D: What brings you in today?

P: Uh, yeah, so I, I just came in because I've been having, for the last, I would say 2 weeks, just a lot of congestion in my nose and then I've also been feeling a lot of pressure in my head as well as just, around my jaws and my face overall.

D: Okay, and um, you said it started two weeks ago. Has it gotten better or worse, or been the same since then?

P: Um, I'd say it's pretty much been the same, except like the pressure's getting worse.

D: Okay, and do you find that the pressure is worse when you're bending down, or um, yeah, when you're like squatting or sitting down?

P: Um, when I'm sitting down, I don't think so, but like sometimes I do feel like, for example, when I'm lying on one side, it gets really bad on that one side and I have to kind of switch over to the other side.

D: Okay, alright. And uh, when did your headaches start?

P: Um it's, I guess it's not so much as a headache as just kind of um, just pain in and around the cheeks and just going up to my head. And it started about, I would say around 2 weeks ago.

D: Um, and do you have a stuffy nose?

P: Yeah, I definitely have a stuffy nose and it started, um, it sometimes gets like, like a runny nose as well.

D: Yeah, okay and what's the discharge like?

P: Uh it's usually clear.

D: Okay, and do you have a cough?

P: No, no coughs.

D: Sore throat?

P: No.

D: Um, and do you have any difficulties breathing?

P: Um, no, not that I've noticed. Sometimes when it gets really stuffy, I, uh, have to breathe through my mouth.

D: Yeah, I see. Do you have any difficulty swallowing?

P: Uh, no.

D: Any chest pain or any heart, um, palpitations?

P: Nope.

D: Um, any pain in your belly?

P: Uh nope.

D: Nausea or vomiting?

P: No.

D: Changes in your bowel movement?

P: Nope?

D: Any urinary symptoms?

P: No.

D: Any muscle aches?

P: Nope.

D: Um, any fevers or chills?

P: No, not that I've noticed.

D: Any weight, changes in your weight recently?

P: No, no changes.

D: Any uh, night sweats?

P: Uh, no.

D: Okay. Um, alright so, have you had any contact with anyone who could have been sick in the past two weeks or before that?

P: No, no, I'm very like careful. Um, I barely go out.

D: Good, that's very good. Um are you, have you traveled anywhere outside the province?

P: No.

D: Okay and um, do you currently work?

P: I work from home right now, um, I'm an accountant.

D: Okay and do you live with anyone else, or do you live alone?

P: Uh, so I live with my family. I live with my husband and um two daughters.

D: Have any of them been sick recently?

P: No, they've been fine.

D: Okay, good. Um, and do you smoke?

P: No, not at all.

D: Do you smoke marijuana or consume any recreational drugs?

P: Probably the last time was in college, um for marijuana.

D: I see. Um, what about alcohol?

P: Alcohol, I'll probably have a glass of red wine a day.

D: Alright, okay. And um, have you, do you have any, um I guess carpets or, or um curtains or any sort of animals around, anything that might cause any kind of environmental allergies?

P: Uh no, nothing like that.

D: Okay, um alright. And do you have any medical conditions that you've been diagnosed with?

P: No, I've been completely healthy.

D: Any hospitalizations or surgeries?

P: I did have a, um, c-section with both my, both my children.

D: I see. Any complications after?

P: No complications after. They were both healthy, I, I didn't have to stay in the hospital.

D: Great, great. Um and any allergies uh to medications, foods or environmental allergies?

P: Nope, not that I know of.

D: Any medications, including over the counter herbal medications?

P: I have uh, I do take uh, Tylenol cold in bed sometimes, to relieve some of the pain and pressure.

D: That's good, that's good. Is there anything else that makes the the pressure and the pain better?

P: Um, I have done those like, kind of those steam um, therapies. That sometimes helps.

D: Okay good, good, good. Um, any uh, anything that makes the, that makes it worse? I know that lying on one side, you said, makes things worse for you. Anything else that's made the pressure worse?

P: Um, no, I would say that's, that's about it.

D: Okay, any changes in your sense of smell?

P: Yeah, definitely. Uh when I get really stuff, stuffy, like I don't really smell anything.

D: What about sense of taste?

P: Um taste, I guess, like with the smell gone sometimes like the taste feels weird too, but like not, not really.

D: I see, okay. Um, and any family history of any medical conditions?

P: Um my, my father did have a heart attack in his uh, I think it was late 50s, but he's well and alive right now, so he's fine.

D: Good. Alright, well that's all the questions I had for you given the symptoms that you've shared with me, it sounds like you might have something called um, rhinosinusitis, uh which is basically inflammation of the sinuses and of the uh, of the nasal cavity or the area inside your nose, and uh, often it's just treated with conservative management, so just continue to take um, Tylenol if that seems to help you, and do the steam therapy. It will take time to get better, um, but if you feel that it's um, it's not getting better in the next week or so, give us a call again and we can maybe see if it's a bacterial infection and see if um, if antibiotics might be needed but oftentimes it's usually a viral infection, and antibiotics are not needed, and sort of just resting and taking care of yourself, um, and trying to manage the symptoms that way can help. Um, but also check your temperature here to see if you have any fevers and uh, go from there. We'll also, I guess, we'll also do a COVID swab because your symptoms do overlap with some of those symptoms. Um, and we'd recommend that you quarantine until at least uh swabs, swab results are out and then public health will let you know what to do.

P: Okay.

D: Do you have any questions for me?

P: Uh no, that's all. Thank you so much.

D: You're welcome.


D: What brings you in?

P: Hi, I was just really worried. My son just yesterday night I noticed that he was making these grunting noises and I did notice that he was a bit warm yesterday as well, and today I, he just hasn't been himself, just very, very irritable, crying a lot. Yeah, I just got bit worried.

D: Yeah, for sure. What started first?

P: I would say the there was a little bit of coughing earlier, like yesterday. But then later on during the night, it kind of turned into this grunting noise, and he's kind of like his chest is moving a lot more when he's taking a breath in and all that.

D: OK. Uhm did you measure his temperature at home?

P: Yeah, so I think it was 38.5 degrees Celsius.

D: OK, and did you do that orally or rectal or under armpit?

P: I did it under the armpit.

D: OK. OK, uhm so you mentioned that he's had a fever, he's been grunting and he just seems a little bit more fussy. Is that right?

P: Yeah.

D: OK is he coughing at all?

P: He was yesterday but not really now.

D: OK and was it a dry cough?

P: I think so. I mean, not-nothing really came out.

D: OK, that's good. So no blood, no sputum?

P: No.

D: OK, and did he seem wheezy?

P: Uh, no.

D: No, OK. So there's no wheezing with the grunting?

P: Maybe a little bit like that, just a little bit of a noise, but it's mostly the grunting.

D: OK. Has he had any weight loss?

P: No, not that I really, we haven't really weighed him now since his last appointment.

D: OK. Does he seem excessively tired or fatigued?

P: Uhm, moreso today I would say he's like earlier, he was very fussy, but now he seems a bit more tired.

D: OK. Any rashes that you've noticed?

P: No.

D: No, OK. Uhm any changes in his vision or hearing?

P: Uh, no, not that I can tell.

D: No, OK. So he's responding to like sounds and he's still looking at you and things like that?

P: Yeah.

D: OK. Have you noticed a runny nose or stuffy nose?

P: Uhm, no, nothing like that.

D: No, OK. And he said he hasn't had any like fainting spells?

P: Uh, no, I don't think so.

D: No, OK. And how many wet diapers is he producing in a day now?

P: Probably 5 or 6.

D: 5 or 6 OK. Has that changed from before?

P: No, it's pretty much the same.

D: OK, and uhm any changes to his bowel movements?

P: No.

D: No. How about his urine?

P: No.

D: No, OK. OK. And then you said he was fussy, is he still eating and drinking OK?

P: Uh no, today he's not really taking anything in, like very fussy, very hard to feed him today.

D: OK, is he crying a lot?

P: Earlier today was crying a lot, but now has calm down and just I guess tired himself out.

D: Yeah, OK. Alright, and is he an otherwise healthy child?

P: Yeah he was, he was premature by three weeks so, Other than that like I remember when he was born they did have earlier some issues with his oxygen not being high enough and they had to like keeping, keep us in the hospital for a bit longer.

