have had trouble like opening jars and various things, but I think that's part of the, um like pain that I'm having in my in my hands it makes it hard to grip. 

assistant: OK, uhm. And in terms of your medical history, have you been diagnosed with any conditions?
user: Uh, yeah I have a low thyroid and or or hypothyroidism. I think it's called I and I also have. Uh, high blood pressure, so I take my medication for high blood pressure and and something for the thyroid as well. 

assistant: OK, and when were you diagnosed with the hypothyroidism?
user: Um this was about I like four years ago. 

assistant: OK, today tell you what it was caused by it at all. 

user: Oh, I think I was, I think they said Hashimoto's. 

assistant: OK, OK, OK, and since then you've been on the thyroid medication?
user: Yeah, I think it's like Synthroid or or something like that. Yeah I think Synthroid. 

assistant: Alright. Any other medications at all that you take regularly? 

user: Yeah, I think it, I'm taking an ACE inhibitor for the blood pressure. 

assistant: OK, any allergies to any medications that you know?
user: Uh, no. 

assistant: OK, any hospitalizations or surgeries in the past? 

user: No. 

assistant: OK. Any family history of any autoimmune conditions?
user: My mom had hypothyroidism as well, and uh, and that's it. 

assistant: OK, so anything else like rheumatoid arthritis, ulcertaive colitis, Crohn's disease, type one, diabetes, anything like that? 

user: I I think my cousin actually has type one diabetes. He's a, like he's much younger than me, but yeah, I think he I have a cousin with type one diabetes as well. 

assistant: OK. Alright, and um currently do you work?
user: Yeah, I've been working as a administrator so it's been tough on the computer with with how my hands have been causing me pain. 

assistant: Oh so from the typing also gives you some pain? 

user: Yeah I can. It can give me a little bit of pain, but once my hands start moving it's it's OK. It's just I'm a bit slower at my job with with how it is, especially starting in the morning. 

assistant: OK, I see. OK, and currently what's your living situation like?
user: So I live with my husband as well as our, uh, our daughter. She's 4. 

assistant: OK, and are you currently right now, do you smoke at all? 

user: I I don't. I quit smoking four years ago when my daughter was born and before that I didn't smoke much to me anyway it was I was only smoking like you like maybe four or five cigarettes a day so I just stopped then. 

assistant: OK, that's really good. Uh, uh, congratulations.
user: Thank you. 

assistant: Yeah, and other than that, do you use any recreational drugs like marijuana?
user: I'll have a glass of wine sometimes, but very rarely. 

assistant: OK. Um yeah, so those are just some of the questions I had for you now. I just wanted to ask a few questions regarding just physically examining the joints that hurt. So when you look at those joints, do you notice any kind of swelling, redness, or when you feel any warmth to them?
user: Yes I yeah I do. I feel swelling, warmth and redness. 

assistant: OK, and do you notice any kind of deformities, for example like you're not able to bend your finger or any kind of deformities that you didn't see before? Or, like, for example, your wrist is turned uh, outwards a little bit. Anything like that?
user: Uh, no, nothing like that, no deformity. 

assistant: No deformities. OK, when you go over your joints, do you notice any kind of like nodules or harder materials that don't seem to be your bones? 

user: Not really, no. No, I don't notice anything like that. They just share a bit larger from the swelling it feels like. 

assistant: OK, I see. Are you able to make a fist with both both hands?
user: Not completely, I can close my hands part of the way, but I can't make a full fist. 

assistant: I see. OK and are you able to completely extend your fingers and show your palms?
user: Yeah I can do. I can do that. 

assistant: OK. And are you able to walk without a limp or anything like that? 

user: Um, yes I can. 

assistant: OK. Alright, so those are just all the questions I had for you today. Do you have any questions or concerns?
user: Um no, I'm just wondering what what this could be. 

