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RES0201.txt | D: I’m just going to have a chat with you get an idea of what's going on and then I can go over it with. The doctor will come back together and talk to you about the next steps. How does that sound to you?
P: Thats great, thank you.
D: Awesome OK. It says here that you have been having a sore throat. Can you tell me a little bit more about that?
P: Sure, yeah the sore throat it started about four days ago. And it's really it's it's very sore. I can drink fluids OK but I'm even having some issues swallowing food.
D: OK, so you said four days ago?
P: Yes, four days ago.
D: OK. So it's been kind of sore, some issues swallowing food OK, and over the last four days has it gotten worse, Better that it stayed the same?
P: Um the sore throat has it's got, it's getting worse for sure.
D: OK, have you ever had anything like this before?
P: I I, I guess when I was younger I had mono. And I had a sore throat when I had that, yeah.
D: OK, is there anything that makes it worse or like anything that makes it feel better right now?
P: No, not really. I've tried, you know, I've tried gargling with salt water. I've tried some painkillers like nothing, nothing seems to be working.
D: Uhm OK, and you said you've also had some difficulty breathing.
P: Yeah, that's right.
D: Did that start around the same time?
P: That actually started yesterday, and it's gotten me very concerned.
D: OK. Yeah, I can understand how that would be concerning. We're definitely going to try to get to the bottom of it today. Um OK so started yesterday, said then has it gotten any worse? Is it the same way better?
P: Um the, well, I guess it's getting worse, yeah.
D: Do you feel like it's all the time or is it on and off?
P: It's it's just there all the time.
D: Have you ever had any difficulty breathing in the past?
P: Um no no, no, not like this.
D: OK. Uh. Have you have you recently been in contact with anyone that's been sick?
P: Um. I have, no. I don't leave the house much nowadays. I go to the grocery store, I go to the bank. Just essential things.
D: OK, have you traveled recently?
P: Um no, no, I haven't left the city for anything.
D: OK. Do you know if your immunizations are up to date?
P: Ah yes, everything's up to date.
D: OK. That’s good. See you so I'm just gonna ask you about a few other symptoms. I just like to get an idea if there's anything else you been experiencing. Have you had a cough at all?
P: No.
D: Have you had a runny nose?
P: No runny nose.
D: Have you had any headaches?
P: No.
D: Have you had any chest pain?
P: Ah nope, no chest pain.
D: Have you have you lost any of your sense of smell or taste?
P: Um maybe taste a little bit but not smell.
D: OK, OK, when did that start?
P: The taste ah. Maybe two days ago?
D: OK. OK taste two days ago. Has it been on and off or has it been kind of constantly like a reduced sense of taste?
P: It's it's. It's been pretty constant.
D: OK. Have you had anything like that before?
P: No.
D: Have you had any fevers?
P: I don't think so.
D: OK. Have you had any chills or night sweats?
P: No.
D: Have you felt overall really tired and weak?
P: I. I felt tired, maybe not weak, but my I feel like my muscles all ache.
D: OK. OK, and when did that start?
P: That started. Like immediately after my sore throat.
D: OK. OK. OK, well we might circle back. I think there is any more questions you want to ask. Right now, but just in general, in terms of your overall health, do you have any chronic conditions that you take medications for or see a doctor for regularly?
P: Um I have mild COPD.
D: OK. And what medications are you currently taking?
P: Um I'm on a long acting beta agonist.
D: OK, is that the only medication you take?
P: Pardon me.
D: Is that the only medication that you take?
P: And I also take a couple of vitamins.
D: OK. Do you have any allergies?
P: Um no, no allergies.
D: Just gonna ask you few questions about your lifestyle. Do you live here in town?
P: I do.
D: Do you ah live alone or with family?
P: I live alone.
D: OK. And do you smoke?
P: I quit two years ago.
D: Oh congratulations, before that did you did you smoke for many years?
P: I did, I smoked for 40 years.
D: OK. Do you drink alcohol?
P: I drink occasionally, maybe like on the weekends.
D: OK. Uhm, and do you use cannabis?
P: No.
D: OK any other drugs?
P: No, no other drugs.
D: OK. And are you retired? Do you work?
P: I am retired, yeah.
D: OK, what did you do for work before?
P: I worked for GM.
D: Crock. OK. And do you have any family history of respiratory problems, heart problems and?
P: No.
D: OK. Uhm. OK, I think that that about covers my questions for you right now. Is there anything else that you wanted to add that I didn't ask you about?
P: Um no, I don't think so.
D: OK. I’m going to go over this with the document I'm working with today, I'm guessing just because some of your symptoms are in line with common symptoms of covid 19, that will probably do a covid swab, and what happens with that is since we do have some syptoms, will have to isolate until the result come back and potentially after that if you still have symptoms, even if it is negative. So that's just kind of a heads up on that. Maybe one of the next things that happens. We will probably get you a chest xray 'cause we want to get an idea of what's going on in there. Did you have any other questions?
P: No, thank you very much.
D: OK well thanks for chatting with me we should be back shortly to kind of let you know with the next step.
P: OK, great, thank you.
D: Thanks. |
RES0035.txt | D: May I just begin with asking you what brought you in here today?
P: Sure, um, I've been experiencing some issues breathing, um and just a lot of coughing over the past year or so.
D: OK. And is your cough, has it been a wet cough or a dry cough?
P: Uh, but it's been a wet cough.
D: OK. You mentioned it started over a year?
P: Well, about, about 8 months.
D: 8 months. And has it been getting worse at all?
P: Yeah, I think it's been getting worse.
D: OK. And so it's been a wet cough. Do you release any kind of like phlegm or sputum?
P: Um, yeah, it's usually clear, but sometimes it can look yellow or green.
D: OK, and how, how much would you say you produce every day?
P: Um, like um, in total per day?
D: Or just maybe every time you cough.
P: Every time I cough maybe like the size of my thumbprint.
D: OK, and have you notice at all coughing up any blood?
P: No.
D: Is the blood ever mixed into the phlegm?
P: No.
D: OK. And uh, has it been constant coughing? Or does it come and go over the last eight months?
P: Um, it comes and goes, but there, there it's always like I have a tickle in my throat or something.
D: OK, and when it first started, had anything changed in your life? Uh, had you move to a new place or started smoking or anything like that?
P: No.
D: No. OK. Is there anything you do that makes the coughing or shortness of breath worse?
P: Um, I guess walking.
D: Walking? Is there anything that makes it better at all?
P: Just resting.
D: Just resting, OK. How much can you walk or run until you feel the coughing or shortness of breath?
P: About like 200 meters.
D: OK. And has this ever happened to you before the eight months?
P: No. Actually, I get wheezy because I have asthma, but it doesn't, it's not as bad as this.
D: OK. And, um how often are you coughing, are you coughing throughout the day? Or is it more so during the day and then or more at night?
P: Uh, it's just kind of always there, um throughout the day.
D: OK. And do you have any other symptoms besides the difficulty breathing and the cough? Do you have a sore throat, runny nose, dizziness, anything like that?
P: No.
D: OK, so just the difficulty breathing and the cough?
P: Yeah.
D: Do you get any chest pain at all?
P: No chest pain.
D: Great, have you traveled anywhere outside of the country recently?
P: Uh, no, no.
D: Any headaches, nausea or vomiting?
P: No.
D: Any fever, chills or night sweats?
P: No.
D: Do you feel increasingly fatigued throughout the day?
P: Yeah, I guess coughing a lot makes me tired.
D: OK, do you ever feel that your heart is racing or you have any kind of chest pain?
P: No.
D: Have you noticed any issues urinating?
P: No.
D: Any changes in your bowel movements, any constipation or diarrhea?
P: No.
D: Any issues with your sleep or appetite?
P: Uh, no.
D: Any significant changes in your weight?
P: No.
D: Have you had any recent infections that you know of?
P: Not that I know of.
D: Any antibiotics that you've had to use for any infections?
P: No.
D: Um, do you think you have had any exposure to tuberculosis in the past?
P: No.
D: And do you have exposure to fumes or dust or animals or pets in your work or home environment?
P: I have a bird.
D: A bird? And when did you get the bird?
P: Like five years ago.
D: OK, but no issues before the eight months?
P: No.
D: OK. In terms of your overall health, do you have any past medical conditions? You mentioned asthma, but anything else like diabetes, high blood pressure?
P: I have type 2 diabetes and high blood pressure.
D: OK. And or do you take any medications for those conditions?
P: No, it's just being controlled by diet.
D: OK, any medications for any other reasons?
P: I take some vitamin D tablets.
D: OK, any allergies, environmental or to medications?
P: No.
D: OK, have you ever been hospitalized?
P: No.
D: Any ill contacts near you at home or work?
P: No.
D: Any previous surgeries?
P: No previous surgeries.
D: OK, do you have any family history of asthma or any other lung condition or any cancers?
P: No lung conditions or cancers.
D: OK. And currently, do you work?
P: I do.
D: And where do you work?
P: I work as an accountant.
D: OK. And do you currently live in an apartment or a house?
P: In an apartment.
D: OK. And do you live by yourself or do you live with anyone else?
P: Just by myself.
D: OK. Any new changes to your house uhm, any new carpets or anything like that? Or have you moved into a new new place recently?
P: No.
D: OK, do you use any recreational drugs like marijuana?
P: No, I smoked when I was younger, but not anymore.
D: OK, and do you smoke cigarettes?
P: I do.
D: OK, and how much would you say you smoke on an average day?
P: Uhm, about half a pack a day.
D: OK, and how long have you been smoking for?
P: Since I was 18.
D: OK. And you drink alcohol?
P: Uhm, sometimes.
D: And how often would you say on an average week, how many drinks of alcohol would you say you have?
P: Uhm, maybe 2 glasses of wine a week.
D: OK. And in terms of your diet and exercise, would you say you get 3 meals a day? Well balance, well balanced diet?
P: Um, yeah, I'd say so.
D: OK, and lastly, in terms of exercise, would you say you're fairly active throughout the week?
P: Uhm, yep.
D: And what kind of things do you do for activity?
P: Um, I take walks when I can. Um, before this whole shortness of breath thing, I used to ride my bike.
D: OK. |
MSK0041.txt | D: How may I help you?
P: I'm I am here because I've had this intense pain in my right foot for the past six hours or so or so, and I thought it was important to come get it checked out by you guys.
D: OK, so you say it started six hours ago has the pain been getting better or getting worse?
P: Uhm, it's been it's been the same since it started.
D: OK, and was there any trauma to the foot or anything happen within the last day, or in the last six hours?
P: No, not no trauma.
D: OK and, where is the pain located if you had to try to pinpoint it with one finger?
P: It's just below my big toe, kind of like on the medial side.
D: OK. Do you feel the pain radiating anywhere else, or you just feeling it at that one spot?
P: I'm feeling it just in that one spot.
D: OK. And how would you describe the pain?
P: It's intense, it's sharp.
D: OK, and and has there been anything that you've tried that's made the pain better?
P: Um no I haven't really tried anything. I've I can't seem to move it so every time I move it, it hurts. I'm trying to keep it pretty still and stationary. I took an ibuprofen, that's not, that doesn't seem to help.
D: OK. And so like any movement makes it it worse, is there anything else that makes it worse, like putting socks on or even having I don't know clothing touch it or your shoes touch it?
P: Yeah, I guess yeah, my shoes, my shoes touching it hurts.
D: OK, and are you able to walk?
P: I'm able to walk on it, it's just very painful and I can't you know, I can't bend that toe. I can't flex it or extend it, but my other toes are OK.
D: Alright, and how would you describe the severity of this pain. One being the least pain and 10 being the worst pain you've ever felt.
P: I say it's like an 8.
D: OK, and have you ever had a pain like this before and in your toes or or any of your other joints?
P: No, never.
D: OK. And have you had any neurological symptoms such as like numbness or tingling or sensory loss?
P: No.
D: OK, how about any muscle weakness?
P: No, nothing like that.
D: Alright, and have you had any any headaches?
P: No, no headaches.
D: Have you had any memory loss or or or confusion?
P: No.
D: OK. Have you had any fevers or chills?
P: No.
D: Have you had any unexpected weight loss?
P: No.
D: And have you had any any night sweats?
P: No.
D: OK, and how about any sensory changes like changes to your vision, hearing, sense of smell or sense of taste?
P: No changes there.
D: Alright and have you had a sore throat or runny nose?
P: No.
D: And how about having a cough or shortness of breath?
P: No, nothing like that.
D: OK, and have you had any chest pain?
P: No.
D: And how about any heart palpitations or feeling like your heart is racing.
P: No.
D: OK. And have you had any lightheadedness or dizziness?
P: No.
D: OK. And how about any nausea or vomiting?
P: No.
D: Alright, have any abdominal pain?
P: Nope.
D: Any changes to your bowel habits like diarrhea or constipation?
P: No, I don't think so.
D: OK, and have you had any changes to urinary patterns like pain frequency or incontinence?
P: No.
D: OK. And have you had any skin changes like rashes or any changes to your nails or hair?
P: No.
D: OK, and how about your energy, have you had a fatigue or malaise recently?
P: Uh no, nothing like that.
D: Alright, and any muscle aches or body pains or or any joint pains anywhere else?
P: No.
D: OK, um and have you been diagnosed with any medical conditions in the past?
P: Um no, I am. Actually sorry I have um high blood pressure as well as diabetes and I am a little overweight. But other than that, nothing else.
D: OK, do you take medications for any of those things?
P: Um I take ramipril for high blood pressure and I'm on insulin for the diabetes.
D: OK, have you had any medication changes recently?
P: Um no, no medication changes.
D: OK. And have you had any prior hospitalizations or surgeries?
P: I was recently hospitalised for kidney stones. But that since has resolved.
D: OK. Have you had any any surgeries?
P: No surgeries, just the lithotripsy for the kidney stone.
D: OK, and are your immunizations up to date?
P: Yep they are.
D: Excellent, um OK and do you smoke cigarettes?
P: No, I don't.
D: How about marijuana or using other cannabis products?
P: No.
D: OK and do you use any recreational drugs?
P: Uh no.
D: OK, and how about alcohol, how many drinks per week would you have usually?
P: Um alcohol have about. I usually have about 2 glasses of wine a day.
D: OK, and has that changed recently for you.
P: No, not really. I've just been I've also been start drinking like a beer every day as well recently.
D: OK. Alright, and alright could you tell me a little bit about your living situation right now who you're living with and and where?
P: I live with my son in a house.
D: OK, uh, and have you been around anybody who's been sick?
P: No.
D: Alright, and have you traveled anywhere recently?
P: Um no no travel recently.
D: OK, and and can you tell me a little bit about your diet an and like do you eat a lot of red meat and or a lot of seafood like like shell shellfish?
P: I eat a lot of red meats. But not a lot of um seafood.
D: OK. And. OK, and anybody in the family have a history of musculoskeletal or or neurological conditions?
P: Um so. Who OK, so my my father had like arthritis and I don't remember what kind of arthritis he had but he had severe arthritis. He also had high blood pressure and diabetes, and on my mother's side. Um there is some arthritis there as well and as well as gout and kidney stones.
D: OK. So that that was everything I wanted to ask all the history. And so, uh, next to ask you to have a look at your feet. And are you seeing any swelling, redness, or discolouration?
P: I see some redness and uh, some swelling in that area.
D: OK, and are you feeling any temperature changes?
P: Yes, and the right one is definitely warmer than the left.
D: OK, then how about any muscle atrophy in the foot or or lower leg or any joint malalignment or deformities?
P: Uh, so in terms of deformity is like it just looks swollen and so there's like a big bump on the right side of my foot, whereas it's completely straight on my left, but other than that, no deformities.
D: OK, and if you were to a palpate or press on areas of your foot or joints of your toes, are you feeling any any pains along the top of your foot or or in any of your other toes?
P: None of my other toes.
D: OK, and how about any pains at the ankle?
P: Um no pain at the ankle.
D: OK, so the metatarsals are not having any pain and then the joints of the 2nd 5th digits are pain free along with the ankle as well. Um and when it comes to range of motion, are you able to flex your toes downwards and extend them upwards towards your nose?
P: Yes, I can do that.
D: OK, and how about your ankle, are you able to um move your ankle on a full range of motion.
P: I can.
D: OK, and are you having a limping with, walking or otherwise called an antalgic gait?
P: Somewhat because I'm trying not to put too much weight on my right big toe.
D: OK. Alright, and so I think that was everything that I wanted to ask and check today. So did you have any other questions or anything that I maybe forgot to ask about you wanted to mention today?
P: Um no just what can I do for my foot how do I make the swelling go down?
D: Yeah, for sure it's so right now with having a like a red, warm and swollen joint that that's extremely tender and has limited range of motion. It's important to rule out a septic arthritis, however. Based on several of the risk factors such as diabetes, and obesity, as well as your family history of arthritis and gout. Taking the most likely thing is that this is a gout flare, and in particular in the toe like that it could be called podagra and so we will need to get a aspiration of the joint fluid just to send it off and make sure that it's not not an infection and that we're treating the right thing. If this is, gout and it comes back that this way it's treated with that high dose, high doses of anti inflammatories. I will start with medication called colchicine to help with this flare, and in the meantime, important things for preventing this in the future are diet and kind of lifestyle related with reducing things like red meats, alcohol, weight loss and um just trying to improve the diabetes management as well.
P: OK, that sounds great. Thank you.
D: Alright, thank you, we will get that started. |
RES0116.txt | D: What brings you in?
P: 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.
D: 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?
P: 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.
D: OK.
P: So I think the last few days have been really tough for him.
D: Yeah, so three, four days. OK, have you taken a look into his ear? Like does does it seem red? Is there discharge?
P: 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.
D: OK, clear to, you said white-ish?
P: Uh like it was a bit of a yellow tinge to to it as well.
D: Yellow, OK, OK. And which ear was it, sorry, the right or left?
P: Left ear.
D: Left ear, OK. And the right ear looks normal?
P: Yeah, right ear, he hasn't been complaining uh at all. I haven't even looked at the right ear yet.
D: OK, is he itching his ears at all?
P: 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.
D: OK, and does it look like it's angry on the outside or on the inside of his ears?
P: I can't really see anything on the outside.
D: OK, OK, and have you noticed that his hearing has changed at all?
P: Um he still like answers to us and like I don't think his ear, hearing is affected.
D: OK. Has he had any past issues with his ears, like ear infections or like hearing issues in the past?
P: 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.
D: OK, OK. Were they were they treated with antibiotics?
P: Uh I think one time they were, but I I'm pretty sure that was on, in his right ear.
D: OK, OK. He's never had to get like tubes inserted or anything like that?
P: No, no, nothing like that.
D: No, OK. Um, alright. Um has he had a stuffy nose or runny nose?
P: Uh not this week, but he he was a bit like stuffy like last week I would say.
D: OK, he was a bit stuffy, you said?
P: Yeah, maybe even, maybe two weeks ago.
D: OK. And that stopped. Did he have anything else along with his stuffy nose at that point?
P: No, nothing else.
D: Um right now, have you noticed any changes in his vision, in his smell or taste?
P: Uh mo, not that I know of.
D: OK, how about weight loss?
P: No, he's been um growing pretty well.
D: OK, and you said um you had taken his temperature. When did you take his temperature?
P: 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.
D: 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?
P: No, we haven't given him anything.
D: OK. Have you noticed any rashes on him?
P: No.
D: No, um how about coughing?
P: Uh no, he hasn't been really coughing.
D: No coughing, how about wheezing or shortness of breath?
P: No.
D: Like anything that would indicate he has chest pain or palpitations of his heart?
P: No, I don't think so.
D: No, OK. Any dizziness or fainting spells?
P: No.
D: Confusion?
P: No, I don't think so.
D: Headaches?
P: Uh not that I know of.
D: OK, and how how have his bowel movements been?
P: His bowel movements have been pretty much the same, um he's uh, yeah, there's been no real changes.
D: No, OK. Um alright, and how about uh nausea or vomiting?
P: Uh no, no, no nausea or vomiting.
D: Any appetite change?
P: Uh no, uh, maybe a little bit more fussy just, but I don't know if that's probably due to the pain.
D: OK. Um and how about his urine?
P: Uh his urine has been the same, like no changes.