D: OK.

P: But yeah, after that, like there haven't really been too many concerns.

D: OK, so he's hitting all the developmental milestones like in terms of motor movements, ah speech, behaviour, all of that?

P: Yeah, no issues there so far.

D: OK, and how about medications? Is he on any?

P: No.

D: No medications, OK. And is up to date with all his immunizations?

P: Yeah, oh he had all his immunizations so far.

D: OK. How about allergies? Does he have any?

P: Not that I know of.

D: No, OK. Any family history of lung or heart conditions?

P: No.

D: OK, and does anyone at home smoke?

P: No, no one smokes.

D: OK. Has he been in contact with anyone sick recently?

P: Uh, no, not that I know of. Uhm his older sister does go to school though, but I don't know if she might have carried something home.

D: OK, how old is she?

P: She's six years old.

D: Six, OK. And is she healthy or is she having similar symptoms?

P: No, she's healthy. No, no symptoms.

D: OK. Any travel recently?

P: No.

D: No, OK. And who does he live with at home?

P: Uh, so his older sister, me and his mother.

D: OK, any reasons to believe like you have old carpets, dust, mold, asbestos, pets, anything like that that could worsen his symptoms?

P: Uh, no nothing like that.

D: OK, so I think those are all the questions that I had for you. Did you have any questions or any concerns? Anything that I missed that you wanted to add?

P: No, I think that was all.

D: OK, uhm so for him we'll do a Covid swab just to rule that out because some of his symptoms do overlap with that. But it it's really sounding like a picture of like community acquired pneumonia, so we'll do a couple of things for him. Uhm, we can get his temperature, get his oxygen oxygen saturation right away we'll get a chest x-ray. We'll do some blood work as well and uhm, he might need to be admitted depending on uhm, the oxygen, oxygen saturation and the fact that he's grunting. So if he's admitted will give him some extra oxygen and keep monitoring him and keep him hydrated. Uhm we'll also give him some antibiotics if, if it turns out he has pneumonia. Yeah, does that sound OK?

P: That sounds good. Thank you.

D: OK yeah, no worries.


D: So what brings you in the clinic today?

P: Hey, uh I just had this cough that's been like really bothering me.

D: OK, how long have you had that for?

P: Uh like in the past few days, it's been really like gross and I've been coughing up this like gunk, but I've had it for, I've honestly had a cough for like three months, it's just like sometimes it's like there, and sometimes it kind of goes away. It feels like it keeps coming back.

D: OK, have you had any chest pain?

P: Um no, like it kinda hurts when I cough now but not not like on its own.

D: OK, have you noticed any fevers at home? Or fevers at all in the last couple days?

P: Uh I've been feeling like hot at night in the past couple days, uh but like I didn't actually take my temp.

D: OK, have you had any night sweats? You wake up, the sheets are soaked?

P: Uh no, not that.

D: Nothing like that, OK, have you noticed any unexplained weight loss over the last little while?

P: Um, no.

D: So so you go on the scale, you lost a few pounds, but you haven't been trying to basically.

P: No, like I, I don't really weigh myself, but I don't think so.

D: So you haven't been noticing clothes have been fitting loose or anything like that?

P: No, no, like I wish but no.

D: Got it, got it. Now let's talk about what you're bringing up with your cough. What colour is it?

P: It's really gross. It's kind of like greenish.

D: Greenish, OK, and also any red or any blood with it?

P: No.

D: OK. And doesn't smell at all, smell funky?

P: I haven't noticed.

D: OK, so you've just been bringing this stuff up for the last couple of days, when specifically? Two days ago, three days ago?

P: Like maybe maybe three days.

D: Three days ago, and you said before that you kind of had this dry cough before. Uh when did you first notice that? Three months ago, you said?

P: Yeah, I was uh, I I do like um, it like sounds silly but I do like a pole dancing class just for exercise and I was like at my class and I kind of just started to like feel like I was like a little coughy and like I don't think there's anything special, that was just like when I noticed it.

D: OK, anyone at the class sick at that time?

P: I don't think so, like it's a really long time ago, I don't really remember.

D: Got it, got it. Anyone sick near you or around you in the last couple of weeks?

P: No, no, not that I can think of.

D: OK, and regarding other, any, we already talked about chest pain, uh you've been able to eat food alright?

P: Uh yeah, like uh yeah it's like pretty normal.

D: So no nausea, no vomiting?

P: Uh no, none of that.

D: You don't have a stiff neck at all, do you?

P: No, no I don't.

D: OK, but how about other parts of your body? Any pain? Tenderness anywhere?

P: I don't think so, no. Like I'm I'm a little tired now, um like the cough is like maybe for like a month, it's been kind of waking me up a little bit so my my sleep hasn't been great, but I don't think it's like I have like pain. I'm just like tired.

D: OK so the cough does wake you up at night?

P: Yeah.

D: Does it wake you up every night?

P: Yeah, like pretty well, for like the last, not like all three months, but probably the last month.

D: OK. Alright. I'm just gonna move on, talk a little bit about you and the past. Uh so any issues that you've seen a doctor for before?

P: Uh just like eczema.

D: OK, and do you take anything for that?

P: Just like moisturizing creams, um like my family doctor back home said like, a couple times when it was really bad she would give me one like to go get at like shoppers, but right now it's not bad so I just have just like a regular cream.

D: Got it, ever been hospitalized before?

P: Uh, no.

D: OK, any surgeries?

P: No.

D: OK so aside from the eczema, it sounds like you're pretty healthy eh?

P: Yeah.

D: OK. Do you have any allergies?

P: Uh I think maybe um maybe cats because, I I don't have one, but sometimes I've noticed stuff, but I've never like, it's never really been too big of an issue.

D: OK, so you've never taken any medications or got stung by a bee and had any trouble breathing or even a certain food?

P: No.

D: Nothing like that, OK, are you taking any medications right now?

P: Uh no.

D: OK, and you just go to Western?

P: Mhmm.

D: Do you live uh near campus with anyone?

P: Uh I have like a roommate, yeah we, I live in an apartment with a roommate.

D: OK, have they been sick at all in the last little while?

P: No.

D: OK, and last little while, have you done any traveling?

P: No.

D: So you haven't been outside the country or any exotic locales in the last little while?

P: No, like I'm planning to on March break, but I haven't gone anywhere.

D: Got it, got it, so you live in town uh with your roommate and you're currently a full time student?

P: Mhmm.

D: OK, and just regards to anything, do you smoke?

P: No, like I don't um I don't smoke cigarettes like I sometimes sometimes smoke marijuana, but usually um usually it's like the vape.

D: OK, how often we say you do that a week?

P: Oh, like, maybe like once every like 2 weeks or something.

D: Got it, any other substances slash drugs?

P: No, like alcohol sometimes, like.

D: OK so no cocaine, no heroin?

P: No.

D: And have you ever um injected drugs into your body?

P: No.

D: Got it, got it. Just coming back to alcohol, uh how often would you say you drink?

P: Maybe like one one night like on the weekend.

D: OK and what do you drink, how much do you drink?

P: I don't know, maybe like 5 or 6 beers. I guess it just depends on the night.

D: Got it, got it, and other questions, when was your last menstrual period?

P: Maybe like 2 weeks ago?

D: Two weeks ago, OK. Are you sexually active?

P: Uh yeah, just with my boyfriend.

D: OK, so do you two use contraception, birth control?

P:  Yeah, we use uh like condoms.

D: OK, any chance you could be pregnant right now? That was a strange question to ask if you're sexually active, but any unprotected sex in the last two weeks?

P: No.

D: Got it, alright, and we're just kind of going over things,so it sounds like you've had this cough or a cough for a little while but it's only become bad in the last three days. You're waking up at night and you're kind of bringing up this foul or not this foul but this kind of greenish sputum, but it's, no blood in it, and otherwise you don't have any constitutional symptoms so I will go review your story with the doctors. Anything else you'd like to bring up with them before I go?

P: I don't think so, I just like I like I hope I just can feel better 'cause I've been missing like my exercise stuff 'cause I feel like it's just like coughing and it makes it hard to like do well.

D: Got it, got it. We'll see what we can do. OK, thank you very much.

P: OK, thanks.


D: What brings you here today?

