D: What brings you in here today?

P: Hi, I'm um, I'm just, so I am here because I have this cough that I've had for the past um, week and a half, and I'm just uh, I usually don't come in with symptoms this minor, but because it's, because we're in the middle of a pandemic, I thought I should come in and get checked out.

D: Okay, yeah, so it's been going on for like more than a week. Um, can you describe to me what kind of cough you're having? Is it like a wet cough or a dry cough?

P: It's a dry cough.

D: Okay, and has it been getting worse over the, over the time period you described?

P: Um, it's kind of the same.

D: It's the same. Um, have you noticed, although it's like dry, have you brought up any kind of sputum or phlegm at all?

P: Um no, not, not, not recently. But yeah, in the first couple of days, the first two, three days.

D: Okay, um and have you noticed any kind of yellowish to greenish tinge to it?

P: No, it was watery.

D: Watery, okay. Have you noticed at all, any blood, have you been coughing up any blood at all?

P: Uh, no.

D: Okay, and is your cough like constant or does it come and go?

P: Um, kind of comes and goes. There's just times when I'm coughing a lot and then it just goes away.

D: Okay, and is there a pattern to it? Like, uh, do you cough more when you're exerting yourself or any time, a certain time of the day?

P: Um, it's worse when I'm smoking.

D: When you're smoking, okay. And uh, how long do those episodes last?

P: Couple of seconds, maybe?

D: Okay, and has this happened to you before at all?

P: Yeah. I think, um, yeah, I usually don't pay much attention to it. You know, I think must have happened last year or the year before. It just kind of goes away on its own.

D: Okay, and is there any anything that makes it better or worse?

P: Um, I um, I take this cough syrup, over the counter syrup, that helps.

D: Okay. And um, have you found that it's been helping over, like, to help improve your cough over the last few days?

P: It goes away for a couple hours and then it comes back.

D: I see. Does it keep keep you up at night at all?

P: No, no, no.

D: No, okay. Are you having any other symptoms like shortness of breath, um sore throat, runny nose, anything like that?

P: Uh, I kind of had those symptoms in those first two, three days, but then it went away, and then I only had this cough that stayed.

D: Okay, okay. And have you been in contact with anyone that's been sick around you at all?

P: Um, my daughter had the sniffles.

D: When was that?

P: Last, two weeks ago.

D: Two weeks ago? Okay. And uh, how is she now like, did it just go away on its own, or did she have to go to the doctor?

P: Um, no, it kind of went away on its own.

D: Okay. Have you traveled at all recently outside of the province or the country?

P: No.

D: No, okay. And besides the cough, are you having any headaches at all?

P: No.

D: Any nausea or vomiting?

P: No.

D: Any fevers or chills?

P: Not anymore.

D: Not anymore, when was the last time that you had fevers or chills?

P: I think I had like a very, it must have been 37.4, um, in the first, two, three days. But it got better really quickly.

D: Okay, I see. Any night sweats?

P: No.

D: No, okay. Any, um, do you feel tired throughout the day?

P: Not anymore.

D: Not anymore, okay. So any kind of chest pain, or sensation that your heart is racing?

P: No.

D: No. Any dizziness or fainting spell?

P: No.

D: Any changes in your bowel movements at all?

P: Um, no.

D: No, so no constipation, diarrhea?

P: No.

D: Okay, any changes in your urination?

P: No.

D: No, okay. Um, have you had to miss work at all or, do you currently work?

P: Yeah, but I've been working from home.

D: Okay.

P: I didn't have to miss work, so.

D: Okay. And any changes in your sleep or appetite?

P: No.

D: Okay, any loss of sense of taste or smell at all?

P: Um, initially, I guess the cough's first few days, my nose was a little stuffy, so yeah, I couldn't smell very well, but since then it's been fine.

D: Okay, but no loss of taste?

P: No loss of taste, no.

D: Okay. Uh, any recent significant changes to your weight at all over the last few months?

P: No.

D: Okay, um, and any exposure in your home environment to dust, fumes? Any animals in the household?

P: No.

D: Okay. And otherwise, uh, do you have any medical conditions that you've been diagnosed with in the past?

P: Uh no, I'm pretty healthy.

D: Pretty healthy, okay. Any allergies, either to medications or environmental?

P: Um, I'm allergic to penicillin.

D: To penicillin, okay. And what kind of reaction do you get to penicillin?

P: Um, I was told that I got a rash when I was a child. I don't really remember.

D: Okay, and do you take any medications on a regular basis?

P: No.

D: No, okay. And have you been hospitalized in the past or had any surgeries?

P: Um, I had my appendix removed about um, five years ago.

D: Five years ago, okay. Any complications at all after that?

P: No.

D: Okay. Any family history of any lung conditions, heart conditions, any cancers at all?

P: Um, colon cancer.

D: Colon cancer?

P: Yeah my dad and my grandfather had it.

D: Okay, um, and have you, have you had any scopes done recently at all?

P: Oh yeah, I had mine done uh, seven years ago.

D: Seven years ago, okay. And were there any findings at all?

P: No.

D: No, okay. Um, currently so you work from home, so what's your home and living situation like? Who do you live with, and where, do you live in like a house, appartment?

P: Uh, I live in an apartment with my wife and my daughter.

D: Okay uh, and uh, do they have any symptoms at all? Or are they, are they fine?

P: Well, my daughter doesn't have any symptoms anymore. She did as I mentioned, have some flu like symptoms 2 weeks ago. My wife's been healthy.

D: Okay, and uh, does your daughter go to school right now or is she doing school from home?

P: Uh, school from home.

D: School from home, okay. Um, and do you at all smoke? So you mentioned your symptoms get worse with smoking.

P: Yeah.

D: Um, how much would you say you smoke on an average day?

P: Um, I don't, I try, I've been trying to cut down, so I, I smoke about 3 or 4 cigarettes a week. I used to smoke a lot more before.

D: Wow, yeah, that's really good! That's really great progress, um, it's really difficult to quit, but it's great to see that you're trying to quit. Um, so how much would you say you used to smoke?

P: Well, half a pack. Um, half a pack a day, but then over the past three years I've been trying to cut it down. I started smoking when I was 20, so it's been um, 30 years now.

D: Okay, so 30 years, okay. And um, are you just, are you using anything to help you quit smoking or are you doing it without any medications, or um, like, have you used anything in the past that has worked for you?

P: Um, no I, I went to my doc and he said to try on my own first and if I'm struggling with it to come back, but I've been doing it very gradually so it's, it's going well.

D: Okay, and that's really good. And yeah, if you, at all, need any resources to help you quit smoking, it's great that you're doing really well, but if you need to talk more about it or need any more resources we can provide that for you. Um, other than uh, smoking cigarettes, do you use any recreational drugs like marijuana at all?

P: No.

D: No. How about alcohol?

P: Uh, I just drink on the weekends. Maybe a glass or two of wine.

D: Okay, and uh yeah. So those were kind of all the questions I had for you today. Do you have any questions or concerns?

P: No.

D: No?

P: I was, I guess I was just worried about the cough um, it's just, I was worried that it could be COVID.

D: Yeah, so definitely right now, any of these symptoms, like COVID can have a lot of different symptoms um, so we should definitely make sure that we, to check if you have COVID or not and we'll get a COVID swab test done for you today, and the results will come back in 24 to 48 hours. Uh, and in that time, you will need to isolate even in your own home. Try to wear a mask around your family members, um, trying to eat separately and use all those methods, and, and then after the test comes back you may, you'll be contacted by public health if it's positive and kind of given more instruction on what to do. And it doesn't necessarily have to be COVID either, it can be just another virus uh, like it can be just your common cold that's been going on. So it does seem that your symptoms have gotten better. Oftentimes uh, a cough can be the last thing to go, it can take up to two weeks or more for the cough to get relieved, but it seems that you're not having any systemic symptoms like no fevers or anything else right now, so it's, it's uh, that's, that's pretty good.

P: Great, I'm glad.

D: Alright, yeah.

P: Thank you.

D: You're welcome. Take care.


D: How may I help you?

P: So I've had this ankle pain for the past day, and and it doesn't seem to be getting better. My right ankle looks swollen and it's bruised and is pretty painful so I just wanted to come here to check, check it out, see if I need any thing done to it.

D: Yeah, absolutely, uh OK. So you said that this started yesterday. Was there any like trauma to the ankle or leg or did you have a fall or or some sort of injury?

P: Yeah so I play rugby and I might have, so I fell during a tackle motion type thing and I fell on that leg and my leg, my foot kind of in, pointed inwards as I fell an I kind of fell on um on my ankle kind of just above, above my lateral side of the foot, so where that bony prominence is.

D: OK, I see and and your foot kind of it turned inwards when you fell?

P: Yes, that's right.

D: OK, and was there pain immediately after the this incident?

P: Yes.

D: OK, were you able to like walk off the field at all, or did you need to be carried? Or were you able to walk at any point after?

P: Um so I can walk um, but. It is very painful and I'm putting a lot of weight on my left foot so it's almost like I'm hopping on my left foot.

D: OK. And and is the pain. Actually, so where is the pain specifically located on your foot or ankle?

P: So it's um specifically, it's on the like lateral malleolus area.

D: OK, and how would you describe the pain in terms of its character or quality, like is it sharp burning, stinging?

P: It feels sharp.

D: OK, and do you feel the pain radiating anywhere else?

P: Oh no, it's pretty much in that area just in the ankle area.

D: OK, and has there been anything you've tried to make the pain better?

P: I've tried some ibuprofen and some ice that seems to help temporarily, but it doesn't help with like like it's not permanent.

D: OK, and. Has there been anything that's made it worse?

P: Um just putting weight or like trying to bear any weight on that ankle has made it worse.

D: OK, and what would you say the severity of the pain is on a scale of 10 to one, with 10 being the worst pain you've ever felt.

P: I would say it's like a 7 or 8.

D: OK, and have you ever had a pain like this before to the ankle or ever injured your foot before?

P: No, nothing like this.

D: OK. And have you had any any headaches?

P: Uh no headaches.

D: Had any fevers or chills?

P: No

D: How about night sweats?

P: No.

D: Have you had any unexpected weight loss?

P: No.

D: OK, and have you had any sensory changes like changes your vision, hearing or even your sense of smell or sense of taste?

P: No, nothing like that.

D: OK, and have you had any neurological symptoms such as like numbness or tingling?

P: No.

D: OK, now have you noticed any sensory loss over your leg or ankle?

P: No, no, no no sensory loss.

D: OK. And have you had any muscle weakness?

P: No.

D: OK. and, and have you had any infectious symptoms, like having like a runny nose or feeling congested or maybe even a sore throat?

P: No.

D: Alright, and have you had a cough?