D: No changes, OK good. Is he an otherwise healthy kid or does he have any longstanding conditions?
P: 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.
D: OK, um do you know if his mother's pregnancy with him was normal? Did she have any complications?
P: 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.
D: OK, OK. Um so it was a vaginal delivery, but they used some tools like forceps maybe or vacuum?
P: Yeah, yeah it was forceps, yeah.
D: OK, OK. Um and he's, you mentioned he was full term?
P: Yeah, he was born at uh 40 weeks.
D: OK, perfect. Did he need to be hospitalized for any reason after that?
P: 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.
D: OK.
P: That kind of went away.
D: OK, OK, good. And is he on any medications?
P: Uh no, no medications.
D: No medications, up to date with his immunizations?
P: Yeah, he's all up to date.
D: OK, any allergies?
P: Um not that we know of.
D: OK, how about family history of lung conditions, heart conditions?
P: 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.
D: OK, OK, any um ear issues like congenital ear, sorry um, genetic hearing issues or ear issues?
P: No, nothing like that.
D: OK, um does anyone at home smoke?
P: No, no one smokes.
D: OK. Um and who does he live with?
P: So he lives with um me, his father, and his mother as well.
D: OK. Uhm, any siblings?
P: No siblings, he's an only child.
D: OK, and how are things at home, um is like, are things financially stable? Any relationship issues?
P: 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.
D: OK, good good. Um has he had any sick contacts recently?
P: 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.
D: OK, OK, three weeks ago. Alright, um travel to anywhere recently?
P: No.
D: 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?
P: 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.
D: 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.
P: OK.
D: Yeah, how does that sound?
P: That sounds good. Thank you so much.
D: OK, great, thank you. |
RES0176.txt | D: How may I help you?
P: I um. I just haven't been feeling very well over the past couple months. And I have decided I just come in and see what's happening, so I've just I've been feeling short of breath. And I kind of passed out sometimes and I'm really worried about it.
D: OK. Uh, so when the shortness of breath start.
P: I say about five or six weeks ago.
D: OK, and and do you get short of breath at rest?
P: No.
D: And has it been getting worse or staying the same?
P: Uhm? Kind of the same maybe a little bit worse, but I yeah maybe the same. Definitely not getting better.
D: OK, how far are you able to walk or exert yourself before you're short of breath?
P: I can walk quite a bit, um, but I, I guess like when I go for my my runs in the morning, I start feeling short of breath. It's maybe like, two blocks or three blocks.
D: OK, and any any symptoms where you get short of breath at night and where you had to get up and and put your feet over the bed?
P: No.
D: Are you able to lay flat without being short of breath?
P: Uhm, yeah
D: Or does it.. OK. And every had any swelling in your feet or ankles.
P: No.
D: OK, and you mentioned that you you passed out as well. Can you tell me a little bit about a little bit about that?
P: Yeah, uh, it just happened two or three days ago. And I was just, I was-I wasn't really doing much I was I guess just like going up the stairs. And when I got to the top, I just kind of suddenly collapsed. And then I got back up.
D: Were you really short of breath at the top of the stairs?
P: I felt like my heart was like beating kind of fast. And I felt little bit dizzy.
D: OK, see, where you sweaty at the time as well?
P: I don't remember, maybe?
D: OK, did you feel like you were going to pass out?
P: Yeah.
D: OK, has anything like that happened to you before?
P: No. No.
D: OK and did you bite your tongue during this or?
P: No.
D: OK, and did you wet yourself at all? Like pee your pants or anything like that?
P: No.
D: OK. And how long did it last for?
P: Maybe a couple of seconds, it's. Yeah. I don't know, I I can't really tell. I was alone at home at the time. And I'd like I couldn't tell how long it took for me to get back up.
D: OK, you picture that your heart was racing. Did it feel like it was like did you have heart palpitations or is your heart beating really fast?
P: Yeah it was.
D: OK. And did you hit your head or or hurt yourself when you fell?
P: No, no.
D: OK, and recently, have you been otherwise feeling well or if you had any viral infectious symptoms like red eyes or itchy eyes or runny nose, sore throat?
P: No.
D: OK, nothing like that and have you had a cough?
P: No.
D: OK. And have you had any wheezing?
P: No.
D: And if you had any chest pain.
P: No.
D: OK, have you had any instances where you felt as though you were having heart palpitations at any other times? And not just during the time that you had the fainting episode?
P: Um, I kind of did when I was. When I was like running outside, but I just thought maybe maybe I was exerting myself too much.
D: I see, alright. And any chest pain?
P: No.
D: And. Uh, OK. Have you had any, any nausea or vomiting?
P: No.
D: Any abdominal pain?
P: No.
D: Any urinary problems?
P: No.
D: OK, any muscle aches or body pains?
P: No.
D: Any fevers or chills?
P: No.
D: Have you had any changes to your weight in the last several months?
P: No.
D: Have you had any changes to your appetite?
P: No.
D: And have you notice any skin changes like rashes or or anything like that?
P: No.
D: OK. And. Uh. In the past, have you been diagnosed with any medical conditions?
P: No, I've been very healthy.
D: OK, I do you so do you take any medications, either prescribed or over the counter?
P: Uhm, I just take some puffers for asthma, but I haven't had asthma in awhile. I actually thought maybe my asthma was getting worse over the past two three months. I didn't really. I just I didn't think too much of it. But then when I fainted, I was just kind of scared.
D: Yeah, for sure. Umm, certainly would be frightening. OK, and do you use the inhaler everyday?
P: No. I used to when I was young. I didn't have asthma for a couple of years for like, I'd say 20 years or so. So then I stopped taking inhalers.
D: OK, so you haven't used them recently.
P: No.
D: And any allergies to medications or, uh, environmental?
P: No.
D: OK, and if you had any hospitalizations or surgeries?
P: No.
D: OK. And have you been pregnant in the past?
P: Uhm, I I was yeah. I have a son. About eight years ago. He was born eight years ago.
D: Ok. Was this a vaginal delivery or a C-section?
P: Vaginal.
D: And any complications, either during pregnancy or delivery or afterwards?
P: Oh no, everything was good, no problems.
D: OK, and could you tell me a little bit about where you're living and and who you're living with?
P: Yeah, I'm living with my husband and my son. We live in a house about 30 minutes from here.
D: OK, uh, has anybody been sick in the house?
P: No, everyones been well.
D: Alright, have you traveled anywhere recently?
P: No.
D: OK, any exposures in the house like carpets or rugs or it's like like things like that?
P: We do have carpets, but I mean I, I don't think that's a problem. Like we've had it for like years and we've had the same carpets for years and years.
D: OK, I see and are you working currently or or at home?
P: Yeah, I'm at home but I work from home. I'm a writer.
D: OK cool, yeah I do you smoke cigarettes?
P: No.
D: Do you smoke cannabis or use any cannabis products?
P: No.
D: OK, and do you drink alcohol?
P: I do, I'll just drink on the weekends.
D: OK, and I like how many drinks would you typically have in a week?
P: Uhm, not much. I'd say one or two glasses of wine.
D: OK, do you use any recreational drugs?
P: No.
D: OK, And like you said, you're a writer currently. In the past, did you work any jobs where you were exposed to asbestos or like any chemicals or fumes in the air?
P: No, no, I haven't.
D: OK, And in the family is there is there anybody who has any heart or lung conditions?
P: No.
D: How about any clotting disorders or or cancers?
P: Uhm, prostate cancer. My uncle had it.
D: I see, OK. So it sounds like over the last little month, you've been having some more short shortness of breath as well as well this fainting episode more recently. So we will. Was there anything else that you wanted to add?
P: Hum, no.
D: Alright, so we will do some pulmonary function testing and get some imaging of your lungs today as well as an ECG and maybe a monitor for your heart as well to just check your heart racing for the next 48 hours. Mentioning that your heart was racing and so to rule out that any abnormal rhythms of your heart, or to check for that. And we will kind of go from there, did you have any questions?
P: No. |
RES0047.txt | D: What brings you in?
P: Yeah, so I've had this chest tightness and and been short of breath and bringing up sputum with this uh cough.
D: OK, so um lets start with the cough. When did that start?
P: So I've had a cough now for a few years, um but over this past uh three days it's gotten quite a bit worse.
D:: OK, for the past three days, three three years. OK.
P: Yeah.
D: Um are there any triggers for your cough?
P: Uh, yeah, if I'm doing, um, like if I'm really active like if I run to catch the bus or uh or if I'm shovelling snow, maybe I can make, become short of breath, but um not if I'm just walking around the block or anything like that.
D: OK, and what caused this cough initially three years ago? Do you know?
P: Uh yeah, I think um I think it's just a smokers cough. I think that my family doctor told me I had like chronic bronchitis before.
D: OK, OK. How often were you coughing before it got worse recently?
P: Uh I would usually cough every day, but the cough would be, usually just in the morning, I I'd get up um, there, I would cough up some sputum and and then maybe, and then I'd usually be OK.
D: OK, um and does anything make your cough better? Like do you take any over the counter cough syrup?
P: Um yeah, I've tried some over the counter uh cough syrups in the past, but it hasn't helped.
D: OK, OK, and if you were to talk about the quality of your cough, is it is it barky? Does it sound harsh? What does it sound like?
P: Uh yeah, I would say it sounds pretty harsh. You can kind of, it sounds like there's um mucus moving around, I guess with with the cough in my chest, I can I can kind of feel it
D: OK, OK and you mentioned that you're producing a lot of sputum with your cough. What colour is that sputum?
P: Greenish
D: Green, OK. Any blood?
P: No blood.
D: No blood, OK. And you mentioned, you've never produced sputum with the cough, especially not green sputum in the past three years, right?
P: I would bring up sputum, but it's usually clear and white.
D: OK, OK, and do you have any wheeziness associated with this cough?
P: Uh, yes I do
D: Yes, OK. And you mentioned you were short of breath. Were you short of breath prior to your cough or did that start um when when this cough got worse?
P: I think the shortness of breath has gotten a bit worse over the um last few days uh as the cough has gotten worse.
D: OK, OK. And if you were to rate the severity of your symptoms, of how you're feeling, 1 to 10, 10 being the worst, where would you put yourself at?
P: Uh I would say an 8, it's been really tough, it's been getting really difficult to um breathe.
D: OK, yeah. And have you ever experienced anything to this severity in the past?
P: No, I haven't had uh this difficulty breathing before.
D: OK. OK. Um do you have any chest pain?
P: Uh, my chest is, it feels tight.
D: OK. Uh it feels tight, OK, does that, does it hurt though?
P: Uh no, no, it doesn't really hurt. It's just uncomfortable.
D: OK. And do you think it's tight because of the coughing or um the shortness of breath?
P: Yeah, I kind of feel it um with the coughing.
D: OK and have you noticed any swelling in your limbs?
P: Uh yeah, maybe a little bit in my in my feet, more than usual.
D: OK, and do you feel like your heart's racing?
P: Uh, no.
D: No, OK. Any dizziness or fainting spells?
P: Uh I haven't had anything like that.
D: OK. Um any changes to your vision or hearing?
P: No.
D: No, um, do you have a stuffy nose or runny nose?
P: No.
D: Um how about a sore throat?
P: No.
D: No, any changes to your smell or taste?
P: No.
D: Um any fevers or chills?
P: No, I've felt OK.
D: OK, any weight loss?
P: Um yeah, maybe I mean over the last few years I've um lost a few pounds, but maybe maybe 10 pounds over the last last couple of years
D: Last couple of years, OK. Was it intentional weight loss or unintentional?
P: Unintentional.
D: OK, um alright, and any changes to your hair, nails or skin, like rashes?
P: No, I haven't noticed anything like that.
D: OK, and how are your bowel movements? Everything normal there?
P: Yeah, that's been normal.
D: OK, everything normal with regards to your urine?
P: Yeah, that's been normal.
D: OK. Any confusion or memory loss?
P: No.
D: No, OK. Any fatigue?
P: Yeah, I've been feeling well, really tired these last three days.
D: Yeah, OK. Any joint pains or muscle aches?
P: No.
D: No, OK um and are you otherwise healthy?
P: Um, well, I use uh these inhalers um and I think I've been told I have COPD before.
D: OK, Um other than your COPD, do you have any other longstanding medical conditions like high blood pressure, diabetes, anything like that?
P: Um yeah I have uh high blood pressure and um I had my gallbladder taken out uh a few years ago.
D: OK. OK, any other surgeries or hospitalizations?
P: Uh I had an ACL repair like when I was a teenager.
D: OK, and besides the inhalers, are you on any other medication?
P: Yeah, there's one for blood pressure um and I take vitamin D, um and that's it.
D: OK, which one, which um medication are you on for the blood pressure?
P: Uh amlodipine.
D: Amlodipine, OK. When did you start taking that?
P: About uh seven years ago.
D: OK, and then for your uh COPD, which inhalers are you on?
P: Uh, there's one that's for, um, like short acting. And then there's one that I use everyday, uh Spiriva, I think.
D: OK, yeah. And how long have you been on these inhalers?
P: Uh it's been a couple of years for well, for the the short one that I I use for rescue therapies been for like a long time, but Spiriva's been the last several years.
D: OK, OK, and do you find that your inhalers are helping?
P: Yeah. They um, I definitely notice a difference when I, if I miss a dose or something.
D: Yeah, OK. And um, do you have any allergies?
P: Uh no, I don't think so.
D: No, OK. How about um immunizations, are you up to date?
P: Yeah, I believe so.
D: OK. And in terms of family history, uh are there any lung conditions or heart conditions that run in the family?
P: Um, uh no.
D: No, OK. Um do you currently smoke?
P: Uh I do, yes. I've been trying to quit, I um I smoke about a pack of cigarettes per day now. I used to smoke like 2 packs per day.
D: OK, well it's it's good that you've cut down, um if you need any additional help cutting down we have resources that we can refer you to.
P: Yeah, that would be great.
D: Yeah, um how much, for how long have you been smoking? Like how many years?
P: Uh well, I started when I was a teenager, so probably like 35.
D: OK. Um and do you do any marijuana?
P: Uh no.
D: No, OK, OK, um how about alcohol? Do you drink alcohol?
P: Yeah, a few beers on the weekend.
D: OK. Um and then where do you live currently?
P: I live in an apartment by myself.
D: OK. Um and any reasons to think that there are any old carpets, mold, or um asbestos or anything like that that could be exacerbating your symptoms?
P: Uh I mean I do have a carpet in the bedroom so, but I mean that that's the only carpet in the apartment.
D: OK. Um and do you live with anyone?
P: No, it's it's just me and my dog.
D: OK. Uh have you, have you been around any sick contacts recently?
P: Um maybe, I mean I I usually will see uh, a couple of friends, we'll meet up to grab some coffee
in the morning in the morning um but I feel like they have been uh OK.
D: Yeah OK, how about um travel, have you traveled anywhere recently?
P: No.
D: No, OK. OK, well I think those were all the questions that I had for you. Did you have any questions or concerns or anything that I missed that you wanted to discuss?
P: Um no, I just wanted to, um, yeah, come in because it's been really difficult to breathe.
D: Yeah, so OK, well we'll do a physical exam on you um to try to understand um how bad your COPD exacerbation is. Um we'll also try to get an um oxygen saturation on you, and we do want that reading
to be between 88 to 92%. If it is less than that um and we think you have a mild exacerbation, we'll just suggest that you use your short acting beta agonist puffer um more often, and then if you,
if we think you have moderate, um moderate exacerbation we'll also prescribe uh antibiotics and or steroids to go along with the short acting beta agonist. And if it is severe, or if it becomes severe, um please do seek out aid um in the ER and they'll try, they'll probably put you on um uh some sort of, um oxy like um some sort of supplemental oxygen, whether it's BiPAP or CPAP. Um and again they'll continue giving you your bronchodilators and steroids, as well as antibiotics to um make sure that you don't have any bad complications of uh pneumonia. Um and it does sound like it is a COPD exacerbation at this point, but if you develop any other symptoms like um fevers, or any symptoms that overlap with uh viral viral illnesses, we'll we'll we'll work you up for that, we'll do, I think we will still do a covid swab on you just to make sure you don't have that, uh but we'll start with um working you up for COPD. How does that sound?
P: That sounds great. Thank you.
D: Alright. Take care. |
MSK0018.txt | D: What brings you in?
P: I just came in because of I just got into like this uh, incident while I was playing rugby. I kind of got tackled and then fell onto my right shoulder. Um, and after I got up, I haven't, I've just been, this just happened a couple hours ago actually and uh, I've just been in intense pain in my right shoulder and I can't seem to move it at all.
D: Okay, um, and sorry, when was this exactly?
P: Uh, probably 2 hours ago.
D: 2 hours ago, okay. Um, and is this pain persistent or is it like on and off?
P: It's, it's constant. It hasn't gone away at all.
D: Okay. 1 to 10, 10 being the worst. How bad is this pain?
P: I don't know, like probably like 8 or, 8 or 9.
D: 8 or 9, okay. Um, and is it a sharp kind of pain or is it dull and aching?
P: It's, it's sharp. Like if I try to move it at all, it's like a sharp pain.
D: Okay, um, and have you ever had anything like this in the past?
P: Uh, no, never.
D: Never, okay. And are you able to move your arm at all or you can't move it?
P: I could move my fingers and hand and elbow, but um, elbow a little bit, but like uh, yeah, I can't move my shoulder whatsoever.
D: Okay, um, and do you, are you experiencing any tingling or numbness?
P: Um, no, I don't think so.
D: No, okay. Uh, how about any muscle weakness?
P: Um, in that area, I don't know if it's weakness or pain, but I just can't move it up and I, I, I do feel some like numbness just above my shoulder. No tingling though.
D: Okay, any pain elsewhere in your body?
P: No.
D: No, okay. Any headaches?
P: Um, no.
D: Confusion or memory loss?
P: Uh, no.
D: Uh, weight loss?
P: Uh, no.
D: Fevers or chills?
P: No.
D: Rashes?
P: Um, no.
D: Uh, changes in your vision, hearing, smell or taste?
P: Uh, no.
D: Um, coughing, shortness of breath or wheezing?
P: Um, no.
D: Chest pain or heart palpitations?
P: No.
D: Changes in your bowel movements?
P: No.
D: Changes in voiding?
P: No.
D: Um, okay. And then with regards to this pain, does anything make it better or worse?
P: Um, um not anything that I've tried that's made it better. Worse is probably just if I try to move it at all.
D: Okay, and the pains in your shoulder, does it radiate down or up elsewhere?
P: Uh, mostly towards my shoulder, um, kind of down towards my upper arm as well.
D: Okay, I see. Um, alright, and um, are you otherwise healthy? Do you have any other medical conditions?
P: No. Yeah, otherwise I'm healthy. I've never been to the doctor much.
D: Okay, alright. Um, and are you on any medications?
P: No.
D: No, okay. And um, are you up-to-date with your immunizations?
P: Yes.
D: Okay, and do you have any allergies?
P: Uh, no.
D: Any family history of musculoskeletal diseases?
P: No, not that I know of.
D: Okay. Uh, and any family history of autoimmune conditions?
P: Um, no.
D: Okay. Um, do you smoke at all?
P; No.
D: No. Um, do you consume marijuana?
P: Uh, no.
D: Uh, do you drink alcohol?
P: Uh no, just, just with friends sometimes on the weekends, but not really.
D: Okay. Um, and then, where do you live right now and who do you live with?
P: Uh, I live just outside of town with my parents in a house.
D: Okay. And um, have you traveled anywhere recently?
P: Um, no, I've been at home.
D: Okay, any sick contacts?
P: No.
D: No, okay. So now we're just going to move on to um, the physical exam part of this. So can you take a look at both your shoulders and let me know if you see any redness or swelling?
P: Um, I don't think I see any redness or swelling, but um, my right shoulder and my arm just seems a little bit lower than my left one.
D: Okay, okay, any um, warmth on, on that shoulder?
P: Uh, no, not that I can feel.
D: Okay, any atrophy, deformities, or skin changes?
P: Um, deformity, I, I do feel like kind of uh, like my shoulder's dropped and like there's just kind of this uh, little, like divots, where like the shoulder should be.