assistant: Yeah, so from what you're describing to me you do fit into. The age range and all the symptoms are kind of point towards arthritis, and in this case it sounds more like rheumatoid arthritis. Ddefinitely it can be different types of arthritis that we will investigate just in case as well. But given that it's symmetrical, you have the morning stiffness that doesn't go away for more than 30 minutes and just the pattern of where those where the stiffness and pain is occurring itt sounds more likely to be rheumatoid arthritis, especially since you've also, you also have another autoimmune condition with hypothyroidism, it's more likely to be another autoimmune condition. So what we will do is get a few tests done. This will involve some blood work as well. And we will also get some imaging done, so we will get like the CRP and ESR for inflammatory markers we will get like your full CBC blood count we will get rheumatoid factor test done as well as antinuclear antibody and a lot of other different just markers to rule out anything else besides rheumatoid arthritis and then we will also get just X-Rays of your hands and feet as well. So does that sound good?
user: It does, yeah, thank you. 

assistant: You're welcome. And then if it does come out to be rheumatoid arthritis arthritis, which seems likely, you will need a referral to a rheumatologist to manage and treat your, uh, treat you with medications.
user: Hi, I'm just coming in here today because I've been just on wall recently over the last, I would say three to four days. I started getting these like really bad muscle pains all throughout my body and then over the past few days I've also been feeling chilly, so uhm, I wonder if I have a fever and I've also just been having this cough for the last few days as well. 

assistant: OK, what started first?
user: I think the muscle pain started first and then it was the coughing then since yesterday, I think I might have a fever as well. 

assistant: OK. The cough started ,or the muscle aches started first. Was that two days ago, three days ago? 

user: Almost four days ago now. 

assistant: Four days, OK, and the cough started when?
user: Cough started three days ago. 

assistant: OK, OK. Uhm before the muscle aches started, did you like do anything different in your life, like you know, do a lot of exercise or any other strenuous activities? 

user: No, I I haven't really changed my routine at all. 

assistant: OK, and where specifically like wha, which muscles ache?
user: Pretty much like throughout my body, but I would say more so like upper back, my thighs, then my arms, yeah, kind of just all over. 

assistant: OK any joint pains as well?
user: Uh, no, I don't think so. 

assistant: OK. And is it hard for you to walk like use your arms? Do you have any sort of like motor weakness? 

user: Uhm, it's not, I I can walk and there's no issues, but I I do feel like just overall general weakness. I don't know if that's to do with the pain or just feeling unwell. 

assistant: OK, so you're able to do those things. You just feel like maybe you're tired?
user: Yeah. 

assistant: OK. Any numbness or tingling?
user: No. 

assistant: No, OK. The cough, is it a dry cough or like productive cough? Are you bringing up phlegm?
user: It's a dry cough. 

assistant: A dry cough, OK. Uhm, so no sputum or blood, right? 

user: No. 

assistant: OK, and you have a runny nose or stuffy nose?
user: Uh, no. 

assistant: Sore throat?
user: No. 

assistant: No, OK. Wheeziness? 

user: No. 

assistant: OK, any fevers?
user: And I have been feeling chilly over the last few days, just, I have been wearing like multiple layers having to put on an extra blanket so I might have been having a fever. 

assistant: OK, but you haven't taken your temperature, right? 

user: No. 

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

assistant: Changes in your hair, nails or skin like rashes? 

user: Not that I've noticed. 

assistant: OK. Changes in your vision or hearing?
user: No. 

assistant: Taste or smell?
user: No. 

assistant: Chest pain? 

user: Oh sorry. Now that you mention I, I think taste a little bit today, I realized I was I wasn't really able to taste my breakfast. 

assistant: OK. So a little bit of change there?
user: Mhmm. 

assistant: OK. And any chest pain?
user: No. 

assistant: OK, any feelings of like feel like feeling like your heart's racing? 

user: No. 

assistant: OK. Uhm, how about uh like calf pain when you do a lot of walking?
user: No. 

assistant: Fainting or dizziness spells?
user: No. 

assistant: OK, any changes to your bowel movements?
user: Uhm, no. 

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

assistant: OK, uh how about appetite changes?
user: Uhm, appetites been the same. 

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

assistant: OK. Uhm, alright so are you otherwise healthy or do you have any longstanding medical conditions? 

user: Uh no, otherwise I've been pretty well haven't even really had to go to the doctor much in the past few years. 

assistant: OK, that's good. And then, any hospitalizations or surgeries in the past?
user: No. 

assistant: No, OK. And how about medications, are you on any?
user: Uh, no medications. 