P: No cough.

D: How about shortness of breath?

P: No.

D: Alright, have you had any chest pain or feeling like your heart's racing?

P: No.

D: Have you had any dizziness or lightheadedness?

P: No.

D: Alright, and have you had any nausea or vomiting?

P: No.

D: How about any loss of appetite?

P: No.

D: Have you had any abdominal pain?

P: No.

D: Have you any diarrhea, constipation, or or blood in the stool?

P: No.

D: OK, and have you had any changes to urinary patterns?

P: No.

D: OK, and have you had any changes to your energy recently?

P: No, no changes to my energy.

D: Alright, and in the past, have you been diagnosed with any medical conditions or any reason to see a doctor regularly?

P: Uh no I've been pretty healthy otherwise.

D: OK, so do you take any medications regularly, either over the counter or prescribed?

P: No.

D: Alright, then do you have any allergies?

P: No.

D: OK, and are your immunizations up to date?

P: I think so. I gave them the most recent ones I've received in high school.

D: OK, OK that's good and have you had any surgeries before or any reasons for hospitalizations?

P: Um no I've never, yeah I've never been hospitalized.

D: OK, uh and. Alright, could you tell me a little bit about your living situation right now, like who you're living with and whereabouts?

P: I live with both my parents as well as two of my siblings. They are younger. We live in a house downtown.

D: OK and are you currently in school?

P: I am. I'm in grade 11.

D: OK, awesome and then how's that been going so far?

P: Going pretty well.

D: OK. And have you been around anybody who's been sick recently?

P: No, no one's been sick.

D: OK, and how about have you traveling anywhere?

P: No, we haven't been doing any of that so since COVID.

D: OK, and and I know sometimes people at like in high school and certainly in your age group may experience with things like smoking. Smoking tobacco or cigarettes, drinking alcohol or using marijuana. Have you used any of those, those substances?

P: No.

D: OK. And and are you currently sexually active?

P: Um I am.

D: OK, and could you tell me about your partners or or partner?

P: Um yeah, she's been my girlfriend for the past two years. And we use protection.

D: OK, great. And any concerns for any sexually transmitted infection at this time?

P: No.

D: OK. And in the family, has there been any history of musculoskeletal or neurological problems?

P: Uh, no, nothing like that.

D: OK, and how about any autoimmune conditions?

P: No.

D: OK, and so I next wanted to move to the physical exam component and ask you to have a look at your ankles. And are you seeing any swelling or redness or discolouration?

P: So I there's a. Like there's a bruise about 4 centimeters wide and it appear swollen, but just by right ankle.

D: Just your right ankle, OK. And is there any temperature changes like warmth when you touch it?

P: Uh slightly warm yeah.

D: OK. And are you seeing any muscle atrophy or deformities of the of the ankle or foot.

P: No.

D: OK. Uhm and, uh if you press on areas of your of your ankle and foot, do you feel pain at the lateral malleolus or the medial malleolus?

P: Uh, there's a lot of pain on the lateral malleolus.

D: OK. Um and do you feel pain if you press on the top of your foot like a?

P: Um on the, no no pain at the top of my foot.

D: OK, and how about on the like outside or lateral aspect of your foot you'll feel a kind of, it's a bony prominence that that sticks out at the base of the 5th or you're kind of last metatarsals is there any pain there?

P: No, no pain there.

D: OK, and then how about any pains on that like medial side of your foot?

P: On the medial side, no.

D: OK, and then when it comes to moving the foot, are you able to point your toes on your foot up towards your face?

P: Up towards my face that's hard.

D: OK, so dorsiflexion is limited. And how about pushing your foot down like you're pressing on the gas pedal?

P: I can do that, but it's still painful just to move the ankle.

D: OK, so planter flexion is is painful as well. And then any issues with moving your toes?

P: No.

D: OK, and then you mentioned that with walking you're having a limp currently?

P: Yes.

D: OK, so we have an antalgic gates with an inability to bear weight as well. OK, so the that was everything that I wanted to ask and check today and based on these features it is starting like it could be either an ankle fracture or an ankle sprain. But because of the pin-point tenderness or that you're finding on the lateral side as well as some of the the inability to bear weight as you're describing it'll be important to get an X-Ray to make sure that there's not a fracture. Um and yeah, and if there is then it will be important to have some sort of air boot or casting so that to make sure that we're offloading the area for the bones to heal, but we'll see what the X-Ray shows.

P: OK, that sounds great, thank you.

D: Thank you.


D: How are you doing?

P: Oh, not too great I've had this cough the last few days.

D: OK, umm, how old are you?

P: I'm 36.

D: OK, so for the past couple of days you said, so is that two days? Three days?

P: I think 3 three days.

D: OK and is it a dry cough or are you bringing up anything?

P: It's dry.

D: OK, so no sputum, no blood?

P: No blood.

D: OK and do you feel wheezy at all?

P: No, no wheezing.

D: No  shortness of breath?

P: Now I ran to catch the bus yesterday and I was a bit more short of breath than I would usually be.

D: OK, and have you had a fever?

P: I've felt hot yes.

D: OK, did you actually take your temperature or do you just feel hot?

P: I just got hot.

D: OK so we can take your temperature today. Any chest pain?

P: No chest pain.

D: OK, and any throat pain?

P: Yeah, my throat's been a little sore, but I thought it was maybe just because I was coughing so much.

D: OK and any issues swallowing food?

P: Umm, no problems swallowing food.

D: OK, any changes in your smell?

P: Now that you mention it, yeah I thought it was maybe just plugged up, but I haven't really been able to smell these last few days.

D: OK, and how about hearing? Any changes in your hearing?

P: No changes there.

D: OK any ear pain?

P: No ear pain, no.

D: OK, any changes in your vision?

P: Umm, I got glasses last year but nothing recently.

D: OK and any eye pain or discharge from the eyes?

P: No.

D: OK, and have you had any night sweats or chills?

P: Nothing like that.

D: Any weight loss?

P: No weight loss, no.

D: OK and then how about changes in your bowel movements?

P: No, everything's been regular there.

D: OK, no diarrhea, no constipation, no blood in your stool?

P: No diarrhea, no constipation, and I haven't noticed any blood.

D: OK, any changes in your urine?

P: Uh, no.

D: No, OK. Um, how about muscle aches or pains?

P: I felt pretty, uh, well, yeah, I guess achy and weak.

D: Did that start around the same time that you experienced your cough and possible fever?

P: :Yeah, I would say it started around the same time.

D: OK, any dizziness?

P: Uh, no.

D: Any confusion or memory loss?

P: No.

D: OK, any fainting spells?

P: No.

D: Any rashes?

P: I haven't noticed any rashes.

D: OK, so it's your cough and just in general how you feel. Does it get better or worse with anything? Have you tried you know Tylenol and any antipyretics?

P: Yeah, I tried some uh like day and night time Tylenol at home to sleep but still, when I woke up in the morning, still not feeling very good and the cough is still here too.

D: OK, yeah. Have you ever experienced anything like this before?

P: Maybe as a kid. I mean, I remember getting the flu. I had a cough and that sort of thing, but I haven't been sick for several years now.

D: OK. Umm, and then since you started having this cough too, now has anything changed? How are you feeling worse? Or do you feel kind of the same as when it started?

P: I would say I feel a bit worse.

D: OK, and has anyone around you been sick recently?

P: Umm, no, not that I know of. Yeah, everybody in the house has been OK.

D: OK, have you traveled anywhere recently?

P: Umm, yeah, I was visiting some cousins up North several weeks ago, but that was just traveling within the province.

D: OK, and they're fine? No one is sick?

P: I haven't heard of anybody being sick.

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

P: I've been told I had high cholesterol before. But I don't take any medications for it. I've been just trying to lose some weight and exercise more.

D: Sure, OK. No surgeries or hospitalizations in the past?

P: No.

D: OK and no other medications?

P: Umm, no,  I just take a multivitamin.

D: Ok, and no other you know over the counter medications or herbal stuff?

P: No, I'll use my Tylenol or Ibuprofen or Advil I guess if I get the occasional headache.  And I guess, umm, something like Reactine or Claritin for the seasonal allergies but that's about it.

D: OK. And so you said seasonal allergies. Any other allergies?

P: Umm, no, just usually like in the springtime.

D: OK, and are you up to date with all your immunizations?

P: Yeah I am. Yeah I get the flu shot every year.

D: OK good. And in terms of family history, do any of your family members have lung conditions or heart conditions?

P: I know mom has high blood pressure, but nobody's had a heart attack or, uh, no lung conditions either.

D: OK, any cancers that run in the family?

P: Umm, none, I can't think of any.

D: OK, and then do you smoke?

P: I just I smoke cannabis every once in awhile.

D: OK, how much do you smoke?

P: Um, I would say maybe, I enjoy it on the weekends.

D: Did you say a joint on the weekends?

P: Yes.

D: OK, so is that like 1 milligram?

P: Yeah, I would say something about that. Yeah, it's not much.

D: OK. But no cigarettes though?

P: No.

D: OK, any other recreational drugs?

P: No.

D: OK, and do you drink alcohol?

P: Umm, I do, yeah, I'll have like two or three beers on the weekend.

D: Sure. And and where do you live?

P: I'm just like 20 minutes down the road in a house here.

D: Sure, is it an apartment complex or is it like a full house?

P: Yeah, it's a single family home. I live there with my wife and three kids.

D: OK, um any concerns with your living arrangements you know, like old carpets or anything like that?

P: Actually last year we had most of the carpets taken out, so not anymore.

D: OK good good. Did you have any other questions or concerns? Anything that you wanted to bring up that I didn't touch on today?

P: Yeah, I was just really worried that this could be COVID. I mean I have a cough and just have been feeling really hot so I was just concerned about that.

D: Yeah, for sure, and I think that's a valid concern. So right now I'm just going through, you know, a list of differential diagnoses that you could possibly have and COVID, it's definitely top on my list and so we will likely get a swab and run those tests and try to get that back to you as soon as we can. It could also be other respiratory infections, especially viral infections this time of the year. And so, if it comes back negative for COVID, it's probably you know something else like respiratory virus or even the flu. So we'll go from there. And if it turns out it's not a viral infection, we will likely see if it's some sort of bacterial infection in which we can prescribe antibiotics for those. But it definitely sounds like there's an infectious picture going on here because of the acuteness of the presentation, and just your symptoms. So we will do afollow up in a week or so. Until then, we will run all these labs. Does that sound good?

P: Alright, yeah, that sounds good, so I guess I will kind of self isolate until the COVID results come back.

