jshargo/medical-interview-conversations2 huggingface dataset:
user: No, there aren't any smokers in the home. 

assistant: OK, and any new carpets or any dust running or mold or anything like that in the house? 

user: That there is a carpet and in the basement that, he uses that as his playroom, sometimes 

assistant: OK. OK. Yeah, so those are all the questions I had. Do you have any questions at all?
user: Yeah, I was just wondering like if this could be maybe asthma as well? 

assistant: Yeah, so definitely. That's something that's at the top of our head right now, especially due to his age and the symptoms that he's been having after exertion in particular. And the family history of asthma as well. So definitely that's something that we want to investigate. So what we'll do for him is first, we'll do like a full physical examination. Listen to his alongs. And just assess his breathing and then afterwards we will order some tests for him, so he's six years old, right? 

user: He is yes.  

assistant: OK, so we'll see if we can do something called a pulmonary function test. Sometimes it depends on the child
user: Yeah, so over the last week I've just been feeling some symptoms. It kind of first started with, like a runny nose. That was around like 5 days ago and then it turned into just a lot of congestion, like around my nose and like my throat. And now over the last two days I've been just feeling so much pressure around my nose and around my jaw so I've been getting a lot of pain there as well. 

assistant: OK, is your nose still running?
user: Yeah, I'm still getting some discharge and I also feel like I'm getting some dripping at the back of my throat too, especially when I wake up. 

assistant: OK, and could you describe the discharge? Is it clear, yellow, greenish?
user: Uh, it's fairly clear and sometimes, like a bit white, but like, it's not like green or yellow. 

assistant: OK, uh, and have you felt that it's difficult to breathe in through either of your nostrils, like it's obstructed?
user: Yeah, so at night sometimes I have to like turn because one side of my nose gets difficult to breathe from and then it kind of balances out on the other side. So yeah, I do have some obstruction. 

assistant: OK, and have you had any changes to your sense of smell? 

user: Yeah, so just in the last three days when the congestion got really bad I started losing the ability to smell. 

assistant: OK, have you had any changes to your sense of taste?
user: No, taste is fine. 

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

assistant: OK, and the symptoms have gone on for five days. Have you had a period of time where you got better and then got sick again? 

user: I did kind of have a runny nose last week as well, so probably like 8 days ago but then the runny nose discontinued a little bit but really got worse 5 days ago, but all these other symptoms just happened in the last few days. 

assistant: OK, and you have pain. Do you feel it in your jaw or do you feel it in the in the front of your nose?
user: Yes, I would say mainly over the cheeks. It can kind of go near the front of my teeth as well, so like I would say like mostly around the cheeks, jaws and up to the front of my teeth. 

assistant: OK, And do you grind your teeth at all at night? or have you had, TMJ issues before?
user: No nothing like that. I think it's not so much on and around my teeth, it's more so just to right below my nose, above my teeth and just around my cheeks. 

assistant: OK, so no pain in your mouth or anything like that? 

user: No, not inside my mouth. 

assistant: OK, have you had any fevers or chills?
user: Uhm, I Don't think I've had a fever. I did feel some chills over the last few days, but just very brief episodes. 

assistant: OK, and over the last few weeks have you had any weight loss? 

user: No. 

assistant: OK, and you said you didn't have a cough or a sore throat, but have you had any wheezing?
user: No wheezing. 

assistant: How about any shortness of breath?
user: Uh, not shortness of breath. Just sometimes when my nose gets like really congested, I just turn into like a mouth breather, but that's about it. 

assistant: I see, OK, and have you had any chest pain? 

user: No, no chest pain. 

assistant: Alright, and any lightheadedness or feeling dizzy?
user: No. 

assistant: OK, have you had any nausea or vomiting?
user: Nope. 

assistant: Any abdominal pain? 

user: No. 

assistant: Have you had any diarrhea?
user: Sorry, what was that? 

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

assistant: OK, and have you had any urinary problems?
user: Uh, no. 

assistant: And have you had any rashes or skin changes?
user: No, not that I know. 

assistant: OK, then how about any muscle aches or joint aches?
user: Uh, no. 

assistant: OK, and have you had any muscle weakness? 

user: No. 

assistant: And how has your energy been? Any fatigue?
user: Uhm, it's been mainly OK, just maybe sometimes difficult to get to sleep with all the all the congestion, but I don't think my energy has been affected too much, no. 

assistant: OK, and, uh, sorry to go back to this, I don't think I asked. Did you notice any discharge from your eyes or any eye redness? 

user: Not discharge, but yeah, maybe a little bit of redness. 

assistant: OK, have your eyes been itchy?
user: Uhm Yeah, a little bit. I would say they have been a bit itchy. 

assistant: OK, alright then, do you have any medical conditions that you see a physician for regularly? 

user: Uh, just uhm, its called dyslipidemia. 

assistant: OK, I see, and any medications you take for that?
user: Just like a Statin medication. 

assistant: OK, do you take any other medications? over the counter? prescribed?
user: No, other than that I take multivitamins. 

assistant: OK, and do you have any allergies to medications or like environmental allergies that might be getting worse? 

user: Uh, no, not that I know. 

assistant: OK, so you don't experience any symptoms like this when the seasons change?
user: I don't think so. I have had this happen to me, Uh, I would say like once before. It happened like two years ago. It was pretty similar. 