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

assistant: OK, and how about allergies, do you have any? 

user: No, not that just like uh, seasonal allergies I sometimes get just itchy eyes and runny nose, sneezing in the springtime. 

assistant: OK. And do your current symptoms feel like that?
user: No, no. 

assistant: No, OK.
user: I feel completely different. 

assistant: OK, any family history of lung or heart conditions?
user: Uhm, think my uncle had a heart attack in his 50s. 

assistant: OK.
user: And I think my father has high blood pressure. 

assistant: OK. OK, any cancers in the family?
user: Uh no, not that I know of. 

assistant: And then do you smoke?
user: Uhm, just socially sometimes when I'm with friends, not-nothing regular. 

assistant: OK, and so for the past like two months, how often have you been smoking?
user: Probably a couple cigarettes on the weekend. We usually smoke marijuana, so not not too much like tobacco or cigarettes. 

assistant: OK. OK. Uhm, do you do any other recreational drugs like marijuana, cocaine? 

user: Just marijuana, no other drugs. 

assistant: OK, do you smoke it or edibles.
user: Smoke it. 

assistant: OK, and how often do you smoke cannabis?
user: Probably just when I'm meeting up with friends. So every weekend I would say. 

assistant: Every weekend? 

user: Yeah. 

assistant: OK. And then how about an alcohol, do you drink alcohol?
user: Yeah, I drink alcohol probably a couple of drinks every few days. 

assistant: OK. OK. And sorry what kind of alcohol do you drink every few days? 

user: Just mostly beers, maybe whiskey sometimes. 

assistant: OK, and how much of that?
user: So probably a couple beers. Uhm every few days and then whiskey, maybe a normal glass every few days, so yeah I would say 3 or 4 beers a week and then maybe 2 glasses of whiskey. In a, in an average week. 

assistant: OK, OK. Alright, and have you been in touch with or in contact with anyone sick recently? 

user: No, no one's been sick. Uhm I do meet up with some friends on the weekends. Some of them are from work, some of them are just that that I know outside of work. 

assistant: OK. OK, uhm and have any of them been sick or have they all been pretty healthy?
user: Uhm, in heard from anyone that's been sick. We we kind of have a rule that if you know if we feel sick then not to, not to show up just because, like you know, when we're when we're drinking and like smoking, we may share like a joint, so it's not like we don't want to get everyone sick if one person is sick. 

assistant: Yeah for sure. Uhm, that makes sense. Alright, any travel recently? 

user: No. 

assistant: No, OK. And where do you live right now?
user: Right now I just live in an apartment by myself just outside of London. 

assistant: OK. Any old carpets, dust, mold, asbestos anything that could make your condition worse?
user: No. 

assistant: OK, so those are all the questions that I had for you. Did you have any questions of your own for myself?
user: Uh no, I don't think so, I just wanted to see what this might be. 

assistant: Yeah, for sure. Uhm so, we are going to do a Covid swab on you because a lot of your symptoms do align with those of Covid, so we just want to rule that out first, so you should hear back in about 24 to 48 hours. Uhm, in the meantime you should isolate for two weeks and if it's not Covid, it could be another viral infection that's been going around this time of year. Either way, kind of management plan is the same, so make sure you're hydrated, eat well, sleep well, and if your symptoms become worse, severe or there any red flags like you have neurological symptoms, like seizures or weakness where you can move your limbs, you should seek help from the ER. How does that sound? 

user: OK. That sounds good. Thank you. 

assistant: OK yeah, no problem.
user: Yeah I have my 2 year old daughter here with me. I don't know what's happening with her, but she seems to be getting really sick. So I'll give you that kind of timeline. So two days ago she was feeling hot and her fever hasn't broken. We've been giving her Tylenol, but she still seems to have a fever. The last time I checked her temperature was 38.5 and she seems to have issues swallowing food. She's drooling and she seems short of breath. 

assistant: OK, and when did she start getting short of breath?
user: That started yesterday. 

assistant: Has her fever been getting worse or has it stayed around the same? 

user: So I just checked the first day. It was like 38, 38.5. 

assistant: OK, and when did the trouble swallowing start?
user: That started yesterday as well. 