P: I have been having this, pains in my in my joints that's been ongoing now for the last several months and it's been getting worse over this period of time.

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

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

D: OK, and what kind of pain is it, is it like an aching pain, is it sharp pain?

P: It'll be a bit at achey when it's there, but I if I move the joints at all when it's really sore, I can get a sharp pain as well.

D: OK, and is this pain worse at all at any particular time of the day?

P: Yeah, I would say in the morning time or if there's any period of time where I I'm like sitting and resting for awhile and I get up to move. I have a lot of stiffness and it takes me over an hour, sometimes to just get moving.

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

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

D: OK, do you have any of this pain or stiffness in the bigger joints in your body, like the hips or the knees or your shoulders?

P: Uh, no nothing, no. Just really the small joints.

D: OK in the morning stiffness lasts more than 30 minutes you said?

P: It does, yeah.

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

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

D: OK now yeah, I I just have. Yeah, this one particular question. It's pretty specific, so when you look at your hands in which joints are painful. In your fingers is, do you, do you have any pain or swelling in the last joints like so just um, just, below the tip of your fingers?

P: No, actually like the those joints are all, have been fine. I can move the tips of my fingers no problem, and I haven't had any joint swelling or pain in the tips of my fingers.

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

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

D: Yeah that your knuckles.

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

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

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

D: OK, I see OK. And are you getting any pain in any other joints?

P: Um actually yeah my my right ankle bugs me a little bit. I'm sorry if that's considered a large joint. But yeah, my ankle hurts and then also my in my hands I have. Like the middle one. Not proximal interphalangeal joint, yeah those ones hurt too.

D: OK.

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

D: OK, I see and has this pain been pretty constant or have there been days that you don't have the pain?

P: Yeah, there are days that are better than others for sure. It just. I'm not really too sure what the reason it is like. Maybe I'm just more rested or something like that, but. There are days that that are better, but over the last several months it's been getting getting worse.

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

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

D: OK, have you tried any medications at all to help with your, help relieve your symptoms?

P: Yeah, I've been trying. Um acetaminophen and different types of anti-inflammatories like ibuprofen or Advil and I've tried creams and stuff too but it it doesn't seem to, help.

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

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

D: A bit warm, OK and how long has that been going on for?

P: So it that varies as well, like some days I'll get. I'll feel like feverish for a little bit and it will kind of go away. I haven't checked my temperature, but, it I have felt warm at times.

D: OK, and have you lost any movement in any of these joints at all?

P: Uh it is harder to to make a fist. Yeah I can't fully close my my fingers all the way down to make a fist.

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

P: No.

D: Any weight loss?

P: Um, well I think a few pounds, I just haven't really been as as hungry now. Yeah, my appetite hasn't been been as good recently.

D: OK, any skin changes or rashes?

P: I over a couple of the joints, I do notice some some redness, but just over the the joints on my hand I can have some redness.

D: OK, but you don't notice any changes anywhere else?

P: No nowhere else.

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

P: No changes to vision or hearing.

D: OK. Any shortness of breath, chest pain?

P: No.

D: Any changes in your bowel movements?

P: No, that's been normal.

D: OK, any changes in your urinary patterns?

P: Nope, I haven't had any pain or anything like that.

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

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

D: OK, have you been sick at all recently, either with like cold symptoms of any viral symptoms?

P: No, I felt OK.

D: OK and any muscle weakness?

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

D: OK, uhm. And in terms of your medical history, have you been diagnosed with any conditions?

P: Uh, yeah I have a low thyroid and or or hypothyroidism. I think it's called I and I also have. Uh, high blood pressure, so I take my medication for high blood pressure and and something for the thyroid as well.

D: OK, and when were you diagnosed with the hypothyroidism?

P: Um this was about I like four years ago.

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

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

D: OK, OK, OK, and since then you've been on the thyroid medication?

P: Yeah, I think it's like Synthroid or or something like that. Yeah I think Synthroid.

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

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

D: OK, any allergies to any medications that you know?

P: Uh, no.

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

P: No.

D: OK. Any family history of any autoimmune conditions?

P: My mom had hypothyroidism as well, and uh, and that's it.

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

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

D: OK. Alright, and um currently do you work?

P: Yeah, I've been working as a administrator so it's been tough on the computer with with how my hands have been causing me pain.

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

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

D: OK, I see. OK, and currently what's your living situation like?

P: So I live with my husband as well as our, uh, our daughter. She's 4.

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

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

D: OK, that's really good. Uh, uh, congratulations.

P: Thank you.

D: Yeah, and other than that, do you use any recreational drugs like marijuana?

D: Uh, no, I don't. OK, how about alcohol?

P: I'll have a glass of wine sometimes, but very rarely.

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

P: Yes I yeah I do. I feel swelling, warmth and redness.

D: OK, and do you notice any kind of deformities, for example like you're not able to bend your finger or any kind of deformities that you didn't see before? Or, like, for example, your wrist is turned uh, outwards a little bit. Anything like that?

P: Uh, no, nothing like that, no deformity.

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

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

D: OK, I see. Are you able to make a fist with both both hands?

P: Not completely, I can close my hands part of the way, but I can't make a full fist.

D: I see. OK and are you able to completely extend your fingers and show your palms?

P: Yeah I can do. I can do that.

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

P: Um, yes I can.

D: OK. Alright, so those are just all the questions I had for you today. Do you have any questions or concerns?

P: Um no, I'm just wondering what what this could be.

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

P: It does, yeah, thank you.

D: You're welcome. And then if it does come out to be rheumatoid arthritis arthritis, which seems likely, you will need a referral to a rheumatologist to manage and treat your, uh, treat you with medications.

D: OK, thank you alright, you're welcome. Take care.


D: Um, what brings you in today?

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

D: Okay, and this just started this morning, you said?

P: Yeah.

D: Were you absolutely fine last night?

P: Yeah, I didn't have any trouble last night.

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

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

D: Okay, um, have you had any other symptoms such as a headache or cough, or runny nose, congestion, sore throat?

P: Um, no. No, nothing like that.

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

P: No.

D: Any urinary symptoms?

P: No.

D: Any um, any pain in your legs?

P: Um, I did notice last, last night and for the last few days that my right calf like, just feels um, painful and it seems a bit more swollen.

D: Um, was there anything that you were doing a couple of days ago? Any, say, any flights or periods um, where you might be sitting still or lying still for awhile? Any surgeries, anything like that?

P: I was, I was just discharged from the hospital um, last week after a hip surgery.

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

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

D: Um, alright, and do you have any medical conditions that you've been diagnosed with?

P: Yes, I have uh, high blood pressure, and um, I also have this thing like, like varicose veins.

D: Um, do you take any medications?

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

D: And any new medications that were started after your hospital stay?

P: Um, no, they gave me like some pain medications I seem to, uh, um I got hydromorphone medication. I've been trying to stay away from it though, just taking Tylenol instead.

D: Is your pain controlled well with Tylenol?

P: Yeah, I tried to suck it up. I just don't wanna go on those other medications. I've heard like, you can get addicted to them.

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

P: An injection in my tummy, um.

D: Every day, once a day?

P: I think so, yeah I did.

D: Okay, okay. Um, alright. And do you have any allergies?

P: Uh, no allergies.

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

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

D: Were you discharged with any support?

P: Yeah, I do have a nurse coming in, like every, everyday, but I don't, they, they didn't come like yesterday.

D: Okay, okay. Um, and do you smoke, or did you ever smoke in the past?

P: I used to smoke in, probably in my 20s and 30s, but then I stopped when I had kids and stuff.

D: Do you drink alcohol?

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

D: Um, and sorry. just going back, how much did you smoke in your 20s and 30s and for how many years?

P: Probably smoked for, probably, 15, 15 years, probably like, like half a pack a day.

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

P: No.

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

P: Okay, I'll be, I'll be here for a while then?

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

P: Okay.

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

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

D: I see, I see. Okay, well, we'll do a COVID swab just in case and go from there. Do you have any questions?

P: No um, yeah, that, that sounds good.

D: Okay, great.


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.


D: Uh, what can I do for you?

P: Hi um, yeah so I, I just came here today um, because I've just been feeling um, like I have this really sore throat for the last uh, week, and I've also been getting some chills over the last few nights as well. Um, so yeah, I just came to check it out.