assistant: OK, uhm, and what was done at that time?
user: At that time it kind of just went away on it's own. It got better. I feel it's definitely worse this time. But at that time I didn't even go to the doctor, it kind of just went away. 

assistant: OK, I see. Any recent hospitalizations?
user: No hospitalizations. 

assistant: Any surgeries?
user: Nope. 

assistant: Alright, and could you tell me where abouts you're living currently and who you're living with?
user: Yeah, so I'm currently living in an apartment by myself, just outside of London. 

assistant: OK, and anybody that you've been around who's had any symptoms?
user: Uh, no, not that I know of. 

assistant: OK, so no sick Contacts. And have you traveled anywhere out of the city or province? 

user: No, I've tried to stay home, besides going to work. I just work at the grocery store. Besides that, no, nowhere else. 

assistant: OK, and any of your coworkers have any symptoms? Or any coworkers being off sick?
user: No, we're pretty careful right now with the pandemic. 

assistant: I see, yeah, that's great. OK, and do you smoke cigarettes?
user: No, I quit just a couple of years ago. 

assistant: Oh, that's great. It's not easy to quit, so that's awesome. And do you drink alcohol?
user: Just maybe like red wine a couple of times a week. 

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

user: Uh, just, in a month, maybe once or twice, I smoke a joint. 

assistant: OK, uh, and anybody in the family have any lung or heart conditions?
user: No, not that I know of. 

assistant: Alright, and how about any cancer in the family? 

user: Uh, no, no cancers. 

assistant: OK, I think I that was everything I wanted to ask about today. Was there any other symptoms or anything else that you wanted to make sure I knew about today?
user: No,  I think that's all. I just didn't know if I needed any, like, medications or if I needed to get tested. I just wanted to make sure. 

assistant: Yeah, so well, certainly check your temperature to see if you have a fever. And if you do and it's high enough, that will increase the chance that you have a bacterial sinusitis,  and if so, with some of your symptoms, including the discharge, obstruction, loss of smell, and facial pain, that all fits the picture for it and also you had a period where you felt a little bit better and then worse again. So that might require antibiotics, but we will check your temperature and go from there.
user: Yeah, so I've been pretty breathless for the past six days and it's it's just worse. I have to stop from, I had to stop so many times walking here from my car. 

assistant: OK, and when did this first start?
user: Six days ago. 

assistant: And did it start like gradually or was it all of a sudden? 

user: Bah, pretty sudden actually. 

assistant: OK, and were you doing anything before it first happened?
user: No. Just work and spending some time at home. 

assistant: OK, and so you're having the shortness of breath, but are you having any like coughing at all? 

user: Oh yeah, a lot of coughing too, yeah. 

assistant: OK, and is it a dry cough or a wet cough?
user: Um, so I've noticed this weird rusty colored sputum and I've noticed that like a couple times a day. 

assistant: And did your cough started around the same time as when your shortness of breath started? 

user: Uhm, yeah, I'd say so. 

assistant: OK, so around six days?
user: Yeah around there. 

assistant: And has it been constant like I've been constantly having a shortness of breath every day with the coughing? Or does it come and go? 

user: Um? It's pretty constant now. 

assistant: OK, and do you find that it's been getting worse at all?
user: Uhm, yeah, I'd say it's getting, I'd say it's getting worse. 

assistant: OK, and is that both the coughing and the shortness of breath or one or the other? 

user: It's, it's both. 

assistant: It's both OK.
user: Yeah. 

assistant: And do you remember if you were doing something at the time when the shortness of breath first started? Have you recently had any infections or anything like that previously? 

user: I don't know bout an infection. Um, but I guess I have been feeling a little feverish. I haven't taken my temperature, but I've been feeling you know, kind of cold. 

assistant: OK. And when you feel the breathlessness, how long does it usually last for?
user: Um, it's kind of hard to say, it's it's always their baseline, but it gets worse when I when I walk or when I exert myself. 

assistant: OK. And besides like the exertion, does it get worse with any when you're near pollen, when you're outside in the cold, anything like that?
user: Um? It gets worse when when no no, I wouldn't say that no, no. 

assistant: OK. And is it worse in the morning or at night? 

user: It it doesn't matter. 

assistant: It is there all the time?
user: Yeah. 

assistant: OK. And is there anything that makes it go away or I mean or anything you've tried that makes it better? 

user: Well, I guess I've tried some taking some Tylenol and that's helping my like regulating my temperature. 

assistant: OK. And have you ever noticed any blood in the cough?
user: It's rusty colored, but I don't know if that's blood. 

assistant: OK, but you've never actually coughed up uhm red blood.
user: No. 

assistant: OK. And. Is there anything that makes your symptoms worse besides exertion?
user: Uh, no. 

assistant: OK. And do you notice, having any wheezing or any other breathing sounds? 

user: I notice some wheezing. Yeah, it's it's, it's not that much though. 

assistant: OK. Before this, before the six days, have you ever experienced anything similar?
user: Uh, no. 

assistant: No, OK. Have you traveled outside of the country at all recently?
user: Uh, no. 

assistant: Yeah, OK. Do you have any other symptoms, like a sore throat, runny nose, chest pain, anything like that? 

user: I do have this sharp chest pain that gets worse with coughing. 

assistant: OK and is is that always there or is it just when you're coughing a lot?
user: I guess when I'm coughing a lot. 