D: Okay, okay. And can you palpate that area for me? Just um, the bones in that area, so like right where your arm would connect to your shoulder and then kind of on your shoulder blade. Does that hurt when you press down?
P: Yeah, it hurts a lot.
D: Okay, so some tenderness and pain in the acromion process and scapula. Um, and if you press down on your biceps, triceps, does that hurt?
P: Not as much, no.
D: No, okay. And then can I get you to um, can you lift your shoulder up at all? Like to where, to the point where your fingers are touch, like reaching the ceiling?
P: No, I, I can't. I can't move it at all.
D: Alright, so um, it sounds like you have a shoulder dislocation. Um, so we are going to do an x-ray of your shoulder joint first to make sure that it's, it's just a dislocation and there aren't any broken bones or fractures. And then um, we can resolve this by doing something called a closed reduction, um, to try to put the joint back in its place.
P: Okay.
D: Um, and if that closed reduction doesn't work, then uh, you may need surgery for like a, um, a weak shoulder joint, or if like ligaments um, aren't like, strong enough and it's it continues to happen.
P: Okay.
D: Um, otherwise, we can keep it immobilized for a few days to a few weeks, um, depending on how bad the dislocation is. Um, and then once that's removed, you can do some rehab as well to restore some range of motion. Does that sound like a good plan? Do you have any questions or concerns in the meantime?
P: Uh, no, I think that's, uh, that's great.
D: Okay. |
RES0099.txt | D: Umm, how may I help you?
P: So yeah I've been having for the last two days, uh, it just started randomly. I had to miss work, Just a headache started at the beginning and then I noticed the same day, so this was two days ago. A headache started and my body just started aching throughout the day and yesterday I just developed, I think it was a fever, I didn't really get a chance to check, like, but I was very chilly yesterday and now I have this cough as well.
D: OK, so just to confirm, so the, the symptoms at first started with a headache and, and fatigue, and that started two days ago?
P: Yeah, like with fatigue, like also just the, my muscles were aching.
D: OK, and any particular muscles that were achy or is this more of a, uhm, general kind of whole body feeling?
P: Just a general whole body feeling.
D: OK. Uh, and in terms of the headache, could you describe, uhm, could you describe the headache?
P: Yes, it's just kind of like at the front like near my forehead, on, on kind of like both sides more. It just feels like, like pressure in there.
D: OK, have you had headaches like this before?
P: Uh, no, not really.
D: OK. Uhm, is the headache on one side or, or the other or on both sides?
P: I think it's like both sides.
D: And is the headache like pulsating or is it more, continuous kind of constant pain?
P: I think it's more continuous constant.
D: Alright, and have you had any sensitivity to light or sound that, that's made the headache a lot worse?
P: No, it's, it's kind of just there, it's about the same as when it was when it started.
D: OK, have you had any nausea and vomiting associated with that, the headache or anything else?
P: Uh, no.
D: OK. And so, and then, last question for the headache piece. Does it feel like it was a like kind of sudden onset, worst headache of your life sensation?
P: Uh, no, it's still like, like I can still cope with it, like, if I wanted to I would have gone into work. But it was the muscle aches that really started bothering me.
D: OK. And so you had a cough as well, when did this start, and is it a dry or wet cough?
P: It's a dry cough and it started yesterday, probably in the morning when I woke up.
D: OK, and has the cough been getting any better or worse?
P: Uhm, since yesterday I would sayit's probably a bit worse now.
D: Alright, and it's dry, but have you seen any blood that's come up?
P: No, no, no blood.
D: And have you had any shortness of breath?
P: No.
D: OK. And have you had any flu like symptoms or infectious symptoms like a red eyes, runny eyes, runny nose, or a sore throat?
P: No, I don't have any of those symptoms.
D: OK, you mentioned you felt feverish. Do you feel hot now?
P: Not right now, but I did have, last night just, was just very chilly and Uh, I had to just wrap myself up in a couple blankets.
D: OK. Did you have any night sweats?
P: No, I, I didn't have any night sweats.
D: Alright, and have you had any chest pain?
P: No, no chest pain.
D: Alright, so how about any dizziness or lightheadedness?
P: Nope.
D: OK. And have you had any wheeze?
P: No wheezing.
D: OK. Uhm, and have you noticed any swelling to any of your extremities? Like your ankles?
P: Uh, no. Nope.
D: OK. And have you had any belly pain?
P: No belly pain.
D: Any urinary problems like pain or, or frequency going to the bathroom?
P: No.
D: And any diarrhea?
P: No diarrhea.
D: Alright, and have you noticed any rashes or, or changes to your skin?
P: No, not at all.
D: Alright, and I don't know, you've had muscle aches, have you had any joint pains?
P: Uh, no, no musc, sorry no joint pain. It's mainly just like in, I would say in around my upper back like my upper arms and kind of like my thighs and glutes areas
D: OK. And how has your energy been these last couple of days?
P: Yesterday I felt a bit drained. I just kind of like stayed in bed the whole day.
D: OK, and have you tried any medications for the, for the headache or any of your symptoms so far?
P: I, I took a Tylenol. I actually took a couple Tylenols, uh, when the headache and pain started. It did help a bit for a couple hours, but it just kind of came back.
D: OK. And in the past, have you been diagnosed with any medical conditions?
P: Uhm, Just uh, like I had type 2 diabetes, that's it.
D: OK, and are you using medications for your diabetes?
P: Yeah, I've been on Metformin.
D: OK, have you used insulin before?
P: No, no, I've never had to use insulin. It's pretty stable, like my family doctors even considering taking me off the metformin.
D: OK, no, that's great. And that reminds me, actually, how has your weight been over the last several months? Have you had any weight changes?
P: Not really, like I, I, I think over the last two years I've just been very focused on my fitness, so I feel like I've probably lost around 30 pounds over the last year. Last one to two, yeah, year, but like I, I've been exercising a lot like uhm, gym every day, it's, it's been, it's been a journey.
D: no that's great though, good for you. I encourage you to keep that up for sure. OK, and so do you take any other medications, other, over the counter or prescribed?
P: Uhm, just a multi vitamins.
D: Alright, and do you have any allergies to medications?
P: No, not that I know of.
D: All right. So have you had any hospitalizations or surgeries?
P: No.
D: Alright, and uh, anybody in the family have any like lung conditions, heart conditions or diseases that run in the family?
P: Uh, my, my son actually just recently was diagnosed with asthma. But I think that he gets that from his mom's side.
D: OK. Uhm, you don't have any asthma or problems breathing like that?
P: No, nothing like that.
D: OK, and right now, so you mentioned your son and wife, is that who you're living with?
P: Yeah, it's just us three.
D: OK, and uh, any exposures to, to anybody who's been sick, either at home or at work or, or any other activities?
P: Uh, unfortunately I do have to, uh, I'm one of the unlucky ones that still has to go into work. And yeah, it's it's hard to say like at work, there are times when we, like at lunch we eat like without a mask. I don't know if, I didn't notice anyone having any symptoms, but like, I don't know if someone, you know, who knows where anyone has been.
D: Yeah, so nobody that you're aware of who's been sick though?
P: No.
D: And everybody at home has been OK?
P: Yeah, at home everyone's good. I kind of just distance myself into like one room.
D: Mhm.
P: Just in case anything goes wrong.
D: OK. And have you traveled anywhere?
P: No, we've been, we've been at home this whole time.
D: OK. And do you smoke cigarettes?
P: No, I've never smoked.
D: OK, so do you, do you smoke marijuana?
P: No.
D: Alright and you use any other recreational drugs like cocaine, opioids, heroin? And how, have you used anything like that in the past?
P: No. Never.
D: OK, uhm, and do you drink alcohol?
P: Yeah, well just occasionally, like I would say maybe, maybe some wine, once, uh, like once every couple days. Maybe a beer on the weekend, but that's it.
D: Alright. So I think that was all I wanted to ask on history today. Was there anything else that, that you wanted to add before we go on to the exam and?
P: Yeah, so I, I, I don't know if I should get a test done, like for covid. Uhm yeah, that's all, just wondering if I, if I can do that here?
D: Yeah, so that is something that that is on the differential for what could be causing your symptoms, especially with uhm, starting at having a cough and the nonspecific viral type symptoms with the cough, headache, muscle aches, so certainly could be caused by covid, but there are other reasons for, that could explain these symptoms, such as other types of viral illnesses, and so we will do a PCR swab today, as well as do, well, check your vitals to see if you have a fever now and we'll also maybe send an influenza swab as well, and and do some blood work. But in the meantime, since we're running the covid swab, it will be important to self isolate for the next 14 days and we will let you know what the test results show. But despite, even if they are negative, it will be important to still stay self isolating for the next 14 days.
P: OK, I'll do that. That sounds good.
D: Alright, thank you. |
MSK0012.txt | D: What brings you in here today?
P: I've had this pain in my back thats kind of like in my lower back and my buttocks and it's now radiating down to my right leg. I've had this for awhile now, but it's getting worse and I just want to come get it checked out.
D: OK, and how long have you had this pain for?
P: About a month.
D: OK, and has gone worse at all like did you have the it radiating through your leg before or is that something that happened after?
P: That's something that happened after that happens that that's been going on for the past week.
D: OK, and is this pain constant or does it come and go?
P: And it's pretty much always there, but certain things can make it worse. Like if I'm walking or doing certain activities it can it can make it worse.
D: OK. And did you have any back pain before this month?
P: No, not, I mean no, not really.
D: OK. An what kind of pain would you say it is. Is it like a sharp stabbing pain or is it more so a dull aching pain?
P: Um usually or well before it was like a mild achy pain, but now it can be. It's sharp and it feels like a burning sensation.
D: OK, a burning sensation, where would you say that burning sensation is?
P: It's like down my buttocks to the right leg.
D: OK, and do you feel any kind of numbness or tingling with it?
P: Um a little, a little bit of tingling. Yeah, a little bit of tingling.
D: OK, and how would you rate the pain from a scale of zero to 10, 10 being the worst pain you've had in your life?
P: So usually it's about like a 5 to 6 out of 10, but when it gets bad and um sharp, I'd give it an 8 out of 10.
D: OK, and are there any kind of motions or positions that cause you more pain?
P: Yeah, so I'd say like just any sort of physical activity, like if I'm on my feet a lot, it hurts.
D: Mmm.
P: Yeah, that's pretty much the only thing that I can think of right now.
D: OK, did anything happen one month ago or before this pain started. Like any injuries or falls that might have caused this pain?
P: Um no like a long time ago, like 6-7 years ago I injured my back at work but. I just did some conservative treatments for that and it went away.
D: OK was it your lower back.
P: Yes.
D: OK. And what do you do for work?
P: I used to work on an assembly line, so I used to. Like carry heavy objects and things like that. Like car parts.
D: OK, and do you still work there?
P: No, I don't.
D: OK when did you stop working there?
P: About three years back.
D: OK and is there any other work you do currently?
P: Um I work from home now. I do daycare at home.
D: OK. OK, and just getting back to the pain so it's kind of in your lower back, your buttocks and then it goes to your right upper leg?
P: Mmmm
D: Does it move anywhere else besides that or those are the regions that it stays in?
P: No, those are kind of the only regions that I'm experiencing it right now.
D: OK. And do you get more pain leaning bending forward or would you say extending your back?
P: I would say ext.. Extending my back hurts more.
D: OK and you get pain with sitting down?
P: Um sometimes.
D: OK, how about lying down?
P: Um lying down I guess it depends on the position. If I am straight on my back it's it's not too bad, but if I like I'm hunched over or something like that, it hurts.
D: OK, I see OK and have you tried any medications over the counter and painkillers that have helped?
P: I tried some ibuprofen and some like topical.. um like ointments but it helps temporarily and then the pain comes back.
D: OK, let's see and. Other than that, so other than this pain that's been going on do you have any fevers or chills?
P: Uhm No, no fevers or chills.
D: OK, no night sweats?
P: No.
D: Any increased fatigue?
P: No, no.
D: Any rashes or skin changes?
P: No
D: Any uh. Any cough or cold symptoms recently?
P: Um no nothing like that.
D: OK and apart from your back, any kind of joint or muscle pain anywhere else in your body?
P: No.
D: Any changes in your bowel movements?
P: No.
D: OK, any urinary problems?
P: Nope.
D: Any stool incontinence for your urinary incontinence?
P: No.
D: OK, and any kind of numbness or paresthesia like around just your lower back and buttocks?
P: No, no numbness just like that, tingling, burning feeling.
D: OK, OK any recent weight changes like any significant weight loss?
P: No.
D: OK. Any muscle weakness at all in that area?
P: I'm finding it hard to walk.
D: Harder to walk? OK. Are you limping at all?
P: Yeah, I'm putting more weight on my left leg.
D: OK. And do you feel, so you mention you feel tingling going down your right leg? Do you feel any kind of numbness at all?
P: No.
D: No, OK alright do you have any kind of urinary or fecal retention like at all?
P: No, I'm going. I'm using the washroom OK.
D: OK, uh. Do you have any history of any cancers at all?
P: No.
D: No OK. Are you on any. So do you have any past medical conditions you've been diagnosed with?
P: No.
D: No. Do you take any medications regularly?
P: No, I don't. I just take calcium and vitamin D and other but multi vitamins.
D: OK, any allergies to any medications?
P: No.
D: Have you had any previous surgeries or have you been hospitalized for any reason?
P: No.
D: No, OK, any family history of any autoimmune conditions, any heart or lung conditions?
P: Um no not that I know of.
D: OK, an and, currently you said you work from home. How would you describe your living situation like?
P: I would say I it's it's OK. I live in an apartment with my husband.
D: OK. And currently do you smoke?
P: No.
D: OK, and do you drink alcohol?
P: I'll have a glass of wine like once a week.
D: OK, and do you use any recreational drugs?
P: Um so I've I've been using cannabis oil for the past month just to see if it helps with the pain.
D: OK, and has that been working for you at all?
P: A little bit I think.
D: OK. OK, so those are some of the questions I had. And I'm just gonna ask a few questions about just examining the areas that are giving you trouble. So along your back, if you if you were to press down on from the middle to your lower back, any kind of pain when you press down.
P: Um lower back, yes.
D: OK, So what kind of pain is it like sharp or is it kind of a dull aching pain?
P: When I press down it feels sharp.
D: OK, and do you have you notice any kind of swelling in your legs or, near the areas where you have pain swelling or redness, or any warmth?
P: Um it seems to. Actually, no, it's not. It's not warm.
D: OK. And in terms of just movement, are you able to bend down?
P: I can bend down, it's just hard for me to get back up.
D: OK See and how about like bend sideways.
P: I can do that.
D: OK nd how about if you're laying flat are you able to raise your legs without bending your knees?
P: I can do that, yeah, actually no. I can't. Sorry that that hurts.
D: So your right leg hurts when you do that?
P: Yeah
D: OK, great. And other than that, like when you when you do any of those movements, can you, do you get like that tingling again?
P: Yeah it does. Yeah.
D: OK alright and when you stand up and walk how would you describe, are you having any kind of limping at all?
P: Um a little bit of limp yeah, I'm putting more weight on the left leg.
D: OK, alright, so yeah, those are just some of the questions I I had for you today. Do you have any questions at all?
P: Um no, what can I do about this back pain and how long do you think I'll have it for?
D: Yeah, so it's been happening for one month right and you're getting some symptoms in in your lower leg, so normally we would wait before we do any kind of diagnostic imaging. But since you're also having these other symptoms we we were worrying about sometimes lower back pain can lead to something called sciatica. It's just when one of the nerves get pinched, and then that's why you're getting the tingling around your right upper leg. So what we can do is. We can do if you haven't had an X Ray, we can do an X Ray of your lower back. And then we can also do an MRI.
P: OK
D: And. Based on what results come back at the same time we will, I will give you some information about some anti- inflammatory medications you could take to help relieve some of your pain, but other than that I will also refer you to some physiotherapy. That will help you do some exercises at home. Just ways to protect your back as well as strengthen some of your muscles to help deal with some of that pain. Yeah, so we'll get the results back. And then we'll go from there.
P: OK, sounds good. Thank you.
D: You're welcome. Take care. |
MSK0017.txt | D: What brings you in?
P: Hi, yeah, so I've had this uh back pain that's been going on now for the last uh two weeks, it's just kind of right in the lower back and it just hasn't gone away.
D: OK, um last two weeks you said, is it getting worse?
P: Uh no, it's not really getting any worse, uh it's just been uh limiting my abilities at work.
D: Right, OK, and what do you do for work?
P: So I work um at a butcher shop.
D: OK.
P: Yeah, and we're like always like carrying heavy things and yeah, it's a lot a lot of like lifting and standing.
D: OK. Did anything trigger this back pain two weeks ago? Did you have some sort of injury or trauma to the area?
P: No, I can't think of anything uh like specific that happened, but there was one night where um like after work, I was sitting down after dinner and um I got pretty stiff that night. It was pretty sore and kind of ever since then, it's been been sore.
D: OK, OK, um and is this a persistent kind of back pain or does it come and go?
P: It's um, I can kind of always feel it, but it certainly gets worse if I am moving. So if I'm just kind of sitting at rest, I don't really, yeah, I don't really feel it that much.
D: OK, OK, and if you were to describe the quality of this pain, um would you say it's sharp, throbbing, achy, crampy?
P: I'd say I get kind of uh, it's a sharp pain.
D: Sharp pain, OK. Um does anything make it better or worse?
P: Um better would just be uh resting.
D: OK.
P: Um kind of just lying down, or um yeah, just just trying to uh rest. But um making it worse, yeah, if I'm uh like really any movement um if I'm like bending forward or um kind of like leaning to the side, I start to get um get some pain in the lower back.
D: OK, OK. And then 1 to 10, 10 being the worst pain you've ever felt, how bad or uh how severe would you rate it?
P: I would say 7.
D: A 7, OK. And have you ever had pain like this in the past?
P: Uh yeah, I've I've hurt my lower back before like many years ago. Um but it's been OK since then.
D: OK. Uh did you get any sort of treatment or management for that pain um back in the day?
P: At that time it was just rest and like did some stretching and I took some um anti inflammatories and it went away after a couple of months.
D: OK, OK. Um and are you having any sort of like numbness or tingling, anywhere on your body?
P: No, nothing like that.
D: Alright, how about any muscle weakness?
P: Uh no muscle weakness.
D: No, OK. Are you still able to walk and do things that you normally would do in a day?
P: Uh yeah, I'm able to walk still.
D: OK. Um any dizziness or fainting spells?
P: Nope, nothing like that.
D: OK. Any pain elsewhere on your body?
P: No, just just the lower back, yeah.
D: OK. Headaches?
P: Uh nope.
D: OK, weight loss?
P: No, I haven't had any weight loss.
D: OK. Fevers or chills?
P: Nope, no fevers or chills.
D: Um rashes?
P: Uh no rashes.
D: Changes in your vision, hearing, taste or smell?
P: No changes like that.
D: OK. Any coughing, shortness of breath or wheeziness?
P: Um nope, nothing like that.
D: Um chest pain or heart palpitations?
P: Nope, nothing like that.
D: OK. Issues or changes in your bowel movements?
P: Uh no changes to bowel movements, no diarrhea and no incontinence or anything like that.
D: OK, um and then uh nausea or vomiting?
P: Nope, nothing like that.
D: OK, how about um changes to your appetite?
P: Um nope, I've been eating uh, I've been eating well.
D: Changes in your voiding?
P: Uh nope, I haven't had any changes to urination.
D: OK. Um and then are you otherwise healthy or do you have any longstanding medical conditions?
P: Uh I I've had a few sports injuries when I was younger, uh like to my my knee, but that's it, I've been healthy otherwise.
D: OK and um those injuries, are they all healed?
P: Uh sometimes I'll get um like a little achiness in my knee from from doing like too much activity, but I know when those, when that happens.
D: OK. Are you on any medications?
P: No, I I don't uh take any medications.
D: OK. Are you up to date with all your immunizations?
P: I am, yep.
D: OK. Um do you have any allergies?
P: Uh, no allergies.
D: OK, any family history of um muscular or skeletal issues?
P: Um no, nothing like that.
D: OK, how about um heart or lung diseases?
P: Uh, no, no heart or lung diseases.
D: OK, uhm how about autoimmune conditions?