D: Um, okay, and um, when did uh, so your sore throat started um, a week ago. What about um, the chills?

P: Um, chills, I've been feeling them over the last few nights um, and I've also just been feeling very tired and um, over the last whole week as well.

D: Okay, um, have you had any difficulties swallowing?

P: Um, yeah, I definitely feel like uh, I do get some pain ones following, but it may be just with the sore throat.

D: And um, have you had, uh, have you had any headaches?

P: Uh, no headaches.

D: Any uh, stuffy nose or runny nose?

P: Uh no, nothing like that.

D: No um, sinus congestion?

P: Uh no.

D: Okay, what about uh, cough?

P: Um, no, not, not, no cough really. I've also noticed, also like the back of my throat, when I look in the mirror, is like just very red and like angry looking.

D: And um, any difficulties breathing?

P: No.

D: Any um, pain in your chest?

P: No.

D: Um, do you feel like your heart is racing?

P: No, nothing like that.

D: Any changes in your bowel movements, or your urinary, or any urinary concerns?

P: Uh, no.

D: No belly pain or muscle aches?

P: Uh no, nothing like that.

D: Alright, um, so uh, are you um, do you have any medical conditions that you've been diagnosed with?

P: No, I've been pretty healthy all my life.

D: Any medications that you've been on?

P: Uh no.

D: Any allergies?

P: No allergies.

D: Okay, and um, any medical conditions that run in the family?

P: Um, I think um, my mom has diabetes, but that's about it.

D: Okay. And um, who do you currently live with? Or do you live alone?

P: I live with uh, my mom.

D: Anyone else at the house?

P: No, it's just us two.

D: Alright, um, and any um, recent exposures to anyone who might be sick.

P: Um my, my boyfriend, he kind of had similar symptoms, I would say a few weeks ago.

D: Um, and um, did he, did he get um, did he see a doctor?

P: No, he didn't want to go to the doctor, and it kind of just resolved, like he, it went away on its own.

D: Okay, alright. Um, and do you um, do you drink?

P: Just on the weekends maybe, uh, some wine.

D: And what about um, marijuana?

P: Um just socially, like right now there's no parties, but like when I'm at parties.

D: Um, what about alcohol?

P: Uh, yeah, so just uh, socially again.

D: Oh, yeah.

P: Right now, with my mom drinking every now and then.

D: I see, okay. Um, alright, well that's all the questions I had, and uh, sorry one more. Have you been up to date with your immunizations so far?

P: Yeah, I've been having all my immunizations. Uh, I also feel like, so with a sore throat, I also have some um, pain on the sides, like on my, on my neck. Like I almost feel like some lumps on both sides.

D: Oh, I see, I see. Okay, okay. Um, so I guess I, at this point I would like to maybe have it, examine you, just have a look inside your throat, maybe feel your neck for those lumps, and uh, then decide what to do from there. Um, given your symptoms, um, this could be a viral infection, or um, it could be a bacterial infection caused by um, bacteria called, or I guess, strep, strep throat. It could also be uh, mono. Um, but I'll uh, I'll have a look, we'll do the rapid strep test and uh, based on those results, we'll decide what to do. If it is strep, you might require antibiotics. If not, if it's mono and if we can do maybe a blood test for that, you might have to um, not engage in, in physical activity um, or exercise, vigorous activity, or like sports for the next couple of weeks or months as, as that can be, uh, as that can cause problems if you get hit in the, in your belly. It could cause your spleen to rupture and sometimes your spleen become very big if you do have mono, but we'll discuss all of that a little bit more after we do uh, the strep test. We'll also check your temperature, um, and see um, how you're doing. Have you been taking anything to help yourself, to help soothe your sore throat?

P: Um, just some lozenges.

D: Yeah, so just continue uh, just drinking water and taking lozenges just to um, provide some comfort for yourself, and we'll do the test, then we can chat a bit more after.

P: Okay, sounds good, thank you so much.


D: What brings you in here today?

P: Yeah hi, I'm so over the past few months I've noticed that I get short of breath sometimes. And my eyes are so irritated. And they feel itchy and red. And I've also noticed this rash below my knees, so I just wanted to get everything checked out.

D: OK and when did this all kind of start?

P: Ah it started a couple months ago like 2, 3 months ago.

D: OK and when did the shortness of breath start?

P: That's been on and off for the past two months as well.

D: OK, and how about the rashes?

P: The rashes started like a month back, but it looks worse now. It started off small.

D: OK, um so for the cough, is it like a dry cough or a wet cough?

P: It's a pretty dry cough.

D: Dry cough OK, are you bringing up any green or yellow material or any blood at all?

P: No.

D: OK, and this also started like a few months ago?

P: Yes.

D: And is it constant or does it come and go?

P: Um it's it's getting worse now so it feels more constant now, but at first it it just came in. Yeah, it came in went.

D: OK, and has this happened to you before at all of these symptoms?

P: No.

D: OK. Alright um. So it started a few months ago and how about the rashes? Are they have they been there like the ones below your knee since the two months? Or do they come and go?

P: Um that's been there for the past month.

D: OK. And can you describe the rash a little bit? What does it look like?

P: Sure, so it's now pretty diffuse. It's just below my knees like on my shins. It's on both sides. The one on my right side is a little bit bigger. It's about I'd say maybe like 10 centimeters and diameter. It's it's red or like a dark pink um. There's nothing coming out of it.

D: OK. Is it painful or itchy at all?

P: It's um painful, yeah.

D: OK. What kind of paint do you feel that when you press on it?

P: It's it's not that OK, so it's not painful painful, it's tender. So if I touch it, it will feel tug tender.

D: OK. Uh. Have you tried anything that has helped you relieve these symptoms?

P: Um I took some ibuprofen that helped a little bit.

D: OK. OK, um and. So you've had the cough, but have you been having any kind of shortness of breath?

P: No. Well, actually sorry, sorry I have had a shortness of breath. I haven't had a cough.

D: OK, so no cough, but you've been having shortness of breath.

P: Yeah

D: And. When your shortness of breath is it more so that you're not able to take deep breaths, or you taking shallow breaths, how would you describe it?

P: It just feels like, yeah, I can take in a full deep breath.

D: I see. And are you having any other symptoms like fevers or chills?

P: No.

D: OK, and how about the eye irritation? When did that start?

P: That started a month ago as well.

D: OK, and you do you have any red eyes? Or can you see any changes in your vision at all?

P: Yeah, my eyes do look a little bit red and. I don't know if my vision changed a lot, but sometimes things will look a little bit blurry when they're far away.

D: OK. And with the shortness of breath, is it brought on by exertion, or can it be at rest as well?

P: It can be at rest as well.

D: OK. And then, do you have any other symptoms? Like any joint pains?

P: No no join pains.

D: OK. Any nausea or vomiting?

P: Um no.

D: OK, any headaches?

P: No.

D: Any muscle pain?

P: Uh no.

D: OK. And any recent travel or contact with someone who's been sick?

P: Um no.

D: Do you see any or do you notice any like fluid coming out from your eyes or anything like that?

P: Uh no, I didn't notice that.

D: OK, do you get any night sweats?

P: No.

D: And any chest pain?

P: Sometimes the shortness of breath.

D: OK, is it just like a discomfort or is it a pressure or stabbing pain?

P: Ah it just feels like a discomfort.

D: Do you feel your heart is racing?

P: Uh. No.

D: OK, and any changes in your bowel movements at all?

P: No, nothing like that.

D: OK. Any changes in your urinary pattern?

P: No.

D: OK. Any sore throat, runny nose, any cold like symptoms?

P: Uh no, but I haven been feeling um a little bit hot, so I wonder if I have a fever. I haven't checked it.

D: OK, we can check. Have you had any recent weight changes?

P: Now that you mention it, I have had some weight loss over the past um six months. I've lost about 15 pounds.

D: 15 pounds OK. How about your appetite? Have you been eating well?

P: Yeah, I've been eating the same.

D: OK, OK, and have you had any exposure to any fumes, dust, animals or pets in your environment?

P: No.

D: Have you been diagnosed with any medical conditions in the past?

P: Uh no.

D: Do you take any medications?

P: Um nope.

D: OK, any allergies?

P: No allergies .