assistant: OK, and has it been getting worse at all?
user: I think so. Now she's barely even drinking fluids. 

assistant: OK, so it's both solids and fluids. OK, have you noticed any swelling in her neck area or redness or swelling in her throat? 

user: Yeah, I've noticed some of that. 

assistant: OK, you see a lot of redness in there?
user: I see, yeah, I see quite a bit of redness in there. 

assistant: And has she been drooling at all?
user: Yeah, a little bit today. 

assistant: OK. Alright, any coughing?
user: Not hat I noticed. 

assistant: No coughing. OK, and do you notice that she's increasingly fatigued, or just not herself? Or is she irritable? 

user: Yeah, she's very irritable. 

assistant: OK, do you notice any kind of paleness or blueness in her skin? Anything like that?
user: She's not blue. She's looking a little pale though. 

assistant: OK, and sorry, when did the shortness of breath start? Is it getting worse at all?
user: Shortness of breath started yesterday as well, moreso today which is why I brought her in. 

assistant: OK, any other symptoms like nausea or vomiting or diarrhea or constipation? 

user: Um, no nothing like that. 

assistant: OK, and how's her appetite and sleep?
user: It's been, it's been not great. She's not eating well, I guess because she's in a lo of pain and she didn't sleep well for the past two nights either. 

assistant: OK uhm, has she had any recent infections at all, like a cold or anything like that?
user: She did have a cough 2 weeks ago, yeah. 

assistant: OK, and did it just go away on it's own or did she need any antibiotics or any other medications?
user: I think no, she didn't need any antibiotics. It kind of went away on its own. 

assistant: OK, any sick contacts within the last week or two weeks?
user: I mean, she goes to daycare so she might have picked something up from there. Yeah, last I checked, no one at daycare was sick like right now. But three weeks ago there was someone who was sick. 

assistant: OK, any past medical history? 

user: Um, no, she's been pretty healthy otherwis. 

assistant: Any issues during pregnancy or after birth at all?
user: No. 

assistant: Are her immunizations are up to date?
user: Um, yes, she didn't get the H. flu vaccine though. 

assistant: OK, OK, any hospitalizations or anything like that in the past?
user: Um, no. 

assistant: OK, and any family history of any medical conditions? 

user: Um, no. 

assistant: And currently, who does she live with at home?
user: I'm she lives with myself as well as her older brother. 

assistant: OK, alright, so yeah those are all the questions that I have. 

user: Do you think this is like an urgent matter? 

assistant: Because she has not been vaccinated with the H.flu vaccine and some of the symptoms that she's displaying like the drooling and trouble swallowing and now especially the shortness of breath are very concerning, I really think we should go to the Emergency Department. I'll give them a call to le them know that you're coming. Yeah, and what they will most likely do there is get a test done to see if she has H. flu and also they might do perhaps like a COVID swab as well. They might get an X Ray of her neck as well to see it. So what I think might be going on is with H. flu you can get swelling of your epiglottis and it can kind of obstruct your throat. It's very urgent matter, so that's why we will make sure you get to the ER and, uh, you know, we'll go from there. Does that sound? I know it may be very worrying right now. Do you have any questions at all?
user: Yeah, do you know how long will she have to be in the hospital? 

assistant: So right now we just need to make sure that she's stable, like all her vitals. You know when she gets to the ER, they can give her the appropriate antibiotics as well. And based on that, we need to make sure her breathing get stabilized, so she might be in the ER for one day. If they think she needs to be on IV antibiotics in the hospital, she might be in the hospital for a few more days or even a week. So it's really hard to say right now, but our priority right now is to make sure she's stabilized in the ER.
user: OK. OK yeah, that sounds good. 

assistant: So I'll give them a call right now, and, uh, you can head over to the ER. Or if you need a ride, we can arrange to do that for you too. 

user: OK, great, that sounds great. 

assistant: Thank you.
user: Yeah, I I. It's just over the last week I can't like do anything without just feeling really like short of breath. I'm having a really hard time breathing. Like kind of do anyways because I have COPD. So I feel like over a few years it's been getting worse, but this week it just got really bad in particular. 