D: Oh yes please do so. That's that's a great point. I do suggest isolating for two weeks at least if you have any sort of symptoms, because even though the PCR that we do to test for COVID is supposed to be reliable and it's supposed to be specific and sensitive, there are sometimes false negative tests. You know, just to be on the safe side, if you're experiencing any of the symptoms that overlap with COVID symptoms, isolate for two weeks. But by the end of the week we should know what the test results are and then you will know for sure what you have.

P: OK, awesome, thank you.

D: Yeah, thank you.


D: What brings you here today?

P: Yeah I had last night um so I'm having this pain in my right wrist. Yeah, but last night. I I tripped over something and I I ended up like landing on my hand to help break the fall and this morning I woke up and I have some like bruising on my hand and it's it's really sore to touch it.

D: OK, and which right, which hand is this?

P: It's my right hand.

D:  OK, and when you had your fall, when was your fall?

P: So it was last night, probably like at 10:00 PM, something like that. Went out with a few friends for dinner and drinks.

D: OK, and do you remember how high you fell from or what what you fell onto?

P: Yeah, I was standing height. We were just kind of walking down the street and I tripped over something on the curb. I think there is that yeah maybe like a pothole or something like that and so I felt right onto the concrete with my hand.

D: OK, did you hit your head at all or lose consciousness?

P: No, nothing like that.

D: OK, so it was. It was mainly your hand that got injured.

P: Yeah, it was just it mostly right my hand.

D: OK and are you having any pain on movement or if you press on it?

P: Um yeah, I do get some pain pain if I'm trying to move the wrist around and it hurts her to press on it as well.

D: OK, and do you notice any kind of swelling or bruising?

P: I do, yes. There's some swelling and bruising.

D: OK, and if you had to describe where the swelling and bruising in the pain are, how would you describe it?

P: Um so I have a sharp pain right at my wrist. I kind of. I feel it mostly at the base of my thumb, kind of right at the wrist, and that's where the swelling and bruising is as well.

D: OK and, is it right under your palm or uh at the back of your hand on the wrist?

P: At the back of the hand, at the wrist and base of the thumb.

D: OK, OK, alright, and what kind of pain are you feeling? Is this sharp, is it a dull aching?

P: Oh yeah, it's really sharp. It feels like sorry just stabbing me in the hand.

D: OK, and how how much would you rate the pain on a scale of zero to 1010 being the worst pain you felt in your life?

P: If I'm not moving it around, it's a three, but if I move it, it goes up to like a 9 out of 10.

D: OK, and is it radiating or moving anywhere else onto your hand?

P: No, I don't feel it anywhere else.

D: OK, and do you have any kind of pins and needles sensation tingling or numbness anywhere in your hands?

P: No, nothing like that.

D: OK, anything that makes the pain worse or better?

P: Um yeah I tried some anti-inflammatories that did help with taking the edge off a little bit and. But the pain just came right back and then also like just moving it at all hurts even texting on my phone was really bugging me.

D: OK. Yeah, so we definitely, uh, you went, so you had the fall yesterday or?

P: Yeah it was yesterday.

D: OK, OK. Alright. So when did it start hurting? Did it start hurting right away or has it gotten worse at all?

P: Yeah it started hurting right away and it's. Well, this morning it's a a bit worse yeah.

D: OK. Do you have any other symptoms at all like fever, chills, headache, anything like that?

P: No.

D: Any dizziness or fainting?

P: No.

D: OK, any diarrhea, constipation?

P: No.

D: Any changes in your vision, hearing a balance?

P: Nope, nothing like that.

D: OK, but yeah, so your main concern today is this pain in your wrist?

P: Yeah exactly.

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

P: Yeah I do. I have a Asthma and I use an orange inhaler daily. It's been well controlled, I'll use, I haven't used the blue one in awhile.

D: OK, so it's pretty well controlled. Yeah, and do you take any other medications at all?

P: Just a Multi vitamin.

D: OK

P: And vitamin D as well.

D: OK, alright, and have you been hospitalized in the past or had any surgeries?

P: Yeah I had my my tonsils out and my wisdom teeth out when I was a teenager and or tonsils when I was a kid actually. Um and a c-second for my son.

D: OK any complications at all with that at all?

P: No no every every that was OK.

D: OK, OK, and have you injured your right hand or broken any bones before?

P: No, I haven't.

D: OK, so this is the first injury on your right hand?

P: Mmm

D: OK and do you have any family history of any medical conditions at all?

P: Yeah my my uncle died of a heart attack when he was in his 60s and I think my Grandfather also had had a heart attack as well. Um yeah, that's about it.

D: OK. And in terms of your work, do you work currently?

P: Um yeah I do, I I work um in a restaurant and so. And this will be a difficult for my job coming up with an injured wrist I and hand. I I just restarted and I'll have to be carrying a lot of different things, and so I just hope it's not broken.

D: Oh, I see. Yeah, it might definitely that's that might be concerning if you know well, we'll get that check though on X Ray and everything, but we just need to do a few few more questions and some examination as well. How would you describe your living situation right now?

P: Oh so. I'm living on on my own actually in an apartment.

D: OK. And do you currently smoke?

P: Um no, I've I. I've never smoked, I couldn't with having asthma so I just stayed away from all of that.

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

P: Yeah I do I. I have a couple of bottles of wine per week.

D: OK. Alright, uh, a couple of bottles a week, so how much would you have in an average day?

P: I'll probably I guess, probably like two or three glasses of wine a day.

D: OK. Yeah, so we definitely recommend for women. Uh to limit themselves to an maybe one to two, max 2 glasses of wine a day as it can have health effects in the future in terms of drinking and on your liver. OK, and other than that I just had a few questions. Do any recreational drugs like marijuana?

P: No, stayed away from that as well.

D: OK, OK, so I'm just going to ask you questions about specifically to examine your wrist so you notice. So can you. Are you able to move your wrist around? Are you able to make a fist?

P: I I can but it I can't really bad my thumb and it it it hurts a lot. So I can bend my fingers but my thumb is kinda out.

D: OK, due to the joints in your thumb hurt at all.

P: Um no.

D: OK. An any pain anywhere else like on your fingers or your elbow?

P: No.

D: OK, and. What movement would you say hurts the most?

P: I I. Probably just moving the the wrist like flexing and extending the wrist

D: OK and where the swelling you said is at the base of the thumb, right?

P: Yeah, exactly at the base of the thumb on the on the back of the hand there are some bad bruising and swelling there.

D: OK is it warm at all to touch?

P: No, it doesn't feel warm.

D: OK, OK, and if you press on are you getting any bony pain in that area, like if you press on a bone?

P: Yeah, like, I mean, if I there's one spot that if I press down on it, it's like 10 of the 10 pain. It hurts really bad if I press at the base of my thumb there.

D:  OK, alright, so those are all the questions I had for you today. We definitely need to, since you're having pain on, just tell palpate palpating the area, there swelling redness, and you did have a fall and you landed on your you caught yourself with your hand. There is a common fracture that can happen in those circumstances to your wrist. And so we need to do an X-Ray and we will see if you have a fracture or not. But we also need to see if we need to get a cast for you or if if we can manage your injury with a splint or. And then based on what we see and if your physical examination we will determine how long you need to be in a cast or splint, and then we'll go from there.

P: OK, that sounds good, thank you.


D: How may I help you?

P: Um so I was playing soccer the other day and I got kicked in the knee and since then my knee has been hurting and it looks a little bit red and a little bit swollen on the medial aspect of my right knee.

D: OK. And. And this started right after the kick at soccer?

P: Yes.

D: OK, and how many days ago was this?

P: This was two days ago.

D: OK, since then, has the pain begin getting any better or worse or staying the same?

P: No, it's staying the same or a little bit worse.

D: OK. Could you describe the pain? Is it sharp, achy?

P: I'd say it's pretty sharp.

D: OK. Uhm and do you feel the pain radiate anywhere like down the leg or or up into the thigh?

P: Um no.

D: OK, any pain in the posterior aspect of the knee or the lateral aspect?

P: No.

D: OK. Um and is there anything that makes the pain worse?

P: I guess if I press on that area or I try to. And. I don't know, flex or extend my knee too much.

D: OK. An anything that you've tried to make the pain better?

P: Um some ice helps.

D: OK, uh. And have you noticed swelling over the area?

P: Just a little bit.

D: OK, and redness as well?

P: Yes.

D: OK. Uhm and what would you say the severity of the pain is a 10 being the worst pain that you've ever felt and 1 being low intensity pain.

P: Um I'd give it about a 5.

D: OK, and have you had any injuries or any knee pain before?

P: No.

D: OK, at the time of the injury, did you hear a pop sound or or any kind of sounds like that?

P: I don't recall.

D: OK, and how about any difficulties walking or having any knee instability?

P: Um a little bit only when I like try to extend or flex my knee too much.

D: OK. Um. And. Uh, um alright. So have you been experiencing any other symptoms?

P: No.

D: Alright, so just to be comprehensive so I'll run through a review. So have you been, having any any headaches?

P: No.

D: Any sensory changes like changes to vision, hearing, smell or taste?

P: No.

D: OK, any eye symptoms or your symptoms?

P: No.

D: Have you had a runny nose or sore throat?

P: No.

D: Have you had a cough?

P: No.

D: Any shortness of breath?

P: No.

D: Have you had any wheezing?

P: No.

D: Have you had any chest pain?

P: No.

D: Any heart palpitations or heart racing?

P: No.

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

P: Um no.

D: Alright, have you had any nausea or vomiting?

P: No.

D: Have you had any changes to your appetite like loss of appetite?

P: No.

D: Have you had any weight loss unexpectedly.

P: No.

D: OK, have you had any abdominal pain?

P: Um no.

D: Any changes to bowel habits like diarrhea, constipation?

P: No.

D: OK, have you had any urinary problems like pain or frequency?

P: No.

D: Alright, and have you had any skin changes such as ra' rashes or anything like that?

P: No.

D: OK, any joint pains anywhere else?

P: Um no.

D: OK, and any fatigue?

P: No.

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

P: Um no.

D: OK, do you have any allergies to medications?

P: No, no, not that I know of.

D: Are you currently taking any medications?

P: No.

D: Alright, and have you had any surgeries or hospitalizations before?

P: No.

D: OK, and. Um, can you tell me a little bit about your living situation, like you you're living with and whereabouts?

P: Sure, I live with both my parents and three of my siblings.

D: OK, and are you going to school?

P: I am, I'm in my last year of grade 12.

D: OK. Well, that's good. How is that been going?

P: It's been going OK. We've been doing part online, part in-person.

D: OK, have you been around anybody who's been sick?

P: No.

D: Alright then. And you play soccer. Do you play any other sports?

P: And I play football.

D: OK, cool and any injuries before to your knee or anything like that?

P: Um not that in the past.

D: Alright. And do you smoke cigarettes?