D: OK. Hospitalizations or previous surgeries?

P: Uh I had a C-section for my second child.

D: OK, any complications with that?

P: No, it was it was a pretty standard. I didn't have any excessive blood loss or anything like that.

D: OK, any family history of any medical conditions like any lung or heart conditions?

P: Um no lung or heart conditions. There are some autoimmune conditions in my family though.

D: OK, and what what kind of autoimmune conditions are there?

P: Uh, there is rheumatoid arthritis um . There is um uh lupus. Like type one diabetes.

D: OK. OK and then. Are they for any like direct relatives like your parents or or children?

P: Yes, my parents.

D: OK. And currently right now do you work?

P: I work from home. Yeah, I teach I teach online.

D: OK and how's your living situation like right now?

P: Pretty good. We live in a house. I live with my husband and two children.

D: OK, um. And do you currently smoke?

P: No.

D: OK. And any recreational drug use like marijuana?

P: No.

D: OK and any um alcohol?

P: I drink once in awhile like I'll have a glass of wine on Fridays.

D: OK. Alright, yeah, so those are all the questions I had. Do you have any questions for me?

P: Um no, like what what do you think I have and how should I treat it?

D: Yeah, so definitely one thing we need to rule out with the shortness of breath is any viral or viral infection like coronavirus so we will get a test done for you today. However, since this seems to be kind of a chronic issue, been going on for a few months and you're having with the shortness of breath, some other symptoms, the rash below knees, or is what we called erythema nodosum and irritation in your eyes and you have a family history
of auto immune conditions as well. So sometimes you can get an auto immune disease that affects the lungs, so we need to rule out something like sarcoidosis which can cause fibrosis in your lungs and cause shortness of breath. So just to work that up will get a chest X Ray and also do some inflammatory marker tests like CRP, ESR and some other rheumatological tests as well, and based on what comes back we may have to refer you to a rheumatologist for further management and treatment. Yeah, so let's just do some of those tests 1st, and then we'll go from there. You have any questions?

P: No, that sounds great. Thank you so much.

D: You're welcome, and you may need depending on what we find, steroid treatment today or until you see the rheumatologist.

P: OK.

D: Alright, take care.

P: You too.


D: What brings you in here today?

P: Hi, I've I've just been. I've been sneezing a lot and I have this runny nose. It's just been very irritating. I kind of want to do something about it. I've had it for awhile, but it's just. You know, I decided to like, come in to find out what's. What's wrong with me? Why do I like? Why does this happen to me? All my friends are OK.

D: Oh yeah, I know it must be very, very irritating. How long has it been going on for?

P: It's been years, I don't even remember.

D: Oh years, OK and years like just sneezing and the runny nose has been going on for the last few years.

P: Yeah, it kind of kind of comes on like around the spring time. It just gets really bad at that time.

D: yeah? OK, and are there any besides during the spring time, any kind of allergens or any anything in the house or around you that triggers it, like dust or anything like that?

P: Yeah, dust makes it a lot worse. Like when I have to vacuum the house, I just feel awful for the next two days.

D: I see, do you get any other symptoms besides the, uh, sneezing and runny nose?

P: Yeah, let my nose so stuffy and sometimes it's just like my eyes and my nose are just itchy and my eyes get like red and teary sometimes. It's so embarrassing when I'm going to school. I also wake up in the morning with this like sore throat and have just cough and clear out my, you know clear my throat.

D: OK, and does that happen like every morning?

P: It's usually worse around springtime.

D: OK. and are you coughing at all?

P: Well, I have to like cough to clear my throat but then not otherwise.

D: OK, and are you bringing up any sputum?

P: Yeah, that yeah I do.

D: Like, uh, how much would you say? Do you just bring it up in the morning, or like throughout the day,

P: just in the morning,

D: just in the morning?

P: Yeah

D: Do you have a sensation of like anything kind of dripping down your throat like after you wake up like just a build up?

P: Yeah yeah I do.

D: Ok. And besides that, have you been having any symptoms of fevers, chills, sore throat?

P: I get a bit of a sore throat, I guess in the morning, but it just goes away after.

D: OK,

P: But no fevers.

D: OK, and is there anything that you've tried at all, like medications or anything that has helped you with these symptoms?

P: Uhm yeah, I tried like umm Reactin and that really helped.

D: That helped OK that's good and are you taking Reactin right now?

P: I didn't take it today. I tried it a couple days ago.

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

P: No.

D: No, OK, and any sick contacts, anyone around you that has been sick?

P: I don't think so.

D: OK, any headaches?

P: No.

D: Any nausea or vomiting?

P: no.

D: Any fevers or chills?

P: no.

D: Any kind of fatigue or tiredness throughout the day?

P: I do feel more fatigued when I have these symptoms.

D: OK, any night sweats, fevers, or chills?

P: no.

D: Any changes in your bowel movements at all?

P: No.

D: Any trouble urinating?

P: no.

D: Any changes to your appetite or weight?

P: I've been losing weight, but I've been dieting and working out more.

D: OK, and how much weight would you say you've lost over the last few months?

P: I've lost about four pounds in the past four, five months. It's been hard to lose weight.

D: And so no, no sudden like loss of weight or anything like that right now?

P: No, no, no

D: Well, it's really great that you're, you know, trying to lose weight and dieting and and having like a healthier lifestyle. It is definitely harder with the pandemic going on right now to to get in the activities. And it's hard like being at home, and sometimes it's really difficult to like not eat right

P: Yeah yeah true.

D: So besides besides that any kind of recent exposures to any fumes, dust, animals, pets like anything like that?

P: Yeah, it was kind of like vacuuming a couple of days ago when it got really bad, but nothing. Not not. I don't think there's not been any other exposures.

D: OK. And do you have any past medical conditions that you have been diagnosed with like asthma, eczema, anything like that?

P: I haven't been diagnosed with anything. No. I did have like I know that I would sometimes get kind of short of breath as a child. But my mom doesn't really trust doctors, so she wouldn't take me to one.

D: OK, have you had shortness of breath after that, like when like as a child, how old were you?

P: I must have been like 8 years old or 9 years old that I remember, but I think I've had it before that as well as my mom tells me.

D: Oh OK, do you have that at all now?

P: No, no, I don't.

D: OK, OK Have you ever seen an allergist before?

P: No, no.

D: No OK. Do you have any known allergies to any medications? Yeah any medication?

P: no

D: no. Do you take any medications at all on a regular basis?

P: No.

D: No, OK. Have you been hospitalized or had any surgeries in the past?

P: No.

D: Any family history of any asthma, eczema, allergic rhinitis. Anything like that?

P: Yeah, I think it kind of runs in my family like everyone in my family is just kind of always having this runny nose and sneezing. My mom has it. My younger brother has it. But like we haven't really been diagnosed with anything like we, we rarely go to the doctor.

D: OK, OK, and currently right now, do you work at all? Or sorry, do you go to school?

P: I do I do. I've been doing it virtually.

D: Virtually OK, so have you noticed anyone sick around you?

P: No.

D: No OK. And what at home? What's your living situation like? Who do you live with?

P: I live with my mom, dad and my younger brother.

D: And, yeah, I just want to let you know that any questions I ask you today and anything we talked about it's completely confidential and unless like there is any potential harm to yourself or anyone anyone else. So yeah, I'm just gonna ask you a few questions. Do you feel safe at home?

P: Oh yeah.

D: OK, and do you drink alcohol at all? Or have you tried alcohol?

P: No, not at all.

D: Have you tried any recreational drugs like marijuana?

P: No. No.

D: How about smoking?

P: Umm no

D: no OK, and are you sexually active?

P: No.

D: No OK. And so overall, do you feel safe in your home and as well as outside of your home environment? Any kind of bullying or anything like that going on?

P: No, not at all.

D: OK, alright. Yeah, so those are kind of all the questions that I had for you. Sorry just one more question, any loss of sense of taste or smell?

P: Yeah, it's hard to smell and my nose is stuffy, but no loss of taste.

D: Yeah, OK. OK, so do you have any questions at all for me?

P: No, I just I I just wanna get some medications to help with this. I'm just sick and tired of my runny nose.

D: Yeah, it must be very frustrating. So you've tried Reactin before, right?