assistant: OK, I see so. How much activity were you doing that was bringing on, the shortness of breath? 

user: Like I, I usually I will walk my dog around the block and I haven't been able to do that like my husband's been doing it. And then I was just going to try to get the mail just like. I don't know. It's probably like 200 feet down the road and I could, I was so tired when I got back and I felt like I could barely breathe. 

assistant: OK, and did you have any chest pain with this?
user: Uh. No, no, nothing like that. 

assistant: OK, and when did the shortness of breath symptoms start coming on?
user: Mmm like it I've been. I feel like it's been sort of getting worse over the past few years. But just like a week ago, it just got really bad. Like very suddenly. 

assistant: OK, um, and has it been getting worse over this past week or has it stayed the same?
user: Pfft maybe getting a bit worse, like it's been pretty bad the whole time. 

assistant: No, OK, I see, and have you had a cough? 

user: Yeah, like I again like I do normally because of my COPD but. It's just been really. It's been even worse this week, and usually when I get sick it's more like I'm like bringing up a lot of like yellowish gunk, but this time it's not been quite as like gunkie. It's been pretty dry. 

assistant: OK, so you're not bringing up any sputum with your cough?
user: No, maybe maybe a tiny bit, but I kinda do that like anyways. 

assistant: OK. Uh, and have you coughed up any blood? 

user: No. 

assistant: OK, and um, have you had any other symptoms that have went along with this difficulty breathing, um and cough?
user: Um I mean I've been, I don't have a thermometer at home, but I have felt like really hot. And. Just this morning, like my husband, you know he was trying to make sure I was still eating and drinking a lot and I don't really feel like I am tasting my food all that well. 

assistant: OK, so would you say that you have a loss of taste right now?
user: Um pretty yeah yeah, I'm pretty sure I couldn't really taste my breakfast. 

assistant: OK. And how about your sense of smell? 

user: Actually, yeah come to think of it, I don't. I don't think I've really been smelling much. 

assistant: OK, so you're not able to smell either. Do you feel like your nose is congested or are really runny?
user: It's not, it's not particularly congested or anything. 

assistant: OK. But still have had these changes in taste and smell. 

user: Mmmm 

assistant: Um OK and we will check your temperature as well to see if we can, if there is a documented fever. Have you had any night sweats?
user: Whats that? 

assistant: So generally, patients would will say that their sheets are soaked and it will wake them up sometimes because it's uncomfortable.
user: Oh no, I haven't had that. 

assistant: OK, how about any chills? So it could be like when you kind of shaking in your in your bed. 

user: No, not really. Just just like there really. I think, like fever, I think fevers. 

assistant: OK, and have over the last several months. Have you had any weight loss?
user: No, I think I've been pretty well the same. 

assistant: OK, an with um the change in taste, how has your appetite been?
user: Well, I mean that was just this morning that I noticed that. Um, before that, I think I was eating like pretty OK. 

assistant: OK, and have you felt as though your heart was racing at any point? 

user: No. 

assistant: OK. Uh, any dizziness or feeling lightheaded?
user: Oh no, I don't think so. 

assistant: OK. And any abdominal pain? 

user: No. 

assistant: How about any nausea or vomiting?
user: No. 

assistant: OK, have you had any diarrhea or constipation?
user: Maybe maybe a little diarrhea. Oh but I didn't know if that was just something I ate or what. 

assistant: OK, so when did the diarrhea start
user: Like yesterday. yesterday. 

assistant: OK, and and approximately how many times did you go to the bathroom, would you say? 

user: So probably like twice where it was really loose. 

assistant: OK, and did you notice any blood?
user: No. 

assistant: OK um, has that happened again today? 

user: Oh no, I didn't go today. 

assistant: OK. And have you had any urinary problems like painful urination or needing to go really often?
user: No. 

assistant: OK and then uh, have you had any headaches?
user: Come to think of it a little bit, I just thought I was like it was maybe because I was tired. But yeah, I've had headaches. 

assistant: OK, have you had headaches like this in the past? 

user: Um, I mean only when there is like reasons for it, like being really overtired or. Uh. Yeah. 

assistant: OK, does this feel similar to any of those times?
user: Let me know it's hard to say like I am tired so. Yeah, I think so. 

