jshargo/medical-interview-conversations2 huggingface dataset:
user: Uh I guess I have, it is a bit painful as well, yeah. I have um like a burning kind of pain. 

assistant: OK and 1 to 10, 10 being the worst pain ever, how bad is this pain? 

user: Uh when it gets to its worst, I would say about a 6. 

assistant: OK, OK. Um and have you ever experienced this before or is this kind of like the first time you're experiencing this?
user: Yeah, this is the first uh really like over these last three months, the first time I've been experiencing it, I think uh the first time that it started it started to wake me up at night though has been like about a couple of weeks ago. 

assistant: Oh I see, OK. Um alright and do you feel like your symptoms are getting worse over the past few weeks or is it kind of the same? 

user: Uh over these past couple of weeks, about the same. It's woken me up uh like two or three times at night. 

assistant: OK, alright and do you have any numbness or tingling elsewhere on your body?
user: No, it's just um just kind of the the outside of my hand here, it's really only the first like 3 fingers. 

assistant: OK, first three fingers so your um thumb, index finger and uh middle finger? Or your pinky to middle finger?
user: Yeah, it's just the uh my thumb index finger and ring finger. 

assistant: And ring finger, OK. 

user: And maybe just like a little bit of the um like of the ring finger too, but not all of it. 

assistant: OK, um alright, so um any weakness in your arms or do you feel like you can still use your arms OK?
user: Uh yeah I haven't had any, uh, any muscle um weakness, I guess I may be a bit more clumsy um with uh with my left hand like I've dropped a few things, I've had it, a little bit more difficult time like opening jars or like car doors and stuff like that. 

assistant: OK, OK, and any confusion or memory loss?
user: No. 

assistant: OK, um how about weight loss? 

user: No, I haven't had any weight loss. 

assistant: Uh fevers or chills?
user: No. 

assistant: Uh rashes? 

user: No rashes. 

assistant: Changes in your vision, hearing, smell or taste?
user: No, that's been normal. 

assistant: OK, how about um a cough?
user: Uh no, I haven't had a cough. 

assistant: OK, um wheezing or shortness of breath? 

user: Nope, neither of those. 

assistant: OK. Chest pain or heart palpitations?
user: Um nope, I haven't had that. 

assistant: OK, how about um changes in your bowel movements?
user: Uh nope, I haven't had any diarrhea and no no constipation and no blood either. 

assistant: OK, good. Any nausea or vomiting? 

user: No I haven't had any of that. 

assistant: OK, any changes in your voiding?
user: Uh, no I I um haven't had any problems with urination. 

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

user: Um I have hypothyroidism, so I take um like uh thyroxine for that and um I am overweight as well, or in obesity class one I think. 

assistant: OK, and um do you take any medications for the hypothyroid?
user: Yeah I do, I take um I take uh Synthroid, I think. 

assistant: OK, alright, and are you on any weight loss medications?
user: No, I've just been trying to uh change diet around when I can and um and trying to um exercise a bit more, but uh it's been it's been tough, especially now with my wrist or my hand bugging me. 

assistant: Yeah, for sure. Um alright, and then are you up to date with your immunizations?
user: I am, yeah and I get the flu shot every year. 

assistant: OK, that's good. Um and have you had any hospitalizations or surgeries in the past? 

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

assistant: No, OK. Um any allergies?
user: Uh no allergies. 

assistant: OK, family history of lung or heart conditions? 

user: Um my grandfather had a stroke when he was in his uh 70s, um and my dad has high cholesterol. 

assistant: Have you been worked up for all of that? Like high blood pressure, diabetes, cholesterol?
user: Uh yeah, I think my family doctor checked a few years ago, but I've been healthy besides this um uh this this pain um so maybe that, yeah maybe that could be investigated as well. 

assistant: OK, um any neural, neurological, or musculoskeletal issues in the family?
user: Um I think osteoarthritis, a few few people have that. 

assistant: OK, um how about autoimmune conditions? 

user: Uh no, I think I'm the only one with the thyroid. 

assistant: OK, um how about cancers?
user: Uh no cancer. 

assistant: No cancers, OK. Um alright and then, do you smoke?
user: I do, yeah, I smoke about um 5 to 10 cigarettes per day. 

assistant: OK, and um for how long have you been doing that?
user: Uh probably yeah about the last 10 years, it was kind of around when I started working um in the warehouse here, um yeah. 

assistant: OK, and have you ever thought about quitting?
user: I have, yeah I've tried, it's just such uh I mean people just go out and I mean have their coffee and cigarettes and it's sort of a social thing while at work, it it's kind of what people do so, I have been trying to cut down though. 

assistant: OK, OK, that's good. If you need any resources, we have some that we can refer you to. Um and do you consume marijuana in any form? 

user: Um no, I don't. 

assistant: No, OK. Any recreational drugs.
user: Um nope, I don't use anything like that. 

assistant: OK, how about alcohol? Do you drink? 

user: Um I'll have wine every once in awhile on the weekends, maybe maybe a drink per week, something like that. 

assistant: OK, um and have you been in contact with anyone sick recently?
user: Uh no, I don't believe so. 

assistant: OK, how about travel? 

user: No, I've been I've been at home and and just going to work. 

assistant: OK. Um and and where do you live and who do you live with?
user: So I live with my husband and our two daughters and we live and we live in a house. 

assistant: OK, um any concerns for STI's? 

user: No, I'm just um, I've been monogamous with my partner now for uh over 10 years and um no concerns for uh an STI at this time. 