P: Um nope, nothing like that.
D: OK. Cancers?
P: Uh no cancers.
D: OK. Um and do you smoke?
P: Um no, I don't smoke.
D: OK and do you consume marijuana?
P: Uh sometimes, I'll have like uh edibles, little candy, sometimes at nighttime they they help me uh relax and sleep, but I don't use that very often.
D: OK, how often do you use them?
P: I would say maybe uh once a week.
D: Once a week, OK. Alright um and then, what else did I wanna ask you? Um do you, do you take any recreational drugs?
P: No, and I haven't used any before.
D: OK, and how about alcohol, do you consume alcohol?
P: Yeah I'll have a couple of beers on the weekend, so maybe like two or three.
D: OK, uhm and who and where do you live right, who with and where do you live right now?
P: Yeah, I live with my wife and our um and our son who's in high school. We live in a in a house.
D: OK, OK. Um alright, and any concerns for STI's at all?
P: Oh no, I've been with my wife now for a long time and we've been monogamous so no concerns for uh sexually transmitted infection right now.
D: OK, how about um sick contacts, have you been in contact with anyone sick recently?
P: No, I don't think so.
D: OK, any travel recently?
P: Uh no, I haven't traveled anywhere.
D: OK um and well, let's move on to the physical exam part of this interview. Um so I'm going to get you to stand up from a sitting position. Does that hurt your back?
P: Um yeah it does. I I do feel a little bit of a a twinge there.
D: OK, and where about specifically?
P: Kind of just, yeah, on the lower uh lower right side like more on the, more on the right side.
D: More on the right side, OK. Now, if you have a mirror with you, or if you have someone there with you who can um speak to this, does your right side appear more red, swollen, or hot compared to your left side of the lower back?
P: Uh no, nothing like that.
D: No, OK, and does it seem like it's more atrophied or do you see any deformities or skin changes in that area?
P: Uh nope, no deformities or skin changes.
D: OK, um alright and I'm gonna get you to um bend down all the way and touch your toes if you can.
P: Um yeah I I can get part part way down.
D: You can get partway down, does it hurt?
P: Um a little bit, I can feel it pulling and stretching, yeah.
D: OK. Um alright, and then I'm gonna get you to uh like laterally flex to your right side. So kind of like you're doing an exercise um and you're just like bending towards that side.
P: Yeah, that hurts.
D: That hurts, OK, how about the other side, the left side?
P: Yeah that hurts too.
D: OK. Um and now I wanna get you to uh bring your knees up towards the ceiling. Does that hurt? One at a time, like your right right knee and your left knee.
P: Uh, not really.
D: No, OK, how about when you um flex your knees backwards?
P: Nope.
D: And kind of point your knees towards the ground.
P: No, no pain there.
D: OK, so no pain on knee extension or flexion. Um how about when you point your toes to the ceiling?
P: Uh no pain there.
D: OK so no pain on plantar flexion, how about when you point your uh toes to the ground?
P: No pain there.
D: OK, so no pain on dorsiflexion, and then sorry I forgot to ask you earlier, do you have any sort of numbness in the groin area?
P: No, no numbness in the groin area.
D: OK, so no numbness in the groin area, no weakness, no um changes in your bowel or bladder habits, including no incontinence, so uh no red flags?
P: Yeah, nothing like that.
D: OK, OK, good um and, OK so those are all the questions that I had for you. Did you have any questions for myself?
P: Uh, no I was just uh yeah, kind of wondering do I do I need any X Rays or like what what what's going on?
D: Yeah, so um what it sounds like right now is that you have something called mechanical back pain. It's pretty common and um it can be anything from your spinal joints to the discs to the vertebrate or soft tissue or muscle. Um and a lot of these can be caused by um hard activity at work, um like carrying heavy things um and then carrying them in like an improper position or something like that. Um and we diagnose that on history and physical exam, um but if after we try some management and treatment plans, it doesn't go away and it persists for more than eight weeks, we do recommend imaging, including an MRI. So uh in terms of management for right now, um modified activity at work, um some short term bed rest, uh very short term though um and bed rest is only really recommended if you have severe back pain and muscle spasms, um and you definitely shouldn't be doing that for more than like 24 to 48 hours, and physical activity can help, um so referral to physical therapy or physiotherapy um can help in rehab and they'll give you some exercises that you can try at home to kind of um strengthen those muscles. And then ice and heating packs um temporarily can help, uh medications like NSAIDs can help as well with the inflammation. Um so we'll try these things out and then we'll continue to follow up. Um yeah, did you have any questions or does that sound like an OK plan?
P: Uh that sounds like a good plan.
D: OK, sounds good, thank you. |
RES0159.txt | D: What brings you in today?
P: Hi uh so I just came in today uh I've kind of put it off for a bit, but I've been having this cough uh for the last five to six months and it seems to be getting worse and over the last month I've also been becoming more short of breath, so I just wanted to come and check if I need to do anything.
D: Yeah, that that it's it's really good that you decided to come in. Um how bad is your shortness of breath?
P: Um, so usually like I I would be able to walk a few blocks, um no problem, but now I have to take a break and catch my breath and even going up and down stairs has been tough.
D: Um Do you feel that uh do you feel that your, uh, difficulty with breathing is worse when you're exerting yourself?
P: Um, yeah, it's definitely worse, but I also just like normally even when I'm resting, I feel like I have to um take in like much deeper breaths.
D: Do you ever wake up in the middle of the night gasping for air?
P: Uh no, nothing like that.
D: Do you feel like you have to raise your head or have multiple pillows to sleep at night so you don't feel short of breath?
P: No, nothing like that.
D: OK. Uhm and this cough that you've had for the past five or six months, did you say it's getting worse?
P: Um yeah it it's, both the shortness of breath and the cough are getting worse and also just I've been having some even some discomfort and pain when taking those deep breaths now too. So, and that's been happening for probably the last couple weeks.
D: I see. Um is it a dry cough that you have or or do you bring up any gunk or any mucus?
P: Um it's mainly just a like a like a dry cough.
D: Have you ever coughed up any blood or anything like that?
P: No, I haven't, I don't think I've seen any blood.
D: OK, uhm do you have any other symptoms? Do you have any fevers or chills?
P: Um not fevers, but I I have been getting night sweats um for the last couple weeks to maybe even a month or once or twice a week, I just wake up completely drenched.
D: And have you had any unintentional weight loss?
P: Yeah, now that you mention it, I probably lost 15 pounds in the last two months.
D: OK. Uhm, have you had any muscle aches or joint pains all over your body? Do you feel achy?
P: Yeah, but I've probably felt like that for the last five years, um so I have uh osteoarthritis.
D: OK.
P: So I don't think that's anything new.
D: Um have you had any changes in your bowel movements or any urinary symptoms?
P: No.
D: Any abdominal pain?
P: No, not that I've noticed.
D: OK. Any headaches?
P: Um no, nothing like that.
D: Uhm, OK. Uh have you had any falls in the past or in the past couple of months or years?
P: No, no, I've been lucky.
D: Good. Any confusion?
P: Nope.
D: Uh any time when you've lost consciousness?
P: Not that I know of, no.
D: OK. Um and any medical conditions that you've been diagnosed with?
P: Um, so I have osteoarthritis. And then I also have um this condition with my prostate, uh BPH. And um I also take medications for my blood pressure.
D: Um what medications do you take?
P: Um I take um this medication called uh Lisinopril.
D: Anything else?
P: Um I do take uh just pain medications like Advil.
D: Um OK. Do you take anything to protect your stomach when you're taking the Advil, any other medications?
P: Yeah, I was given um this other medication for, for, to take with my Advil like, but it's only when I'm taking Advil like every day. Um and, um I haven't really been taking that, um I probably took, the last time I took it was probably a month ago.
D: OK, OK. That's good. Um are you taking anything for your uh BPH?
P: Oh yeah, sorry. So I'm taking uh this medication called Tamsulosin.
D: OK, alright, any allergies, to medications or otherwise?
P: Uh mot that I know of, no.
D: OK, any um I guess social history, who do you currently live with?
P: Uh I live alone right now in my apartment I, um but I have pretty good support from my kids, they just live a few blocks away and come visit me.
D: That's good. That's really good. And uh do you, are you able to um take care of yourself or do you need help with things like um finances and groceries and cleaning?
P: No, I'm I'm fairly independent in those matters.
D: OK, do you require any assistance uh with walking any cane or walker or wheelchair, anything like that?
P: No, not yet.
D: OK good good. Do you smoke at all or did you ever smoke in the past?
P: Yeah, I've been smoking for my whole life.
D: How long and how much and for how many years?
P: Um probably for almost, I guess 50 years or maybe even more, maybe like 55 years and uh I've been smoking, at one point I even smoked up to like two two packs a day, but now, like for the last, at least 20, 30 years, it's been like one pack a day.
D: OK. Have you ever been diagnosed with any lung conditions?
P: Uh no.
D: OK, have you um had any marijuana or any recreational drugs?
P: Uh no, nothing like that.
D: Alcohol?
P: Nope.
D: OK, uhm, alright, um you mentioned that the cough started 5 to six months ago. Have you had a cough before that?
P: Um, it's here and there, like maybe just when I wake up sometimes, but this is kind of uh more frequent and, I I do feel just kind of this discomfort in my chest when I take these deep breaths as well. Um yeah so, I I don't really know what's going on.
D: Um do you go to your family doctor for your uh health checkups?
P: I haven't been for a while, for the last few months, but yeah, I generally do go to my family doctor.
D: You do, OK. Um have you been, uh, sometimes for people who have been smoking for a long time, they do uh these scans of the lungs, uhm, have you been getting those?
P: No, I don't remember the last time I had one.
D: OK Alright. Um OK, those are all the questions I had for you. Uhm, we'll we'll do a physical exam and uh do your vitals um and see if you uh, do some labs, and then go from there.
P: OK, sounds good.
D: You're welcome. |
RES0112.txt | D: What brings you in today?
P: Yeah, I brought my son here. I'm a little bit worried about him because like yesterday he had he had this temperature of like 38.5 um so he's been feeling a little bit hot and he's not swallowing his food, like we've been feeding him some mashed up food but he's not swallowing it. He's just kind of throwing throwing it back out there. Um he's drooling now uh and he sounds kind of muffled um and he's been very short of breath.
D: That doesn't sound good. Um uh yeah, I'm I'm currently looking at him and he doesn't uh look great. While the uh while the doctor's um taking his vitals and examining the baby, I'll just ask you a couple of questions.
P: Sure
D: So you said that all of this started about a day ago. How was he doing before that?
P: He was fine before that, he had like a an infection, like some sort of viral infection recently, like about a week back, he had like a runny nose and a cough, but that went away.
D: Um OK, so he had these symptoms about a week ago. Did he see any, did you take him to the hospital or to a clinic?
P: I took him to our family doctor um and they just suggested some supportive treatments um which we've been doing at home like we try to keep him well hydrated, and we've been keeping an eye on his like um diapers and things like that.
D: OK, has he been um has he been, how many diapers is he um, are you changing a day?
P: Usually like about 5, 6, but yesterday it was like 2.
D: OK. Um and uh has he been uh irritable or agitated?
P: Uh he has been very irritable and fussy.
D: Has he been sleeping OK?
P: I um no you know what last night he didn't sleep well at all. He was crying the whole night.
D: Um and uh in terms of uh, so how much has he has he had to eat or drink in the past uh day or two?
P: Uh he's had about like maybe a bottle of his milk, like of that.
D: OK.
P: Yeah.
D: That's it?
P: Yeah, he's not taking. He's not he's not taking anything else like he's been so fussy and so like he's unwilling to try anything.
D: OK, um and, OK. Do you feel like he's been drowsy uh and um lethargic?
P: Um yeah, I feel like he's been a little bit lethargic. Like today, he's more lethargic. All of yesterday, he was very fussy and irritable, but today seems like, he's very slow.
D: OK, and just a couple of questions about um his past medical history. Does he have any uh medical conditions uh that he was diagnosed with?
P: Uh no, he's been healthy otherwise.
D: How was your pregnancy with him?
P: Normal, yeah no complications there.
D: Did did you have GBS or gestational diabetes?
P: No.
D: No, OK. Did you have any viral infections during that time, during pregnancy?
P: No, no.
D: Was he born via Caesarean section or uh C-section or a vaginal birth?
P: Uh vaginal.
D: OK. Any complications during birth?
P: No.
D: Was he um kept in the hospital for a couple days in the NICU after he was born?
P: No.
D: Did he develop jaundice?
P: No.
D: OK, and and he's been OK for the past two years? Any concerns about his growth, his height and weight, and his head circumference? Has your family doctor uh said anything about that?
P: No, he's been pretty good. Um he's been growing and gaining weight OK.
D: Any um developmental issues?
P: No.
D: OK, alright, and any medical conditions that run in the family?
P: Uh no, just like some heart issues.
D: Um OK, and uh does he, I forgot to ask, has he had any hospitalizations in the past?
P: No.
D: Any surgeries?
P: No surgeries.
D: Uh has he been on any medications? Any antibiotics recently?
P: No.
D: OK. Has um has he been vaccinated? Uh has his vaccinations, immunizations up to date?
P: Yeah, they're all up to date so far.
D: OK, alright, that's that's good. Um OK, and does he have any allergies that you're aware of?
P: Pardon me?
D: Any allergies?
P: Oh, uh no allergies.
D: OK alright um well it looks like um I, it's great that you brought him into the emergency room. Um if he hasn't been eating, drinking well, hasn't slept well, has been fussy, and and has been lethargic and tired, uh and is having difficulty swallowing food, um that's definitely very um serious. Uh we'll have a look inside his mouth and see what's going on. It could be that he has an infection or an inflammation of some sort. Um given his fever, he probably has an infection, um and uh we'll likely start him on antibiotics and put in an IV drip just to get in get some fluids inside him, just to get him hydrated, uh and monitor him very closely. We'll also check his vitals and um we'll do uh, yeah, we'll go from there. Do you have any questions?
P: Uh no, thank you.
D: OK. |
RES0151.txt | D: How may I help you?
P: Hi yes I'm just coming in, uh over the last week, I've been having um like a cough, runny nose and a lot of congestion as well. So I just wanted to come in here to make sure nothing's wrong.
D: I see, alright, and when did the uh cough start? Was it 7 days ago?
P: A bit less than that, I would say it's been probably like five or six days.
D: OK, um and has the cough been getting any better or any worse or staying the same?
P: Um it's kind of the same.
D: OK, and are you bringing up any uh sputum with the cough?
P: No, it's mainly like a dry cough, but I am getting like a lot of drainage and uh just congestion in my nose.
D: OK, so you're, you are, are you feeling um like mucus drain from your nose like into the back of your uh mouth?
P: Uh yeah, sometimes I feel like that over the last week.
D: OK. And you you haven't caught up any any sputum, but have you brought up any any blood?
P: Uh no, no blood.
D: OK, have you had any wheezing?
P: No, no wheezing.
D: OK, and how about um any chest pain?
P: Um no chest pain.
D: OK, and you've had a, and did you, have you had a cough before or is this a new cough?
P: Um no, this is like fairly new.
D: OK. And um could you, is your nose uh like, could you describe the discharge from your nose?
P: Yeah, it's more like kind of a clear to maybe whitish discharge.
D: And these symptoms start about a week ago as well or about five days ago?
P: Um yeah, around the same time.
D: I see, OK. And have you had any uh like facial pain like over your over your cheeks or or forehead?
P: Uh no, nothing like that.
D: OK, and have you felt like your nose um is obstructed, like you're not able to breathe in through either one of your nostrils?
P: Yeah, that happens and sometimes the nostrils keep switching.
D: OK, and have you had a loss or a change in your sense of smell?
P: Um just when I'm congested like I feel like I can't really smell.
D: I see, alright. Have you had a loss or a change in your sense of taste?
P: No.
D: OK. Um and have you had any shortness of breath with the cough?
P: Uh no.
D: OK, um and have you had any eye redness or um eye discharge?
P: No, I don't think so.
D: Alright, and how about a sore throat?
P: Uhm, maybe a little bit of a tickle in my throat, but not sore.
D: I see, OK, so have you had any pain with swallowing food or liquids?
P: No.
D: OK, and um have you had any headaches?
P: No.
D: Any fevers or chills?
P: No, nothing like that.
D: Any uh night sweats?
P: No.
D: And how was your weight been recently? Any changes?
P: No, no changes.
D: OK, um and have you had any nausea or vomiting?
P: Uhm no, nothing like that.
D: Have you had any diarrhea?
P: Uh no, no diarrhea.
D: OK, and have you had any urinary problems like painful urination or or frequency?
P: Nope.
D: OK, and then any skin changes or or rashes?
P: Uh nope, nothing like that.
D: Alright, any muscle aches or body pains?
P: Uhm no, nothing like that.
D: Alright, and how has your energy been over this past week? Have you had fatigue?
P: Uh no, I've been, I haven't been tired or like, it's just been like these symptoms that don't seem to go away.
D: I see, OK. Um and uh, have you had any changes to your um to your voice?
P: No.
D: Or any any neck swelling?
P: No.
D: Alright, um so it sounds like over the past uh week you've been having this dry cough uh as well as some nasal discharge and some congestion with um a little bit of a scratchy throat. Um any other symptoms?
P: Uh no, that's pretty much it.
D: I see, alright, and in the past have you been diagnosed with any medical conditions?
P: Uh no, I've been pretty healthy.
D: OK, that's good. And, uh, any uh prior hospitalizations or surgeries?
P: Uhm no, nothing like that.
D: Alright. And do you take any medications regularly, prescribed or over the counter?
P: Um I've just been taking like Tylenol cold, but it's not really been helping too much.
D: OK, um do you have any allergies?
P: Uh no.
D: OK, uhm and, uh currently are you, could you just tell me a little bit about your living situation, um like who you're living with and uh and whereabouts?
P: Um yeah, so I just live in an apartment with my boyfriend and uh live like just within the city.
D: OK, and are you going to school right now or are you working?
P: Yeah, I'm working uh currently um just at a grocery store.
D: OK, and have you been around anybody who's been sick?
P: Uh not that I know of, yeah, I haven't seen anyone like have symptoms or anything.
D: OK, have you traveled anywhere?
P: No, I've been in the province.
D: OK, um and you mentioned um that you have a boyfriend. Are you currently uh sexually active?
P: Yep.
D: And do you use condoms or any form of birth control?
P: Uh yeah, usually like just condoms.
D: I see, OK, and is there any chance that uh you could be pregnant currently?
P: Uh, no, I don't think so.
D: OK, uh, and I just want um, are you currently smoking?
P: Uh no, I have haven't, haven't smoked ever.
D: OK, and that includes cigarettes and marijuana?
P: Uh Yeah, no no marijuana either.
D: OK, do you drink alcohol?
P: Uh just like once or twice in a week.
D: And is it like one or two drinks?
P: Yeah, so I would say, like it would usually be wine.
D: I see alright, and do you use any other uh recreational drugs?
P: Uh no, nothing else.
D: OK, um and in the family, um are there any history of heart or lung problems?
P: Um not that I know of, no.
D: Alright, and how about any uh any cancers?
P: No.
D: Alright, um so uhm that was everything I wanted to ask today on on history, was there anything else that maybe I forgot to ask about, you wanted to mention?
P: Uh no, I just yeah, I was just wondering if like I should be worried at all about Covid.
D: Yeah, certainly um something that we'll be testing for today with some of the symptoms that you're having like um cough and some nonspecific symptoms like that can show up in Covid, um for sure so it will be important to get a test for that today, which will require a nasal swab. Um that being said, it could be uhm another type of viral illness like the common cold, which is causing your your symptoms here today, um and so it will be just be important to be diligent and if your symptoms, diligent with the testing I mean, with the Covid, and if your symptoms get any worse we, it might be important to go to the hospital or or the emergency department.
P: Yep, sounds good. Thank you so much. |
RES0006.txt | D: What brings you in to see us?
P: So I've just been having this cough that I feel has just been getting worse, and I've also been feeling a bit short of breath for the last few months.
D: OK, could you tell me when the cough started?
P: So I would say it started around two months ago.
D: OK, and has the cough been dry or have you been bringing up sputum?
