D: Would you mind by starting to tell me what brought you in?

P: Sure, my 5 year old daughter, I noticed that she's been coughing a lot over the past two days. She sounds like she has a stuffy nose and now she's got this pink eye so I just wanted to get it checked out by you.

D: Yeah, for sure. So the cough started 5 days ago?

P: Two days ago.

D: OK and is the cough barky or harsh sounding?

P: Yes, it sounds harsh.

D: OK, alright was there anything that changed two days ago that might have triggered the cough?

P: I don't think so, although she does go to daycare.

D: OK, uh and so has she been bringing up any sputum with the cough?

P: No, no sputum that I've noticed.

D: OK, notice any blood?

P: No.

D: Alright, and is the cough worse at any particular time of day?

P: No.

D: OK, and has there been any wheezing?

P: No, not that I noticed.

D: OK. And you mentioned the red eyes. When did you notice that?

P: That was just yesterday.

D: OK, any discharge from the eyes?

P: No.

D: OK, nothing like that? No tearing or anything like that?

P: No.

D: OK. Umm and has she complained about any like changes to vision?

P No, not really, just the pain.

D: No. OK, uh, and how about any itchiness in the eyes?

P: She's been rubbing it and so it's possibly itchy.

D: OK. And have you noticed any mucus coming out?

P: Umm, no, it's actually stuffy.

D: OK

P: Yeah, not so much mucous.

D: OK, has she mentioned anything about losing smell?

P: No.

D: OK, umm and has she mentioned anything about being congested?

P: She just sounds like she's congested.

D: OK. Umm any sore throat?

P: Umm, possibly.

D: OK, how has she been eating?

P: Um, she's been eating OK. I guess she's been eating alittle less than usual.

D: OK umm, would you say that she's been going to the bathroom as often as normal?

P: Yep, I would say so.

D: No changes there, OK. Um and has she had any loss of taste?

P: Umm, possibly since she's not eating as much.

D: OK. Any fevers or chills?

P: Um, she did feel a little bit hot, but I didn't take her temperature.

D: OK, so hot. We will definitely check for fever today. Any night sweats?

P: Umm, no.

D: OK. And has she been gaining weight OK?

P: Yep, Yep, no change, nothing abnormal there.

D: OK, and has she been complaining about having any stomach pains?

P: Umm, no.

D: OK, has she had any nausea or vomiting?

P: Um no no.

D: OK, and how about any painful urination?

P: No.

D: OK, and any diarrhea?\

P: Umm, no.

D: OK, and has she mentioned anything about headaches?

P: No.

D: OK. And how about any aches or pains anywhere?

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

D: Have you noticed any rashes?

P: No.

D: OK, and has she been diagnosed with any conditions before?

P: No.

D: OK. And any reason for her to be hospitalized?

P: Uh, no.

D: OK, um does she take any medications regularly?

P: Um, no.

D: OK, does she have any allergies to medications?

P: Umm, no.

D: Alright, any surgeries before?

P: Umm, no.

D: Any concerns with her growth or development?

P: Umm, no, everything's been pretty normal.

D: OK, and any concerns about her vision or hearing?

P: No.

D: OK. And can tell you tell me a little bit about the living situation currently? Are you the primary caregiver?

P: I am.

D: OK, and who else is in the home?

P: Her father.

D: OK, are there any pets around?

P: No.

D: Alright. And does anybody in the house smoke?

P: No, no one smokes.

D: OK, any exposures in the house to like carpets or dust or inhalants that might bring on a cough?

P: No.

D: OK. Ummm and uhh anybody in the family been sick?

P: No.

D: OK, and how about anybody you mentioned at the daycare? Was anybody been sick there?

P: No, I don't think so. I contacted them and checked, but it seems like no one's been sick.

D: OK, and you say you haven't traveled anywhere?

P: Oh no, no, not recently.

D: OK. And any lung conditions or heart conditions that run in the family?

P: No.

D: OK, and how about any genetic conditions or congenital conditions in the family?

P: No, none, none that I know of.

D: OK, so the main symptoms are the cough that started two days ago and also you've noticed she's been congested. And sorry, what was the last symptom?

P: She has this pink eye and she has a cough.

D: Yeah, right, that could be conjunctivitis. OK, so at this point we will certainly run some investigations to look into what this could be. It sounds like a viral infectious type of process, especially if it's involving the eyes, nose, and and with a cough. And so we will test with a swab for covid for sure. But it could be something more common, like the common cold. We just need to make sure that we're comprehensive in that with the testing.

P: That sounds great, thank you.


D: How may I help you?

P: Hi, yes it's nice to meet you. I've been having this cough that's been going on for the last few days and I have had difficulty breathing.

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

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

D: OK, well let's focus on the shortness of breath first and then we'll talk about your cough as well. So you noticed that you had difficulties with breathing sometime within the past three days. When do you find that it's difficult for you to breathe? Is there anything that makes breathing more difficult for you?

P: Yeah, not really. Actually, it's been well, but just bad after I cough.

D: So say walking up the stairs or doing any exercise doesn't make it worse?

P: Not really, I've been able to do the same amounts of of activity I guess.

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

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

D: OK, and your cough, you said that started three days ago. Is it a dry cough or wet cough?