assistant: OK, alright good, um so now we're just going to move on to the physical exam part um of this interview. Um so I'm going to get you to look at both your arms, hands, and wrists, um side by side. Does your left one seem at all more red, swollen, uh or hot.
user: No, no symptoms like that. 

assistant: No, OK. And um do you, does that one seem to be more atrophied or are there any deformities or skin changes on that one?
user: Um maybe uh a little less muscle bulk on the, like where my thumb is. 

assistant: OK, OK. Um and then I'm gonna get you to palpate certain areas of that arm. So let's start um at the top, when you when you press down on your shoulder blades or just at the very top of your um arm where your, or at the very top where your arm connects to your shoulder, does it hurt over there?
user: No, no pain there. 

assistant: OK. So no pain on the acromion process or the scapula. Um any pain where your biceps are? 

user: No. 

assistant: No, OK. How about at your elbows?
user: Uh no pain at the elbows and full, I can move my elbows and shoulders, uh no problem either. And my neck doesn't hurt at all either, I can move my neck around. 

assistant: How about when you um palpate your wrists, both sides, medial and lateral? 

user: Uh, yeah no, no pain if I'm just pressing or palpating the wrist. 

assistant: OK. Um and I'm going to get you to um straighten out your arm and flex at your shoulder and extend at your shoulder, does that hurt?
user: No. 

assistant: How about when you flex your elbow and extend your elbow?
user: No. 

assistant: Um how about when you flex your wrist and extend your wrist?
user: No. 

assistant: OK, so I'm going to do a special test for something called carpal tunnel syndrome. Um so um I'm gonna get you to straighten out your left arm again um and right where um alright, how do we do this? OK, so with your right hand or with your yeah, with your right index finger and middle finger, you're going to tap um just below uh where the bulk of your thumb muscles are um connecting to your wrist. I'm just going to get you to tap that area. Do you feel tingling like an electric shock sensation in your hand or anything like that.
user: I do, yeah. 

assistant: You do, OK, so that's a positive Tinel's sign. Um and then we're going to do one more test, so I'm going to, OK so make like a prayer motion with your hands like um putting your 2 palms together and then um and then instead invert your hand so that the outer parts are touching and your fingers are pointing towards the ground.
user: OK. 

assistant: So kind of like upside down but with your outer parts of your hands touching. Um and then I'm going to get you to uh just hold your arms like that um for about 60 seconds. Do you feel any tingling, numbness, or pain in those fingers? 

user: Yeah, I get a bit of uh numbness and tingling when when I do that. 

assistant: OK, so that's a positive Phalen's sign test. Um alright, so that brings me to the end of um this interview, did you have any questions or concerns, anything that you wanted to bring up?
user: Hi, I'm, I'm the mom of the patient and I just wanted to talk to you about the, just about Thomas here. He's just been not, he's just not been feeling well. He's had this cough for the past three or four days. And he's also had this stuffy nose, and this, this watery discharge. Yeah, he's just not feeling good. 

assistant: OK, I see and so the, the cough you said started three or four days ago. Has the cough gotten any better or any, stayed the same or gotten worse?
user: Gotten a bit worse, I would say. 

assistant: Is he bringing up any sputum?
user: No. 

assistant: So has there been any blood?
user: No no. 

assistant: OK, and has the cough interfered with sleep? 

user: Yeah, his cough is usually worse, uhm, at night. 

assistant: OK. And you say that he's also had a runny nose. What does the discharge look like?
user: It's just, uh, it's watery. 

assistant: And this started three or four days ago as well? 

user: A little, a little after the, uhm, yeah actually, around the same time, around the same time, yeah. 

assistant: OK. Has he had any, uhm, like difficulties breathing, like saying that he feels one of the, like the nostrils obstructed?
user: Hmmm, he hasn't, well, he's just been breathing with his mouth open, so that's what he does at night as well. He also has this nasal voice right now, probably because it's, it's, you know, he has this stuffy nose. But he hasn't really complained about it. 

assistant: Yeah, has he had any pain, like facial pain? 

user: Uhm, no, not really. 

assistant: OK, how about any changes to smell or loss of smell?
user: Yeah, I don't think he can smell much right now. 

assistant: OK, and uh, did those, did that start a few days ago as well?
user: Yeah, yeah, since he's been complaining of his stuffy nose. 

assistant: OK, and has he had any headaches?
user: No, but he has had a fever. 

assistant: OK. How, did you check it?
user: Yeah, I did, I did. It was uh, 39 last night. 

assistant: Alright, it's certainly a fever. Uhm,  has he had any chills or night sweats?
user: Yeah, he's, but he's been feeling pretty chilly. 

assistant: OK. 

user: Yeah, he's wearing a couple, a couple of layers at home, still feels chilly, and yeah, he has alot of chills and definitely has a fever. 

assistant: Alright, and has the fever been there the whole whole time, if you're aware or has that kind of come and gone?
user: Uhm, you know what, I actually just checked yesterday so I don't know. 

assistant: Alright, has he had a sore throat? 

user: Yeah, it's usually worse in the morning. I think it's more of a, I guess the post nasal drip you know with the, with a runny nose. It's just, It's pretty bad in the morning. 

assistant: OK, has he had any red eyes or, or eye discharge or eye pain?
user: No no no. 

assistant: OK, and has he had any shortness of breath?
user: No. 

assistant: How about any wheezing? 

user: No. 

assistant: Any chest pain?
user: No. 