assistant: OK, would you say this was the worst headache of your life or a kind of like a Thunder clap sensation? 

user: No, nothing like that. 

assistant: OK. And have you got any photo sensitivity or kind of sensitivity of your light or sensitivity to sound?
user: No. 

assistant: OK. And next question would be. Have you have any any joint aches or muscle aches or general body aches? 

user: I mean, I'm a little I feel like I haven't been moving as much. Feel a little sore. I thought it was maybe just 'cause I, you know, wasn't going for my long walks and my body was like getting tired and stiff. But yeah, I feel a bit achey when I come to think of it. 

assistant: OK, and have you noticed any rashes or changes in your skin?
user: No. 

assistant: OK, uh, and then I'm not sure if I asked, but did you have a sore throat? 

user: Uh, no. 

assistant: OK. Um and next just wanted to ask about your past health. Um is there anything you see a physician for regularly?
user: Just like the COPD. 

assistant: OK. 

user: My family doctor. 

assistant: OK, and do you use inhalers for that?
user: Oh geez, I haven't seen my family doctor in awhile because of, the covid stuff. But I have an inhaler. Ah. That was probably like before covid that it was prescribed and then I ran out at some point and I haven't got it renewed. 

assistant: OK, so. When was the last time you used an inhaler, a a week ago, a month ago? 

user: I probably ran out like two months ago, but I wasn't using it every day. It was like one of those ones for like when you need it and, now, now this week I wish I would have had it. 

assistant: OK, I see. So before like two months ago, how often would you say you were using it?
user: Oh, maybe once you're once a week. 

assistant: OK um. And when what types of situations where you finding yourself needing to use it more often? Or rather where there any kind of triggers to those events?
user: Like if I if I say I took my dog for a walk and they kind of got away and I had to run a little like run a little bit. Usually I walk like pretty fast but if I have to run that would that would make it, would make me have to use it. 

assistant: OK, so a lot more exertion than what you're able to do now it sounds like. 

user: Yeah, like heavier exercise. 

assistant: I see, and any other medications like prescribed or over the counter that you take?
user: No, that was it. 

assistant: Alright, and have you had any surgeries before? 

user: I had my appendix out when I was in my 20s. 

assistant: OK, and any allergies?
user: No. 

assistant: OK, and um. Have you been anybody sorry, have you been around anybody who's been sick recently?
user: Well, we haven't really seen anyone because of the covid stuff so. It's just my my husband has someone, like has, a friend that comes over for them to the they watch like the sports games together like our friend lives alone. So that's really the only person that's been coming into our house and I don't. I don't know that I don't think he's been sick. But he he might have been around people that were sick. 

assistant: OK, I see so he hasn't had any symptoms though? 

user: Not that I know of. We haven't heard from him in a few days though. 

assistant: OK, and how was your husband been?
user: Oh, he's been well. He said he like he had a bit of a scratchy throat, but I don't think he's he hasn't really felt sick. I don't think. 

assistant: OK yeah, and do you live with anybody else or is it just you and your husband? 

user: Just the two of us and our dog. 

assistant: OK, and, uh, do you smoke cigarettes?
user: Yeah, I've tried to stop but I I smoke like a pack a day. 

assistant: OK, we can talk maybe about quitting if you're interested later on in the appointment or at another time at a follow up.
user: Sure, sure. 

assistant: OK, and do you drink alcohol? 

user: Like maybe like a glass of wine on a Friday. 

assistant: OK, so very it sounds occasionally, maybe a drink a week?
user: Yeah, something like that. 

assistant: Alright, and um do you smoke marijuana?
user: No. 

assistant: OK alright, how about that use like any like edibles or anything like that? 

user: No nothing like that. 

assistant: OK and then how about any recreational drugs?
user: Um like what? 

assistant: Like things like cocaine, crystal meth, ecstasy. 

user: No, no. 

assistant: I See, OK, and Is anybody in your family had any heart conditions before?
user: My dad had like high blood pressure. 

assistant: OK, anybody ever heard attack? 

user: No, not that I know of. 

assistant: OK, and anybody in the family have lung conditions in the past?
user: Uh, no. 