P: No.

D: Um do you drink alcohol?

P: No.

D: OK, did you use any recreational drugs like marijuana or anything else?

P: No.

D: OK, are you currently sexually active?

P: I am.

D: OK, are you in a relationship?

P: I am. We've been together for a year.

D: OK, is there any concern for a sexually transmitted infection?

P: No, we were both tested.

D: OK, great, um and any chance that you could be pregnant?

P: No.

D: OK and uh in the family, are there any musculoskeletal or neurological conditions?

P: Um no.

D: OK, um. And so that I that was everything I wanted to ask on history. So for the physical exam, when inspecting the knee, are you seeing any joint effusions or joint swelling or ecchymosis or bruising?

P: It looks or is that a bruise, it looks red and I would say it's a little bit swollen on the medial aspect only.

D: OK, is there any muscle atrophy?

P: Um no.

D: OK, and is there any misalignment or joint deformities?

P: No, not that I notice.

D: OK. And alright on gait or walking, is there any limp or antalgia?

P: Um no.

D: You're able to walk normally?

P: I am able to walk normally and it hurts, but I think I'm walking OK.

D: OK. Uhm and next is there any changes to temperature like the joint itself feel hot?

P: No.

D: OK and are there any areas of the joint line itself of the knee that is painful to palpation?

P: At just the medial part of it like the I guess where the ligament would be.

D: OK, so just let me OK, and, any pain over the patella?

P: No.

D: Any pain over the tibial tuberosity or patellar tendon?

P: No.

D: Any pain over your over the fibular head or the lateral part of the knee?

P: No.

D: Any pain in the calf or the thigh muscles?

P: No.

D: Any pain in the hamstring muscles?

P: No.

D: OK, and is there any pain to a like varus stress of the knee?

P: To the varus stress? I guess it would be, there will be pain if I press down in that area.

D: OK, and is there any joint yeah, the joint laxity or pain too, like a valgus stress of the knee?

P: Yeah, so when I press when I do that it hurts on the medial aspect but not the lateral aspect.

D: OK. Uhm and does it feel is as though there's some like the joints opening more when you put the valgus stress?

P: A little bit, yes.

D: OK. Uhm and is there any instability moving the tibia anteriorly, if you're like, pull it outwards?

P: Um no.

D: And how about if you pull the tibia posteriorly, any instability?

P: No.

D: OK, um and the is their full range of motion of the knee?

P: Yes.

D: And full range of motion of the hip and ankle?

P: Yes.

D: OK, um and do you have any like numbness, tingling or muscle weakness?

P: No.

D: OK, and any sensory changes to the skin?

P: No, no.

D: OK and reflexes are normal.

P: Mmmm

D: OK. So I think that was everything I wanted to ask and and kind of go through on the physical exam. Did you have any other questions or anything that maybe I forgot to mention today?

P: Ah no, that was it. Just what can I do about my my knee?

D: Yeah, so right now it's sounding like this could be an MCL or medial collateral ligament strain, or injury and so these types of injuries are usually treated conservatively, like with things like NSAIDs or anti-inflammatories to help that pain and swelling. If the pain depending on how severe it is, it might be useful to use maybe crutches for a day or two to try to help let the pain to subside and allow you to be able to do some physical therapy exercises like strengthening the quadriceps and hamstring muscles.

P: OK.

D: But typically injuries that are lower grade will heal within two weeks and so if it's more more severe, it could take a bit longer. And although that it's most likely an MCL injury that you're describing, it could be a medial meniscal injury as well or possibly even a bursitis at the medial aspect of the knee. But the treatment to start with would be the same and maybe we will get any x-ray if things aren't improving.

P: OK, that sounds good, thank you.


D: Uh, what brings you in here today?

P: Uhm, so I've had this runny nose, well first it was a stuffy nose, but now I've had this runny nose for the past week and a half and it doesn't seem to be getting any better. So I was just wondering if you could give me something for that?

D: Yeah, so yeah, let's just try to first see what's going on. So you've been having this, so when did it start getting stuffy?

P: Uhm, it started getting stuffy about two weeks ago.

D: Two weeks ago, and when did it start getting, like just a runny nose?

P: Yeah, that started a week and a half ago.

D: OK, and have your symptoms, have these symptoms gotten worse at all?

P: No, it stayed about the same.

D: OK and do you have any coughing?

P: No, no coughing.

D: No coughing, uhm, any fevers or chills?

P: No.

D: No, uhm, and the, from the runny nose, are you having any yellow or green discharge?

P: No, it's clear.

D: It's clear, OK. Have you at all coughed up any blood at all?

P: No, nothing like that.

D: OK, and do these symptoms come and go, or are they pretty constant?

P: Uhm, they are pretty constant.

D: OK, and is there anything that you have tried that has helped you with these symptoms? Any over the counter medications?

P: No, I haven't tried anything. I've been thinking about using some nasal decongestion but I don't want to make my runny nose any worse.

D: Yeah, no, that's a, that's a fair point. And yeah, there's multiple things that you can try over the counter, but we can get into that more later. Are you having any other symptoms at all, like any, shortness of breath, chest pain, any kind of dizziness, anything like that?

P: No dizziness, I feel like sometimes I have a headache though, because I feel like there's a lot of fluid or something backed up into my sinuses.

D: OK, so do you, are you feeling, that pressure in your face at all?

P: Mhm, a little bit, yeah.

D: OK. Have you at all in the past couple weeks to a month had contact with anyone that was sick?

P: No, nothing like that, that I can think of.

D: OK and any travel?

P: Uhm, no.

D: OK, and any symptoms of a loss of taste of, sorry, loss of sense of taste or smell?

P: No.

D: No, any nausea or vomiting?

P: Uh, nope.

D: Any night sweats?

P: No.

D: How about fatigue, or do you feel tired?

P: A little bit, yeah.

D: OK, are you, do you work at all?

P: I work from home right now.

D: OK, and has this affected your work in any way?

P: No.

D: OK, uhm, where, where do you live? Do you live in an apartment, a house?

P: I live in an apartment.

D: And do you live with anyone?

P: No, just by myself.

D: OK, and any mold or dust or fumes, anything in your household?

P: I have some old carpets, but that's about it.

D: OK. Have you felt any changes in your sleep or appetite?

P: No, nothing like that.

D: OK. Any changes in your bowel movement, like diarrhea or Constipation?

P: No.

D: Any urinary trouble?

P: No.

D: Any weight loss?

P: No.

D: OK. Do you have any past medical conditions that you've been diagnosed with, like asthma or anything else?

P: Uhm, no, I'm healthy otherwise.

D: OK, any allergies that you know of?

P: Uh, nope, no allergies either.

D: OK. Do you take any regular medications?

P: Uh no, I don't even take vitamins.

D: OK. Any hospitalizations or surgeries in the past?

P: I had an arm fracture when I was younger, but that's it.

D: OK, but other than that, nothing else?

P: No.

D: OK. And currently right now, do you smoke cigarettes at all?

P: No.

D: Have you smoked in the past?

P: No.

D: Any recreational drugs like marijuana?

P: No.

D: OK. And do you drink alcohol?

P: Once in a while I'll have like a glass of wine every week.

D: OK. And yeah, those are pretty much all the questions I have right now. Do you have any questions?

P: Uh, no, what can I do about this runny nose?

D: Yeah, so it seems like it's been going on for more than one and a half week. What, what is reassuring is that you're not having any other symptoms that are concerning, like you're not having any cough, you're not having any green or yellow sputum, you're not having any fevers, so it seems that you might just be having a cold, which can be caused by just a viral, uh, infection, but it should go away on its own. Just make sure that you're getting some rest, you're hydrating well, uhm, you can get some over the counter medications like Tylenol cold for example, but for now I would say we should just wait and watch. But just in case, also, since it is one of the symptoms that's for covid as well, in this time period we will just get a covid swab just in case, but most likely it's nothing to be worried about. Until you get your test, I would recommend staying isolated. And then we can go on from there, is that, does that sound good to you?

P: Yeah, that sounds great. Thank you so much.

D: You're welcome, take care.

P: You too.

D: Bye.


P: Hi, I'm Rob and I just feel like I can't catch my breath.

D: OK, how old are you Rob?

P: I'm I'm 50 I'm gonna be 50 soon.

D: OK, OK, when did this start?

P: Well, like last night I kinda had like an ache on my chest, kind of like here like on the left. I just I didn't do anything really last night and you know I just went to sleep and I got to sleep fine like I just thought maybe I pulled a muscle on this side. But then I woke up and I was like walking up the stairs and I like was kinda having a hard time breathing and I took some Tylenol. It didn't really do anything. Um, and then it just got worse and then a few hours ago is like I could barely walk. And if I'm breathing deep it's like it just hurts. And I feel like I can't like catch my breath like I can't get a good like a good breath in.

D: Um, OK, so I just want to state at this point I would do ABC's, like I would do the vitals and make sure you're stable and then do airway breathing circulation if you weren't before I continue with the history. OK, so. OK, so that's how it started. Um, are you having any chest pain at all associated with that?

P: Like when I breathe in, I get like and it's like an ache. And then if I breathe really deep it feels like a little sharp.

D: OK.

P: I have never had anything like this before.

D: No? OK, that was going to be my next question. On a scale of 1 to 10, how severe is your shortness of breath, 10 being the worst?

P: Um, I don't, I don't know, um. Like I can breathe right now, I can't get like a deep breath, like...

D: Does it? Oh sorry, go ahead.

P: Maybe like you know five or six.

D: OK, OK. Does it hurt when you take a deep breath in?

P: Yeah.

D: Yeah?

P: Yeah, it's like it's like sharp.

D: OK, sorry, sounds like you're having some pleuritic chest pain. Do you have any coughing associated with that?

P: No no.

D: No? You're not coughing up any blood?

P: No.

D: Any swelling in your legs?

P: I I don't think so.

D: No? OK, how about on exertion? Like when you walk or run, or you know, does it hurt more or does I mean sorry, does your shortness of breath get worse?

P: Oh yeah, it was like going up the stairs, can't really breathe in after.

D: OK, how about when you're laying down?

P: I don't know. I don't think that's any different. No, I slept fine last night. I got up and when I went up the stairs I was like holy...

D: OK. How about wheezing? Are you experiencing any wheezing?

P: I don't think so.

D: OK, how about fevers or chills?

P: No, not that I've noticed, no.

D: OK. Any abdominal pain?

P: Uh, no, no, it's like it aches kind of it, but it's all up here and like kind of in my back a little bit.

D: OK and, do you think anything triggered this?

P: I don't know.

D: No? OK. And you said this has never happened to you before, right?

P: Right, yeah.

D: Does it get better with you sitting forward?