assistant: Any lightheadedness, dizziness or fainting? 

user: No. 

assistant: OK, and does he mention anything about feeling as though his heart's racing?
user: No. 

assistant: OK and has he had any abdominal pain?
user: No. 

assistant: Any diarrhea or Constipation?
user: No. 

assistant: How about any urinary problems like pain or, or frequency?
user: No, nothing like that. He hasn't complained of anything like that. 

assistant: Has he had any skin changes or rashes? 

user: No. 

assistant: And how about any muscle aches or joint pains?
user: Yeah, yeah he definitely has that. He's complaining a lot about muscle aches. 

assistant: OK, and how has his energy been? Has he been fatigued?
user: Oh yeah. He hasn't gone out to play. He hasn't done anything, he's just been lying in bed. 

assistant: OK, and over the last several months has he had any weight loss?
user: No. He's been gaining weight actually. 

assistant: OK, no that's good. Certainly yeah, at the age of 11 should be still gaining weight, so that's good. And has he been diagnosed with any medical conditions in the past?
user: Yeah, he was diagnosed with uh, cystic fibrosis when he was a, he was a child, four years old. 

assistant: OK, and, uh, is he on, uh, like any medications for that? 

user: He's on, he was on an antibiotic until the age of five. Uh, that he had to take on regular basis, but he is, he's not really on any medications right now. I know that there are a couple of new ones that are out there, but those are very expensive. 

assistant: OK, and has he had any exacerbations or hospitalizations?
user: uh, yeah, he's he's had about, uh, one hospitalization every two years? 

assistant: Alright, and is he followed by a respirologist, currently? 

user: Yes, yes, yes. 

assistant: OK, uhm and has there been, like an increase in the sputum production or like worsening shortness of breath over these last few days?
user: No, not really. 

assistant: OK. And has he had any surgeries? 

user: No. 

assistant: Does he have any allergies to medications?
user: Uhm, Sulfa drugs. 

assistant: And the reaction is? 

user: Uhm, he just gets a rash. 

assistant: OK is it, are immunizations up to date?
user: Oh yeah, yeah, we're very careful about that given his diagnosis. He's got all the, all the vaccines. 

assistant: That's great, that's really important for sure, uhm, and so I just wanted to ask about life at home a little bit. So who's in the house and who's the primary caregiver for him? 

user: I'm the primary caregiver, its just, uh, me, him and my husband. 

assistant: OK, and uh, is he, uh, what grade is he in right now?
user: He's in grade six? 

assistant: OK, how is school going? 

user: Schools going well, it's just the, yeah, the hospitalizations can sometimes be disruptive, but it's going well. He's, he's getting B's in his class. He's doing well, he's got a good group of friends. 

assistant: Excellent and have you had any concerns about about development or, or his growth?
user: Uhm, no. 

assistant: OK, so meeting all milestones and? 

user: Yeah. 

assistant: OK. And in regards to, uhm, birth history, were there any complications throughout pregnancy or, or at birth?
user: Uhm, no, nothing at birth or during pregnancy, but he did start having lots of respiratory infections, which is when the pediatrician did that test. I forget the name, for the test and then they were, uhm, the, uhm, he was found to have, CF. 

assistant: OK, uhm, and does anybody in the home smoke?
user: No. 

assistant: Or drink alcohol? 

user: no. 

assistant: OK, uhm, and are there any pets in the home?
user: No. 

assistant: OK, has he been around anybody who's been sick? 

user: I don't, I don't think so. 

assistant: OK, and, uh, have you guys traveled anywhere?
user: No, just been at home. 

assistant: OK, uhm, and has anybody in the, else in the family have cystic fibrosis? 

user: No, no, no, no one else does. But we got tested and we were both found, my, my husband and I were found out have the gene for it. We were carriers. 

assistant: OK, uhm, I see. And any, any heart conditions or, or other lung conditions that run in the family?
user: No, nothing else. 

assistant: OK. And were there any other symptoms that, or anything else that you wanted to tell me that maybe I forgot to ask about?
user: Yeah hi, um, I have been coughing nonstop for the past three days, and today I have been feeling very short of breath. So I just wanted to get it all checked out. 

assistant: Yeah, for sure. And, so you said the cough started uh, three days ago. Were there any triggers to the cough or anything that, uh that changed three days ago? 

user: No, nothing that I can think of um, I have, like the only thing that I've been doing is going to the grocery stores, uh the bank, and laundromat. Um, and once I ran all these errands, like, I just started having this coughing fit that hasn't stopped. 

assistant: Okay, uh, has the cough gotten any better, or stayed the same, or gotten worse these past three days?
user: Uh, it seems like it's getting worse. 

assistant: Okay, are you bringing up any uh, sputum or phlegm?
user: Um yes, it's yellow. 

assistant: Okay, is this um, any different from before? Like have you had a cough in the past and, and brought up phlegm, or is this entirely new for you? 

user: Um no, this has happened to me before, um, like I don't know, like maybe a year or two years back. Uh, and it kind of feels the same, but just a little bit worse. 

assistant: Okay. Um, and uh, have you seen any blood in the sputum?
user: No, no blood. 

assistant: Okay. Um, and you mentioned you've been short of breath as well. Uh, how has that come on? 

user: Um, it was, I, I don't know if it's because of all the coughing that I've been doing, but it just started this morning. 

assistant: Okay, um, and have you been experiencing uh shortness of breath um, on exertion otherwise, like prior to this?
user: Um no, no. 