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

assistant: Alright, so was there anything else that um you think I should know today that maybe I didn't ask about?
user: I just feel tired. I just feel like really tired. 

assistant: OK, certainly that can be part of a kind of what how you're feeling and right now with the situation with the pandemic, COVID-19 is definitely pne thing that will be testing for today. 

user: Do you think I have COVID? 

assistant: It's very possible because of how general the symptoms are for covid, and so it's something that we want to test for. That being said, you could have another viral illness, such as the common cold like adenovirus. Or you could have a bacterial infection that's not Covid really related at all Or this could be an exacerbation of your COPD and maybe We need we need to just titrate your inhaler so we'll need to. Just run some lab work and do the PCR nasal swab as part of the work up an we will see what some of those investigations show.
user: Oh geez, OK. 

assistant: OK, it's all in the meantime. You'll need to quarantine for 14 days. And if the results are positive, well after note notified public health so that the appropriate contact tracing can be made. But we'll get the investigation started now.
user: I'm I'm here because my right knee is very painful. It looks kind of swollen and it's it's also a little bit warm so I'm just worried, I'm worried about it and I was wondering if you could look at it. 

assistant: Yeah, certainly, um. So where are you feeling the the pain exactly?
user: So it's where, so right in the middle of my knee. So just below the bone that, the big knee bone. 

assistant: OK, so like underneath the kneecap, like below that? 

user: Yeah just just a little bit below. 

assistant: OK, so slightly below the Patella. Sounds like somewhere in the region of the tibial through tuberosity.
user: Right. 

assistant: OK, and when did this pain start?
user: It started about two weeks ago. 

assistant: OK, two weeks ago when the pain started, was there any trauma or could you remember any movement that that caused the pain? 

user: Nothing like that, but I recently found out that I had some osteoarthritis on my left knee, so I was trying to put more pressure on my right knee one whenever I was doing like gardening work um and I think something something may have happened when I was doing that, something maybe, maybe I put too much strain on it. 

assistant: OK, I see an. Alright, like are you doing a lot of kneeling on on or during the gardening work?
user: I am. 

assistant: OK. Um, and. How long has the pain been going on for, has it been constant over these two weeks? 

user: Yes, it has been. 

assistant: OK, and how would you describe the pain, is it sharp, burning, achy?
user: I would say mostly achy, but it can be sharp. 

assistant: OK, and do you feel the pain radiate anywhere else? 

user: No, just it's pretty local. 

assistant: OK, have you tried anything to make the pain better?
user: I tried some topical like what are those like ice and fire gels. Those seem to help temporarily, but the pain comes back. 

assistant: OK. And. Have you tried, has anything made the pain worse? 

user: I guess like when I kneel down on it, it gets painful or If I touch it or palpate it, I guess painful if I'm I'm flexing my knee too much that hurts as well. Kind of keeping it straight and not touching it makes it feel better. 

assistant: OK, and. What would you say the severity of the pain is with 10 being the worst pain you've ever felt and one being the least pain?
user: I give it about a 6. 

assistant: OK, and have you had a pain like this in your right knee before? 

user: No, nothing like this and I have osteoarthritis in my left knee but it feels different. 

assistant: OK, and um. OK, and have you had any fevers or chills?
user: Uhm, no. 

assistant: OK, and how about any night sweats?
user: No. 

assistant: OK, and have you had any unexpected weight loss over the last several months? 

user: No. 

assistant: Have you had any headaches?
user: No. 

assistant: Have you had any changes to your senses like vision or hearing? 

user: No 

assistant: Any changes to your sense of smell or taste?
user: No. 

assistant: OK, have you had any sore throat or cough?
user: No. 

assistant: Alright, have you had any shortness of breath?
user: No. 

assistant: Had any lightheadedness or dizziness?
user: Um no. 

assistant: Have you had any heart palpitations? 

user: No. 

assistant: OK um an have you had any nausea or vomiting?
user: No. 

assistant: Have you had any abdominal pain? 

user: No. 

assistant: Have you had any diarrhea or constipation, or blood in the stool?
user: No. 

assistant: Have you had any pain with urination or frequency with urination? 

user: No. 

assistant: OK, and have you had any like muscle aches or joint pains anywhere else?
user: No. 

assistant: OK, and have you had any neurological symptoms such as numbness or or tingling or reduced sensation?
user: No. 

assistant: OK, and how is your energy been recently have you had any fatigue?
user: No, not really. It's been the same. 

assistant: OK, and in the past have you been diagnosed with any medical conditions? 

user: Uhm I have Class 2 obesity. And then also arthritis in my left knee. As well as high blood pressure. 

assistant: I see and. Do you take any medications?
user: Currently I'm on Ramipril and I take some ibuprofen sometimes for the osteoarthritis in my left knee. 