P: I don't know, like I, I feel like that it's still kind of aching like it doesn't, it's not really like changing very much.

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

P: No.

D: No? Any rashes?

P: No.

D: No? Weight loss?

P: I, I mean, I've been trying to to lose weight.

D: OK.

P: They told me a year ago I have like high blood pressure so I've been cutting out like salt and trying to walk more.

D: OK, OK, good.

P: So I've lost like 15 pounds but like not... Like I've been trying to.

D: OK, OK. 15 pounds, that's good. Are you experiencing any dizziness or you feeling faint?

P: No, just like a I can't get like a good breath.

D: OK, and are you otherwise healthy? You mentioned you have high blood pressure, anything else?

P: No, that's that's like it. I've never had any like chest problems.

D: OK. Have you had any investigations done for your chest like pulmonary function tests, ECG's, chest X-rays?

P: No, no, they just they just put the thing on my arm. But my doctors office and said that it was high. So they said to you know, eat better and I don't I don't wanna start any drugs so, I didn't do anything. I've been fine ever since.

D: OK, so you're not on any medications?

P: No, just yeah, no that's it. I mean I, you know sometimes take like a Tylenol if I'm
not feeling well but...

D: And do you smoke?

P: I, like I, smoke a little bit. Maybe like a pack a week.

D: A pack a week, OK? For how long?

P: Oh like since college.

D: OK OK. Um, do you smoke marijuana?

P: Uh. No, no and I I smoke, I'm trying to smoke less, you know, since they told me I have the high blood pressure. So I used to smoke a little more but this is this is less but not since I've been having trouble breathing. Is it, yeah.

D: Yeah, OK. Any other recreational drugs?

P: No no.

D: No, OK. How about alcohol? Do you drink alcohol?

P: Oh like, maybe you know, a beer on the weekend.

D: OK, and are you up to date with all your immunizations?

P: Like I don't I think I got all the ones when I was like a kid. What else should I have?

D: OK, so like the flu vaccine every year?

P: Oh, I get that, like my wife, my wife makes me get that.

D: OK that's good. Any family history of lung or heart disease?

P: Oh like my, uh, my mom and dad have high blood pressure too, so I wasn't surprised when I heard that I did.

D: OK. OK. Um, OK so Rob, is there anything that you wanted to tell me that I haven't asked you already today?

P: I am really like nervous 'cause I haven't felt anything like this before. Um, like it's scary, like do you think it's like cancer or something like I don't I don't really know?

D: Um, I mean, it's hard to tell right now what it is. It sounds like it's it started pretty suddenly, um, like it started a day ago, correct?

P: Mhm.

D: Yeah, so it's unlikely that cancer would present itself like this so acutely, you know? And, but it could it could be a number of things like, it could be something like a pulmonary embolism, but you said you don't have any swelling. Um, but you did say you have some chest pain when you're breathing pretty, when you take a deep breath in. So I mean, that's a possibility. It doesn't sound like it's an infection because you don't have a fever or chills or any any other symptom really. And you mentioned there weren't any triggers like no trauma to the area. And then, other things could be like COPD because you which is a chronic obstructive pulmonary disease because you have been smoking since college and that's basically just inflammation in your lungs that causes your airways to narrow, and so you may have a hard time breathing. So for all of these things, we first start by doing some blood work and then we'll do some imaging like a chest X-ray and a pulmonary function test if indicated, and so that will give us a better idea of what you have and how we can best help you. Sounds good?

P: Yeah yeah, I just really want to get a good breath so yeah, whatever we can do.

D: Yeah for sure, and then in the meantime we'll keep monitoring you to make sure your vitals are OK and if we need to give you oxygen, we will.

P: That'd be great.

D: OK, thank you.


D: What brings you in here today?

P: Uh, I've had this cough ongoing for a couple of months now, uhm, and recently I've started to notice some blood.

D: OK, so this cough has been going on for how many months?

P: I would say maybe six months.

D: Six months, and have you had this cough before, then?

P: Yeah, I've had a cough before and kind of for a long time, 'cause I've smoked for a while.

D: OK, I see, Uhm, what kind of cough do you have, is it productive? Like, is it a wet cough or is it a dry cough?

P: It's usually a dry cough, but recently I've been bringing up a little bit of blood.

D: OK, and is the blood mixed in with like sputum that you're bringing out or is it that you're just coughing up blood?

P: It's mostly red, yeah, mostly blood.

D: OK, I see, and is your coughing constant or does it come and go?

P: It's kind of like, constant throughout the day.

D: OK, and have you noticed any kind of greenish or yellowish color of your sputum?

P: Not really, no.

D: How much blood would you say you're coughing up now in an average day?

P: I would say, maybe two or three teaspoons.

D: OK, I see. Has your coughing gotten worse or has it stayed about the same?

P: It's been about the same.

D: OK, is there anything that makes your symptoms better or worse?

P: Not really, it's just kind of been there most days.

D: And do you have any other symptoms like shortness of breath or chest pain, runny nose, anything like that?

P: Uhm No, no I haven't really had anything like that.

D: OK, so with your coughing, you don't feel like you have any difficulty breathing?

P: No, I mean, I haven't had any shortness of breath, I've just had uh, well yeah, actually sorry, I have had difficulties breathing as well.

D: OK, and when did that start?

P: Uh, well that's been an ongoing problem for the last several years now, I thought it was related to smoking, but it's gotten worse.

D: I see, OK, and do you have any chest pain with inspiration or expiration?

P: No, no chest pain.

D: OK, any dizziness? Any fainting episodes?

P: Nothing like that.

D: OK, any recent travel outside of the country?

P: No, I've been at home.

D: OK, any headaches, fevers or chills?

P: No, no fevers or chills, and I haven't had any headaches either.

D: OK, any losses in sense of taste or smell?

P: No.

D: Any nausea or vomiting?

P: Uhm, yeah, I have been a bit more nauseous recently, but I haven't had any vomiting.

D: OK, and when did you start feeling nauseous?

P: It kinda comes and goes, I've had that problem for the last two months or so.

D: OK, and do you feel nauseous at anytime particularly in the day, like after eating, Or does it just come on randomly?

P: Randomly.

D: OK, and have you been having any kind of diarrhea or Constipation, changes in your bowel movement?

P: No.

D: OK, any blood in your stools at all?

P: No.

D: OK, have you been feeling fatigued at all?

P: Yeah, a little bit more tired recently, yeah.

D: And how recently would you say?

P: I thought it was related to like, just being short of breath, Yeah, so maybe in the last couple of months as well.

D: OK, and when do you get short of breath? Is it when you do any activities? Is it when you're laying down? Is there anything related to it?

P: If I exert myself or if I'm  doing more activity, it it does get harder to to keep up with it, but yeah.

D: And do you notice you have to like get up at night to take a breath? Or when you're laying down,do you have any trouble breathing?

P: No.

D: OK, and have you noticed any kind of swelling in your extremities or anything like that?

P: No swelling.

D: OK, have you had any night sweats?

P: No

D: OK, and how about your sleep and appetite, have they changed it all?

P: Oh yeah, my appetite's been less. I've lost some weight over the last few months.

D: OK, and how much weight would you say you've lost?

P: Maybe ten to fifteen pounds.

D: OK, and how much do you weigh?

P: I think now I weigh about one hundred and sixty pounds.

D: OK, so yeah, ten to fifteen pounds in the last, how many months would you say?

P: Maybe two months.

D: Two months, OK. Have you recently had any infections, like viral symptoms, like runny nose, fever, or any cold like symptoms?

P: No.

D: OK, and any exposure to anyone that you know of that might have tuberculosis?

P: No, I've been been mostly at home. I Haven't really been seeing many people lately.

D: OK, and do you have any past medical history or any diagnosis like COPD, asthma, high blood pressure, diabetes, anything like that?

P: Uhm, I had a cataract surgery, but that's about it.

D: OK, and are there any medications that you take on a daily basis?

P: Multi-vitamins.

D: Multi vitamins, OK, any allergies that you know of to medications or any environmental allergies?

P: I think sulfa, but that's it.

D: OK, and what kind of reaction do you get?

P: Uh, I get a rash.

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

P: I just had cataract removed from my right eye, and uh, that's about it.

D: OK, any Contacts of yours that have been sick recently?

P: No.

D: No, OK, and in terms of your family history, are there any cancers like lung cancer in your family or any heart conditions, anything like that?

P: I think my great uncle had lung cancer, my mom had type 2 diabetes, but that's it.

D: OK, and currently right now, do you work?

P: Yeah, I'm retiring soon. I work as a bus driver.

D: OK, and in the past have you worked in any environment where you were exposed to any metals, toxins, any asbestos or anything like that?

P: Uhm, I don't think so.

D: OK.

P: I worked as a bus driver for quite a number of years now.

D: And where do you live right now? In an apartment? In a home? And who do you live with?

P: I live in a home with my wife and it's just us two.

D: And do you know if there's any like asbestos exposure in your home at all?

P: I don't think so, no.

D: OK and currently do you smoke?

P: I've been cutting down, but I do smoke, yes. I smoke about a half a pack per day now. There was a time I was smoking two packs per day for a number of years and I started smoking when I was probably fifteen.

D: Mhm.

P: Yeah, so it's been about forty, Yeah, forty-ish years at least.

D: And have you thought of quitting at all?

P: Yeah, I've been trying. I was thinking of maybe talking about a prescription for helping quit or something like that today. I was feeling like this is causing some of my symptoms like my cough, shortness of breath.

D: Yeah, well, it's really great that you're thinking about quitting. We can definitely help you with some resources, and some medications. Have you tried anything before that I should know of, to help you quit?

P: I've tried nicotine patches and gum, but that's it.

D: OK, so yeah, there's uh, like other options as well that you can take. Have you heard of Champix?

P: Uh, I did hear of it actually. Yeah, so one of my friends tried it and it worked well for them so, Yeah.

D: OK, yeah, so we can, if you're wondering about that, I can give you some information on that medication, like a whole package for you and then we can discuss if that could work for you.

P: That sounds great.

D: OK, sweet. And other than smoking, do you use any recreational drugs like marijuana?

P: No, I don't.

D: OK, and do you drink alcohol?

P: Well I'll have one or two beers on the weekend.

D: OK. Alright, so yeah, that's pretty much all the questions I had right now. It seems that your symptoms, You do have that cough and the shortness of breath and it's been chronic, but now you're coughing up some blood as well, so that is definitely something that's concerning and we want to make sure there is nothing going on so we will get a chest X-ray for you and see if we can find anything there. Are still producing the bloody sputum?

P: Yeah, that's been coming up a daily still.