assistant: Okay. And have you had any shortness of breath after, like if you lie down flat?
user: Um, no, not that I've noticed 

assistant: All right, and have you had a wheeze?
user: A little bit, yeah. 

assistant: Okay um, uh, and have you had any um, infectious-like symptoms such as like red eyes, runny nose, or, or a sore throat? 

user: No, nothing like that. 

assistant: Okay, um, have you had any, any chest pain?
user: Nope, nothing like that. 

assistant: Have you had any lightheadedness or, or feeling dizzy?
user: No. 

assistant: Or feeling like your heart's racing or, or beating really fast?
user: No. 

assistant: Okay. And, um, have you had any fevers or chills? 

user: No, not that I've noticed. 

assistant: Have you had any night sweats?
user: No. 

assistant: And how has your weight been over the last several months? Have you had any weight loss or gain? 

user: Uh no, it's been pretty stable. 

assistant: Okay. Um, and have you had any abdominal pain?
user: Um, no. 

assistant: Any diarrhea?
user: No. 

assistant: Or any urinary problems? 

user: No. 

assistant: Okay. Um, and in the past um, oh sorry, before that, have you had any nausea or, or vomiting?
user: No. 

assistant: Okay. Uh, and any confusion or, or changes to um, um memory? 

user: No. 

assistant: Okay, uh, or loss of taste or sense of smell?
user: Uh no. 

assistant: Okay uh, so the, you've been experiencing this cough that's been getting worse over the last couple of days, as well as bringing up some yellow sputum, um, and been short of breath. Have you been experiencing any other symptoms?
user: No, that's pretty much it. 

assistant: Okay. Um, and in the past, have you um, been diagnosed with any medical conditions? 

user: Um, I have diabetes, I have high blood pressure and I have high cholesterol. 

assistant: I see. Alright, and do you take uh, medications for those things?
user: Yes, so I am on ramipril for the high blood pressure, rosuvastatin for the cholesterol, and insulin for the diabetes. 

assistant: Okay, thank you. And uh, you mentioned you had a similar episode in the past. Um, what, uh, were you diagnosed with COPD before?
user: I was, I was diagnosed with COPD about five years back. 

assistant: Okay, did you have pulmonary function tests for this? The test where you had to breathe into a tube. 

user: Um yeah, I had that done like five years ago. 

assistant: Okay, um, alright um, just wanted to see if it was uh like formally diagnosed. Sometimes people uh, um, yeah, it's important to have that, uh, those tests done. Um, and do you have any allergies?
user: Um, no none. None, yeah. 

assistant: Okay. Um, and uh, are your immunizations up to date? 

user: Yes, I believe so. 

assistant: Okay, um and have you had any surgeries or, or um, hospitalizations?
user: Um, I had my Gallbladder removed when I was in my 50s. Um, and I had a hip fracture three years ago. 

assistant: Okay, and how is your mobility now? 

user: Um pretty good. My hips still give me some issues once in awhile, but um, for the most part, it's been okay. 

assistant: Okay, that's good. It sounds like the rehab went well.
user: Yeah. 

assistant: And uh, right now, can you tell me um, a little bit about your living situation? Like where you're living and who you're living with?
user: Um, I live by myself in an apartment on the 1st floor. 

assistant: Okay, um and, do you smoke cigarettes?
user: Uh no, I quit two years ago. 

assistant: Okay, and that's, that's great. Um, prior to that, how long did you smoke for, and how much? 

user: Oh, for like 40-plus years um, I used to smoke a pack a day. 

assistant: Okay, well that's great that uh, that you quit, so congratulations.
user: Thank you. 

assistant: And do you drink alcohol? 

user: I drink once in a while. Like maybe every other day, I'll have a glass of wine. 

assistant: Okay, and um, uh anybody, or sorry, have you been around anybody who's been sick recently?
user: Uh no. 

assistant: You said you went to the stores and stuff like that. 

user: Yeah, maybe from there, yeah. 

assistant: Okay, and have you traveled anywhere else, outside of the city?
user: Um, not recently, no. 

assistant: Alright, um, and any exposures to any like dust, chemicals, things like that?
user: Um, I live in an old building so maybe. Um, but it hasn't bugged me before. 

assistant: Okay, uh, and are you working currently or, or retired?
user: I'm retired. 

assistant: Okay, well, what did you do before?
user: I used to work uh, on the assembly line for Chrysler. 

assistant: Okay, were there any exposures uh, there that you were aware of, like things that you were breathing in? 

user: Uh not that I was aware of, but they were always like smoke and fumes and things like that because it was like a factory, so maybe. 

assistant: Right, okay, that makes sense. Um, and in the family, are there, anybody who, who's had problems with their hearts or lungs?
user: Um, my mom had lung cancer when she was 50. And, like, all the, like diabetes, hypertension and high cholesterol runs on my, ran on my father's side of the family. 

assistant: I see, did anybody have uh, heart attacks or, or stroke?
user: Uh, yeah, so my father had a heart attack when he was 49. Uh, stroke I'm not too sure about. 

assistant: Okay, thank you. And, um, so that was all I wanted to ask about. Um, was there anything else that you wanted to add that I maybe forgot? 

user: Um, no, that's about it, but I, how can I treat myself now? How do I make this cough go away? 