assistant: And that starts six days ago too as well. Or is that?
user: Yeah. 

assistant: OK. And do you ever feel any kind of is it so you said, mention it was sharp, but do you ever feel like increased pressure in your chest? Anything like that?
user: Uh, no. 

assistant: And how would you rate this pain when it occurs from a scale of 1 being the least amount of pain you've felt in your life, and 10 being the worst?
user: The sharp chest pain? I'd say maybe like a 7. 

assistant: OK, and does it go away on its own or does it spread to different areas of your body at all? 

user: It just starts gradually going away at when I stop coughing. 

assistant: OK. Have you experienced any kind of headaches with nausea or vomiting?
user: Uhm, no. 

assistant: OK. So you mentioned you had some chills, but you don't know if you had a fever.
user: Mhmm. 

assistant: OK. Have you experienced any kind of dizziness or fainting spells?
user: Uh, no. 

assistant: OK. And have you been in contact with anyone who has been ill recently? 

user: Not that I know of, no. 

assistant: OK. Have you experienced any night sweats?
user: I feel chilly at night, but I don't, maybe, yeah. 

assistant: OK, any significant weight loss recently? 

user: No. 

assistant: And have you noticed any kind of symptoms like your heart is racing? Or anything like that?
user: No. 

assistant: OK. Have you experienced any changes in your bowel movements at all like in constipation or diarrhea? 

user: No. 

assistant: Any changes in your urinary patterns?
user: Um, no. 

assistant: Any issues with your sleep or appetite at all?
user: Uhm, no. 

assistant: OK. Have you had any recent infections like a cold or anything like that recently? 

user: Um, I guess I had a runny nose a few days before. 

assistant: OK.
user: Yeah. 

assistant: Have you at all been exposed to anyone with tuberculosis in the past?
user: No. 

assistant: Any exposure at your workplace or at home to any fumes or dust in pets or animals?
user: Ah, well I have birds, but I've had them for awhile. 

assistant: OK. How long have you had the birds for? 

user: Ah about three years. 

assistant: OK, and no, they haven't caused you any issues before?
user: No. 

assistant: OK. And do you have any allergies that you know of? 

user: No allergies. 

assistant: OK. Any past medical conditions, like high blood pressure, diabetes, asthma?
user: No. 

assistant: Any previous surgeries? 

user: No, none. 

assistant: OK. Any hospitalizations for any reason?
user: No. 

assistant: OK, are you on any medications currently? 

user: No.  D" And do you have any family history of any medical conditions like cancers or heart attacks or any lung issues?  No. 

assistant: OK. And currently, do you work?
user: I do. The place I work is very crowded and it's not the best conditions to work in, and there's an air conditioner, which I think is broken. It's quite humid, it's never been checked. Yeah. 

assistant: And how long have you been working there?
user: For the past year. 

assistant: OK. And where do you live currently? Do you live in a house or an apartment?
user: Uhm, I have a small apartment, also not in the greatest location. 

assistant: OK, do you have any exposure to mold or excessive dust in your household? 

user: Um, maybe, ah it's a very badly kept apartment, so it's possible. 

assistant: OK, do you have any potential exposure to asbestos in your house or at work?
user: I mean, yeah, probably. Both buildings are very, very old. I doubt they're being maintained. 

assistant: OK. And do you currently smoke at all? 

user: I smoke 10 cigarettes a day. 

assistant: OK, and how long have you been smoking for?
user: Um, since I was 20. 

assistant: OK. And do you use any recreational drugs like marijuana? 

user: I smoke a little cannabis sometimes. 

assistant: And how often, would you say you smoke in an average week?
user: Maybe about 5 milligrams. 

assistant: OK. And do you drink alcohol?
user: I do, but not a lot. 

assistant: How much would you say you drink in a week? 

user: Ah, maybe 5 drinks? 

assistant: OK. And in terms of your daily routine, do you think you get enough exercise?
user: Probably not. 

assistant: OK. Uhm, and how about your diet? Do you get 3 meals a day or is it well balanced? 

user: I eat a lot of fast food and junk food. 

assistant: OK. Alright, is there any other questions or concerns that you had for us today?
user: Um, hi, I'm here with my daughter. Uh, we noticed that uh, since yesterday she's been having this pain just in her elbow. Um, and like today, we've noticed right after she woke up, she's been in pain and also just keeping her elbow like protected, um, kind of like just flexing it and just holding on to it. So I think it's uh, giving her a lot of discomfort and she's been crying as well. 

assistant: Oh yeah, for sure. Um, when did this start?
user: I think it started, uh, after we went for a walk last uh, evening. Um, and we just went to the park and since then like she's been having that pain. 

assistant: Okay, okay, and did anything happen to trigger this? Did she fall on that arm? Or like, injuries? 

user: Um, I think like just uh, she was playing and then um, she was about to fall like right, like right on to the playground pavement. So I remember like, but like I caught her right away, so to protect her, and then since then, I don't know if like there was like a jerk movement as like I kind of pulled her back up, or um, when I was stopping her from falling, like if that caused it. But she didn't hit herself or anything like that. 

assistant: Okay. Alright, um, and in terms of the type of pain she's having right now, did she say if it was a dull, achy kind of pain, or is it sharp?
user: She says it's aching a lot. 

assistant: Okay, and has it been constant since she um, started experiencing this? Or does it come and go? 