P: yeah

D: Yeah, so one method is to definitely like stay away from some of those allergens that are potentially causing your symptoms. But I I do really think so you might have something called like allergic rhinitis. And I think it might be beneficial to for you to see like an allergist

P: sure.

D: And so I can refer you to someone as well. Just have a sense of what kind of things allergic to you and like what medications you would require. In the meantime, definitely like any antihistamine medications would help with your symptoms. But since you're also having congestion and sneezing, just just in case, we will just do a COVID swab test for you today. And it takes around 24 to 48 hours to come back. And in the meantime, you should just isolate as much as you can in your own home. And then based on the result they would give you more instruction.

P: Sure

D: Alright. Thank you, take care.


D: It's nice to meet you. What's your name?

P: It my name is Scott. It's nice to meet you too.

D: Alright, um so Scott. How old are you?

P: 15.

D: OK, What brings you in today?

P: Um, I've had a sore throat now for a couple of weeks and it's just not going away.

D: Couple of weeks. OK, so about two weeks, three weeks?

P: Yeah, about two to three weeks.

D: OK, um what does it feel like is it, is it kind of like a burning feeling? Is it more like an itchy feeling? What does it feel like?

P: Uh I would say it's kinda yeah like burnin' or burning or scratchy.

D: OK, and does it hurt when you swallow?

P: It does, yeah, uh, If my throat hurts when I'm eating or Um uh or swallowing like liquid's as well, but cold stuff seems to make it feel a little bit better.

D: OK, good, and does your neck hurt too?

P: Um. A little tender, I've noticed the um some lumps at the front of front of my neck that have been a bit sore.

D: OK, and is it mostly sore, kind of like midline? Or is it more sorta one side versus the other?

P: Um I'd say, maybe the, uh, the right side is a little bit more sore, but I think I can feel it on both sides of my neck.

D: OK, and how bad would you say your discomfort is 1 to 10, 10 being the worst.

P: Um. I would say maybe a two or three if I move my neck I I can feel it more, but otherwise I can just barely notice that it's there.

D: OK, so it's not preventing you from sleeping, going to school, playing, things like that?

P: No, it's more so the sore throat when swallowing.

D: OK. OK. Um, have you noticed a fever at all?

P: Um, I have. Yeah I felt hot and Um I checked my temperature this morning and it was 38.7 I think it was. Is that a fever?

D: Yeah, I'd say that's a fever. We can also do another temperature check today.

P: OK

D: Um yeah, but that definitely sounds like a fever. Um, have you noticed rashes anywhere?

P: Um Yeah, I've had this, uh this, like red I guess pink rash that I have noticed it's come over my chest and and belly area.

D: OK, how big is it? Is it more than a centimeter?

P: Uh huh. Yeah, it's pretty well, I mean, it's kind of, um spread out over over an area like it's not all continuous I guess. You can kind of see patches or blotches.

D: OK and, is it raised?

P: No, it's it's not raised.

D: OK. OK, is it itchy?

P: Uh, no, it's not itchy.

D: Painful?

P: No, not painful.

D: OK and is it bleeding or oozing anything like pus?

P: Um no it's not, nothing like that, it's just pink and red and it's just kind of shown up over the last little while. I've noticed it on my um like hands a little bit too.

D: OK, and you said this started when like was this before the sore throat or after?

P: Oh I can't like remember the onset. I I think that the sore throat started first and maybe a rash came a little bit later.

D: OK, OK and have you noticed that your that your glands are swollen?

P: I think so, um maybe that's what's swollen in my neck.

D: OK, OK. Um how about coughing?

P: No, I haven't had a cough no.

D: And how about a stuffy nose or or a runny nose?

P: Nothing like that.

D: OK, body aches?

P: Yeah, I felt so some muscle aches for sure.

D: OK, upper limbs or lower limbs?

P: I say I got a whole body, I just feel like my muscles and joints are sore.

D: OK, yeah, and or do you have any headaches?

P: Uh. No, I haven't really had any headaches.

D: No OK. And how's your appetite? Are you still eating well?

P: Um. It might be a little ah might have been a little bit down. I just kind of haven't been feeling so great, so I'm I've probably eating less the last few weeks, yeah.

D: Have you been around anyone who may have been sick recently?

P: Yeah, actually I think a few of my friends or there was somebody in my gym class knew that I sounded like they had similar symptoms.

D: OK, OK, and when was this?

P: Um, Uh, now that I think about it, probably about three or four weeks ago.

D: OK, and were they ever treated for that? Did they see a doctor?

P: Um I'm not sure.

D: No, OK. No worries.

P: I just remember them being off for school 'cause they were they were sick.

D: OK yeah, any issues with your eyes?

P: No.

D: No, nothing like crusting or pus coming out of your eyes? Red eye, anything like that?

P: Um. No, that well, did they might have looked maybe a little bit more more red, red then usual but I haven't noticed any anything in terms of itchiness or um discharge.

D: OK. Any nausea or vomiting?

P: Um, no nausea or vomiting.

D: OK, how how about your stools? Have they been normal? Have you had diarrhea, constipation, anything like that?

P: No changes to bowel habits.

D: OK how about urine?

P: Um, that's been OK.

D: OK, OK. Um, have you ever had these symptoms before?

P: Um, I mean I've had sore throats in the past, but not while feeling like this though.

D: Yeah. OK, when was the last time you had a sore throat?

P: Um, I don't know maybe when I was a kid.

D: OK.

P: It's been awhile.

D: Yeah, like a strep throat kind of thing, or or more viral?

P: Yeah, I do remember getting antibiotics when I was younger.

D: OK, OK, and are you otherwise healthy? Do you have any medical conditions?

P: I was diagnosed with uh with asthma.

D: OK, and are you on any medications for that?

P: Um yeah, so I, I just use ah Ventolin as needed, but otherwise oh and then I take Flovent daily so um.

D: OK.

P: I think that's the one, there's there's a couple inhalers that that I take.

D: OK, OK, and any other medications?

P: Uh, sometimes I'll take um like Reactine or some other type of allergy pill, but that's it.

D: OK, What are you allergic too?

P: Um mostly seasonal allergies, bug me like um yeah, like seasonal allergies and dust, maybe.

D: OK. And are you up to date with all your immunizations?

P: Yeah, my mom makes me get the flu shot every year.

D: OK, good. And it's, OK, have you seen another doctor for the symptoms at all? Have you been worked up for that? Any blood work testing done for it already?

P: No, I thought I would have felt better by now and so I haven't seen anybody but it's kind of just been going on now, not seeming to get better. So wanna come see somebody.

D: Yeah for sure. Have you tried anything for your symptoms? Any medications, anything over the counter?

P: Um yeah, I've tried some Tylenol and it's, I I think what is it Advil? And that definitely is helped with some of the kind of aches and pains, but they've come right back.

D: OK, um any family history of Lung issues, heart issues?

P: Um, No. nothing like that, um no.

D: Yeah, OK. How about cancers?

P: I, I think my Grandfather had a like pancreatic cancer.

D: OK, OK. Um, alright, so do you live at home correct?

P: Yeah, I live with my parents and my younger sister. She's 12.

D: She's 12, Is she healthy?

P: Yeah she is.

D: OK, good and have you guys traveled recently?

P: Um no we've been, we've been at home.

D: OK, OK, Um, and do you smoke?

P: No, I don't smoke.

D: No, How about marijuana?

P: I I've tried it once or twice but it was just those couple times, nothing that I do or used regularly.

D: OK, And how about alcohol?

P: No, no alcohol.

D: No alcohol. OK, are you sexually active?

P: No, I'm not.

D: No, OK um. Is there a possibility that? Or actually sorry I should rephrase that. Have you kissed anyone recently?

P: Um I. Well, I I guess I kinda have a girlfriend now. Um that we, that I started hanging out with about two months ago.

D: OK, OK.

P: And so I guess yes.

D: OK, alright, well that's good. Um have, has she had any of these symptoms?

P: Uh, well she she was, wasn't feeling well for awhile back, but, I don't think it was this bad for her.

D: OK. Actually, and she's better now?

P: Yeah, she's better now.

D: OK. Alright, so you mentioned you're not sexually active. If you were to be, make sure you use protection. Um and OK. So everything at
home is OK then? No ones, no ones sick at home you mentioned, right?