assistant: For sure, so, um, we will first get your vitals here and we'll see if your oxygen levels um, are low, then it would be important to put on some oxygen first, um, just to make sure that that's stable. Um, and from there we will um, get a chest x-ray um, and uh, run some lab work to, to try to help figure out the, the diagnosis better, but in the meantime, we'll use um, some inhalers because it's possible that this is a COPD exacerbation similar to uh last year, um, and the inhalers should help open up the airways and dilate, so make breathing easier, and then um, also if it is a COPD exacerbation, it will likely require antibiotics, as well as some steroids for the, the inflammation for five days. Uh, but since your symptoms currently overlap with uh, COVID as well, you'll have to get a, a COVID nasal swab.
user: Okay, okay for sure. 

assistant: Okay, so uh, we'll get that started.
user: I brought my son in today because he had a fever that started two days ago and, and then since then he he's had a cough that started as well and it it he's been short of breath. It looks like he's like breathing faster and just having a harder time to breathe. 

assistant: OK, uhm, before the fever, did you notice any other symptoms, like a runny nose or a stuffy nose? 

user: No, nothing like that. Yeah, the fever kind of came on pretty, pretty suddenly it seemed like. 

assistant: OK, and did you take his temperature at home?
user: I did, yeah. It was like 38.7 and then like two days ago and then it was high again, like yesterday and today. 

assistant: OK, and you mentioned the coughing started soon after the fever, correct?
user: Yeah, yeah kind of like the day after e started having getting this cough. 

assistant: OK and is it a dry cough or is it a productive cough?
user: It's, uh, yeah, he is bringing up a little bit of sputum, yeah he's doing it. 

assistant: OK, what color is the sputum?
user: Uh, it's a maybe like like greenish, greenish, yellow? 

assistant: Greenish yellow, OK. Any blood in there?
user: No, I haven't noticed any any blood. 

assistant: OK, and does he seem short of breath or wheezy? 

user: No wheezing, but he does have some shortness of breath. 

assistant: OK. And the service of bread started with a cough?
user: Ii did, yeah. 

assistant: OK. Uhm, how much shortness of breath is he having? Is it just when he's exerting himself or is it at rest as well?
user: I'd say ah, even at rest now he's like breathing faster. 

assistant: OK, umm, and it does anything help with that? So does sitting up help? Or, uh, you know, getting fresh air or anything like that? 

user: No. But you'd say, like taking a smaller breaths helps because like if he if he takes a deep breath and he gets, he gets like chest pain. 

assistant: OK, OK, and how about when he's laying down?
user: No, he hasn't said anything like, like that for laying down just I think when he's just taking a deep breath, he said. 

assistant: OK, is it waking him up from sleep? 

user: Uh, no. 

assistant: No, OK. How about chest pain?
user: Yeah, so yeah he's had some pain when he, when he just really takes that deep breath in. 

assistant: OK. Does he ever feel like his heart's racing? 

user: Uhm, no. 

assistant: No, OK. Uhm how about any dizziness or fainting spells?
user: No, he doesn't have anything like that. 

assistant: OK, has he had a sore throat? 

user: No, no. 

assistant: Any changes in vision or hearing?
user: No. 

assistant: Uh, smell or taste? 

user: No. 

assistant: No. Weight loss?
user: No, he's been gaining weight well. 

assistant: OK, how about any rashes?
user: Nope, I haven't noticed any. 

assistant: OK, uhm, and then any numbness or tingling? 

user: No, he hasn't said anything like that. 

assistant: OK, muscle aches or joint aches?
user: No. 

assistant: Changes in his bowel movements?
user: Nope, yeah, that's been been getting out, no diarrhea or anything like that. 

assistant: OK. Changes in his voiding? 

user: Nope, he hasn't had any urinary problems. 

assistant: OK. And is he an otherwise healthy child? Umm, does he have any longstanding medical conditions?
user: No, he doesn't. That's uh, this was so surprising, he's been healthy. 

assistant: OK. Has he, so he's never had any hospitalizations or surgeries?
user: No, he hasn't. 

assistant: OK. How about his mother's pregnancy with him? Were there any complications at that point?
user: Nope, everything went went well. No complications and he was like a good birth weight and went home right away. 

assistant: OK. OK, and how about the delivery itself? Any complications during that, that point?
user: Oh no, not it was a vaginal delivery and it was normal. 

assistant: OK. And he didn't need to be hospitalized as a newborn for anything like jaundice or shortness of breath? 

user: Uh, nope, he hasn't had any any reason to be hospitalized. 

assistant: OK. Uhm alright. And has he been hitting all his developmental milestones as well as like his height, weight and head circumference milestones?
user: He has, yeah, he's been growing well and reaching the developments stones, milestones. 

assistant: OK, is he on any medications? 

user: Uh, no he's not on any medications. 

assistant: OK. Any allergies?
user: No allergies. 

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

user: He is, yeah. 

assistant: OK. Any family history of lung or heart conditions.
user: Uh, no, nothing like that. 

assistant: OK. Have about cancers in the family? 

user: No, no cancers luckily. 

assistant: Can you think of anyone he's been in contact with who's also been sick?
user: Yeah, maybe, he has a younger sister that goes to daycare and she was sick last week with like she had a cough and stuff as well. 

assistant: OK. OK, and does she have a fever as well? 

user: She did, yeah, she got better. Right uh, last week we we had to take her to to see the doctor and she got antibiotics for that. Actually for, for a few days. 

assistant: OK, OK. And have you traveled anywhere recently?
user: No, we've been at home. 

assistant: OK. Does anyone at home smoke? 

user: No. 

assistant: No, OK. And who lives at home with him?
user: So it's me, his mom, and then his younger sister. 