user: It's, it's been pretty constant since then and yeah, she just kind of keep, keeping, she's kind of keep, just keeping it like, her arms extended um, and then yeah, just holding on to it. 

assistant: Okay. Um, and then, is the pain just in the elbow, or does it radiate down into her hands or up to her shoulders?
user: Um, it kind of goes into her upper arm, like from her elbows to her upper, upper arm. 

assistant: Okay, have you tried anything for this pain?
user: Uh, no, I haven't tried any medications or anything. I just wanted to come in before I tried anything. 

assistant: Yeah, 1 to 10, 10 being the worst type of pain, how bad is this pain for her?
user: I would say it's probably, at least a 7. 

assistant: Okay, and then um, has she ever experienced pain like this in the past? 

user: Um, no. This is the first time. 

assistant: Okay. Um, and then does she have any numbness or tingling in the area?
user: Um, no, not that I know of. 

assistant: Okay, how about memory loss or confusion? 

user: No. 

assistant: Um, any headaches?
user: Nope. 

assistant: Um, dizziness or fainting spells? 

user: No. 

assistant: Any weight loss recently?
user: No. 

assistant: Fevers or chills? 

user: Nope. 

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

assistant: Uh, changes in vision, hearing, smell or taste? 

user: No. 

assistant: Uh, any coughing, shortness of breath, or wheezing?
user: Um, no. 

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

assistant: Uh, any changes in bowel movements?
user: Uh, no. 

assistant: Um, how about changes in urine? 

user: Um, no. No, no changes. 

assistant: Okay, and is she otherwise healthy? Does she have any longstanding medical conditions?
user: She's been healthy so far, no concerns at all. 

assistant: Okay, and um, with her mother's pregnancy with her, were there any complications at that point?
user: Um, no, it was like a normal pregnancy, no complications. She was born at 39 weeks, like with vaginal delivery, didn't have to stay in the hospital or anything like that. 

assistant: Okay, and no issues as a neonate?
user: Uh, no, she, we were able to bring her home pretty quick. 

assistant: Okay, that's good. Um, and then, she hasn't had any hospitalizations or surgery since then? 

user: No, no surgeries or hospitalizations. 

assistant: Alright, his she on any medications?
user: No, no medications. 

assistant: Okay, um, is she up-to-date with her immunizations?
user: Yeah, we've had, we've got all the immunization. 

assistant: Okay, how about allergies? Does she have any? 

user: Um, no allergies. 

assistant: Okay, any uh, family history of musculoskeletal issues?
user: Nope. 

assistant: Uh, lung or heart conditions?
user: Nope. 

assistant: Um, autoimmune conditions? 

user: No. 

assistant: Cancers?
user: Um, nope. 

assistant: Um, is she like on par with her peers in terms of developments and reaching milestones?
user: Uh, no, like she's been meeting, all her milestones have been on par with her siblings and other children. No concerns from the doctor whatsoever. 

assistant: Okay, and who does she live with at home? 

user: She lives with me, her, her dad, and um, we, she has two siblings, two older brothers. 

assistant: Okay, um, and does anyone at home smoke?
user: Nope. 

assistant: Any concerns for her safety at home? 

user: No, like we're, like, no, I don't think so. 

assistant: No, okay. And how are things at school for her?
user: Schools been well, like it's been difficult with the pandemic, but um, she's doing well. 

assistant: Okay, that's good. Has she come in contact with anyone sick recently?
user: Um, no. 

assistant: Have you done any travel recently? 

user: Nope. 

assistant: Okay. Alright, and those are all the questions I had for history taking. Let's move on to the physical exam part of this interview. Um, I'm just going to get you to take a look at both her elbows and arms. Do you see any, um, redness or swelling in the right elbow compared to the left?
user: No, I don't see that. No, I don't see any changes. 

assistant: Okay, how about um, any muscle atrophy, deformities, or skin changes, like bruises?
user: Um, no, I don't see anything like that. 

assistant: Okay. How about, um, when you palpate her elbows, does, is she in pain?
user: Um, she doesn't really let me, but if I try to, I think that does cause her some pain. 

assistant: Okay, how about when you palpate her like forearm muscles? 

user: Um, no, not as much. 

assistant: Okay, how about her biceps and triceps?
user: Um, no, not really. 

assistant: No, okay. Um, alright, and those are all the questions that I kind of had for you. Did you have any questions of your own for myself? 

user: No, I just wanted to find out if she broke something, or like, yeah, I didn't know what was going on. 

assistant: Okay. Yeah, it seems like someone of her age and just the kind of history that you're giving me, it sounds like she has something called a radial head subluxation. Um, and that's usually caused in young children when they're like pulled or lifted by the hand or wrist while their arm is held straight, um, which can kind of pull the bone out of its socket a little bit. Um, so um, in terms of like a management plan, you can try conservative things like ice packs, um, over the counter painkillers. Um, otherwise, we can try to um, put the radius back into its normal position here, which will just take uh, like a few minutes. Um, and, and then after we reduce it back into its place, um, she should have normal function of her arm again. Um, if she's still experiencing pain, we can continue keeping it on a splint, um, but otherwise, I don't think we need any imaging for this at this um, at this time. So did you have any questions or any concerns about that?
user: Yes I did, it was uh it was behind my left uh knee kind of in like the joint behind where it bends. Um it was stuck pretty good, it's still kind of red and tender there. I noticed it because the back of my knee was starting to just feel a bit sore, um not the joint itself, but just kind of the skin, the whole area back there. Um and I found this tick, I brought I brought it in with me if you wanted to have a look at it, um it's in like this little plastic container, uh and I don't really know when I got it. I was hiking on Friday um and then Saturday I was out in my garden, I hope they're not around my house, I hope that it was from hiking um and not gardening, but uh I did spend a lot of time outside on Saturday as well. 