P: Uh, it's usually always, uh, produces like the sputum, and it's usually white or yellowish in colour.
D: OK, and how much sputum are you producing each day? Some, sometimes it's useful to think about like teaspoons or tablespoons.
P: I would say every time I cough like a teaspoon I probably have like. I don't know. Maybe 5 to 10 teaspoons a day.
D: Uh OK, and is there any particular time of day that the cough is worse?
P: Um, not really. It's pretty, pretty much the same. Sometimes it is worse in the morning. Yeah, and sometimes it gets better when I go out for a smoke.
D: OK um. And have you noticed any blood?
P: No, um I haven't noticed any blood.
D: OK, and have you had, so you had shortness of breath, when did that start?
P: It's around two months ago, around the same time.
D: OK, And. Is this? Do you have shortness of breath at rest or is it when you exert yourself?
P: Uh, it's it can happen like at anytime, but worse when I am exerting myself.
D: OK and then have you had a cough before?
P: Uh. Not as frequently. I would say not really, it just started in the last two to three months.
D: OK, and have you had shortness of breath like this before?
P: Just throughout my life I've had asthma so when I am exercising too much or get exposed to like dust, sometimes get shortness of breath.
D: OK. Has there been anything, um besides exerting yourself, that's made that either the cough or or shortness of breath worse?
P: Uh, over the last year like I've had a couple of chest infections. After going to the ER, they gave me some antibiotics. But yeah, when that happens it usually gets worse. The shortness of breath and the cough.
D: OK, and uh, do your symptoms feel like any of those times right now?
P: No, I I don't feel like I have a fever and no other symptoms, just the shortness of breath and cough.
D: OK, and have you been doing anything that's made it better?
P: I've been taking some Tylenol Cold, hasn't really helped too much. I've tried my inhalers, they sometimes help, but I've never had have this frequent of coughing and shortness of breath before.
D: OK, um, and how has your energy been? Have you been experiencing fatigue?
P: Um, when it gets really bad then I can't really step out of the house, but other than that I feel like my energy's still there.
D: OK and you have it, have you had any fevers or chills?
P: No.
D: OK, how about at a loss of smell?
P: No.
D: Um a loss of taste?
P: Nope.
D: OK, and have you had any chest pain?
P: No, just sometimes when I'm like coughing a lot it gets a little bit uncomfortable. But other than that, no.
D: OK, um have you had any instances where you felt like your heart was racing?
P: No.
D: OK, how about being lightheaded or or like you were going to pass out?
P: No.
D: OK, have you had a runny nose or or a sore throat?
P: Nope.
D: OK, and how about headaches?
P: No headaches.
D: Alright, and have you had any wheezing?
P: Um, sometimes I've noticed it, but I had it before. Like with asthma as well, but not not that much.
D: OK, and how about abdominal pain?
P: No abdominal pain.
D: Alright, then any urinary problems?
P: Nope.
D: Any bowel problems?
P: No.
D: Any rashes?
P: Nope.
D: OK, and then how about any muscle aches or or joint aches or or body aches?
P: No, nothing like that.
D: Alright. And you mentioned asthma, but have you been diagnosed with any other medical conditions?
P: No, just asthma.
D: OK, and do you use inhalers? Are there any other medications you're currently using?
P: Oh no, just the salbutamol and like the steroid inhaler.
D: OK, yeah, and how often are you using both of those?
P: So the steroid one I am using pretty much every day but the salbutamol I found I've been using a lot more recently. I would say probably at least six to 10 times in a week.
D: OK, um that reminded me I I forgot to ask. Have you notice any changes to your voice?
P: Um no, not really.
D: OK um. And I was wondering if you had any allergies to medications?
P: No, not that I know of.
D: Alright, and have you been in the hospital recently?
P: No.
D: Alright, so when was the last time that you had antibiotics?
P: I would say like six months ago.
D: OK and any surgeries?
P: Nope.
D: OK, and did you get the flu shot this year?
P: Yep.
D: OK, great um and I was wondering if you could tell me a little bit about your living situation.
P: So I live in London um in a small apartment with my wife.
D: OK, do you have any pets around?
P: No, no pets.
D: Alright, and um, any exposures at work too, like dust or any types of like chemicals like that.
P: No, not really. My work is pretty much a desk job, so nothing like that.
D: OK, and do you smoke cigarettes?
P: Yeah yeah, I smoke a lot of cigarettes just like I would say 30 cigarettes a day.
D: OK, and how long have you smoked for?
P: I'd say, probably at least 25 years.
D: OK and sorry, could you remind me of your your age again?
P: So I am 60 years old now.
D: OK, so you started smoking um around 35.
P: Yeah yeah.
D: OK. Have you tried to quit?
P: Yeah, tried to quit. I've even quite a couple times but then just got back onto it. Yeah, not not really ready to quit.
D: OK. That's fair enough. If there's something that you wanted to talk about quitting smoking at another appointment, we can arrange follow up for that.
P: Alright
D: Do you drink alcohol?
P: Not much, just out say one or two beers on the weekend.
D: Alright, and you use any recreational drugs like cocaine, crystal meth, or IV drugs.
P: No, nothing like that.
D: Alright, and has anything similar like this happened in your family before?
P: Uh, I think my um sister has a COPD, like she smokes a lot too. But that's that's about, I don't know if that's genetic.
D: Oh OK, um I. So I mean anybody in the family have cancers?
P: Um no, not that I know of.
D: Alright um so, that that was all the questions that I wanted to ask on history. Was there any, uh, any other questions that you had?
P: No, not really. Just wanted to get to the bottom of this.
D: OK for sure so um we will run some investigations and likely get a chest X Ray because it's been a couple of months that these symptoms have been going on for. But I think it could be related to your smoking and most likely um Bronc, chronic bronchitis, but we can definitely will be looking into this, and then also with possibly some pulmonary function tests as well.
P: OK, sounds good. |
RES0064.txt | D: What brings you in?
P: My child has been having a sore throat and chills yesterday as well.
D: OK, so you mentioned the sore throat started three to four days ago and the chills started yesterday. And is he having any issues swallowing food or fluids?
P: Yeah, it seems like appetite's gone down, like a lot of pain in his throat, especially when swallowing solid foods.
D: Have you taken a look into his throat? Is it red? Do you see any yellow streaking white stuff, anything like that?
P: I definitely did take a look yesterday and definitely saw a lot of redness. I don't know if I saw any white or yellow streaks, but definitely looks very red in there.
D: OK, do his tonsils look enlarged?
P: Uh, everything looks swollen in there, I don't know what's what, but it does look very angry in there.
D: OK, OK. And has he had a stuffy nose or runny nose?
P: No, not really, no.
D: Any loss of taste or smell?
P: No, nothing like that.
D: OK, how about changes in vision or hearing? Any changes in her nails or skin like rashes?
P: No, no rashes.
D: OK. Have you taken his temperature at home?
P: No, I think he might have had a fever yesterday, but we didn't really take a temperature.
D: OK. And, any fatigue or exhaustion?
P: Energy's pretty much the same, just really complaining a lot about the throat.
D: OK, OK, have you noticed any swelling in in the neck area?
P: Uhm, I think there might be like a few lumps near his neck, so I don't know if that's swelling, but definitely there is. There's a few that I felt over the last few days.
D: OK, coughing?
P: No, hasn't been coughing at all
D: OK, um, and how about shortness of breath or wheezing?
P: No, nothing like that.
D: Chest pain?
P: No.
D: Feeling like his heart is racing?
P: No.
D: Swelling in his limbs?
P: No. I haven't noticed anything like that.
D: OK, dizziness or fainting spells?
P: No.
D: Headaches?
P: He was complaining of a headache a few days ago, but it kind of went away on its own.
D: OK. So the headache's gone completely now.
P: Yeah, yeah.
D: OK. Have any confusion or memory loss?
P: No, not that I know.
D: Joint pain or muscle aches?
P: No.
D: OK, how about his bowel movements? Have those been normal?
P Yeah, they've been normal. No diarrhea or constipation.
D: OK, how about in nausea or vomiting?
P: No, no, he hasn't told me anything about that.
D: Any appetite changes?
P: Yeah, just with the trouble swallowing I'm trying to make sure that he gets like liquids because over the last few days he can't tolerate like solid foods at all.
D: Yeah, how about a weight loss over the past few weeks?
P: No, not really. t's just been over the last few days that he hasn't been eating like himself.
D: OK. Alright and has he been healthy otherwise?
P: Yeah, otherwise he's a very healthy child. We have rarely gone to a doctor for him before, so yeah, nothing. Nothing else with him.
D: OK, have you tried anything for his sore throat? Anything over the counter?
P: We did try, uh, like Tylenol cold. It helped with this headache, but it didn't really help with his sore throat
D: OK, and has he ever experienced anything like this in the past?
P: No, not that I know of.
D: OK. Any hospitalizations or surgeries in the past?
P: No.
D: Any medications that he's on?
P: No, no medication.
D: OK, is he up to date with all his immunizations?
P: Yeah, all his immunizations are up to date.
D: OK, any allergies?
P: No, not that I know.
D: OK, family history of lung conditions or heart conditions?
P: No, no lung or heart conditions. His father does have diabetes though.
D: OK, how old was he when he was diagnosed with diabetes?
P: I think probably in his late 30s with type 2 diabetes.
D: Type 2, OK and then any sick contacts recently that he may have had?
P: I don't think at home at least, uh, but maybe at school, like you never know who they are in contact with, so I'm wondering if he just picked it up somewhere from school.
D: OK.
P: Yeah, yeah, they're all wearing masks right now, but I don't know if he picked something something up from his classmates.
D: Yeah for sure. OK, and then any travel to anywhere recently?
P: No, we've been at home, haven't left even to go to like a different city, have been in London the whole time.
D: OK, yeah, and who does he live with at home?
P: So he lives with myself and his dad.
D: Any siblings?
P: No, he's an only child.
D: OK, any reason to believe you have old carpets, mold, asbestos, anything that could be triggering his symptoms?
P: You know we don't have any pets. We don't have any like old carpets, it's a fairly new apartment, so I don't think any of that should be an issue.
D: Okay, well, I think those are all the questions that I had for him. Anything that you wanted to add or anything that I missed today?
P: Uh, no, I think those are everything I wanted to talk about but I just was wondering if he needs to get tested or like if there's anything we can do today for him.
D: Yeah, so he does seem to be checking off some of the criteria for strep throat. So just to make sure, because he does have a score of right now at least three or four, or maybe even five, definitely over four, we can prescribe him some antibiotics. But we will do a rapid strep test first in the clinic here today just to rule out in or rule that out. If it comes back positive and I guess even if it isn't positive because he checked off a lot of the boxes for strep throat, we will give him a prescription for penicillin or amoxicillin for 10 days. And then you can take that if his symptoms don't go away in a day or two. Because his symptoms also overlap with COVID, we will. do a swab for that as well and you should hear back within 24 to 48 hours and then you should isolate for 14 days. Does that sound good?
P: Yeah, that sounds good.
D: OK, great thank you.
P: Thank you. |
MSK0015.txt | D: How may I help you?
P: Yeah, so I'm I'm George, the father, my daughter is 5 years old and I noticed just a few days ago that she was walking a little bit funny and kind of having a limp when she came back from school. And since since that then, she's been saying that it just hurts too much to put any weight on on that leg, on the right leg. And since then I've been like carrying her around. It's been very painful for her. So I just wanted to come in and check what might be going on.
D: OK and so so. And this, when did this exactly start?
P: So just two days ago.
D: OK, an um did she have any trauma to her right hip or or to hurt your right leg like a fall or any injuries?
P: Sorry um no. Not that I know of at least and she hasn't told me anything like that. She does do some activities, some sports, but I haven't seen her fall anywhere.
D: OK. Um. Alright, and uh, has she has she not not been able to walk then?
P: Yeah, so I've I've been carrying around for at least like she's missed school too, but been carrying her around for the last 1 1/2 to two days. As soon as I had like ask her to walk she starts kind of a hopping and saying that there's a lot of pain near the top of her leg and by your hips whenever she puts her foot like a foot down. So yeah, she's in pain crying, so I kind of have to carry her.
D: OK. And, uh, how has her behaviour been recently like her mood and things like that?
P: She's definitely been more just, a bit anxious about the pain. Very scared about putting her foot down and just overall, I think also more irritable crying more because of the pain so but I I guess I understand if there's something going on it must be very painful.
D: OK, and. Alright, has she had any fevers or chills?
P: Uhm I. Did notice a couple of days ago she felt a bit warm but we didn't really measure her temperature. Over the last few weeks, though, she has had a. Kind of a runny nose and a cough and I think she might have had a fever last week as well so she has been sick recently.
D: OK, so it sounds like she might have had a cold last week and did like the runny nose and cough go away?
P: Yeah, the runny nose and cough are gone. Fever was gone too, but she did feel a little bit warm yesterday so I'm not sure about that.
D: OK, so she's at a a bit warm now still OK.
P: Yup.
D: Has she had any any headaches?
P: No, no headaches.
D: Any sensory changes like things to her vision or hearing or taste or smell?
P: No.
D: OK. Any um sore throat or cough?
P: No.
D: Alright, any shortness of breath?
P: No.
D: Any chest pain?
P: No.
D: Has she had a loss of appetite?
P: No.
D: OK, and has she had any unexpected weight loss?
P: Oh no, nothing like that.
D: Any night sweats?
P: No.
D: Any nausea or vomiting?
P: No.
D: Any abdominal pain?
P: No abdominal pain.
D: OK, any diarrhea or constipation or blood in the stool?
P: No, nothing like that.
D: Alright, and any problems with urination like pain or frequency?
P: No, not that she's mentioned, no.
D: OK. And any skin rashes or changes?
P: No.
D: OK, and any muscle aches or body pains or any other pains anywhere else?
P: No, it's mainly just her upper right leg and hip.
D: OK, I have she had any numbness or tingling?
P: No, not that she's mentioned no.
D: OK and and, how about a muscle weakness?
P: No.
D: No OK. And any confusion or or memory loss?
P: Um no.
D: OK, I'm and in the past has she been diagnosed with any medical conditions?
P: She did have this condition with her hips. Dysplasia, like developmental dysplasia of the hip. So when she was born she she was getting like this clicking noise and her, in her hips and so she was in this splint for probably almost two months at the start, like after she was born.
D: OK, and did her hips, did like was she able to walk afterwards?
P: Yeah, yeah. And we were seeing a specialist, an orthopedic surgeon and they were managing her and after one year they stopped following her. She was well like she was walking, no issues.
D: OK, so she's walking around one year.
P: Mmm
D: Have you had any other concerns about her, either social or physical development?
P: No, she's been really great. She's good with people, she's has great social skills. She has grown well, met all her milestones, she's doing really well at school and gets along well with her peers as well.
D: OK, excellent. And were there any concerns throughout pregnancy, such as gestational diabetes or hypertension or any exposures to infections?
P: No, her mom's pregnancy was perfectly normal. She was born, like she was delivered vaginally at 39 weeks. She was breech at that time, which the doctor said might have to do with her clicking hips. But yeah, but since then or during pregnancy, no other complications.
D: OK, that's great. And. Uh, in regards to, you mentioned her hurt hip any other past medical history?
P: Um no other than that she's been healthy.
D: OK, and does she take any medications regularly over the counter or prescribed?
P: No no, no medications.
D: OK, any allergies to medications?
P: No, not that I know.
D: And sorry has she taking anything for the, the pain?
P: No, I haven't really given her anything, I didn't know what to give.
D: OK all right, we'll talk more about that. Has she had any prior surgeries or hospitalizations?
P: No.
D: Can you tell me about who she's living with and whereabouts she's living?
P: Yeah, so she's currently living at home with me, my wife, and she has an older brother. We live in a small house just near near the city.
D: OK, and what do you guys do for work?
P: Yeah, so I'm a lawyer and my wife is a music teacher.
D: OK, is there anybody who smokes in the home?
P: No, none of us smoke.
D: OK um, OK, And any family history of heart or lung conditions?
P: Uhm, no, no family history our family is pretty healthy.
D: OK, how about any family history of any autoimmune conditions such as hypothyroidism?
P: No nothing like that.
D: OK. And then any musculoskeletal or neurological conditions in the family?
P: No.
D: OK, so next on um just the exam. Um when you're looking at the right hip are you seeing any swelling, redness?
P: Uh, no, not that I see anything.
D: No OK, and is there any like muscle atrophy around the hip?
P: No, not that I see at all.
D: OK and then is there any misalignment or deformity of the joints that you can see?
P: No, I can't. Yeah, I don't see anything in the hips or legs that really points out to me.
D: OK um and is there any pain to palpation over the hip or or knee?
P: Uh, if I if I press on it, I don't think she's in that much pain. It's mainly just when she's trying to walk or put put weight on it.
D: OK, and is she able to move the hip in a full range of motion of like flexion, and extension, abduction, adduction?
P: Uhm, so she does. She is able to move it if she really tries. But it's mainly just the putting her weight on it and anytime she puts her weight on it is is when it really hurts.
D: OK, so more about the weight on it, and is she able to move that her knee with a full range of motion?
P: Yeah.
D: OK, and any any muscle weakness when testing around the joint?
P: No.
D: No, OK. So I think that was everything that I wanted to ask on history and check was there anything I maybe forgot about you thought would be more important today,
P: No I think that's all just just was wondering what might be going on?
D: Yeah, certainly, so a couple of things that it could be. One is that it can be common in this age group is something called transient synovitis. Where, which can happen in the hip where there's some inflammation and it causes some pain following a viral infection. And it sounds like she had a viral infection last week with the cough, fever and and runny nose and her. She was feeling a bit warm and maybe feverish today as well, which could be a sign with the lower kind of slightly elevated temperature, pointing towards transient synovitis, which is a condition that will be self limiting and can use anti- inflammatories to help with the pain such as ibuprofen, but also something that would be important to rule out would be is septic arthritis because it could could lead to damage of the joint, but this will be lower on the differential and then finally something to consider is Legg-Calve-Perthes disease. And, but this would be more of progressive onset, but if she's not getting any better and or if she becomes more sick like develops a really high fever or a red hot swollen joint, then we'd be thinking more along the lines of septic arthritis and we want to reassess.
P: OK, sounds good. Thank you so much. |
RES0049.txt | D: What brings you in?
P: Yeah, nice to meet you I, I've been having just over the last week my cough that's been getting worse and I had a fever a couple of nights and just yesterday I noticed that I started having a loss of taste and smell so that got me really worried.
D: OK, so yeah, let's rewind a little bit. The cough you said started a couple of weeks ago, so would that be about 2 weeks? Three weeks?
P: I would say last week, so like 7 seven days ago.
D: Seven days ago, OK. So that started seven days ago and then when did the fever start?
P: The fever I hasn't been constant, but I've like had some nights where I just feel really chilly and then during the day sometimes even getting these chills I've been recorded at a temperature, but I think I've had a fever at least three times in the last week.
D: OK, so you haven't actually taken your temperature, but it you just feel like you have chills?
P: Yeah.
D: OK, we could take your temperature today. And then the loss of smell and taste. Do they both happen at the same time?
P: I think the taste happened like before, but that was just yesterday and then yesterday morning like at breakfast, I couldn't really taste anything and then continued during lunch and dinner, but smell, I kind of lost around the evening.
D: OK.
P: Yeah, all just started yesterday.
D: OK. Um alright, so let's go back to the cough and has it been constant since it started?
P: Yeah, it's been pretty constant. It's been getting worse, especially like in the last few days. I'm mainly coughing like before I was coughing mainly at night, but now I'm coughing throughout the day.
D: OK, um so yeah, you mentioned possibly a trigger would be like time of day at night? Or did you notice any other triggers like you know, the cold air or dust or anything at home that could be potentially triggering your cough?
P: Uh no, not really. Like I've lived in the same place for awhile, no new changes and I've been barely going outside, so I don't think there are any triggers.
D: OK, and in terms of the quality of your cough is that, would you say it's harsh? Barky?
P: Uhm, I would just say it's like kind of harsh at times, but mainly it's a dry cough, like I'm not bringing anything up.
D: OK, OK. And then you said dry cough so no sputum or blood right?
P: No.
D: OK. Have you ever experienced anything like this in the past?