assistant: OK. Any old carpets, mold, dust, asbestos, anything that could exacerbate his condition?
user: No, I don't think so. It's a newer home. 

assistant: OK, good. Umm, so those are all the questions that I had for you. Did you have any questions of your own?
user: Uhm, no, I, no that was everything I think. The only I I guess other thing that that I forgot to mention is that just he doesn't really like his appetite's been a little bit lower couple of days as well. But uh, he hasn't had any, like nausea or vomiting though. 

assistant: OK, OK, yeah, that's good to know. Uhm, so because some of his symptoms overlap with those of Covid, we will do a swab on him and you should hear back in about 24 to 48 hours with those results and he should isolate for 14 days because of those symptoms. And it doesn't, it sounds more in keeping with the picture of community acquired pneumonia, so for that we will get a chest x-ray, we'll check his oxygen and his temperature and if the chest x-ray shows consolidation umm, or some sort of infiltrate, it is likely that he has pneumonia. So, we will start by giving him some amoxicillin populate or cefuroxime for five days, and just keep monitoring his symptoms. They should resolve in about 5 days when the course of antibiotics is complete. If his condition gets worse like he's getting neurological deficits like weakness or seizures, just take him to the ER. And if symptoms don't resolve in five to seven days, we can do further work up or things like fungal infections or TB, or things like that. How does that sound? 

user: That sounds great. Thank you. 

assistant: OK, yeah, no problem.
user: Hi, yes it's nice to meet you. I've been having this cough that's been going on for the last few days and I have had difficulty breathing. 

assistant: Oh, I'm so sorry to hear that. When did this start? 

user: Oh, so the cough started about 3 days ago. Yeah, the shortness of breath has come on since then. 

assistant: OK, well let's focus on the shortness of breath first and then we'll talk about your cough as well. So you noticed that you had difficulties with breathing sometime within the past three days. When do you find that it's difficult for you to breathe? Is there anything that makes breathing more difficult for you?
user: Yeah, not really. Actually, it's been well, but just bad after I cough. 

assistant: So say walking up the stairs or doing any exercise doesn't make it worse?
user: Not really, I've been able to do the same amounts of of activity I guess. 

assistant: OK, so there's really no relationship with activity with your shortness of breath. OK, and I can see that you're able to sort of talk in full sentences.  OK, how is it making it difficult for you to do things at home, your difficulty breathing? 

user: I am a little bit, I mean, I feel I just haven't been feeling very good overall so I've been resting these last couple of days mostly. 

assistant: OK, and your cough, you said that started three days ago. Is it a dry cough or wet cough?
user: It's dry. It's a dry cough. 

assistant: OK, and there's no sputum production with it? Anything coming up at all?
user: No, I haven't noticed anything like that. 

assistant: OK, and is there anything that's making the cough better? Did you take anything? Any medications for it? 

user: I tried some over the counter stuff but it didn't help. 

assistant: OK alright. Other than the difficulty breathing and the cough, have you noticed any other symptoms?
user: Yeah, I've been really tired. I guess I've just sort of been  resting the these last few days and I've had a headache as well. 

assistant: OK. Can you tell me a bit more about your headache?
user: Yeah, it feels like somebody is just squeezing the top of or just squeezing the sides of my head. 

assistant: Have you had a headache like this before?
user: I have, yeah. I usually get them when I'm dehydrated. Or maybe I haven't slept well. And that's also been the case for the past two to three days. Yeah, it's been kind of off and on, there are some times that are worse than others, but I've noticed that I had it for the most part for the last few days, OK, 

assistant: Have you taken anything for your headache? Any pain meds? 

user: Yeah, I've been taking some Advil, it's helped. 

assistant: And so you talked about being tired, having a headache, difficulties breathing, and coughing over the past three days. Have any of these symptoms gotten worse overtime?
user: Yes, I would say, but both the cough and the shortness of breath has been getting worse over these last few days. 

assistant: OK, and have you had any chills or have you checked your temperature? 

user: I haven't checked my temperature, but I felt like I've had a fever or might be getting a fever. 

assistant: We can check your temperature here. And have you had any muscle aches?
user: Yeah, I guess I felt a bit achy. 

assistant: Any redness in the eyes? Or any runny nose or sore throat like flu-like symptoms?
user: Umm, I have, I don't know maybe my nose is a little bit congested, but not really running. 

assistant: OK. And have you had any change in your sense of smell?
user: No, I haven't noticed that. 

assistant: What about your sense of taste? Are you able to taste things? 

user: Yeah, I think so. 

assistant: Have you noticed any rash anywhere on your body?
user: Umm, no,  I haven't. 

assistant: OK, any changes in your bowel movement, diarrhea or constipation? 

user: No, no, nothing like that. 