P: Yeah, no ones, no ones sick at home.

D: OK. And school is going OK?

P: Um yeah, schools been been going OK for the most part it's been tough these last few weeks feeling like this though.

D: Yeah for sure. And are you and your girlfriend in an exclusive relationship?

P: Uh. I I think so yeah.

D: OK, I ask because there's something called what you may be familiar with um it's called the kissing disease. In medical terminology, it's called mono, as caused by a virus called EBV, and so it could be that so we're covering all our bases.

P: Oh, I've heard of mono before.

D: Yeah,

P: OK.

D: It's it's likely it could be up there in terms of what you have, so I think those were all the questions I had for you. Did you have any questions for me? Anything you wanted to add?

P: Um, no, I think that's you covered everything.

D: OK alright so I will will go off a few, we'll try to cover our basis and get you tested for mono which I would have to do like a monospot test and we can do rapid strep test as well to see if he has something called strep throat. But yeah, we'll see what those results come back as. And we'll go from there. Does that sound good?

P: Yeah, no, that sounds good.

D: OK, thank you.


D: What brings you here today?

P: I'm just having this really sharp pain in my chest and I'm scared. I think I'm having a heart attack.

D: Oh wow, yeah um that must be really scary. When did this, when did this pain start?

P: So about 3 days ago.

D: Three days ago, OK, and where exactly in your chest do you feel it?

P: It's kind of right here, right over my heart I think, that's where it's the worst.

D: OK, and is it, what kind of pain is it? Is it more like a dull pressure pain, or is it a sharp pain? How would you describe it?

P: I would say it's a sharp pain.

D: A sharp pain, OK. Um, so it started three days ago, has it been coming and going or has it been constant?

P: It just lasts for a few seconds and then it goes away.

D: OK, does the pain come on when you're doing any activities or When does the pain usually come on?

P: Oh, it's usually worse when I'm coughing or laying down. Yeah, yeah.

D: OK, and um, does it improve with any positional changes at all, or anything that you do that does it help?

P: When I when I lean forward, it actually does get better. I think about it, yeah.

D: OK, and has this ever happened to you before?

P: No, no it hasn't.

D: OK and on a scale of 1 to 10, one being the least amount of pain felt and 10 being the worst, how much would you rate it?

P: I would say a 6 out of 10.

D: OK, and does the pain move anywhere in your chest or does it stay in the same spot?

P: Yeah, I think it kind of goes to my neck sometimes.

D: OK, and do you have any other symptoms, like do you have any shortness of breath, dizziness, anything like that?

P: No, I don't.

D: OK any any palpitations?

P: No.

D: OK. Alright, and other than that, have you been having any other symptoms at all besides the pain?

P: No, no, nothing else, that's it, just have these sharp episodes of pain that last a couple of seconds.

D: OK, um have you have you tried like any medications that has helped the pain?

P: Yeah, I took some um, I took some Tylenol and that did help.

D: OK.

P: I took it once yesterday.

D: Alright, um, any recent injuries to the area like did you have any falls or anything like that?

P: No, no I haven't.

D: Any headaches, nausea or vomiting, fevers, or chills? Any of those symptoms?

P: No.

D: OK, any cough, runny nose, any viral symptoms?

P: No, well not right now, but I did have a, I did have a flu last week. I had a fever, had a runny nose. I did have a bit of a cough and I was feeling super tired, but not anymore. I'm OK now.

D: OK, and have you at all had any dizziness or have you fainted at all?

P: No.

D: OK. Have you been noticing any kind of weakness or numbness?

P: No.

D: No, OK, and in terms of your past medical history, do you have any medical conditions like diabetes, high blood pressure, any other diagnosis?

P: No. I'm a pretty healthy 25 year old.

D: OK. Um, do you take any medications?

P: I sometimes take Tylenol.

D: OK, and any allergies at all?

P: No.

D: OK, and any previous surgeries?

P: No no, no surgeries.

D: Do you have any family history of any heart conditions or any cancers or anything like that?

P: Yeah, my father, he he had a heart attack two weeks ago and he and he passed away. And I'm worried I am having a heart attack too.

D: It was just two weeks ago?

P: Yeah.

D: I'm so sorry to hear that. Yeah, it must be really difficult time for you right now. OK, so you're worried you might be having a heart attack as well?

P: Yeah.

D: OK, so we can definitely do some tests and see what was going on. I just have a few more questions and then I'll just get to some of the management and what we will be doing for you in the future. So currently right now do you work at all?

P: No, I'm a student. I, well as a part time job, I do work as a post man.

D: OK, and where are you a student? What do you do?

P: I'm studying engineering at Western.

D: Alright, and currently where do you live? Do you live in student housing, an apartment or a house?

P: I live with my parents, well my mom now, in a house.

D: Right, and you drink at all any alcohol?

P: I drink occasionally, maybe one or two drinks on the weekends.

D: OK, and any recreational drug use like marijuana or cocaine?

P: No.

D: And do you smoke?

P: No.

D: Alright, so those are all the questions we had for you today. And yeah, it must be really difficult and scary for you right now, but we'll make sure to get to the bottom of this to see what's going on. So what we can do is get you an ECG to see how your heart is functioning and then see getting the blood work if we need it for the future. But yeah, right now I would say try not to worry too much about it right now and see um what some of those tests come back.

P: Thank you.

D: So yeah, you're welcome.


D: What brings you in?

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

D: Yeah, it's good that you came in. Lets rewind a little bit and get a full history. So you said the, what started first, the fever or the headache?

P: So, the headache started first, so that was around four days ago.

D: OK

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

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

P: Like 38 to 39.

D: OK, so headache started four days ago. Is it persistent or constant or does it come and go?

P: It was pretty constant, the headache kind of got better yesterday but last few days it's just been constant headache Pretty much every day.

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

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

D: How long does the headache last when you get it?

P: If I don't take medications, it can last honestly, the whole day.

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

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

D: OK.

P: Sometimes it's just like a throbbing pain.

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

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

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

P: Right now it's not that bad, probably like a two or three, but when it was, just a few days ago, it was like probably an 8 or 9.

D: Yeah, and then have you ever experienced something like this before?

P: No, I'm not usually one to get headaches. My wife, she gets migraines, but like I rarely ever have headaches.

D: Yeah, OK, and then you mentioned the headache is getting a little bit better now?

P: Yeah, the headache has improved a bit, the body aches are still there and the fever is still there but like the headaches I feel have gone down.

D: OK, alright. Have you had any fainting spells or dizziness?

P: No, nothing like that.

D: Any confusion or memory loss?

P: No.

D: Any neck pain?

P: Uhm, not neck pain but like just below my neck, like my back, upper back hurts as well.

D: OK, and, any weight loss recently?

P: Uhm, no, I don't, I don't think so.

D: Any excessive fatigue?

P: Yeah, I have been feeling pretty tired and just, uh, I haven't even gone to work this whole week, just kind of laying in bed honestly with all the pain and the fever and headaches, just yeah, it's exhausting.

D: OK, any changes in your hair, nails or skin, like rashes?

P: No, nothing that I've noticed.

D: How about changes in your vision or hearing?

P: No.

D: No OK, how about a stuffy nose or runny nose?

P: Uh, I do feel a bit more stuffy like today, but there's no like runny nose or anything like that, but I do feel a bit more pressure and stuffiness in my face today.

D: OK, OK, how about changes in smell or taste?

P: Yeah, I think, just last night dinner, it was just kind of a funky like, different taste. I couldn't really tell, uh, everything was kind of a bit bland. Yeah, I think my taste buds are acting all weird too.

D: OK, um, any coughing or shortness of breath?

P: Uh, no, no, I haven't been coughing or no shortness of breath at all.

D: OK and how about wheezing?

P: No, no wheezing?

D: OK, any chest pain?

P: No.

D: How about feeling like your heart's racing?

P: No, nothing like that.

D: No, OK. Any swelling that you've noticed in your limbs?

P: No.

D: No, ok. Any issues with your bowel movements or urine?

P: No, nothing.

D: OK, how about nausea or vomiting?

P: uh no, no nausea or vomiting.

D: OK, and those were all the questions I had about your symptoms. Are you otherwise healthy or do you have any longstanding medical conditions?