P: Not the loss of taste and smell, but like the other stuff when I just had a cold or flu like symptoms previously, but the taste and smell is something completely new.
D: OK. And then, um, have you experienced any shortness of breath?
P: Um, not really, no.
D: No, OK. How about we wheeziness?
P: No.
D: Chest pain?
P: No chest pain.
D: OK. Uh, experienced any weight loss recently?
P: No, not that I know.
D: OK, how about fatigue?
P: I have been a bit tired in the last few days. The fevers at night and morning. Just feeling a little bit crummy, just not really energetic, energetic to do anything.
D: Yeah, for sure.
P: Just been planner, just sitting on the couch.
D: OK. Any changes to your hair, nails, or skin, like rashes?
P: No, I haven't noticed anything like that.
D: OK, you mentioned loss of smell. Do you have a runny nose or a stuffy nose?
P: I did have a runny nose earlier this week, but that's kind of subsided. Other than that, I don't really feel too much congestion. I've been taking Tylenol, the Tylenol cold so I don't know if that helped.
D: OK, how often are you taking the Tylenol cold?
P: I just took it like for four days just before going to sleep in the last week.
D: Oh, I see. OK. OK and then. Any I do have a sore throat?
P: No.
D: No, ok. How about any changes to your vision or hearing?
P: No, nothing like that.
D: Any pain or discharge in the eyes or ears?
P: No.
D: OK. Do you ever feel like your heart's racing?
P: Uh no, not really.
D: No, OK. And any swelling in your limbs?
P: Uh, no, I don't think so.
D: OK, any dizziness or fainting spells?
P: No.
D: OK. Confusion or memory loss?
P: No, not that I can tell.
D: OK, any changes in your bowel habits like constant constipation or diarrhea.
P: Oh no, not really.
D: No, no blood in the stool, right?
P: No.
D: OK, any changes to your appetite?
P: Um, just maybe in like a little bit with the loss of smell and taste, the food is not really the same in the last day, last few days?
D: Yeah yeah, that makes sense. Any nausea or vomiting?
P: No.
D: No, OK. And any changes in terms of urine?
P: No, I've been peeing alright.
D: OK, good. Any major or a longstanding medical conditions, or are you otherwise healthy?
P: No, I've been fortunate otherwise healthy. I had asthma as a kid, but like I haven't had to use the puffers for more than a decade.
D: Oh ok. OK. And what triggers your asthma?
P: I think back then it was just when I did sports and I was running around a lot. I've been fine for the last 10 years at least.
D: OK. OK, that's good. And any surgeries or hospitalizations in the past?
P: No.
D: No, OK. Any are you on any medications?
P: Currently just the other thing, Tylenol cold, but other than that no other medications.
D: OK, not even other over the counter medications or herbal supplements?
P: No, nothing like that.
D: OK. Do you have any allergies?
P: Um, sometimes in the fall like I get a bit sniffly and, but other than that, I don't know of any allergies to any foods or medications.
D: OK. And how about immunizations? Are you up to date?
P: Yeah, they're all up to date.
D: Any lung conditions or heart conditions that run in the family?
P: Uh, my father did recently have a heart attack at age of 58 I think he was, he, he's fine though, but that's that's about it.
D: OK, um any cancers that run in the family?
P: Um, no, I don't think so.
D: OK. And, and do you smoke?
P: Uh, yeah, yeah I do.
D: OK, how much do you smoke?
P: Probably, I would say a pack a day.
D: Pack a day, OK. For how long?
P: Ah, probably since in my 20s, so at least 10 years now.
D: OK, have you ever thought about cutting down?
P: Yeah, especially with this pandemic going on, it's been, I've been trying to cut down just because like I don't want to get the, get COVID and then you know my lungs are probably already weaker because of the smoking. So I've been trying to cut down.
D: Yeah, for sure it's good that you're trying to cut down. We have resources to help you if you ever need them.
P: Yeah, for sure.
D: Do you do marijuana?
P: No, no, I've never tried marijuana.
D: OK, how about other recreational drugs?
P: No, um, besides alcohol, nothing else.
D: OK, and then um, I guess I'll ask you about the alcohol, uhm, how much do you drink?
P: Um, um, not that much. I'd probably say like a few times a week when there's a game on. I just grab a couple of beers, but that's about it.
D: OK. Uhm, and where do you live right now?
P: Yes, I just live just outside of London with my wife and daughter in a small townhouse.
D: OK and anyone else at home sick?
P: No. I I've kind of stayed away once I noticed some symptoms. I'm just kind of just staying in my room, not getting out. I don't wanna make any of my families like.
D: Yeah, that makes sense. And have you traveled to anywhere recently?
P: No, umm, I haven't really traveled. I do I do go to work though I haven't in the last last week. I've told them that I've been having these symptoms, but other than that, no traveling.
D: OK. Uhm, OK, that's good. Those were all the questions I had for you today. Was there anything that you wanted to ask me or anything else that you wanted to discuss that I may have missed?
P: Uh, yeah, I I that I'm just wondering like I could it be COVID I I don't know. I don't know if someone in the office had it or yeah, it was just basically worried about, if I had COVID.
D: Yeah for sure. that's definitely something that we need to rule out, so we will be doing a COVID swab on you and and you will hear back in about 24 to 48 hours with the results. But regardless, because your symptoms overlap with symptoms of COVID especially umm, the loss of smell and taste, we do recommend that you isolate for 14 days and that includes trying to isolate from family members as well. So we'll, that's where we'll start. If it's not COVID, it could be another viral illness that's going around at this time of year. But, we'll start with, we'll start with these COVID swabs. How does that sound?
P: Yeah, that sounds good. I'll, I'll let my work know and yeah, hopefully it comes back negative, but I'll stay away from everyone till then.
D: OK, sounds great, thank you.
P: Alright, thank you so much. |
RES0111.txt | D: How can I help you today?
P: Hi, um I'm here because I've had this awful sore throat for the past four days. Doesn't seem to be getting any better and I think I'm developing a fever now.
D: Have you checked your temperature?
P: No, I haven't checked my temperature, I'm just really hot.
D: We'll check that here then. And, uh, do you, OK so you've had this sore throat for four days and a fever. Have you had any difficulty swallowing?
P: Yeah, um not, like I can drink OK, but it's really hard for me to eat solid foods right now.
D: Um why is that?
P: Oh it just hurts.
D: Yeah, OK, but it's not that you can't um, you can't sort of like, you don't feel like it's getting stuck?
P: No, no, nothing like that.
D: Um and have you noticed any changes in your voice? Do you find that your voice is more hoarse?
P: Um a little bit uh but I think that's just because I try not to talk as much since my throat is so sore.
D: OK, OK and uh have you had a runny nose?
P: No, no runny nose.
D: Uh a cough?
P: No.
D: OK. Have you had any difficulties breathing?
P: No.
D: Any chest pain?
P: No.
D: Any sort of um congestion, do you feel like your nose is stuffy or hurts your, uh, in your cheeks or your head when you bend down?
P: No.
D: No, OK. Um so all you have is a sore throat and this fever, OK um and um, OK. You have a headache?
P: Um no headaches.
D: Do you feel like you've been confused or just feeling not yourself?
P: No, nothing like that.
D: OK. Any uh changes in your hearing or your vision?
P: No.
D: OK, any um and do you feel like your heart's beating very fast?
P: Uh no.
D: Do you feel short of breath?
P: Nope.
D: Any uh belly pain?
P: No.
D: Any nausea or vomiting?
P: Uh no.
D: OK, any diarrhea or constipation?
P: No.
D: Any fatigue?
P: No.
D: Weight loss? Unintentional.
P: No weight loss, no.
D: Uh and uh do you have any medical conditions?
P: Uhm no, I don't think so.
D: OK, are you up to date with your immunizations?
P: Uh yeah the only one that I haven't gotten is um that HPV vaccine.
D: OK OK, um OK, any uh, did you get the flu shot?
P: Oh, I didn't get that this year.
D: OK, well we recommend that you you get your vaccines and um also the uh HPV vaccine. Um it's it's best to get the HPV vaccine earlier on. It's a little bit less effective as you um go past a certain age, you are still obviously nowhere close to that, but it's, I I don't believe it's covered after the age of 26 either, so it's best if you get it done earlier. And let's go back to your symptoms, then. Have you had any surgeries?
P: Uhm, I got my appendix removed when I was 13.
D: Anything else?
P: No.
D: OK, are you taking any medications including over the counter?
P: No, I just take my multivitamins.
D: And uhm are you um are you currently living alone or do you live with someone?
P: I live with my parents and my two siblings.
D: And uh do you feel safe at home?
P: Yes.
D: OK. Are you um currently sexually active?
P: No.
D: OK. Um do you plan on being sexually active in the near future?
P: Uh no, not before I finish high school.
D: OK, alright. Um and um are you uh, do you uh drink alcohol?
P: No.
D: OK, do you smoke?
P: No.
D: Have you tried marijuana or any recreational drugs?
P: I haven't.
D: OK. Are things going well at, are you in school right now?
P: Um yep, I'm in grade 10.
D: OK. Are things going well?
P: Yes, I would say so.
D: Any bullying uh at school?
P: No.
D: OK, any um any any concerns about depression or anxiety?
P: No.
D: OK OK alright and uh you uh traveled anywhere recently?
P: No, I've been um just at school and home.
D: So it's not it's not virtual, it's in person?
P: So half the day is in person and the other half is virtual.
D: OK and are you maintaining social distancing at school, wearing a mask?
P: Yeah we do, except sometimes I guess like I don't know if you have to drink water or something, we take it off.
D: Yeah, sure, OK. Um and uhm, I suppose just um OK. What was I gonna ask? Um do you uh, so no travels, OK. Do you feel like you've been in contact with someone who might be sick or might have Covid?
P: Uh I don't think so.
D: No, OK alright. And have you looked at your throat? Does it look swollen or red?
P: Yeah, it looks pretty swollen and red.
D: Well, that's all the questions, oh one more question actually. Do you have um any medical conditions that run in the family?
P: Um no, I don't think so. Maybe like high blood pressure.
D: Uh all right, well um that's all the questions I had. We'll do a physical exam, have a look inside your throat. Um given uh the symptoms that you have, it sounds like you have um an an inflammation or swelling of your throat which could be caused by bacteria or viruses. It could be something like um mono, or it could be um strep throat. Um it could be other things as well. Um seeing that your symptoms are somewhat overlapping with the symptoms for covid, we would also like to do a Covid test. Um we'll do a rapid strep test here as well um just to rule it out and then uh we'll uh ask you to quarantine for the next 14 days um until or at least until your covid swabs are back or your symptoms improve um and we'll let you know about um the management based on the strep test result. Do you have any questions?
P: Um no, that sounds great, thank you.
D: OK sounds good. |
RES0044.txt | D: What brings you in?
P: Um I just uh I have, I have a cough that I've had for a couple of days and like normally if I had a cough or cold, I would just like stay home and rest, but just because you know there's like Covid I I wanted to make sure, like I wanted to get checked out.
D: Yeah, of course that that was a great idea. Thanks for coming in. Um how long have you had this cough for?
P: Uh it's like 2 days. Like maybe three days ago, I started to feel like my throat was dry and I was like, oh, maybe I need to drink more water or something and then the next day I started like actually coughing.
D: OK, is it a dry cough or a wet cough?
P: Yeah it's really dry.
D: Really dry, OK. So no sputum, no blood that you're bringing up?
P: No, nothing like that. It's just kind of annoying.
D: Yeah, um do you have any wheeziness associated with your coughing?
P: I don't think so.
D: No, OK. No shortness of breath?
P: No, no, I've been, I feel like I've been tired, but I don't think it's been actually hard to breathe. I just feel overall like really tired.
D: OK, OK, and have you tried anything for the cough, like um over the counter cough syrup or anything like that?
P: Uh like I have, I've just been drinking tea and just like tea with honey just to like make it feel better. I I didn't like take any medicine.
D: OK, and do you, have you noticed that there are any triggers for your cough, like the cold, or dust, or any like environmental triggers?
P: I mean, I've been, just because of Covid and stuff, I've been staying home ever since I had it.
Uh so, I don't, I can't think of anything, but I don't think so.
D: OK, and do you find that it's constantly there or um is it worse during a particular time of day, like morning, afternoon, or evening?
P: It's kind of just been there
all the time right now.
D: OK, and um is it getting worse, do you think?
P: I think so. I think like today is worse than yesterday, and the day before that, it just felt like dry and then and then like the next day I started coughing, so yeah.
D: OK, and have you ever experienced anything like this in the past?
P: I mean, I've had coughs before, um this one feels like particularly dry, but uh like it, it's not too different than like when I'm just like, like had a cough in other years.
D: OK, OK. Um and you mentioned that your throat was also dry. Do you have a sore throat?
P: Maybe a little bit this morning, yeah, like at first it just felt dry like I was thinking like, oh it's like you know I need to take a sip of water or something and now it just feels, now it's starting to think, I feel a little bit sore, I think.
D: OK, um is it hard for you to swallow foods or fluids?
P: Oh sorry, could you repeat that? I just missed the last part.
D: Oh no worries. Is it hard for you to swallow food or fluids?
P: Uh no, it's not hard. It's not hard to swallow things.
D: OK um, and then have you had a runny nose or a stuffy nose?
P: No, not particularly.
D: No, OK. How about any changes to your hearing or vision?
P: No.
D: No, how about changes in smell or taste?
P: Uh, no, that's like a Covid thing, right? Like I was hoping because I could still, I could still like taste my coffee this morning, I was hoping that that means I don't have Covid, but yeah, I don't really know.
D: I mean yeah, some people have it, some people don't. Um I guess people with Covid present in different ways, yeah yeah, do you have a fever at all?
P: Um like when I came in here, when the nurse took my temperature, she said I had um, like she said I had a fever. Uh I don't have a thermometer at home, um but like I've been feeling really hot so would probably, I've probably been having it for a couple of days.
D: OK, OK, we can take, yeah we can take your temperature. Sorry, did you say you already took your temperature today and?
P: The nurse took it, yeah, I don't know what it was, but the nurse kept coming in and she said it was a
little high like I don't know if it was like a fever but I've been feeling hot, so.
D: OK OK yeah so yeah we'll double check to make sure that um you either do or don't have a fever. Um have you experienced any chills or night sweats over the past few days?
P: Uh, no.
D: No, OK. OK, how about um any weight loss?
P: No, like I don't weigh myself regularly, but I don't think so.
D: OK, um any changes to your hair or uh nails or skin, like rashes?
P: Uh no.
D: No, OK. How about um chest pain?
P: Uh, no.
D: No chest pain, OK. Um swelling in your limbs?
P: Uh, no.
D: No, do you ever feel like your heart's racing?
P: Uh, no.
D: No, OK. Um how about um, how about any dizziness or or fainting spells?
P: Um, no, like I've been just tired.
D: Just tired, OK.
P: Yeah I don't, I don't, I haven't fainted or anything.
D: OK, any headaches?
P: No.
D: No, OK. Uh how about confusion or memory loss?
P: Um, no, I don't think so.
D: OK, um any changes to your bowel habits?
P: Um, no.
D: No, OK. So no constipation or diarrhea or blood in your stool?
P: Yeah, exactly.
D: OK, any changes to your urine?
P: No.
D: OK. Any nausea or vomiting?
P: No.
D: No, OK. And um no abdominal aches?
P: No.
D: No, OK. Um are you otherwise healthy?
P: Um like I have um, I have uh Like some um Like digestive problems generally, like I haven't had any changes to that, but they think it might be like Crohn's or something. Um but other than that, no.
D: Um you said you had digestive problems. Did you say it might be Crohn's?
P: Yeah, like I, I've been seeing my family doctor and they they said they thought it might be, um but we don't really know, just like in general, I guess they've been calling it IBS.
D: Oh, I see, OK. Um, OK.
P: I wish I knew exactly, but they just said, yeah, they don't really know.
D: OK.
P: But there haven't been any changes right now.
D: Oh yeah, I see, OK. Um have you ever had any hospitalizations or surgeries?
P: No.
D: No, OK. Um are you on any medications?
P: No.
D: OK, and how about um any allergies?
P: Um, just uh pineapple, like not any medications or anything.
D: Pineapple, OK. Um are you up to date with all your immunizations?
P: Uh yeah yeah.
D: OK. Um any family history of lung conditions or heart conditions?
P: Um, like my my uncle had a heart attack.
D: OK.
P: I don't, like, not my parents.
D: OK, I see. Um any cancers in the family?
P: Uh, no.
D: OK. Um and do you smoke?
P: No.
D: No, OK. How about marijuana?
P: No.
D: No, OK, um any other recreational drugs?
P: Um no, no
D: OK, how about alcohol?
P: Uh, like I drink, I don't know maybe I'll drink like a bottle of wine on like a weekend, like over a whole weekend or something so like, I don't know maybe like 3 or 4 drinks over the weekend.
D: Three or four drinks a weekend, OK.
P: Yeah, something like that.
D: Sure, OK.
P: I'm not at all like.
D: OK, so occasionally?
P: Yeah.
D: OK. And where do you live?
P: Uh I live in town here.
D: OK, do you live in a house, in an apartment?
P: Um my fiancé and I live in a townhouse.
D: In a townhouse, OK, um, any um concerns for like old carpets or mold or asbestos, anything like that?
P: Uh no, it's like a new a new building.
D: OK, OK, and do you think you may have been in contact with anyone who's been sick recently?
P: Well, so um, I work uh in like, I work in an office that's attached to a factory um and I, so like I have to actually be there, I haven't been able to work from home. Um and there was someone else in my office that I think was coughing in that, like last week and I I don't know, I questioned it but I I didn't actually get to talk to them and ask them, or like I don't know if they were actually sick or something. So, I might have been, and we wear masks and everything, like we're really good, but I don't know, I feel like the offices aren't like super, like the air flow's not that great.
D: Yeah.
P: So yeah, I think that's another reason I was concerned, that I I feel like some people might have been sick and I didn't really know the whole story.
D: Right, OK, so potentially, from from the workplace then, OK.
P: Yeah.
D: And, OK, um have you traveled anywhere recently?
P: No.
D: No, OK. Well those were all the questions that I had for you today, was there um anything that I missed that you wanted to discuss today?
P: Uh not that I can think of.
D: No, OK. So right now it seems like, if I'm going through my differential diagnosis list for you, at the top is, the thing that we have to rule out is Covid, so we'll take a swab and send it off for those PCR results and you'll hear back either tomorrow or the day after, about the results. But in the mean time, and I guess even if the test is negative, um and you're still having symptoms, please do isolate for 14 days. Um and if your symptoms get worse, um like you know, you're having trouble breathing, uh your fever, your temperature is off the charts, um or you're having any sort of neurological symptom, please do um go to the ER and seek out help. Um if it's not Covid, it could be another viral illness that's going around at, during this time of year, um, and usually the treatment for that kind of stuff is supportive, so make sure you're staying well hydrated, you're eating nutritious foods, uh you're getting good sleep. Um and if not, and your symptoms, you know you're having a productive cough, um you're really short of breath, uh we can test you to see if you have some sort of bacterial pneumonia, and those are usually treated with antibiotics, so that's kind of the plan right now. Um so we'll just start with that Covid swab for now. How does that sound?
P: Yeah, that that sounds great. That's really what it, like, I I don't feel super sick, I just really wanna know if I have Covid or not.
D: Yeah for sure and I, and I think it's good that you came in.
P: Awesome.
D: Alright, thank you.
P: OK thanks. |
MSK0040.txt | D: How may I help you?
P: So I've had this ankle pain for the past day, and and it doesn't seem to be getting better. My right ankle looks swollen and it's bruised and is pretty painful so I just wanted to come here to check, check it out, see if I need any thing done to it.
D: Yeah, absolutely, uh OK. So you said that this started yesterday. Was there any like trauma to the ankle or leg or did you have a fall or or some sort of injury?
P: Yeah so I play rugby and I might have, so I fell during a tackle motion type thing and I fell on that leg and my leg, my foot kind of in, pointed inwards as I fell an I kind of fell on um on my ankle kind of just above, above my lateral side of the foot, so where that bony prominence is.