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

assistant: OK. Alright, well it sounds like you have multiple symptoms right now that started about 3 days ago. You're feeling tired, you have a headache, difficulties breathing, some muscle aches and you've been feeling feverish. You've also had this cough, and your nose is feeling congested. Is there anything else that that you've been experiencing over the past three days that I haven't talked about yet?
user: No, as you mentioned, the headache's there too, then yeah, that's everything. 

assistant: OK, umm, alright, can you tell me about your past medical history? Do you have any medical conditions?
user: Yeah, I have asthma and GERD I think. 

assistant: Umm, does the shortness of breath that you're experiencing feel similar to the asthma attacks in any way?
user: No, I haven't had any issues with like asthma attacks in a long time. 

assistant: Do you have an inhaler? 

user: I do but I don't use it very often. 

assistant: I see, did you use it over the past three days at all?
user: Yeah I did try it and it didn't really seem to help that much. 

assistant: Uh, and other than that, have you had any any surgeries in the past? 

user: Uh, I had a colonoscopy two years ago. 

assistant: Any reason for that?
user: Uhh, my father had colon cancer when he was in his 60s. 

assistant: I see OK, and any hospitalizations? 

user: No. 

assistant: OK. Do you take any medications? I know you have puffers. Any medications, including over the counter pills?
user: Yeah, I'll take like a Zantac or like Tums sometimes for reflux. 

assistant: And, uh, any allergies to food, medications, or environmental allergies?
user: Yeah, I have environmental allergies. I think like usually they come on in the springtime. 

assistant: In terms of family histories, you did mention that your dad had colon cancer. Any other medical problems that that run in your family? 

user: Umm, no. 

assistant: OK. And do you currently smoke?
user: No, I don't and have never smoked in the past. 

assistant: OK, what about marijuana? 

user: Umm, no. 

assistant: OK, do you or have you ever had alcohol?
user: I will have some wine on the weekends, maybe a glass or two with dinner. 

assistant: OK, sounds good and have you ever had any street drugs? 

user: Like a long time ago, maybe when I was in college, once or twice. 

assistant: Alright, sounds good, and have you had any contact with any sick people? Anyone who's sick recently?
user: Not that I know of. I mean, I went to a few stores here and there that I had been going to. I've been working from home so maybe at one of the stores. And I would imagine I were wearing a mask and of course trying to maintain social distancing as much as possible. But yeah, you never, really know. 

assistant: What about any other travels or any travels at all outside the city or the country recently? 

user: Umm, no, I had been at home. 

assistant: Alright. So I guess that's all I wanted to know. I'll go talk to the attending and we'll come back and do a physical exam and maybe ask a couple more questions and then discuss the management with you. Does that sound good to you?
user: I can't, I can barely breathe for like 2 days now and I've been coughing and been having like a little bit of pain in my chest. 

assistant: OK, the pain in your chest, uh can you point point out or can you describe the pain to me, is that sharp or is it dull?
user: Um, it's hard to say, I haven't really had this before. Um, it's more like it just kind of hurts just in the middle and it gets worse like when I cough and when I if I take like a really deep breath, it will hurt, yeah. Does that make sense? 

assistant: Yeah, so the shortness of breath and chest pain, they occurred simultaneously right? On the same day, like 2 days ago? 

user: Yeah, I mean now that I think of it, I maybe started coughing a little bit earlier than that. But when it got harder to breathe is pretty well around the same time that I started feeling more the pain. 

assistant: OK, alright so let's focus on the coughing first. Are you coughing up any blood at all?
user: Uh, no, I haven't noticed any blood. 

assistant: OK. And how about sputum?
user: I guess I guess it feels like there's some like mucus, I don't know kind, kind of like spit looking, but maybe like thicker than that. 

assistant: OK, is it yellow?
user: Yeah, yeah. Yeah well yeah, it's creamy yellow. 

assistant: OK, sure, and are you wheezing with the cough?
user: I I don't think so. 

assistant: No, OK, um and is it is your shortness of breath worse with exertion?
user: I haven't been doing much really 'cause I've just been so wiped out. Um, till probably I guess it's kind of, I'm really, you know, haven't been getting up very much. I'm normally really active like I I train for triathlons and I I'm not like a couch potato, right? And I feel like I've been just kind of sitting down. 

assistant: OK. Um, do you have the chest pain at rest as well, or is it just with the coughing? 

user: Like if I take a deep breath I'll have it. But no, I don't think not not like right now. Not like just sitting here. 

assistant: OK. And the coughing, how often are you coughing?
user: Oh, like it kind of varies. I feel like I get up in the night kind of sweaty and I'll cough for for a while. And it it'll keep me up, and then during the day, it's like I might go, you know, a couple hours without, but then I'll cough and I'll kind of keep going for a few minutes so, it's a lot, like probably, yeah, I probably don't go more than like 2 hours without. 

assistant: OK, OK. And how far can you walk before you start feeling shortness of breath?
user: I mean, I haven't been walking very far. Like I I walked in here from the parking lot and that was fine, but I'm tired. 

assistant: OK, OK, and I just want to ask you some other questions. Um, Jessica, so have you had any fevers race recently?
user: I don't actually have a thermometer at home that works, but I like I said, when I've been getting up in the night coughing, I've been like really hot and sweaty. Kinda gross like feel like I just I feel like soaked and but yeah, I don't have a thermometer. 

assistant: Um, OK, so these night events that you're describing, are they more chills or night sweats? 

user: Well, I don't know, it just feels like when you know when you're, I don't like when you're a kid and you get really sick and your parent tells you have fever like I don't have an actual temperature. 

assistant: But do you feel hot?
user: I feel hot, yeah. 

assistant: OK, OK. And have you lost any weight recently?
user: No, I mean I'd like to, but no, no. 

assistant: OK and any changes in your vision? 

user: Uh, no. 

assistant: Hearing?
user: No. 

assistant: Smell?
user: No. 

assistant: Any, do you have like a stuffy nose? Runny nose?
user: Maybe a little little bit. It's been more the coughing that's that's bothered me. So I haven't thought that much about it. 

assistant: OK, sorry you said your nose was stuffy or runny?
user: So it's a little stuffy, maybe a little. 

assistant: OK, OK um, and have you had any like pressure behind your eyes in your head? 

user: No no no. 