assistant: OK, so sounds like it's been a little bit of time since you were last outdoors to when you first noticed it?
user: Yeah. 

assistant: OK, so when you picked it off the tick, obviously you have it for me, is it quite swollen or engorged?
user: It's not too bad, um I I have actually had a tick in the past and this is a long time ago and um maybe like 10 years and I actually had that kind of target rash thing that they talk about. And, uh at that time I remember I had to take antibiotics for a bit. Um this um didn't look like that, it was more, it was just kind of sore in one spot, I don't think it um it was as bad as that time and the tick that time, sorry I've kind of gotten off track, that time it was quite swollen, this one was maybe a little bit, but not as much. 

assistant: OK, so just in terms of the tick's size, it doesn't look like it's been feeding for too long, so when ticks uh are feeding they tend to engorge, they tend to swell up, so this looks more like a tiny little bug or does it kind of look like a little grape, almost like it's been swollen up with blood? 

user: No, this one, this one's pretty small. 

assistant: This one's pretty small, OK. And I should mention that, well obviously you've had a tick bite in the past, the big concern for us is a disease called Lyme disease, which is spread by bacteria, but in fact only one type of tick predominantly is a transmission transmitory agent for it. It's called a deer tick, and its coloration, it's got a little bit of a brown butt and there's some black legs. Does it look like that at all?
user: I don't think so, uhm, I uh I was looking at the pictures online, I think it looks like the other kind of tick, um but I heard that, yeah, but I heard that lately now they've been considering all ticks in this area as possibly carriers of Lyme um because I think it's kind of become more more of a problem sm so that was making me a bit nervous. 

assistant: OK, absolutely, what we can do is we can send this tick off to the lab and they'll be able to identify the species for it, but for tick bites in general, one of the key considerations is for how long it's been on your body for. So unfortunately, if you're out on Friday and Saturday, that'd mean that this tick has been on you for longer than at least 72 hours. So I think one way or another, we're likely going to have to put you on antibiotics just as kind of a prophylactic at the very least, just want to make sure that um you're not at risk of developing Lyme disease. I'm sure you've heard from the news that Lyme disease can present in a variety of ways, but it's a disease that we try our best to avoid. And just in terms of your symptoms, so you say you've had a bite in the past and you you've got that rash before, that kind of bullseye rash, do you have that rash now? 

user: No, I don't uh as far as I know, I mean, you can have a look too. It's behind my knee, so it's not the easiest place to see, but it's uh it looks a little red, it's like tender where the tick was, but I don't see that like larger circle rash. 

assistant: OK, that's reassuring. Now any, it'd be pretty unlikely for you to have other symptoms, but just in case, do you have any other joint pain?
user: No. 

assistant: Have you been feeling ill or have been feverish in the last little while? 

user: No, no, I've been fine. 

assistant: OK, and you removed that twit tick once you found it, you presented to me, have you checked your body for any other possible bites?
user: Oh yeah, I looked around and I looked at my husband too 'cause we we were just a little bit, you know, gave us a little bit of a scare, but no, there's been nothing else. 

assistant: That's good. And did you bring a pet with you at all when you were hiking and gardening?
user: Uh no, I didn't, no. 

assistant: OK, good. Any other family members you think might have been exposed? 

user: Uh no it was just uh me and my husband. 

assistant: OK, and what geographic area were you in um when you were hiking?
user: We were uh in Strathroy along the creek. 

assistant: OK. I can do, if I remember there's a Lyme disease distribution map for Ontario and we can see exactly how that lines up to see if we should be a little bit concerned or not. Looks like Strathroy is close enough to be considered a little bit of a concerning point, so I think that we will be moving forward with antibiotics, but of course we'll be talking to the physician who'll be having a look at you as well. So it sounds like you haven't been having too much symptoms aside from you've noticed this tick, the skin around it is fairly sore and you've had this in the past, but you were treated with antibiotics in the past and since then you haven't had too many health problems after that? 

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

assistant: OK, and just about your health right now, is there anything that you see the family physician or doctor for in general and regarding your health?
user: Uh just for my cholesterol. 

assistant: OK, are you taking and medications for that? 

user: Uh Yeah, I take a uh statin, can't remember which one. 

assistant: OK, got it. And do you have any allergies?
user: Uh no. 

assistant: So no drug allergies?
user: No. 

assistant: OK, now we've already talked about other exposures, so it doesn't sound like anyone else in your family or any pets are around, so it's unlikely that you have ticks coming in and you said you might have gotten this from gardening, but um you're hoping that your area doesn't have ticks. Maybe just take a look, ticks like to live in long grass, kind of on the intersection between woods and fields to see if there's any hovering around that kind of make a waving motion with their legs and they're sometimes easy to spot, you might wanna get some insecticide out there. But it sounds like this is fairly recent, unfortunately just for the length of time this tick might be on you for, it's probably safer than not to start you on some medications, but I'm going to go talk to the doctor after we do a quick physical exam, and we might also send the tick off to a local laboratory so they can identify the species for it definitively, as well as might just send some blood work just to see if there's any titres or any serology that would make us a little bit more concerned for Lyme disease. But aside from that you've been feeling well otherwise? 

user: Yeah, totally fine. It was just a little tender there and that's the only reason I looked. 