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

assistant: Have you had any surgeries before? 

user: Nope. 

assistant: Or have you had any hospitalizations for any reason?
user: No. 

assistant: OK. And. Have you been pregnant in the past? 

user: Um I I have one, one child, she was born through c-section. 

assistant: And are you currently sexually active?
user: I am. 

assistant: OK, could you tell me about your partner or partners?
user: Yeah, so just with my husband of 10 years. 

assistant: OK, any concerns for a sexually transmitted infection like vaginal discharge or or pain or itchiness? 

user: No. 

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

assistant: OK. And have you been around anybody who's been sick recently?
user: No. 

assistant: And have you traveled anywhere recently?
user: No. 

assistant: OK, are you currently working right now? 

user: I yes I am. 

assistant: OK, well then what what do you do?
user: I work as a full time gardener for a landscaping company. 

assistant: OK, I see. So you're spending a lot of time doing kind of like repetitive kneeling type movements to do your job? 

user: Yes, that's right. 

assistant: OK And do you smoke cigarettes?
user: I don't. 

assistant: Alright, and do you drink alcohol?
user: I'll have a glass of wine every other night. 

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

user: No, I don't. 

assistant: Have you used anything like that in the in the past.
user: No 

assistant: like IV drugs, no, OK. And in the family or is there a history of any musculoskeletal or neurological conditions? 

user: No. 

assistant: OK. So next I just wanted to do the physical exam portion and ask you to have a look at the knee first and let me know if the if you're having any swelling, redness or warmth to the knee compared to the other side.
user: Sure. 

assistant: Sorry so you are having, having swelling, warmth and redness to the right knee? 

user: Yes. 

assistant: OK and are you having pain to like palpation is there a specific spot you can press on that causes a sharp pain?
user: Um so just below that kneecap area there is some swelling there and when I press down on that swollen area, it causes a bit of pain. 

assistant: OK. And are you able to fully bend, bend and straighten the knee? 

user: I can do that, but when I bend my knee it really hurts. 

assistant: OK. And are you able to walk normally or do you have a limp?
user: Um I can walk normally, it just hurts. 

assistant: OK. So that was a everything that I wanted to ask today on the history and and physical. Was there anything? That you maybe I forgot about you wanted to add? 

user: No, I don't think so. 

assistant: OK, so right now it's sounding like this could possibly be a knee Bursitis. Or Prepatellar, or sorry, infra patellar bursitis or a prepatellar bursistis which are the kind of the more common types. One thing to make sure that we rule out would be a septic Bursitis. Although you're not having any fevers or chills so that makes it a little bit less likely.
user: Mmmm 

assistant: But if your symptoms are getting worse and you're developing a fever, it's becoming even more painful then certainly will have to rule out infection. And as well if things are not improving, potentially a structural disease and any, such as a meniscal injury, or like a ligamental injury from all of the like kneeling and and repetitive movements. But right now I think it's mostly sounding like a knee bursitis. 

user: OK. 

assistant: OK, and treatment for that will be activity modification as well as using things like as um NSAIDS and icing to help with um the inflammation.
user: Yeah, so for the past two days I I've I've noticed that I can't smell things as well, as I used to be able to smell them and I seem to have lost my sense of taste as well. And I have this mild dry cough. I'm just worried it's covid. 

assistant: OK. You said for a couple days?
user: Yes, for two days. 

assistant: OK, have you ever had anything like this before? 

user: No, no, nothing like this. 

assistant: OK, when you say you feel like you've lost sense of taste and smell, is it totally gone or do you taste a little bit? Or how? How is that working for you?