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

assistant: No dizziness or fainting spells?
user: Like I feel tired but I haven't I don't know I haven't like fainted. 

assistant: OK, so you're tired, do you feel weak at all like you can't move a certain limb? 

user: Oh no, that that's all fine. 

assistant: That's all fine, OK?
user: I haven't like wiped out like I said. 

assistant: OK, OK, um do you get this shortness of breath or difficulty breathing when you're laying down? 

user: I mean, I've mostly been laying down lately, um, so yeah, like I kinda have it all the time. 

assistant: All the time? OK, but it's not worse when you're laying down or standing up?
user: Don't think it's worse, no. 

assistant: OK, and have you noticed any swelling?
user: Um, I don't think so, no. 

assistant: OK, any palpitations like you feel like your heart's racing?
user: No. 

assistant: No um, and then how about in terms of like your abdominal system? Any pain there?
user: Oh no, nothing. I mean it's like a little sore just 'cause I'm coughing all the time but yeah, but yeah, not not like, not anything like noticeable. 

assistant: OK, and then how about your stools? Have they been normal? 

user: Yeah yeah. 

assistant: And then how about your urine, is that, has everything been normal from that standpoint?
user: Yeah yeah. 

assistant: OK OK um, and then, have you had any issues with breathing or coughing in the past? 

user: No, I mean, I like I said I'm really active. I do a lot of like right, I've been like training for a triathlon, like I haven't had any problems before. 

assistant: OK, OK um, any any past medical conditions that you know of?
user: Uh, I got like I am a type 1 diabetic. 

assistant: OK, OK, have you ever, OK, have you ever had a pulmonary function test in the past? 

user: Well, maybe when I was like kid or like a teenager. 

assistant: And any recent chest X-rays ECG's any other investigations you've done so far?
user: No, like I have been, I've been really healthy. 

assistant: OK, good and are you on any medications? 

user: Um, like I take a, my insulin. 

assistant: Yeah.
user: And like I take I take a statin. Is that what it's called? 

assistant: OK. Is that because you have high triglycerides or like cholesterol? 

user: Uh, I, they just said 'cause I like had diabetes that I should probably start taking it. 

assistant: OK yeah alright.
user: There's no like a big problem. It was just, you know, my family doctor. I think my my dad has diabetes and he he he had heart problems so, like she also my family doctor knows my dad too so I don't know if that has something to do with it. 

assistant: OK. OK, and then yeah, I guess I will talk about family history since you brought it up. Any lung issues in the family?
user: Uh, not that I know of like. 

assistant: OK.
user: Just I mean the heart like my dad had a heart attack. I don't know if that counts as like it's close to the lungs. 

assistant: How old was he?
user: Um? It wasn't that long ago he was like in his 60s. 

assistant: OK. 

user: Yeah. 

assistant: OK. Um, I'm gonna name a few things and you let me know if this is in your history, OK, in your
user: Maybe like my cousin, but yeah, not like my mom or dad. 

assistant: OK, cystic fibrosis? 

user: No. 

assistant: OK alpha one antitrypsin deficiency?
user: I don't think so, no. 

assistant: Pulmonary fibrosis?
user: No no. 

assistant: OK, OK. And are you up to date with all your immunizations?
user: Like I I always I always got like the ones I was supposed to. Um, I normally like normally where I go into work, there's like a pharmacy outside and I would get my flu shot. But this year it's like I'm working from home, I haven't even been around there so I didn't get it this year. But I have all the normal ones. 

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

assistant: No? Do you smoke marijuana? 

user: No no. 

assistant: Any other recreational drugs?
user: What like alcohol? 

assistant: Um, no other than alcohol, like cocaine or meth, anything like that?
user: Ah, no. 

assistant: OK no? OK, and yeah, do you drink alcohol? 

user: Oh like if I'm like with friends, maybe on a weekend. 

assistant: OK OK.
user: Couple drinks or something. 

assistant: OK, and have you been in contact with anyone who's been sick around you? 

user: Like I said, I work I work from home so I've been seeing very many people. Um, I like I, geez. I my my sister, I saw my sister and like she, I guess she works she works in like a retirement home. 

assistant: OK.
user: Like she, I don't think she was sick. 

assistant: OK. OK, is it possible that she was in contact with someone who may have been sick? 

user: I think it's I mean it's possible like that's what she does for her work, right? She works at like a retirement home, so yeah possible. 

assistant: OK, and what what kind of work do you do Jessica?
user: I'm an accountant. 

assistant: OK, and have you traveled anywhere recently? I know with COVID obviously that's hard. 

user: I wish I wish, but you know I haven't been anywhere. Like I said, I've just been at home. 

assistant: OK. Um, in particular, have you been in a country where TB is endemic and have you been in any of those countries in the past, like 5 to 10 years?
user: I don't know like I've been to the like the states before COVID. I I don't, I didn't really haven't traveled anywhere cool in a long time. 

assistant: OK, OK. Um, so just kind of going through what it could be that you have right now. I'm thinking a few things and we kind of like to go through and make sure we're not missing anything. So in terms of like vascular stuff it could be something like like CHF or pulmonary embolism and that stands for congestive heart failure, but you're very young. You seem like you're very healthy, so that's probably lower on our differential obviously. 

user: OK, yeah hopefully. 

assistant: An infection would be the biggest one right now with the cough with it seems like you have chills and night sweats. Yeah, so would have to do more in terms of taking your temperature, and see if you can do like more