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

assistant: Nothing like that? 

user: Nothing like that. 

assistant: OK, excellent, alright. I'm fairly happy with what we talked about today. Do you have any questions for me Jean?
user: No, this is pretty well what I expected today, so thanks for helping me out. 

assistant: No problem. OK, I'll go talk to the doctor, we'll come back and talk to you, OK?
user: Yeah, so uh I'm just bringing my son uh here to the clinic. He's been having um just I think he's been complaining of uh ear ache in his uh I think it's mainly in his left ear for the last, I'd say at least a week. Um he's been kind of just having discomfort um and over the last few days uh he also started crying because of how much pain he is having, and then um we also noticed that he had like was just feeling warm, so we took his temperature and he actually had a fever just yesterday of like 39 degrees Celsius. 

assistant: OK, uhm, alright. So let's back up just a little bit. The ear pain, when did that start? You said a couple of days ago, so was that two, three, four days?
user: Uh I think the discomfort like uh, we saw him scratching his ear for the whole last week, but uh the crying actually started just I would say four days ago, um. 

assistant: OK.
user: So I think the last few days have been really tough for him. 

assistant: Yeah, so three, four days. OK, have you taken a look into his ear? Like does does it seem red? Is there discharge? 

user: Uh I think we did see some uh, just like it wasn't red or anything, but I think we did uh see some um just kind of clear to almost uh clear to yellowish fluid from his affected ear. 

assistant: OK, clear to, you said white-ish?
user: Uh like it was a bit of a yellow tinge to to it as well. 

assistant: Yellow, OK, OK. And which ear was it, sorry, the right or left?
user: Left ear. 

assistant: Left ear, OK. And the right ear looks normal?
user: Yeah, right ear, he hasn't been complaining uh at all. I haven't even looked at the right ear yet. 

assistant: OK, is he itching his ears at all?
user: Uh he was he was itching like pretty much this whole week, but I think right now he's hesitant to even touch his ears. 

assistant: OK, and does it look like it's angry on the outside or on the inside of his ears? 

user: I can't really see anything on the outside. 

assistant: OK, OK, and have you noticed that his hearing has changed at all?
user: Um he still like answers to us and like I don't think his ear, hearing is affected. 

assistant: OK. Has he had any past issues with his ears, like ear infections or like hearing issues in the past?
user: Uh no hearing issues, but he did have uh like he used to, probably when he was uh like 2 years old, he did have a couple ear infections. 

assistant: OK, OK. Were they were they treated with antibiotics?
user: Uh I think one time they were, but I I'm pretty sure that was on, in his right ear. 

assistant: OK, OK. He's never had to get like tubes inserted or anything like that? 

user: No, no, nothing like that. 

assistant: No, OK. Um, alright. Um has he had a stuffy nose or runny nose?
user: Uh not this week, but he he was a bit like stuffy like last week I would say. 

assistant: OK, he was a bit stuffy, you said?
user: Yeah, maybe even, maybe two weeks ago. 

assistant: OK. And that stopped. Did he have anything else along with his stuffy nose at that point? 

user: No, nothing else. 

assistant: Um right now, have you noticed any changes in his vision, in his smell or taste?
user: Uh mo, not that I know of. 

assistant: OK, how about weight loss? 

user: No, he's been um growing pretty well. 

assistant: OK, and you said um you had taken his temperature. When did you take his temperature?
user: I just took it yesterday but uh he was feeling a bit warm yesterday so we just took it and it was like um 39 degrees Celsius. 

assistant: OK, OK sweet. Um so 39 degrees, so he does have a fever uh for sure. We'll take his temperature again today just to make sure. Have you been giving him anything for his high temperature, like Tylenol?
user: No, we haven't given him anything. 

assistant: OK. Have you noticed any rashes on him?
user: No. 

assistant: No, um how about coughing?
user: Uh no, he hasn't been really coughing. 

assistant: No coughing, how about wheezing or shortness of breath? 

user: No. 

assistant: Like anything that would indicate he has chest pain or palpitations of his heart?
user: No, I don't think so. 

assistant: No, OK. Any dizziness or fainting spells?
user: No. 

assistant: Confusion?
user: No, I don't think so. 

assistant: Headaches?
user: Uh not that I know of. 

assistant: OK, and how how have his bowel movements been? 

user: His bowel movements have been pretty much the same, um he's uh, yeah, there's been no real changes. 

assistant: No, OK. Um alright, and how about uh nausea or vomiting?
user: Uh no, no, no nausea or vomiting. 

assistant: Any appetite change?
user: Uh no, uh, maybe a little bit more fussy just, but I don't know if that's probably due to the pain. 

assistant: OK. Um and how about his urine?
user: Uh his urine has been the same, like no changes. 

assistant: No changes, OK good. Is he an otherwise healthy kid or does he have any longstanding conditions?
user: Yeah, he's pretty healthy. There have been no concerns at all that we've had for the doctor. Uh he's been growing well, um meeting all of his milestones. Um yeah, no, nothing that's concerning. 