D: OK, so if you think you can produce that, we can even take a sample of that as well and see if there is any presence. The one thing that we are concerned about with some of your symptoms and a long history of smoking as well is lung cancer. So yeah, we will do a chest X-ray, get some cytology done as well and then once we have that in the future we may need to maybe do a biopsy but right now we'll do a few of the first things that I mentioned and then go from there.

P: That sounds good. Thank you.

D: You're welcome. Take care.

P: Bye.


D: What can I do for you?

P: So I've been, just over the last week, I've been feeling pretty sick. I have this pretty bad headache that started like probably a week ago, and then for the last few days I've been having these chills. Um, and I didn't get a chance to measure my temperature at all, um, but the worst thing has been just these muscle aches all over my body, and that's been going on for the last three to four days.

D: Sorry to hear that you're feeling so, uh, horrible over the past week. Um let's uh, let's try to understand this a little bit better. So you've had this headache for the past week or so. Where exactly is it?

P: It's kind of just uh, all across my forehead. It's been going to the sides, like into my temples as well.

D: Okay, and what does it feel like? How would you describe it?

P: Uh yeah, it feels like, kind of like uh aching um, I, I have had headaches with throbbing before, but it's not so much throbbing it's more just constant, aching pain.

D: Um, if you had to give it a number from 1 to 10, with 10 being the worst um, pain ever, what number would you give it?

P: Uh, probably like a 7.

D: Oh wow, yeah, that sounds severe. How long have you, how long has it been a 7 for?

P: Um, it's actually a bit better now, but yeah, like over the last week it's been a 7. I would say now, it's probably around 5.

D: Okay. Um, anything that makes the headache better?

P: Um I, I take like Tylenol, then like, it gets relieved for a bit, for like a few hours, and then comes back.

D: Anything that you feel makes the headaches worse? Any postures, or positions, or activity or um, any kind of exposure to light or sounds?

P: Uh no it's, it's just kind of there. Nothing makes it worse.

D: Do you have nausea or vomiting?

P: Uh no, no nausea or vomiting.

D: No. Any sensitivity to light or sounds?

P: No.

D: Okay. Uh, and is it only, is it only on one, on one side of your head or forehead, or is it on both sides?

P: Uh it, it seems like it's on both sides.

D: And have you noticed any visual changes? Any blurry vision with the headaches?

P: No.

D: Any other visual changes? No, okay. Um, and you've also had chills, but you said you haven't checked your temperature, right?

P: No, I haven't, uh, I've been having chills for the last few nights.

D: Yeah, we can definitely check your temperature here in the, um here. Um, and you mentioned that the muscle aches have been quite bothersome for you. Is it all over your body or anyone, uh, in any one muscle group?

P: It seems like it's all over.

D: Okay, okay. And um, I'll ask you about a couple other symptoms just to rule out um, any other issues that you might be having. So have you noticed that you've been confused at all over the past few days?

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

D: Have you had any like stiffness or rigidity in your neck?

P: Maybe a little bit of a stiffness in, in my neck.

D: Okay.

P: Then like I, I don't know if that's just the muscle pain. It's like kind of on my upper back, lower neck area.

D: We can definitely um, examine that, um, when I'm doing physical examine and see how that is. Um, okay, and uh, have you had any, um, redness in your eyes, or any teary eyes?

P: No, nothing like that.

D: Do the headaches come and go, or is it always there?

P: Uh, they're pretty much like constant throughout the day.

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

P: Uh no, no I don't I, I think I'm kind of, I'm developing a little cough though.

D: Okay, when did that start?

P: Probably just yesterday I noticed myself coughing.

D: Is it like a dry cough or wet cough?

P: Uh, a dry cough.

D: Any sputum or any blood come out?

P: No.

D: Any sore throat?

P: No.

D: Uh, any chest pain?

P: No.

D: Any difficulties with breathing?

P: Uh, no.

D: Any palpitations, or feel like your heart's beating very fast?

P: No.

D: Okay, any belly pain?

P: No.

D: Any uh, nausea or vomiting?

P: Nope.

D: Any uh, diarrhea or constipation?

P: No, not that I've noticed.

D: Any weakness in any one side of your body?

P: Nope.

D: Any numbness or tingling?

P: Nope.

D: No, okay. Um, any exposures uh, to anyone who could be sick?

P: Um, I haven't noticed, but I, I do go to work, um, and we recently switched to like in person instead of I, I used to do um, home work, but for the last month I've been going into the office.

D: I see, and have you been wearing a mask?

P: Yeah, well I try to wear the mask. Sometimes like uh, in the, in the stock, like lounge, we like take take off the mask to eat and stuff but that's about it.

D: Are you maintaining social distancing when you're taking your mask off?

P: Yeah, it's uh, most of the times we're pretty socially distanced when we're eating, but sometimes it's like hard to control when you know, when you're going near the microwave to heat up your food, and sometimes it gets hard. It's a, it's a fairly small room, so.

D: Yeah, well I would, I would recommend that you try to eat when people are not in the room if possible because you are putting yourself at risk.  Like if it's a small room, I think you should also talk to management or try to limit the number of people who can be in the room at a time. Um, for your own safety, you know, and for the safety of others uh, working with you. Um okay, and um, have you traveled anywhere recently?

P: No, we've been uh, at home.

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

P: I live with my young, like uh, daughter and then my wife as well.

D: Okay, and you, do you think they might have got any contacts to anyone who is sick?

P: Uh no, they've been completely fine. Uh, my daughter is like, is uh, doing school from home right now, so she's not really seeing anyone.

D: Okay, that's good. And um, do you currently smoke?

P: I do, I do smoke um, probably half a pack a day.

D: For how long?

P: Um, for probably the last 20 years.

D: Okay, and do you uh, consume marijuana?

P: Just um, maybe once or twice a month.

D: Okay.

P: Just uh, sometimes, it helps me sleep sometimes.

D: Sure. Do you take any recreational drugs like cocaine, amphetamine, LSD, ecstasy, etc.?

P: No, nothing like that.

D: Any alcohol?

P: Yeah, I drink probably uh, a beer or two every couple days.

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

P: Uh yeah, so I do, they're saying I might have um, high blood pressure. Um they like, it, it's still ongoing. Um they're testing, testing me for things.

D: Sure yeah, and have you uh, taken any medications for it?

P: No, not yet, I haven't been put on any medications.

D: Have you, do you take anything over the counter? Any herbal pills, vitamins, minerals, etc.?

P: No.

D: Okay, and do you have any allergies?

P: No allergies.

D: Okay, good. Um, and have you had any surgeries in the past or any hospitalizations?

P: Um I was pretty young, I had my tonsils removed um, but other than that no no other surgeries or hospitalizations.

D: Good. Any family history of any medical conditions?

P: Um, so I think my mother, she, she has like type 2 diabetes.

D: Okay.

P: And uh, my father has been pretty healthy, like no issues with him.

D: Good. Um, okay, have you had any um, have you had migraines in the past?

P: Um, yeah, sometimes I, when I'm like stressed at work and like I uh, it's not like anything regular that happens to me. I probably have had migraines in the past.

D: Okay, okay, and have you ever been diagnosed with asthma or um, with uh, COPD?

P: No.

D: Okay, alright, um so it sounds like you've had a headache for the past week, which has been kind of constant, about 7 out of 10. And then you've also developed a fever, but you haven't, or I guess you've been feeling, you've been having chills uh, and we can measure temperature here, and you also had a cough that started yesterday. What about um, sense of taste? Have you noticed any changes there?

P: Uh, no, not that I've really noticed.

D: What about your sense of smell?

P: Um, my smell, I don't think so, but like sometimes I do feel a bit, like stuffy as well. Like not, not right now, but before when I felt stuffy I lost my sense of smell.

D: Sure, yeah, okay. Um, okay well that's all the questions I have for you. We'll do a physical exam um, get a chest x-ray done, also examine your neck as well a little bit, just to make sure there's no stiffness or rigidity, have a look inside your mouth, um, listen to your chest.

P: Okay.

D: We will also get a COVID swab done, simply because your symptoms sound very similar to um, or I guess a lot of these symptoms do overlap with symptoms of COVID, so we'll do that. And um, I would require, would request that you continue to uh, stay at home if you haven't been doing so so far. Um, take a leave from work, try to do work from home, and quarantine at home as much as possible and stay away from your wife and your daughter as well, at least until the swab is back and you get some more guidance from uh, public health. If it is positive, they will give you a call. Um, there are lots of guidelines on how to self isolate and I, I can share that with you. Um, it's best that you do that for now. Um, we will run a couple of tests, do labs, and based on those results, uh, we'll decide if you need to stay in the ER or if we can um, if you can be discharged later today. Do you have any questions for me?

P: Uh no that, that all sounds great. Thanks for explaining it to me.

D: You're welcome.

P: Okay.


D: What can I do for you?

P: I've been feeling really, just, bad these last couple of days. I've had these, uh, muscle aches and headache and cough that have been really bothering me.

D: When did all this start?

P: So yeah, about 3 days ago I woke up in the morning with, uh, and yeah, I started having these, like muscle aches and a cough started kind of that day.

D: OK, can you tell me a little bit more about the cough? Is it a dry cough or wet cough?

P: It's a dry cough, I haven't brought up any any sputum and no blood.

D: And the muscle aches, is it all over? is it specific part of your body?

P: Yeah, It's just kinda all over, just feels kind of icky.

D: OK, and has the cough gotten better or worse over the past three days?

P: It's got a little worse. I think I would say it's a bit more frequent. But the cough isn't that bad, but it's gotten worse.

D: OK, and you mentioned headaches. When did those start?

P: So within the last couple of days, yeah, I've had a headache, want to say, most of the time. And I've been using Tylenol or Acetaminophen to help with those. Its taken the edge off of the headaches, for sure.

D: Do you usually get headaches?

P: Every once in a while, maybe once or twice a month, maybe even less than that.

D: Is your current headache similar to the headaches that you usually get?

P: It is, yeah, it's yeah, It feels like my head is being squeezed and I kind of have a pressure, where yeah, that kind of squeezing sensation on my forehead.

D: That front part, both sides, left and right?

P: Yeah, kind of both sides.

D: Is it accompanied with, uh, so is the headache worse when you're in bright light?

P: No.

D: No, OK, is it worse when, are you trying to stay in a dark room with no sound? Is it worse when you're, when people are talking or there's loud noises around you?

P: No.

D: No, any nausea or vomiting?

P: No.

D: Any stiffness in your neck? Any difficulties moving your neck?

P: No, that's OK, I mean a bit, like I don't know, like, kind of achy I guess with my upper back and shoulders feel a bit sore but, yeah I can move my head around ok.

D: Alright, OK and, uhm, let's see. So have you had any fevers or chills?

P: I don't think so.

D: OK, and any sore throat?