P: Yeah, I have a couple conditions that I see my family doctor for. I do have diabetes, then I have high cholesterol. I also have this thing called fatty liver but that's that's about it, and a high blood pressure.

D: OK, when were you diagnosed with all of these things?

P: Yeah, probably like, it all kind of went down in my 40s. I did gain a lot of weight at some point during my 40s and that's when all these things started happening.

D: OK, so you said diabetes, high blood pressure, fatty liver, and sorry, what was the other one?

P: High cholesterol.

D: High cholesterol, OK, are you on medications for all of these things?

P: Yeah so I am on a statin medication for the cholesterol, then I'm on metformin, and then I'm on a blood pressure medication as well. I can't recall the name. Uh, so yeah, those are the medications that I'm on.

D: OK. And do you take your medications regularly as prescribed?

P: Yeah, I don't miss any doses.

D: OK, good. And, are you up to date with all your immunizations?

P: Yeah, I think so.

D: OK, good. Do you have any allergies?

P: No, no allergies.

D: How about family history of lung conditions or heart conditions?

P: Yes, I have a pretty significant family history for heart conditions. My father passed away from a heart attack in his 50s. My mom has high blood pressure. Diabetes is also pretty big in my family as well.

D: OK, well I'm sorry to hear that. Any cancers in the family?

P: No, no cancers.

D: OK, do you smoke?

P: I used to when I was in my 30s. I quit a pretty long time ago.

D: OK, how much did you smoke before that?

P: I probably smoked up until I was 35, so for probably like 10 years from 25 to 35 and probably smoked a pack a day at that time.

D: OK, yeah, and do you drink alcohol?

P: I've been told like, not to for my liver, but I sometimes maybe have the rare red wine maybe once a month.

D: Once a month, OK, any other recreational drugs?

P: No, no recreational drugs.

D: OK, no recreational drugs, and where do you live right now?

P: I just live with my wife in an apartment in the city, and yeah.

D: OK, any old carpet, dust, mold, anything that is concerning from that standpoint?

P: Nope.

D: No, and have you been in contact with anyone who's been sick recently?

P: Not that I know of.

D: Do you still go to work?

P: I just have like a desk job. I have my own room. It's not like, I don't see too many people and like, when I do I'm wearing a mask so I don't think so.

D: OK.

P: I have stopped going to work though like, just in case.

D: OK, good and have you traveled to anywhere recently?

P: No, we've been pretty homebound.

D: Pretty homebound, OK, alright, well that's good and those are all the questions that I had for you. Did you have any questions for myself?

P: Yeah, I don't know, what do you think is causing all of this?

D: Yeah, it sounds like you have some sort of infection, so the first thing we need to rule out is covid, of course. So we'll do a swab and those swabs should come back to you in about 24 to 48 hours and until then, it's important that you do isolate and you isolate for 14 days at least, and that includes from other people at home. And if those swabs come back negative, you could possibly have like, another infection. But if your symptoms worsen, like you start getting neurological deficits like weakness or seizures or anything like that, you should come back to the ER and we'll get that checked out. And, so that's where we'll start for now, because your presentation is acute, we think it's likely infection related.

P: OK, that sounds good to me and should I be staying in my own room or anything like that at home?

D: Yeah, if you can like, it's recommended that you try to isolate in your own room for the next 14 days because your symptoms do overlap with that of covid, yeah.

P: OK, sounds good.Thank you.

D: Yeah, no worries, take care.

P: Thank you.


D: Can we just begin with what brings you in here today?

P: Yeah, so I've been pretty breathless for the past six days and it's it's just worse. I have to stop from, I had to stop so many times walking here from my car.

D: OK, and when did this first start?

P: Six days ago.

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

P: Bah, pretty sudden actually.

D: OK, and were you doing anything before it first happened?

P: No. Just work and spending some time at home.

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

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

D: OK, and is it a dry cough or a wet cough?

P: Um, so I've noticed this weird rusty colored sputum and I've noticed that like a couple times a day.

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

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

D: OK, so around six days?

P: Yeah around there.

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

P: Um? It's pretty constant now.

D: OK, and do you find that it's been getting worse at all?

P: Uhm, yeah, I'd say it's getting, I'd say it's getting worse.

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

P: It's, it's both.

D: It's both OK.

P: Yeah.

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

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

D: OK. And when you feel the breathlessness, how long does it usually last for?

P: Um, it's kind of hard to say, it's it's always their baseline, but it gets worse when I when I walk or when I exert myself.

D: OK. And besides like the exertion, does it get worse with any when you're near pollen, when you're outside in the cold, anything like that?

P: Um? It gets worse when when no no, I wouldn't say that no, no.

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

P: It it doesn't matter.

D: It is there all the time?

P: Yeah.

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

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

D: OK. And have you ever noticed any blood in the cough?

P: It's rusty colored, but I don't know if that's blood.

D: OK, but you've never actually coughed up uhm red blood.

P: No.

D: OK. And. Is there anything that makes your symptoms worse besides exertion?

P: Uh, no.

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

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

D: OK. Before this, before the six days, have you ever experienced anything similar?

P: Uh, no.

D: No, OK. Have you traveled outside of the country at all recently?

P: Uh, no.

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

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

D: OK and is is that always there or is it just when you're coughing a lot?

P: I guess when I'm coughing a lot.

D: And that starts six days ago too as well. Or is that?

P: Yeah.

D: OK. And do you ever feel any kind of is it so you said, mention it was sharp, but do you ever feel like increased pressure in your chest? Anything like that?

P: Uh, no.

D: And how would you rate this pain when it occurs from a scale of 1 being the least amount of pain you've felt in your life, and 10 being the worst?

P: The sharp chest pain? I'd say maybe like a 7.

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

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

D: OK. Have you experienced any kind of headaches with nausea or vomiting?

P: Uhm, no.

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

P: Mhmm.

D: OK. Have you experienced any kind of dizziness or fainting spells?

P: Uh, no.

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

P: Not that I know of, no.

D: OK. Have you experienced any night sweats?

P: I feel chilly at night, but I don't, maybe, yeah.

D: OK, any significant weight loss recently?

P: No.

D: And have you noticed any kind of symptoms like your heart is racing? Or anything like that?

P: No.

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

P: No.

D: Any changes in your urinary patterns?

P: Um, no.

D: Any issues with your sleep or appetite at all?

P: Uhm, no.

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

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

D: OK.

P: Yeah.

D: Have you at all been exposed to anyone with tuberculosis in the past?

P: No.

D: Any exposure at your workplace or at home to any fumes or dust in pets or animals?

P: Ah, well I have birds, but I've had them for awhile.

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

P: Ah about three years.

D: OK, and no, they haven't caused you any issues before?

P: No.

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

P: No allergies.

D: OK. Any past medical conditions, like high blood pressure, diabetes, asthma?

P: No.

D: Any previous surgeries?

P: No, none.

D: OK. Any hospitalizations for any reason?

P: No.

D: OK, are you on any medications currently?

P: No.

D" And do you have any family history of any medical conditions like cancers or heart attacks or any lung issues?

P: No.

D: OK. And currently, do you work?

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

D: And how long have you been working there?

P: For the past year.

D: OK. And where do you live currently? Do you live in a house or an apartment?

P: Uhm, I have a small apartment, also not in the greatest location.

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

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

D: OK, do you have any potential exposure to asbestos in your house or at work?

P: I mean, yeah, probably. Both buildings are very, very old. I doubt they're being maintained.

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

P: I smoke 10 cigarettes a day.

D: OK, and how long have you been smoking for?

P: Um, since I was 20.

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

P: I smoke a little cannabis sometimes.

D: And how often, would you say you smoke in an average week?

P: Maybe about 5 milligrams.

D: OK. And do you drink alcohol?

P: I do, but not a lot.

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

P: Ah, maybe 5 drinks?

D: OK. And in terms of your daily routine, do you think you get enough exercise?

P: Probably not.

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

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

D: OK. Alright, is there any other questions or concerns that you had for us today?

P: No.

D: OK. So yeah, based on what we discussed today, it seems that you may have an upper respiratory tract infection. The other things on differential would be a COPD exacerbation due to your significant smoking history. So we will do some investigations ti figure out what this is, and then perhaps can give you antibiotics or other medications to help you, unless it's a viral infection.