D: OK, I see and and your foot kind of it turned inwards when you fell?
P: Yes, that's right.
D: OK, and was there pain immediately after the this incident?
P: Yes.
D: OK, were you able to like walk off the field at all, or did you need to be carried? Or were you able to walk at any point after?
P: Um so I can walk um, but. It is very painful and I'm putting a lot of weight on my left foot so it's almost like I'm hopping on my left foot.
D: OK. And and is the pain. Actually, so where is the pain specifically located on your foot or ankle?
P: So it's um specifically, it's on the like lateral malleolus area.
D: OK, and how would you describe the pain in terms of its character or quality, like is it sharp burning, stinging?
P: It feels sharp.
D: OK, and do you feel the pain radiating anywhere else?
P: Oh no, it's pretty much in that area just in the ankle area.
D: OK, and has there been anything you've tried to make the pain better?
P: I've tried some ibuprofen and some ice that seems to help temporarily, but it doesn't help with like like it's not permanent.
D: OK, and. Has there been anything that's made it worse?
P: Um just putting weight or like trying to bear any weight on that ankle has made it worse.
D: OK, and what would you say the severity of the pain is on a scale of 10 to one, with 10 being the worst pain you've ever felt.
P: I would say it's like a 7 or 8.
D: OK, and have you ever had a pain like this before to the ankle or ever injured your foot before?
P: No, nothing like this.
D: OK. And have you had any any headaches?
P: Uh no headaches.
D: Had any fevers or chills?
P: No
D: How about night sweats?
P: No.
D: Have you had any unexpected weight loss?
P: No.
D: OK, and have you had any sensory changes like changes your vision, hearing or even your sense of smell or sense of taste?
P: No, nothing like that.
D: OK, and have you had any neurological symptoms such as like numbness or tingling?
P: No.
D: OK, now have you noticed any sensory loss over your leg or ankle?
P: No, no, no no sensory loss.
D: OK. And have you had any muscle weakness?
P: No.
D: OK. and, and have you had any infectious symptoms, like having like a runny nose or feeling congested or maybe even a sore throat?
P: No.
D: Alright, and have you had a cough?
P: No cough.
D: How about shortness of breath?
P: No.
D: Alright, have you had any chest pain or feeling like your heart's racing?
P: No.
D: Have you had any dizziness or lightheadedness?
P: No.
D: Alright, and have you had any nausea or vomiting?
P: No.
D: How about any loss of appetite?
P: No.
D: Have you had any abdominal pain?
P: No.
D: Have you any diarrhea, constipation, or or blood in the stool?
P: No.
D: OK, and have you had any changes to urinary patterns?
P: No.
D: OK, and have you had any changes to your energy recently?
P: No, no changes to my energy.
D: Alright, and in the past, have you been diagnosed with any medical conditions or any reason to see a doctor regularly?
P: Uh no I've been pretty healthy otherwise.
D: OK, so do you take any medications regularly, either over the counter or prescribed?
P: No.
D: Alright, then do you have any allergies?
P: No.
D: OK, and are your immunizations up to date?
P: I think so. I gave them the most recent ones I've received in high school.
D: OK, OK that's good and have you had any surgeries before or any reasons for hospitalizations?
P: Um no I've never, yeah I've never been hospitalized.
D: OK, uh and. Alright, could you tell me a little bit about your living situation right now, like who you're living with and whereabouts?
P: I live with both my parents as well as two of my siblings. They are younger. We live in a house downtown.
D: OK and are you currently in school?
P: I am. I'm in grade 11.
D: OK, awesome and then how's that been going so far?
P: Going pretty well.
D: OK. And have you been around anybody who's been sick recently?
P: No, no one's been sick.
D: OK, and how about have you traveling anywhere?
P: No, we haven't been doing any of that so since COVID.
D: OK, and and I know sometimes people at like in high school and certainly in your age group may experience with things like smoking. Smoking tobacco or cigarettes, drinking alcohol or using marijuana. Have you used any of those, those substances?
P: No.
D: OK. And and are you currently sexually active?
P: Um I am.
D: OK, and could you tell me about your partners or or partner?
P: Um yeah, she's been my girlfriend for the past two years. And we use protection.
D: OK, great. And any concerns for any sexually transmitted infection at this time?
P: No.
D: OK. And in the family, has there been any history of musculoskeletal or neurological problems?
P: Uh, no, nothing like that.
D: OK, and how about any autoimmune conditions?
P: No.
D: OK, and so I next wanted to move to the physical exam component and ask you to have a look at your ankles. And are you seeing any swelling or redness or discolouration?
P: So I there's a. Like there's a bruise about 4 centimeters wide and it appear swollen, but just by right ankle.
D: Just your right ankle, OK. And is there any temperature changes like warmth when you touch it?
P: Uh slightly warm yeah.
D: OK. And are you seeing any muscle atrophy or deformities of the of the ankle or foot.
P: No.
D: OK. Uhm and, uh if you press on areas of your of your ankle and foot, do you feel pain at the lateral malleolus or the medial malleolus?
P: Uh, there's a lot of pain on the lateral malleolus.
D: OK. Um and do you feel pain if you press on the top of your foot like a?
P: Um on the, no no pain at the top of my foot.
D: OK, and how about on the like outside or lateral aspect of your foot you'll feel a kind of, it's a bony prominence that that sticks out at the base of the 5th or you're kind of last metatarsals is there any pain there?
P: No, no pain there.
D: OK, and then how about any pains on that like medial side of your foot?
P: On the medial side, no.
D: OK, and then when it comes to moving the foot, are you able to point your toes on your foot up towards your face?
P: Up towards my face that's hard.
D: OK, so dorsiflexion is limited. And how about pushing your foot down like you're pressing on the gas pedal?
P: I can do that, but it's still painful just to move the ankle.
D: OK, so planter flexion is is painful as well. And then any issues with moving your toes?
P: No.
D: OK, and then you mentioned that with walking you're having a limp currently?
P: Yes.
D: OK, so we have an antalgic gates with an inability to bear weight as well. OK, so the that was everything that I wanted to ask and check today and based on these features it is starting like it could be either an ankle fracture or an ankle sprain. But because of the pin-point tenderness or that you're finding on the lateral side as well as some of the the inability to bear weight as you're describing it'll be important to get an X-Ray to make sure that there's not a fracture. Um and yeah, and if there is then it will be important to have some sort of air boot or casting so that to make sure that we're offloading the area for the bones to heal, but we'll see what the X-Ray shows.
P: OK, that sounds great, thank you.
D: Thank you. |
RES0168.txt | D: What brings you in?
P: So I've just I had some sinus problems in the past. I've had some sinus infections and I just feel like I have one right now and I know that like I know that you know, a lot of the time I I've done all the things that I've been told to do in the past like I've been doing, like Saline rinses and just doesn't feel like it's helping very much right now. When I rinse, I'm getting like this greenie gross kind of mucus coming out. And it's just like giving me this like headache. It just feels crappy.
D: Yeah, I'm sorry you're feeling that way. So this runny nose, OK, do you have a cough at all?
P: Uh, no I don't have a cough.
D: Any shortness of breath?
P: Uhm, I don't have a real like shortness of breath, but it does feel congested.
D: OK, how about wheeziness?
P: Uh, no wheeziness.
D: No wheeziness, OK. And how about, how about like sore throat or loss of taste?
P: Uhm, uh so my throat not sore in like the way that you get catch a sore throat but I get a lot of post nasal drip and it makes it like stingy. So it's like it's sore in that way, but it's not like you know if you have like strep throat or something.
D: OK. How about changes in your vision or hearing?
P: No, nothing like that.
D: Weight loss?
P: No.
D: Fevers or chills?
P: I, I took my temp last night. It was pretty high. It was like 99 point like something, uhm 99 like 7 or something.
D: Ah, OK.
P: So my thermometer said that's high, I don't, I don't really know, but yeah.
D: OK and how about like, facial pain or pressure or feeling like it's full?
P: Oh yeah, I have that. It's like yeah, all on the front part of my face.
D: OK. And then you mentioned some nasal obstruction, some discharge and you said no loss of smell, right?
P: No, I didn't lose any smell. Like sometimes it's kind of hard to smell because it's so plugged up.
D: Right.
P: I still have like I'm able to smell like, especially after I do the rinses. It helps a little bit.
D: OK, how about like a chest pain?
P: Uhm, no, I haven't had any chest pain.
D: No, OK. Any issues with bowel movements or have those been normal?
P: Those have been normal.
D: OK. Any changes in your urine?
P: No.
D: No, OK. Any headaches?
P: Yeah, like I get that like sinusy headache that you know, it's pretty common for me, like kind of just all in like the front of my face and sometimes it kind of feels like it goes all over.
D: How about umm, how about like dizziness or fainting?
P: No.
D: No, OK. Are you otherwise healthy or do you have any longstanding medical conditions?
P: No, this is pretty well, pretty well the only thing. I had some problems with my knee like I had some problems with the ACL, so like I see like an orthopaedic person for that, but otherwise, otherwise I'm healthy.
D: OK. OK, uhm, and are you on any medications?
P: No, like I I sometimes like I used this saline rinse.
D: OK.
P: For a bit. I used to use the nasal steroid spray and I I hadn't had an infection for awhile and things were feeling OK, so I haven't been using it recently. Umm, and then I occasionally will use like, like an Advil if my knees sore.
D: OK. OK, and no hospitalizations or surgeries?
P: Uh, so I had an ACL repair surgery.
D: Oh right, yeah, OK.
P: And like I went to the emergency department once when I had a bad sinus infection, but I didn't like stay over at the hospital.
D: OK, OK. How about immunizations? Are you up to date?
P: I think so. I never really didn't get any.
D: OK. Any allergies?
P: Uh, like a little bit to cats but nothing else.
D: OK. Any family history of lung or heart conditions?
P: No, not that I know of.
D: OK. How about smoking, do you smoke?
P: No, no.
D: No, OK. Do you drink alcohol?
P: I drink a few beers on the weekend.
D: OK.
P: You know five or six per weekend.
D: OK. And then, five or six for weekend. OK and any recreational drugs?
P: I will occasionally take like a cannabis, like a capsule like the oil in the capsule.
D: OK, and what is that for?
P: Just like recreational. Also like I mean my knee, my knee pain. Sometimes it helps.
D: Mhmm, OK.
P: But essentially that that might be like once like per month or something.
D: OK. OK. Alright, and, any sick contacts recently?
P: No, no. I've been working from home.
D: OK. OK, and any travel recently?
P: No.
D: No, OK. And where do you live?
P: I live here in town with my wife and our teenage son.
D: OK. Is anyone at home sick?
P: No, they're fine.
D: They're fine. OK, and what about.. Sorry?
P: They're both working from home like doing school from home too. So we rarely don't go anywhere like my wife goes to get groceries and that's about it.
D: OK, I see. And any old carpets, smoke, asbestos, mold anything like that at home?
P: No, no, it's a pretty new house.
D: OK, alright, any pets at home?
P: We have a dog. It's a labradoodle.
D: OK, yeah.
P: And that's it, yeah.
D: How long have you had him?
P: Oh, like, he's like 3 now. Like my sinus infections and that have been going on for longer than we've had him.
D: OK, alright. Those are all the questions that I had for you. Did you have any questions of your own for me?
P: I don't think so. I just I hope you know, we can do something about this. Because you know, I tried all this stuff that is supposed to be like, you know, conservative like the first steps and it just doesn't seem like it's getting better. It's been like few weeks. So, I thought it was probably time to come see you.
D: Yeah, sorry. What have you tried at home again?
P: So I use the, the rinses the saline rinses. I used a little bit of nasal decongestant but I know like I know I've been told I'm not supposed to do that for more than a few days, so I don't. Yeah, that's, I think that's pretty well it 'cause they said there's not much we can really do.
D: OK, yeah. So your symptoms, OK because some some of these things overlap with Covid, we're going to have to swab you and they'll notify you of your results in like 24 to 48 hours. But what it sounds like is something called Sinu, Sinusitis and it sounds like acute bacterial rhinosinusitis because of some f the symptoms that you have, and it's been going on for more than a week and it's, it's not going away with the rinse, saline rinses and these decongestants. So we will prescribe some antibiotics for you. Probably amoxicillin. Take those for five to seven days and see if some of your symptoms clear up. If they continue to be severe, umm, actually, at this will also prescribe you some inhaled corticosteroids because I think those can help as well, so will give you both of those for now and then just follow up with us in a week after you've tried both things and we'll see how your symptoms are holding up at that point. Does that sound like a good plan to you?
P: Yeah, I think that sounds that sounds fair. Yeah, thank you.
D: OK, yeah no problem. |
RES0001.txt | D: What brings you in today?
P: I so I've just had this pain in my chest for just over a week now and it's caused me to have trouble breathing.
D: OK, um how old are you, Jen?
P: Um 52.
D: OK when did this pain start? You said a week back?
P: Uh, yeah, just about that I I think maybe 8 days ago.
D: OK, and is it a constant pain? Is it always there?
P: Ahh it it is, but it's definitely worse that um, it's the breathing that's been bothering me a lot more. When I take a deep breath that the pain is a lot worse.
D: OK, OK um. And when you do get that, get that pain. How long does it last?
P: Um I would say, uh. Around 15-20 minutes. It's it goes away over overtime.
D: OK, and the shortness of breath do you have that at rest as well?
P: Uh no if I if I take a break or sit down to rest then I can usually catch my breath. But if even if I'm doing a little bit of exertion like walking a few a few blocks or something like that I'm finding it, I'm I'm short of breath.
D: OK um do, did anything trigger this a week back? Any trauma to the chest area? Anything like that?
P: Uh, No, no one else has been sick. I I had a cough about a week ago so I thought it might be a
chest infection, but I'm not feverish, so I'm not sure.
D: OK, the cough is it still there?
P: Yeah, it's um. I still have a cough.
D: OK, and are you coughing up any blood?
P: No, I haven't. I haven't noticed any any blood.
D: OK, how about sputum?
P: Um, no sputum.
D: No, OK. And do you feel like you're wheezing?
P: Oh no wheezing.
D: No wheezing, OK. Um, the shortness of breath 1 to 10, 10 being the worst, the most severe. How bad is your shortness of breath?
P: I would say when I'm exerting myself, it could get up to like a 7 or 8.
D: OK, and you mentioned how, how far can you walk before you need to rest.
P: I I would say maybe 100 meters. But before I was able to run uh like I was running a few days per week so. So this is not like me.
D: OK and the chest pain. Is it sharp or is a dull crampy? What does it feel like?
P: I say it's sharp.
D: OK, have you ever experienced this before?
P: No, nothing like like this before at all. I I have never had any, any problems like this before?
D: OK um, and has it changed since it started a week back or has have your symptoms been pretty much the same?
P: They've been pretty much the the the same.
D: OK, OK Um, do you have anything like COPD, Congestive heart failure, anything like that?
P: No, I've never had any heart problems, uh in the past. I've been healthy up to this point though, nothing I see a doctor regularly for.
D: OK, OK. This you mentioned, no fevers, no chills. And no night sweats too I guess?
P: Yeah, no night sweats.
D: OK, and how about weight loss? Any weight loss?
P: No weight loss
D: No, OK. Um, have you experienced any changes in your vision?
P: Yeah no, my visions been been, been fine.
D: OK hearing?
P: Hearing has been OK.
D: OK, how about smell?
P: No changes in smell.
D: No, um have you had a stuffy nose or runny nose in the past week or so.
P: No, it's just that the dry cough.
D: OK, dry cough. Any changes in your skin like rashes?
P: no rashes.
D: OK, and you mentioned some chest pain. Any palpitations like you feel like your hearts racing?
P: Uh, actually I did feel like that a little bit. Especially when I was moving a little bit more, I felt like my heart was racing.
D: OK, um, any calf pain.
P: Um yeah my left, my left leg's actually a little bit sore.
D: OK, any swelling in the area?
P: um uh nope, I don't see any swelling there.
D: OK, no?
P: Um, Yeah, we'll say that there is swelling.
D: Oh, OK. And, and you mentioned shortness some shortness of breath on exertion, how about when you're laying down?
P: Not when I'm laying down.
D: No OK, and not when you're OK, not when you're laying down, OK. Um alright and in terms of like
your stool, so bowel movements and urination. Like all of that's normal?
P: Yeah, all that's been normal.
D: OK, any headaches?
P: Um no headaches.
D: no, no confusion?
P: No confusion.
D: OK, how about dizziness or fainting spells?
P: Um, No fainting spells.
D: OK, OK, and have you already received any sort of imaging or pulmonary function tests or anything like that for this recently?
P: Oh no. I I I haven't.
D: OK and are you otherwise healthy? Do you have any past medical history of any conditions really?
P: No, like I've been um previously healthy, but I I guess I did have a hysterectomy a few weeks ago. I know it was, I I didn't bring it up before 'cause it's just a day procedure, but I was definitely
spending a lot more time um relaxing at home after that, a few weeks ago.
D: OK, OK, so you haven't been moving around as much. I guess since the hysterectomy?
P: yeah exactly it's starting to it was starting to get, the pain was starting to improve but it was keeping me on the couch a lot of days.
D: OK, yeah. Um, are you on any medications?
P: Um no I try, I've tried some Tylenol and Advil for the pain throughout this week, and it didn't really help much. But other than that, don't take any any medications, nothing for blood pressure or anything like that.
D: OK, and sorry. What was the hysterectomy for?
P: Um I I was having a lot of bleeding.
D: OK, so were they thinking it was like a cancer or something?
P: Um I think it was um. It was from Fibroids.
D: OK, OK and then, So you mentioned no medications, any allergies?
P: Um no allergies to medications .
D: no. And are you up to date with any with all your immunizations?
P: Um, I am yeah.
D: you are OK. Any family history of lung conditions?
P: No lung conditions.
D: But how about heart?
P: Yeah, it's just my mom had a heart attack when she was 56.
D: OK, OK. I'm sorry to hear that. And. Any history of family history of something called pulmonary embolism or DVTS.
P: Uh, no, I haven't heard of a heard of pulmonary embolism before.
D: OK, so it's basically blood clots in your lung. And then DVT's are deep vein thrombosis. So also blood clots but in different parts of your body.
P: OK.
D: Yeah, anything like that that you know of?
P: Uh no, I I have might have heard of something like that happening in my mom actually, it might have been related to her heart attack, but I'm not specifically sure.
D: OK, sure. Um an then do you smoke?
P: Um I I smoke, I may be about half a pack of cigarettes per day. I've smoked ever since I was a teenager. I've tried to quit multiple times I I was smoking about a pack per day before, so I have
cut it down, but still something that I'm working on.
D: OK good, I'm glad you're trying to cut down. Um, we have resources available if you're interested
in some more help. And you smoke um marijuana?
P: No, I don't.
D: OK. Any use of other recreational drugs?
P: No, no.
D: OK. And how about alcohol? Do you drink alcohol?
P: Uh may be a glass of wine on the weekends, but other than that no.
D: OK. I mean, have you had any sick contacts recently? People around you? People you live with at work.
P: I can't think of any anybody who's been sick no.
D: OK, OK, and and what do you do for work Jenn?
P: I work as an administrator at at a bank.
D: OK, OK. I'm and I have you traveled anywhere recently?
P: Um, no I I can't remember the last vacation.
D: OK, alright, and so those are all the questions that I had for you. Did you have anything that you wanted to add? Anything that I hadn't touched on?
P: Um No, I think you covered everything. Thank you.
D: OK yeah, no worries. So I guess at this point we would do a physical exam. Just take a listen to your lungs and your chest. After that, so right now it sounds like it could be something vascular you know, like a pulmonary embolism like we talked about. That's kind of high on my list of things to
work up for. But also, we don't want to miss other things you know, like
cancer, infection, autoimmune things that could affect your lungs, so we'll just do a
work up for all of that. How does that sound?
P: Yeah, whatever, whatever you think we need to do.
D: OK sounds good. Thank you for your time.
P: Yeah, thanks. |
RES0155.txt | D: What brings you in here today?
P: Yeah, so over this past five days I've had um worsening shortness of breath and uh some discomfort in my chest um and this cough that that's been getting worse as well.
D: OK, so it's just been for the past uh past week or five days?