P: No.

D: Runny nose, congestion?

P: No.

D: OK, uhm, any other, I guess, any difficulties breathing?

P: No, no,

D: Any chest pain?

P: No.

D: Any palpitations? Do you feel like your heart's racing?

P: No.

D: Any pain your belly?

P: No.

D: Changes in your bowel movements or your urinary function?

P: No, I haven't had any diarrhea, things have been normal.

D: OK, good. OK, I suppose, OK, so you've had this cough and you've had muscle aches and this headache, how has, uh, so you've tried Tylenol, have you tried anything else?

P: No, I just use the Tylenol, and I took a Tylenol cold and sinus at night, which helped with the sleeping.

D: OK, can you tell me if you have any medical problems, any medical conditions?

P: Yeah I have, uh, high cholesterol and yeah, I just have high cholesterol.

D: Any medications that you're on?

P: Yeah, I take a statin.

D: And any allergies?

P: Uh, maybe penicillin, I think I got hives when I was a kid or some sort of rash.

D: I see, OK, and any medical conditions that run in your family?

P: I know my dad had a stroke when he was in his late 70s and my mom had high cholesterol as well.

D: OK, OK, and do you currently smoke? Or have you ever smoked?

P: No, I quit smoking when I had my first kid, so that was about, yeah, that was 17 years ago.

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

P: I smoked about a half a pack per day.

D: For how many years?

P: For about 12 years I guess

D: OK, and do you consume alcohol?

P: Yeah, I'll have three or four glasses of wine over the weekend.

D: Alright, and what about any marijuana?

P: Uh, no.

D: Any recreational drugs?

P: No.

D: OK, do you take any herbal medications or any vitamins or anything else over the counter?

P: Yeah, I do take magnesium and, like, vitamin D and, uh, a multi vitamin.

D: And, do you, have you had any contact with anyone who is sick or you think might be sick?

P: I don't think so, um, everybody in my family has been been OK.

D: Have you had exposure to anyone or met anyone who you think might have had covid?

P: Uh well, I did go to a family party, just last weekend. It was outside and we were maintaining distancing, but, yeah.

D: Are you vaccinated?

P: No, not yet.

D: No, OK, alright, OK, so you've had this dry cough and muscle aches and headache for the past three days or so and your symptoms are getting a little bit worse or your cough's getting worse for the past three days. We're gonna, it could be that you have some sort of a viral infection like an upper respiratory infection but you might also or you could possibly have covid, so we'll do a covid test, and I just recommend that you stay hydrated and continue to eat and drink well and and monitor your symptoms. Take Tylenol, it sounds like Tylenol has been helping a little bit, continue to take Tylenol, get lots of rest and if you have any shortness of breath, or if you feel like your symptoms are getting worse call 911 for help if your concerned about your health at all. And we'll get a covid test set up for you.

P: OK, thank you.


D: What brings you in here?

P: I've had this cough for over a week now, and it just hasn't gone away.

D: OK, and uh, so this cough has been going on for a week. Can you describe the cough a little bit for me?

P: Yeah, so I mean sometimes I produce sputum and sometimes I don't. It's uh, white and whiteish clear in color.

D: OK, um, and it's been going on for more than a week.Has it been getting worse?

P: It got a little bit worse at first, but then it's been kind of the same, um, since.

D: OK, have you noticed at all, um, like green or yellow color of your sputum or any blood tinged sputum?

P: Uh, No blood, and maybe a little yellowish.

D: OK, little yellowish, OK. And how much would you say you bring up, um, on an average day?

P: Uh, a couple of teaspoons.

D: Couple of teaspoons OK.OK, has there been anything that um, makes it worse or better?

P: Nothing that I can think of.

D: OK, and have you had this happen to you previously in the past?

P: No.

D: And is the cough uh, constant or does it come and go?

P: It comes and goes, uh, throughout the day. No particular time of the day it's worse.

D: OK, and, um, are you having any, uh, other symptoms besides the cough, um, like shortness of breath,sore throat, um, runny nose, congestion, anything like that?

P: Uh. yeah, I've had, um, a sore throat, uh, and a headache, as well.

D: OK, and when did the sore throat start?

P: Um, that started about five days ago.

D: Five days ago? And has it been getting worse?

P: No, that's been about the same.

D: And do you have any difficulty, uh, swallowing at all?

P: It's a little sore, but, uh, it's been OK, to eat and drink.

D: OK, and have you noticed any kind of redness in your throat or any swelling around your neck?

P: No, I took a look in the mirror as best I could with my phone and I couldn't really notice anything that looked red.

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

P: So it's been, uh, kind of off and on over the past, uh, week or so. Um, feels like a like a pressure sensation and my head is just really squeezing.

D: OK, and um. So is it on one side of your head or both sides?

P: Both sides.

D: And it's Kind of like a pressure and squeezing. Is it at all pulsating?

P: No

D: No? OK, Is it constant or does it come and go?

P: It comes and goes.

D: OK, and have you taken any medications to make any of these symptoms better?

P: Yeah, I have used some Advil for the headaches and over the counter medicine at night time to help sleep.

D: OK. Uh,and do you recall doing anything in the last few weeks which you might believe that Uh, caused some of these symptoms? like for example, were you in contact with anyone that was sick at all?

P: Well, I'm a nursing student and I've been on rotations in the hospital recently.

D: And anyone that you probably saw in the hospital, anyone sick that you were in contact with?

P: I did see some people who had, like, infectious symptoms.

D: OK, and other than that, have you been having any fevers or chills?

P: Yeah, I've felt chills.

D: OK chills, and when did you feel them?

P: I've been feeling chills throughout the day and at night, I just feel like I can't get warm even with a blanket on.

D: OK, and have you taken your temperature at all?

P: No.

D: OK yeah, we can do that for you today. Uh, other than that any recent travel outside of the province.

P: No, been just at school.

D: OK, and any loss of sense of taste or smell?

P: No.

D: Any nausea or vomiting?

P: No.

D: Any night sweats?

P: No,

D: OK, any fatigue?

P: Yes.

D: OK, and When did that start?

P: Just over this past week I've been really tired, I've been been needing naps and not feeling rested in the morning.

D: OK, any chest pain at all?

P: Yeah, It does feel sore, kind of, uh, the center of my chest.

D: OK, so any coughing at all?

P: Yeah, I feel it, like more, like it does hurt when when I'm coughing, that's kind of what I'm feeling it. I think it's being caused by how much I'm coughing.I kind of feel it there in the center.

D: And besides, when you're coughing, do you have any pain in your chest when you're breathing in or out?

P: No,

D: No? OK. Alright, any changes to your bowel movements, like any Constipation or diarrhea?

P: No.

D: Any urinary issues?

P: No.

D: OK, any changes with your sleeping or your appetite?

P: No.

D: Have you noticed any significant weight loss in the last few weeks?

P: No, it's been the same.

D: OK. And have you recently, prior to your coughing, have you had any infections like a viral illness or like a cold for example, anything like that?

P: Yeah, now that I think about it, I mean, maybe like a month ago I had like a runny nose for a couple of days and it just went away.

D: OK, were you on any kind of medications or antibiotics at all?

P: No, just went away on its own pretty quickly.

D: Alright, do you have any past medical conditions, like high blood pressure, diabetes, anything like that?

P: No, I don't, I'm healthy.

D: OK, do you have any allergies?

P: No.

D: Do you take any medications regularly?

P: Uh, no.

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

P: No.

D: OK, and any family history of any lung or heart conditions or any cancers?

P: I think my mom has high blood pressure, but that's about it.

D: OK. I forgot to ask you this earlier. Have you been experiencing any wheezing?

P: Yeah I have noticed a bit of a wheeze, yes.

D: And currently you are nursing student. Where do you live?

P: I live with a couple of my classmates downtown.

D: OK, and do you live in an apartment or dorm, a house?

P: An apartment.

D: OK, anyone sick in your household at all?

P: No, nobody's been sick.

D: OK, do you drink alcohol at all?

P: Sometimes with friends, on a weekend.

D: Do you smoke cigarettes at all?

P: No, I don't.

D: And any recreational drugs like marijuana?

P: Nope.

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

P: No, I was just hoping to feel better. It's been going on for so long now.

D: You said it's more than a week now, right?

P: Yes.

D: Yeah, so what we will do today is, uh, first of all, with the pandemic going on, with some of these symptoms, we need to rule out coronavirus. And so we will be getting a swab done for you as well today and considering you are having these symptoms, we will also get another test done for you today to see if there's any bacteria causing what we call walking pneumonia. It's community acquired pneumonia that's fairly common in like the younger population. And so we'll see if you could have that. And so from there we'll see if we need to put you on any antibiotics which will help you. And if we need to get any blood work or X Rays we'll let you know as well. Is that OK? And if you feel like you have worsening symptoms like shortness of breath, you need to make sure you come back to the Emergency Department.

P: Yeah, that sounds great. Thank you.

D: Yeah, you're welcome and take care, and we'll get all those things done for you and we'll be with you shortly.

P: OK, sounds good.

D: Great.


D: Uh how may I help you today?

P: Hi, I've been um just having this just sore throat for the last uh let's say three or four days.

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

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

D: OK, have you noticed any changes to your voice? Like having a hot potato voice or or feeling as though your um your throat is kind of closing off?

P: Um not closing off, but like I definitely do uh, maybe a little bit of hoarseness, but not not too much. Mainly it's just the pain that's concerning me.

D: OK, and have you had uh a cough?

P: Uh no, I haven't had a cough at all.

D: OK. Um and have you had any um, any neck swelling?

P: Um I I I have actually noticed like a little bit of neck swelling just right at the front on both um, yeah, just at the front.

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

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

D: OK.

P: And just kind of like at the front, front of my neck.

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

P: Yeah.

D: OK. Um and have you had any uh fevers or chills?

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

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

P: Yeah, I would say so.

D: OK. Um And have you had any headaches?

P: Um no, no headaches.

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

P: No, nothing like that.

D: Have you had a runny nose?

P: No.

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

P: No, nothing like that.

D: OK. Um and have you had any any shortness of breath or difficulties breathing?

P: Uh no, no shortness of breath.

D: Have you had any wheeze?

P: No, no wheeze.

D: OK. Have you had any um any chest pain?

P: No chest pain.

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

P: Nope.

D: OK, do you feel like you're breathing faster or your heart's beating faster?

P: Uh, no, I haven't really felt that no.

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

P: No.

D: How about any nausea or vomiting?

P: Um not, no, I haven't felt that at all.

D: OK, have you have you had any diarrhea?

P: No.

D: Have you had any urinary problems?

P: No.

D: OK. Have you had any any um skin changes or rashes anywhere?

P: Uh, no, not that I've noticed.