assistant: OK, um do you know if his mother's pregnancy with him was normal? Did she have any complications? 

user: Um she didn't have any like complications during the pregnancy. Uh they did have to, um I forgot what it's called, but uh he was like a difficult baby coming out. Um and he was at term though, he wasn't premature, but they had to use just um some tools to get him out. 

assistant: OK, OK. Um so it was a vaginal delivery, but they used some tools like forceps maybe or vacuum?
user: Yeah, yeah it was forceps, yeah. 

assistant: OK, OK. Um and he's, you mentioned he was full term?
user: Yeah, he was born at uh 40 weeks. 

assistant: OK, perfect. Did he need to be hospitalized for any reason after that? 

user: No, he wasn't hospitalized. Uh we stayed there maybe one day extra just because um there was some just kind of misshaping of his head. 

assistant: OK.
user: That kind of went away. 

assistant: OK, OK, good. And is he on any medications?
user: Uh no, no medications. 

assistant: No medications, up to date with his immunizations?
user: Yeah, he's all up to date. 

assistant: OK, any allergies?
user: Um not that we know of. 

assistant: OK, how about family history of lung conditions, heart conditions? 

user: Um no, we've been pretty healthy as parents. Um and I think my my father has like high blood pressure, diabetes, and all those types of things. 

assistant: OK, OK, any um ear issues like congenital ear, sorry um, genetic hearing issues or ear issues?
user: No, nothing like that. 

assistant: OK, um does anyone at home smoke? 

user: No, no one smokes. 

assistant: OK. Um and who does he live with?
user: So he lives with um me, his father, and his mother as well. 

assistant: OK. Uhm, any siblings? 

user: No siblings, he's an only child. 

assistant: OK, and how are things at home, um is like, are things financially stable? Any relationship issues?
user: No, we've been pretty uh fortunate like it it's, no financial issues uh and we have a lot of support from our parents as well. Uh the relationship is great, so no, no issues. 

assistant: OK, good good. Um has he had any sick contacts recently? 

user: Um I don't think so. He's, we've been at home so I don't know. We we did have like, with our with my brother's uh kids like uh they came to see us once um but that was like, that was, I think at like three weeks ago. 

assistant: OK, OK, three weeks ago. Alright, um travel to anywhere recently?
user: No. 

assistant: No, OK. Alright, those were all the questions I had for you today. Do you have any questions that you wanted to ask me today before we end the interview? 

user: Uh no, not really. Just wanted to know if, like I remember he did need antibiotics before so I was just wondering if he needs them now. 

assistant: Yeah, um so, well first, because some of his symptoms overlap with Covid, like the fever especially, we'll do a swab on him anyways um and you should hear those results in about 24 to 48 hours. Um and then it, this picture sounds like acute otitis media, so like an ear infection. And um it's especially likely because he's had them in the past, so I'm gonna have to take a look into his ears first before like um coming up with a management plan. But I'll kind of walk you through what we look at. So if I take a look and I see like a perforated tympanic membrane with like pus, we'd prescribe like 10 days of um antibiotics. If he has some like middle ear effusion, so like some fluids with like a bulging tympanic membrane and he appears to be really ill, uh which from the sounds of it, he sounds ill, he's had this fever for more than two days, we'll also prescribe antibiotics for 10 days. And then, if it's just some middle ear effusion, so just that clear fluid um or just the bulging tympanic membrane, we can just um reassess him in 24 to 48 hours to see how he's doing. And if he's worse, again, we'll prescribing prescribe him some antibiotics. Um the antibiotics that we usually prescribe are amoxicillin, and because he doesn't have a penicillin allergy, that should work.
user: Hi, I've been um just having this just sore throat for the last uh let's say three or four days. 

assistant: OK, and um are you having pain with swallowing? 

user: Um yeah, a little bit I've noticed uh with swallowing especially solids as well. 

assistant: OK, have you noticed any changes to your voice? Like having a hot potato voice or or feeling as though your um your throat is kind of closing off?
user: Um not closing off, but like I definitely do uh, maybe a little bit of hoarseness, but not not too much. Mainly it's just the pain that's concerning me. 

assistant: OK, and have you had uh a cough?
user: Uh no, I haven't had a cough at all. 

assistant: OK. Um and have you had any um, any neck swelling?
user: Um I I I have actually noticed like a little bit of neck swelling just right at the front on both um, yeah, just at the front. 

assistant: OK, um is it is it on both sides of your neck or kind of in the middle? 

user: Um I would say it's more uh on both sides. 

assistant: OK.
user: And just kind of like at the front, front of my neck. 

assistant: OK, and you've noticed that um within the last three four days as well? 

user: Yeah. 

assistant: OK. Um and have you had any uh fevers or chills?
user: Uhm, I have had a fever in the last day like I've been feeling warm. I didn't get a chance to take my temperature. Um and also uh just to correct myself I, it's more so the swelling is just on one side. I've noticed like this lumpiness on one side of my neck. 

assistant: OK, thank you yeah. We'll certainly uh, I'll look at it during the in the physical exam. Right, so so yeah, you've had a fever for the last two days? 

user: Yeah, I would say so. 

assistant: OK. Um And have you had any headaches?
user: Um no, no headaches. 

assistant: Alright, and have you had any um like eye redness or eye discharge? 

user: No, nothing like that. 

assistant: Have you had a runny nose?
user: No. 

assistant: OK, and any um loss of uh smell or or loss of taste? 

user: No, nothing like that. 

assistant: OK. Um and have you had any any shortness of breath or difficulties breathing?
user: Uh no, no shortness of breath. 

assistant: Have you had any wheeze? 

user: No, no wheeze. 