P: Yeah, I mean I've had um a cough and uh in the in the in the past, and and and shortness of breath in the past. But yeah, just over these past five days it's been there um at all, like it's been there all day and it's been getting uh worse as well.
D: OK, and what is the cough like? Is it wet or dry?
P: Yeah, I'm bringing up sputum uh pretty much um like every time I'm coughing up I'm bringing up some yellowish or greenish uh sputum.
D: OK, and have you noticed at all any blood?
P: No, no, no blood.
D: No blood, OK, um and how much sputum are you bringing up like uh every time you cough?
P: I I would say its um would would be the like just the little inside of my uh palm each time.
D: OK, and uh is this uh, and then what about the shortness of breath, is it uh are you having trouble taking deep breaths or do you find yourself breathing faster? Like how would you describe it?
P: It's um yeah, I'm just really feeling like I just can't, uh catch my breath even with um some small things around the apartment uh that normally I can do, it's any type of exertion, I just can't catch my breath. I'm OK right now just sitting here though.
D: OK yeah, so at rest you're fine but like when you exert yourself, it gets worse.
P: Yeah, well I'm I still have this like uh chest discomfort. Um so while while sitting here, it doesn't feel um like my breathing is normal.
D: OK, and when do you get that chest discomfort? Is it when you're breathing in or breathing out or it, can it be just due to exercise?
P: It's it's kind of just always, it's just kind of been there over these past uh like four or five days.
D: OK, and how would you describe uh, is it pain at all or is it like sharp stabbing or pressure like pain?
P: Um no, nothing like that. I kind of I just I feel congested I guess.
D: OK, um so just discomfort. Do you do your symptoms get worse at all when you're laying down flat?
P: No.
D: No, OK. Uh, do you wake up at night gasping, gasping for air?
P: No, I haven't done that before.
D: OK, um have you had any fevers or chills?
P: Yeah, uh now that you mentioned, I do think I I feel a bit feverish. Um uh yeah, and I I've noticed that actually over the last uh couple of days.
D: Oh, have you had a chance to take your temperature at all?
P: No, I just felt feverish.
D: OK, um do you have any other symptoms like um sore throat, runny nose, anything like that?
P: No, I don't.
D: OK, um have you traveled at all recently?
P: No, I I I I've been been home.
D: OK, have you tried anything to help you with your symptoms?
P: Yeah, I I did try uh, using an inhaler. I have um a couple up those and um usually that that helps, but hasn't really been able to um help much this time.
D: OK, um how often are you having to use it?
P: Um so uh I I used it um I I took three or four puffs this morning and um and that was about it. I was using it last night as well, uh but typically I will use it maybe two or three times a week.
D: OK. Um and have you had any headaches or changes in your vision or anything like that?
P: No, I haven't noticed anything like that.
D: OK. Any nausea or vomiting?
P: No.
D: Um any increased fatigue?
P: I, I mean, I haven't been able to do as much with uh being so short of breath, but my energy has been been OK.
D: OK, and how about um, do you have any sensation of palpitations or your heart is racing at all?
P: No, I haven't felt anything like that.
D: OK. Um and any kind of diarrhea or constipation?
P: No.
D: OK. Any issues with urination?
P: No, uh no problems there.
D: Uh any changes in your sleep or appetite?
P: Um no, that that's been pretty good.
D: OK, any night sweats?
P: Uh no, I haven't had any night sweats.
D: OK. Um any kind of uh significant weight change recently?
P: Um I I I might have, uh no, I think my weight's been about the same.
D: OK, um any exposure to anyone sick around you recently?
P: No, I don't think so. Um but I I've had I've had a couple of uh chest colds over the last year that I needed um antibiotics for uh and it, they they went away after that, I got that, those from a walk in clinic.
D: Sorry, you got antibiotics from the walk in clinic?
P: Yeah, the last time was uh probably about about four months ago.
D: OK.
P: So I haven't been around anybody sick recently, but um but I mean I I've had similar symptoms um before, I feel like this time might be just a bit worse though.
D: OK. Um and do you have any past medical history? Uh any conditions you've been diagnosed with?
P: Um yeah, so I I have been I've been diagnosed with COPD uh as well as uh, high blood pressure and uh GERD.
D: OK, and when were you diagnosed with COPD?
P: Uh about three years ago.
D: Three years ago, OK. Do you take any medications for any of these conditions?
P: Yeah, so I have a medication uh Ventolin, I take Symbicort daily um which is like a steroid type medication. And then um I take an ACE inhibitor I think for blood pressure and just Tums or something like that if my reflux is bad.
D: OK. Um and do you have any allergies to any medications?
P: Um, no.
D: No, OK. Any past hospitalizations or surgeries?
P: Um, no.
D: OK, any family history of any medical conditions, any lung or heart conditions?
P: Uh nothing like that, no.
D: OK. Um and any cancers in the family?
P: Um, no.
D: OK. Um and any, currently right now, what's your living situation like?
P: Yeah, so um I'm living with um with just my uh daughter in a in an apartment.
D: OK. Um and currently do you work?
P: Yeah, so I I've been working at the um at the grocery store. Uh yeah, I've been at the grocery store.
D: OK, and do you smoke currently?
P: I do, yeah. Uh I smoke about a pack a day. Um and I I've smoked for, now well, probably like 30 or 40 years. I used to smoke more.
D: OK. Um you have cut down, that's good. Um yeah, definitely the more you cut down, and if you need to talk about quitting, there's a lot of resources that we can go through. Um do you use anything else besides uh cigarettes, like any marijuana or any other drugs?
P: Uh no, no, just just cigarettes.
D: OK, um and any alcohol?
P: Uh yeah, I mean I'll have some uh wine with dinner on the weekends, but that's about it.
D: OK. Alright, so those are all the questions I had for you. Do you have any questions?
P: No, that was, uh, about it I was uh I was wondering if you think I I have an infection or is this uh COPD acting up, or what's going on?
D: Yeah, so definitely with your history of COPD and um these symptoms, it can just be an exacerbation of your COPD and that can happen sometimes when you have COPD and then you get a either viral or bacterial infection and that makes your symptoms worse, and you've also had a fever, so we'll do like a full physical examination, get your vitals, everything, but uh and then we'll give you some uh like nebulized like um for your home puffers too, but all just in the hospital and monitor your response to them. Uh and then we'll also get like your, some of your blood work and chest X-ray just to see if there's any like pneumonia. And lastly we'll just get like a Covid swab done since some of these symptoms also overlap with Covid symptoms. Um and yeah so we'll, so that's what we'll do um and I'll let the emergency department know that you're on your way. I think you'll need to get all those tests there, and then they'll decide whether or not you need any kind of admission or you can just go home on antibiotics um from there, OK?
P: OK, that sounds good. Thank you.
D: Yeah yeah alright take care.
P: Bye. |
RES0118.txt | D: What brings you in here today?
P: Hi I'm coming in because I've had this like on and off runny nose and stuffy nose for the past week. Um and I just came to make sure it's not something serious like Covid.
D: OK, yeah no I completely understand why you might be worried um with everything going on. So just to get an idea of the timeline, so when did this start?
P: So it started about I'd say, seven days ago.
D: Seven days ago, OK. And was it just a runny nose that started or did you have any other symptoms?
P: So at first I felt kind of stuffy um and then now it's more runny. Um and no other symptoms.
D: And are you coughing at all?
P: No.
D: Are you bringing up any discharge from like your nose, or are you coughing any material up?
P: No, no. I mean there's some discharge from my nose, like it's runny, but it's it's not yellow or anything, it's clear.
D: OK, and do you think this issue has gone worse over the last seven days or is it improving at all?
P: Um I don't think it's improving. It's changed 'cause it used to be stuffy, now it's more of a runny nose. Um but yeah, it seems to be runny, like it's the same amount of runniness for the past couple of days.
D: And are you having any symptoms of loss of smell at all?
P: No, no loss of smell.
D: How about loss of taste?
P: No.
D: Um were you uh with anyone around you sick at all before those seven days?
P: Uh I don't think so, I visited my sister and she has a nephew who goes to daycare, but my nephew's been OK, no, no runny nose or stuffy nose.
D: Uhm, and is it just a constant issue that goes on throughout the day or is it worse at night, during the day, how would you describe it?
P: Um it's it's pretty constant throughout the day. It's just it just feels bad at night because it um makes it hard for me to fall asleep.
D: OK, uh have you tried any medications at all over the counter that would help?
P: Um I tried some antihistamines because I do have seasonal allergies. Uh but they don't seem to be helping.
D: Um any anything that makes your symptoms worse at all, like any exertion or any kind of uh position?
P: No.
D: Um do you have any shortness of breath or chest pain at all?
P: Uh no.
D: Any sore throat or muscle aches?
P: No.
D: Any uh headaches?
P: Nope.
D: Have you traveled at all recently?
P: No.
D: Have you had any nausea or vomiting?
P: Uh no.
D: Any fevers or chills?
P: No.
D: Any night sweats or fatigue?
P: No.
D: OK. Um any kind of sensation that your heart is racing?
P: Uh no, nothing like that.
D: Any changes in your bowel movements like any constipation or diarrhea?
P: No.
D: Any changes in your urinary pattern?
P: No.
D: Uh any issues with your sleep or appetite?
P: No.
D: Have you lost any weight, significant weight, uh recently in the last few months?
P: No.
D: And uh do you have any exposure to like fumes, dust, or like uh carpet, pets, or animals? Anything that you might have an allergic reaction to?
P: Uh no nothing like that.
D: OK and currently are you sexually active?
P: I am.
D: And um can you just tell me a little a little bit of a detail like about like a partner? Uh and if you've had any new partners recently at all?
P: No, I've been with the same partner for the past five years.
D: OK, and uh do you have any history of any STI's?
P: No.
D: OK nice, um, in terms of your uh past medical history, do you have any um diagnoses or anything any medical conditions at all?
P: Uhm no, no nothing, nothing long standing.
D: Um anything you take medications for?
P: No.
D: Are you allergic to any medications?
P: Uh not medications.
D: Uh any environmental allergies?
P: Just yeah, some seasonal allergies.
D: OK. Any previous hospitalizations or surgeries?
P: Um I was hospitalized for um Like an appendectomy when I was younger. Um but that's about it.
D: And when was that?
P: That was when I was 18.
D: And any complications after that?
P: No.
D: And uh in terms of your family history, does anyone have any lung conditions, heart conditions, or any cancers?
P: Uh nope, nothing like that.
D: And currently uh do you work?
P: I do. I work from home though.
D: OK. And how would you describe your living situation right now?
P: Um I live in an apartment with um my partner and we have a dog.
D: Um and currently, uh do you smoke at all?
P: Uh no.
D: Do you use any recreational drugs like marijuana?
P: No.
D: How about uh any alcohol?
P: Uh I drink like a glass of wine every other day.
D: OK. Um yeah, so those were some of the questions I had for you. I know it's a bit concerning because of the pandemic going on and um a runny nose can be a symptom uh of Covid as well, but uh it can also be a symptom of just the common cold or any other virus. Um but since you're having, uh you're symptomatic right now, we will definitely get like a Covid swab test done for you.
P: OK.
D: And if you start having any, just monitor for your symptoms. Um you should have the test back within 48 hours. Until then, uh at least for 14 days you should try to isolate in your own room, wear a mask around uh your partner, uh and not go outside, so just self isolate.
P: OK.
D: And and then you will get the test results back in a, hopefully in a few days. So do you have any questions at all?
P: Uh no, thank you, that was good.
D: Take care, bye
P: You too. |
RES0053.txt | P: I was just bringing my son and he's just had cough for the last couple of days. I thought about a day and a half ago, it doesn't feel like a cold. He hasn't been too sick, but I was a little bit worried and I wanted to get him seen to see if there's anything we could do.
D: Yeah, for sure. It's a good thing that you brought him in. So the cough, is it consistent? Or does it come and go?
P: It seems to be a little bit worse at night. He'll have this cough during the day. Sometimes I'll notice when he's playing. He's had these coughing fits that last for up to a minute but usually recovers from. He hasn't been too active to be honest. He's been a little bit slowed down these last couple of days, but in regards to consistency, I'd say it's a little bit worse at night.
D: OK, any other triggers like dust or the cold air? Anything like that?
P: I haven't really noticed anything. We've been mainly keeping inside due to covid, right? I think my wife left a window open the other night, and maybe the cough was a little bit better. I'm not sure. It's kind of hard to tell when we sleep.
D: Yeah, have you tried anything for it, like have you given him any over the counter cough medications?
P: No, we're a little scared to give him anything. He's so young. He's 2 1/2. We haven't been really giving him any medications to be honest.
D: OK, good. And if you were to describe the quality of this cough, would you say it's barky? Is it harsh?
P: Barky might be a good word to describe it, like he's had colds before his coughs were quiet but this sounds harsh. It sounds like he's really trying to cough hard there. Very violent sometimes.
D: OK OK. And has he ever had a cough like this in the past?
P: No, never.
D: OK, and then in terms of the timeline, is it getting worse? His cough?
P: I think it has been to be honest. He was a little ill like he had a runny nose a couple of days ago, maybe two days ago and then the cough started but it only really started getting noticeably different about the night of the first day, about two days ago so. Now it's been more present I suppose,than it was when he just first had it.
D: OK, and is it a dry cough or does he bring up sputum?
P: Sputum like phlegm,no he doesn't bring anything up really, so dry.
D: OK so no blood as well right?
P: No blood.
D: OK, does he have any shortness of breath with his cough?
P: I feel like when he has the coughing fits, he's winded. He's weak after them. Sometimes he cries after them or before the middle can be a trigger for it, but just resting normally, he doesn't seem that out of breath, no.
D: OK any wheeziness?
P: No, not really. He's able to breathe. I can't really hear him breathing that much. Sometimes at night after a bad cough he'll be really winded. And yeah, it does sound like a little different when he's breathing, but just right now he sounds normal.
D: OK, and any reason for you to think he has chest pain?
P: He hasn't any sort of chest pain. He says his throat hurts, but I don't think it's his chest.
D: Has he had any fevers?
P No.
D: Any change in his hair, nails or skin like rashes?
P: No, no rashes.
D: How about weight loss?
P: No weight loss, he's a fairly healthy kid.
D: And his vision and hearing are normal?
P: You know, I haven't gotten him formally assessed yet, but seems to be able to read pretty well from a distance. He's not in school yet, but I haven't noticed anything, and he can hear fine. I think he responds when I call.
D: OK, has he had a stuffy or runny nose?
P: Yeah yeah, that's kind of how it first started three days ago. Maybe had a runny nose. OK, yeah.
D: Does he still have a runny nose?
P: Umm, a little bit less now. No, not as much now.
D: OK. And his taste, any reason to believe there are any changes there?
P: Well, we've been kind of spoiling him a bit, just giving him ice cream. His throat hurts a little bit and he seems to still like it, so it's hard to tell.
D: OK, so he has a little bit of a sore throat as well?
P: Yeah.
D: OK OK, and then any dizziness or fainting spells that you've noticed?
P: No fainting or dizzy spells, but he's really gassed after he has like a coughing fit and he doesn't want to stand up, he'll just be sitting down or he wants to be held.
D: OK, is he more irritable than usual?
P: Yeah after he has a bad coughing fit, he wants to be soothed and he'll be crying, but it's just more of because he's worn out, I believe he's tired.
D: Yeah, OK, and then any confusion or memory loss?
P: No.
D: OK, and then in terms of his bowel movements, have things been normal from that standpoint?
P: Oh yeah, process of potty training him, but no, no real changes.
D: OK, so no diarrhea, no constipation, no blood in the stool?
P: No.
D: OK and he's passing gas?
P: OK yeah I'd say so.
D: Any nausea or vomiting?
P: No. We haven't been really feeding him solid meals, it's because he's been sick, we've been trying to give him soup and liquids for the most part because his throat hurts, but he's able to keep them down. So no, no nausea, no vomiting.
D: OK, and then how about changes in his appetite?
P: Yeah, he's not eating as much but still, we're trying to force food into him to keep his energy up. Most of time he always will be asking for snacks in the afternoon, but now not so much.
D: OK. Alright and any anything else that I missed that he's been experiencing over the past few days?
P: No, just the cough.
D: OK, and then he otherwise healthy? Does he have any longstanding medical conditions?
P: No longstanding medical conditions. Yeah, nothing really. We had a little bit of stay in the NICU, just because he was a little bit underweight, but no, nothing really.
D: OK. And then his mother's pregnancy with him? Any complications at that point?
P: Yeah he's a little pre term. 34 weeks I think.
D: OK, was he also underweight too? You mentioned just a little bit.
P: Yeah.
D: OK, and any complications during the actual delivery?
P: Yeah, not that I remember like she started going to labor early, like earlier than we expected. We thought it was just a regular contraction and that it will just resolve but she wound up proceeding when we showed up at the hospital
D: OK and then in terms of growth, weight and head circumference, has he been hitting all those milestones for the past 2 1/2 years?
P: Yeah, we we bring him to the family doctor every couple of month for his regular checkups and nothing has been brought up to be concerning for his vaccines. He has been doing well.
D: OK and then how about other milestones like speech, movement, fine movement, all of that, like have those been normal? Is he on par with his peers?
P: Yeah, this is our first kid, but compared to his cousins he seems to be doing well. He's speaking, he's got little sentences, now he has good eye contact. He's a good kid.
D: OK, good good. Any hospitalizations or surgeries aside from when he was born?
P: No no.
D: OK good and is he on any medications?
P: No, OK we give him like a flintstone gummy.
D: OK, is he up to date with all his immunizations?
P: Yeah.
D: Any allergies?
P: Not that we know of.
D: Any family history of lung conditions?
P: So my grandfather, so his greatgrandfather I suppose passed away from lung cancer. He was a heavy smoker though. On my mom's side there's some breast cancer. No, nothing really that comes to mind for lungs.
D: And any heart conditions?
P: No, not that we know of.
D: And how about other cancers?
P: No, not that I know of.
D: OK, how about asthma, eczema or allergies in the family?
P: You know, I think my sister is allergic to peas, but she was never sick from them like go to the hospital. I don't think there are any allergies in the family.
D: OK, good, has he been in contact with anyone who's been sick recently?
P: You know, like 5 days ago we had a playdate with his cousin. And we kind of thought that that's where he got the cold from. Like the runny nose, but it just turned weird, you know.
D: OK and how's this cousin doing?
P: Last time I talked to Charlotte, Hank seems to be doing well so.
D: Alright, and has he traveled to anywhere recently? Have you any of you traveled anywhere recently?
P: No, with covid and everything, we have just been keeping to ourselves.
D: And with who and where does he live?
P: He lives with me and his mother in a house
D: OK. Any old carpets or mold or concerns for asbestos? Anything like that at home?
P: I don't know when this house is built. I don't think there's any asbestos in it and it's all hardwood. So no.
D: OK, good. Anyone at home smoke?
P: No, no.
D: OK, good. So those were all the questions that I had. Do you have any questions for me?
P: No, no that's it, no.
D: OK, well, from the sounds of it, he most likely has some sort of viral infection. We will do a COVID swap to rule that out because some symptoms do seem to overlap with COVID and we want to make sure to rule that out. So we'll take a swab. Those PCR results should come back in about 24 to 48 hours. In the meantime, he should isolate for 14 days at home and if it's not COVID, it could be another viral infection like parainfluenza, also known as croup. So for that, for any of these viral infections, actually the best treatment is to stay at home and make sure that he's very well hydrated and eating well. If his symptoms persist for three to five days or more, or if his symptoms worsen, especially if he has like a seizure or urological issues, he should go to the ER and if his symptoms do become worse, we can also prescribe him some steroids or epinephrine just to open up his airways. And if it's really, really bad he might be hospitalised as well. So just keep an eye on on that for now. And if you have any
questions or concerns, just give us a call. How does that sound?
P: A little scary. Sounds good. OK, I'll just keep an eye on him for the next five days.
D: Give us a call if his symptoms are becoming worse or if they're not resolving and we will try to do an assessment on him. Of course we will do a physical exam today and will let you know how severe his symptoms are. Most children will get over their infection on their own and he likely won't need any additional treatments.
P: OK, sounds good.
D: Alright take care.
P: Thank you. |
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