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

P: Nope.

D: OK. Have you had any um any symptoms like this before?

P: Uh, no, not that I can recall. Um maybe when I was like like 7 years old like I may have had like a sore throat.

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

P: No.

D: OK. Um and uh so do you take any medications or anything over the counter?

P: Um I've tried like Tylenol cold, but it didn't really work.

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

P: No.

D: Are your immunizations up to date?

P: Uh yeah, they're all up to date.

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

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

D: Alright, excellent, and have you traveled anywhere recently?

P: No, I I've mainly stayed at home, I I'm mainly doing virtual school.

D: OK, have you been around anybody who's been been sick?

P: Um my my sister she she just got back from college and she she was complaining of like a sore throat uh two weeks ago.

D: OK, I see. Um uh who are you living with currently and where are you living?

P: So I'm living with my parents and my sister at, in a in a house just outside of the city.

D: OK. Um and is your sister doing better now or um what happened with her?

P: Yeah, yeah, I'm not sure, I think she did go to the doctor, now she's doing better. She did get some medications but I don't know what they were.

D: OK, I see. Um and uh I know some people in your age group will sometimes experience with uh like smoking or anything like that. Do you um do you smoke cigarettes or any of your friends?

P: No, I haven't I haven't done that.

D: OK, this same type of questioning for uh cannabis and alcohol. Um have you experimented with any of those substances or any recreational drugs?

P: No, not at all.

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

P: No.

D: OK. Um and how's school going?

P: Uh school is going well, like uh it was uh it was weird adjusting to all the online stuff, but now I feel like I kind of got the hang of it.

D: OK, excellent. Um and um any concerns for um like safety at home? Anything that we talk about is, uh, is confidential.

P: No, I have a pretty pretty loving family.

D: OK, well that's great. Um and I just wanted to finish here with your family history. Um does anybody in the family have heart or lung conditions?

P: Uh, no, they they're pretty healthy, my mom and dad.

D: OK, and any uh other conditions that run in the family?

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

D: OK. Um uh so that was everything I wanted to ask um on the history today. Did you have any other questions for me or anything that that I didn't ask about you wanted to mention?

P: Uh no, nothing that I wanted to ask, just uh was just wondering if I need any medications.

D: OK, yeah, so um it's possible, so based on your symptoms currently it does suggest that uh it it is a bacterial cause with uh, since you don't have a cough and you have um like it sounds like sounds like lymph node enlargement. Um we'll we'll look and see if there's exudates or or purulence on your um, that we can see in your in your throat as well as checking temperature and do a rapid strep test. Um see if um if that's the cause, and if so, um then yeah, there will be a course of antibiotics um will be required, but um we will uh wait for um the physical exam and then the uh the rapid test.

P: Alright, sounds good.


D: What brings you in?

P: So I've had a fever that I measured this morning and I had a cough.  I've had a cough these last several days. Yeah, today is Friday so it started Monday, so I guess like yeah the cough started four days ago.

D: OK, and the fever started four days ago as well?

P: Well, I've been feeling hot this week, but I checked my temperature this morning and it was the first time I checked it and it was 38.5.

D: OK, so that's definitely a fever, so we can take your temperature today as well. Umm, so have your symptoms been the same or getting worse, or be getting better over the past few days?

P: They are getting worse. I've been starting to feel really fatigued and, uh, tired as well and the cough has gotten worse too.

D: OK, have you ever felt like this before?

P: I mean, maybe a really long time ago when I was a kid or something like that. Maybe I had the flu, but nothing recently.

D: OK. And do you have a sore throat at all?

P: No sore throat. It does get a little scratchy with my cough but hasn't been sore.

D: OK, and do you have any issues swallowing food?

P: No, but I haven't been as hungry.

D: OK, you haven't been as hungry. Um, have you had any changes to your taste?

P: No, I feel like I've been tasting my food OK.

D: OK, how about smell?

P: I feel like I've been able to smell.

D: OK, do you have a runny nose or a blocked nose? Do you feel congested?

P: Maybe a little runny, but not too bad.

D: OK, how about your hearing or vision? Any changes there?

P: No, I haven't noticed anything.

D: OK, any pain or discharge from either your ears or eyes?

P: No, nothing like that.

D: OK, so let's go back to the cough. Um, are you producing any sputum?

P: No sputum.

D: OK, so it's a dry cough?

P: Yeah it is.

D: OK, any blood associated with the cough?

P: I haven't seen any blood.

D: OK, do you feel wheezy at all?

P: I haven't noticed any wheezing.

D: OK, how about shortness of breath?

P: Usually well, after some of my coughing fits, I can be a little bit shorter in breath, but otherwise they've been.

D: OK, any chest pain?

P: No, I haven't had any chest pain.

D: Do you ever feel like your heart's racing?

P: No, I don't.

D: OK, and any night sweats or chills?

P: I have felt a little chilly at night, but I haven't had any night sweats.

D: OK, and how about weight loss? Have you had any weight loss over the past few months?

P: No, it's been about the same. Maybe down a few pounds over this week as I just haven't been eating as much.

D: OK, yeah. Umm, does anything make the cough better or worse?

P: Umm, no, I can't think of anything.

D: OK, and how have your bowel movements been?

P: They've, I would say they've been normal.

D: OK, and any abdominal pain?

P: No pain, but I have been a little nauseous.

D: Nauseous, OK. Have you thrown up?

P: No, I haven't vomited, but I've certainly felt like it a few times.

D: OK, and any triggers for your nausea?

P: Oh I can't think of anything. It just sort of came on. And it really went away on its own pretty quickly, but uh I don't know, maybe it was when I had my headache.

D: OK, when when did your headache start?

P: Um, so it's been on and off these last several days so I've been kind of resting a bit more too.

D: OK yeah, you said past several days, have you ever had headaches before that?

P: Yeah, I've had, I think they're called tension headaches. I get those every so often and will take Advil or something like that for them, and they usually go away.

D: OK. Do these headaches feel like the same headaches?

P: Yeah, they they feel about the same, kind of like a pressure or vice grip on my head.

D: OK, so it's not like the worst headache you've ever experienced?

P: No, I think it's just been a part of how I haven't been feeling well these these last few days.

D: OK, yeah. Do you feel fatigued or tired at all?

P: Yeah, for sure. I haven't really had any changes, but just haven't been really getting my work done throughout the day because I have just been feeling so tired.

D: Yeah, umm, and do you feel any sort of body aches that go along with your fatigue?

P: Maybe a little.

D: OK. Umm, can you think of anything that may have caused your symptoms? You know, have you been in contact with anyone who's been sick recently?

P: I can't think of anybody I've been around who's been sick, but last weekend I went shopping in the mall so I went into quite a few stores.

D: OK, and you were wearing your mask? Everyone else was wearing their mask?

P: Yeah, everybody far as I could tell.

D: OK, have you traveled anywhere recently?

P: Uh, no, I've just been home.

D: OK, I just want to ask you a few more questions. Any memory loss or confusion?

P: No.

D: Any dizziness or fainting spells?

P: Nothing like that, no.

D: OK. Are you otherwise healthy?

P: Um, yeah I've well, I've been told I had high cholesterol so I've been taking Rosuvastatin for that the past few years.

D: OK, and is it helping with the cholesterol levels?

P: Yeah, the last time I was at the family doctor I was told they were at a good level. O

D: OK, good.

P: I'm sorry I'm pre-diabetic as well.

D: OK, when was the last time you had blood work done?

P:: I think, uh six months ago.

D: OK, and that's when you were told you were pre-diabetic?

P: Yeah, I think my A1C was like 6.2% so uh, on the cusp.

D: OK, yeah, that's understandable. Um, have you made any sort of lifestyle changes to get your blood glucose under control?

P: Well, I have been walking the dog more. he weather is getting better and trying to eat out less often. Yeah, I've been trying to lose weight, but it it's been yeah, relatively stable still.

D:OK, we can review some options with you later on in the visit if you would like.

P: Yeah, certainly we can talk about that later.

D: OK, sounds good. Have you had any surgeries or hospitalizations in the past?

P: Yeah I had an inguinal hernia repaired about five years ago.

D: And are you on any medications?

P: Just Rosuvastatin right now.

D: OK, and any over the counter medications or herbal supplements?

P: Just a multi vitamin.

D: OK, umm, do you have any allergies?

P: Penicillin. I break out in hives.

D: OK, and did you need to be treated with any sort of antibiotics recently?

P: No, no, I haven't had any antibiotics for a long time.

D: OK, and are you up to date with all your immunizations?

P: I am, yeah, I get the flu shot every year.

D: OK, good. An yeah, that's really good. Um, do you know if you have any family history of any lung conditions or heart conditions?

P: No, I don't think so.

D: OK, how about cancers in the family?

P: I think my grandfather had bladder cancer, but, uh, I'm not sure.

D: OK, and I forget if I asked you earlier, but have you had any changes to your urinary habits, any changes in your urine itself or voiding frequency?

P: No, I haven't had any changes there and I haven't noticed any like blood or color changes. No pain.

D: OK, great. And do you smoke?

P: Um, no I do not.

D: OK, how about marijuana?

P: Nope.

D: Any other recreational drug?

P: No, I just have a few beers on the weekend. Like probably I don't know two or three on Saturday and Sunday.

D: OK, and where do you live?

P: I live in a like duplex and rent the basement in a house nearby.

D: OK, do you live with anyone?

P: Yeah, I live with my girlfriend.

D: OK, and um, any concerns for you know old carpets or mold or asbestos in the duplex that you're living in?

P: Not in our unit so I mean, maybe upstairs, but if it's anything like our place, then no.

D: OK. I think those were all the questions that I had for you. Did you have any questions or concerns that you wanted to bring up before we end the interview?

P: Uh, no, well  I guess I was just concerned about about COVID.

D: Yeah, you know that's the top on my list of differential diagnosis for you. So what we'll do is a COVID swab and that should come back in a day or so, but we do encourage isolation for 14 days and that includes from your girlfriend as well. So even if the COVID swab comes back negative, sometimes it can be false negative, so as long as you're having these symptoms, and these symptoms are common in COVID,  we do ask that you isolate for 14 days if the swab comes back positive. We will also notify public health so that they can get in touch with you and do some contact tracing to see where you may have gotten COVID from, but other than that, if it's not COVID, it could likely be another upper respiratory viral illness because of this time of year. A lot of different viruses are going around like common viruses or the flu, you know, so it could be one of those. And then if you're still sick or your symptoms change, we can reassess to make sure it's not a bacterial infection or bacterial pneumonia, in which case we can prescribe antibiotics.

P: OK yeah, thank you for all that information. Sounds great.

D: OK, well take care then, alright.

P: Thank you.