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

assistant: Alright, any dizziness or feeling like you were gonna faint? 

user: Nope. 

assistant: OK, do you feel like you're breathing faster or your heart's beating faster?
user: Uh, no, I haven't really felt that no. 

assistant: OK. Um and have you had any, uh, any belly pain? 

user: No. 

assistant: How about any nausea or vomiting?
user: Um not, no, I haven't felt that at all. 

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

assistant: Have you had any urinary problems?
user: No. 

assistant: OK. Have you had any any um skin changes or rashes anywhere?
user: Uh, no, not that I've noticed. 

assistant: Alright, have you had any muscle aches or body pains? 

user: Nope. 

assistant: OK. Have you had any um any symptoms like this before?
user: Uh, no, not that I can recall. Um maybe when I was like like 7 years old like I may have had like a sore throat. 

assistant: OK, so quite a while ago, yeah, and have you been diagnosed with any medical conditions before? 

user: No. 

assistant: OK. Um and uh so do you take any medications or anything over the counter?
user: Um I've tried like Tylenol cold, but it didn't really work. 

assistant: OK, and any allergies to medications or environment? 

user: No. 

assistant: Are your immunizations up to date?
user: Uh yeah, they're all up to date. 

assistant: OK, excellent, and um have you had any hospitalizations or any surgeries? 

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

assistant: Alright, excellent, and have you traveled anywhere recently?
user: No, I I've mainly stayed at home, I I'm mainly doing virtual school. 

assistant: OK, have you been around anybody who's been been sick?
user: Um my my sister she she just got back from college and she she was complaining of like a sore throat uh two weeks ago. 

assistant: OK, I see. Um uh who are you living with currently and where are you living?
user: So I'm living with my parents and my sister at, in a in a house just outside of the city. 

assistant: OK. Um and is your sister doing better now or um what happened with her?
user: Yeah, yeah, I'm not sure, I think she did go to the doctor, now she's doing better. She did get some medications but I don't know what they were. 

assistant: OK, I see. Um and uh I know some people in your age group will sometimes experience with uh like smoking or anything like that. Do you um do you smoke cigarettes or any of your friends?
user: No, I haven't I haven't done that. 

assistant: OK, this same type of questioning for uh cannabis and alcohol. Um have you experimented with any of those substances or any recreational drugs?
user: No, not at all. 

assistant: OK, um and are you currently sexually active? 

user: No. 

assistant: OK. Um and how's school going?
user: Uh school is going well, like uh it was uh it was weird adjusting to all the online stuff, but now I feel like I kind of got the hang of it. 

assistant: OK, excellent. Um and um any concerns for um like safety at home? Anything that we talk about is, uh, is confidential.
user: No, I have a pretty pretty loving family. 

assistant: OK, well that's great. Um and I just wanted to finish here with your family history. Um does anybody in the family have heart or lung conditions?
user: Uh, no, they they're pretty healthy, my mom and dad. 

assistant: OK, and any uh other conditions that run in the family?
user: Uh no, I don't think so. 

assistant: OK. Um uh so that was everything I wanted to ask um on the history today. Did you have any other questions for me or anything that that I didn't ask about you wanted to mention?
user: Uh no, nothing that I wanted to ask, just uh was just wondering if I need any medications. 

assistant: OK, yeah, so um it's possible, so based on your symptoms currently it does suggest that uh it it is a bacterial cause with uh, since you don't have a cough and you have um like it sounds like sounds like lymph node enlargement. Um we'll we'll look and see if there's exudates or or purulence on your um, that we can see in your in your throat as well as checking temperature and do a rapid strep test. Um see if um if that's the cause, and if so, um then yeah, there will be a course of antibiotics um will be required, but um we will uh wait for um the physical exam and then the uh the rapid test.
user: I've um I've been having this numbness and tingling and I guess kind of burning sensation that well uh it's been happening more often in my uh left hand. 

assistant: On your left hand, OK. And sorry when did you say this started?
user: Uh it's been going on for probably four or five months um. 

assistant: OK. 

user: Yeah, it first uh it would only bug me for a couple of minutes at a time and I could kind of shake my hand out, like flick like flick my wrist and um and it would go away after a few minutes. But now I'm starting to get uh like symptoms at night sometimes as well. 

assistant: OK, so um it's gotten worse then, you said over the past few weeks?
user: Yeah it has. 

assistant: OK um and is it always there? Is it persistent or does it come and go?
user: It comes and goes. 

assistant: OK and what makes it better or worse?
user: Uh better uh I've tried some um Advil um and Tylenol and it's kind of the, hasn't done much um for the pain really, uh I think only the thing that kind of helps it is just not using it as much, um yeah. 

assistant: Yeah, alright, um have you tried any like cold compresses, um topical creams? Anything like that? 

user: No. 

assistant: No, OK. And uhm if you were to describe the quality of how it feels like, does it does it, is it painful, is it tender, or is it just numb and tingling, kind of like when your foot goes to sleep?