P: It's dry. It's a dry cough.

D: OK, and there's no sputum production with it? Anything coming up at all?

P: No, I haven't noticed anything like that.

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

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

D: OK alright. Other than the difficulty breathing and the cough, have you noticed any other symptoms?

P: Yeah, I've been really tired. I guess I've just sort of been  resting the these last few days and I've had a headache as well.

D: OK. Can you tell me a bit more about your headache?

P: Yeah, it feels like somebody is just squeezing the top of or just squeezing the sides of my head.

D: Have you had a headache like this before?

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

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

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

D: And so you talked about being tired, having a headache, difficulties breathing, and coughing over the past three days. Have any of these symptoms gotten worse overtime?

P: Yes, I would say, but both the cough and the shortness of breath has been getting worse over these last few days.

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

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

D: We can check your temperature here. And have you had any muscle aches?

P: Yeah, I guess I felt a bit achy.

D: Any redness in the eyes? Or any runny nose or sore throat like flu-like symptoms?

P: Umm, I have, I don't know maybe my nose is a little bit congested, but not really running.

D: OK. And have you had any change in your sense of smell?

P: No, I haven't noticed that.

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

P: Yeah, I think so.

D: Have you noticed any rash anywhere on your body?

P: Umm, no,  I haven't.

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

P: No, no, nothing like that.

D: Any chest pain?

P: No, I haven't had any.

D: OK. Alright, well it sounds like you have multiple symptoms right now that started about 3 days ago. You're feeling tired, you have a headache, difficulties breathing, some muscle aches and you've been feeling feverish. You've also had this cough, and your nose is feeling congested. Is there anything else that that you've been experiencing over the past three days that I haven't talked about yet?

P: No, as you mentioned, the headache's there too, then yeah, that's everything.

D: OK, umm, alright, can you tell me about your past medical history? Do you have any medical conditions?

P: Yeah, I have asthma and GERD I think.

D: Umm, does the shortness of breath that you're experiencing feel similar to the asthma attacks in any way?

P: No, I haven't had any issues with like asthma attacks in a long time.

D: Do you have an inhaler?

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

D: I see, did you use it over the past three days at all?

P: Yeah I did try it and it didn't really seem to help that much.

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

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

D: Any reason for that?

P: Uhh, my father had colon cancer when he was in his 60s.

D: I see OK, and any hospitalizations?

P: No.

D: OK. Do you take any medications? I know you have puffers. Any medications, including over the counter pills?

P: Yeah, I'll take like a Zantac or like Tums sometimes for reflux.

D: And, uh, any allergies to food, medications, or environmental allergies?

P: Yeah, I have environmental allergies. I think like usually they come on in the springtime.

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

P: Umm, no.

D: OK. And do you currently smoke?

P: No, I don't and have never smoked in the past.

D: OK, what about marijuana?

P: Umm, no.

D: OK, do you or have you ever had alcohol?

P: I will have some wine on the weekends, maybe a glass or two with dinner.

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

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

D: Alright, sounds good, and have you had any contact with any sick people? Anyone who's sick recently?

P: Not that I know of. I mean, I went to a few stores here and there that I had been going to. I've been working from home so maybe at one of the stores. And I would imagine I were wearing a mask and of course trying to maintain social distancing as much as possible. But yeah, you never, really know.

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

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

D: Alright. So I guess that's all I wanted to know. I'll go talk to the attending and we'll come back and do a physical exam and maybe ask a couple more questions and then discuss the management with you. Does that sound good to you?

P: Yeah, that sounds great.

D: Thank you. OK alright.


D: What can I do for you?

P: Hi, so yeah, so I just came in here today at I've been having just this congestion around my nose and face like it's just something that just started an around 5 days ago. And it's been getting worse, but I started to get like these headaches as well as just pain around my cheeks.

D: OK. It all started about five days ago. OK alright. Have you, can you tell me about your headaches?

P: Yeah, so there, I started getting these headaches just two days ago, but like it's more than a headache, it's kind of mainly over the cheeks and then it goes and just above the nose

D: I see.

P: The light kind of up into the forehead.

D: Yeah, do you feel like it's worse when you're bending down or squatting?

P: How I'm not sure, actually.

D: OK. Alright, and do you have any other symptoms? Do you have a runny nose or sore throat or cough?

P: Uhm, I don't have a cough. I don't have a sore throat. I do sometimes get a runny nose though like every every now and then.

D: OK. In the past five days?

P: Yeah, I probably had like, it's usually in the morning I sometimes get a runny nose.

D: And what what comes out of your nose? What do you see?

P: Uhm, over the last week it's kind of like almost like a yellowish discharge.

D: Have you had any difficulties breathing?

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

D: Like that OK. Have you uhm had any chest pain?

P: No.

D: OK. Uhm any other any other symptoms that you've experienced over the past five days?

P: I also like I. I do also feel like a fullness and pressure going into my ears as well. And then I'm not sure, but yesterday I was feeling a little warm throughout the day. I didn't get a temperature but I don't know if I had a fever or not.

D: Have you had any I guess like weight loss or any night sweats?

P: No.

D: No. OK. Any muscle aches?

P: No, not that I know.

D: Any fatigue or malaise?

P: I have been feeling a bit tired over the last few days, but I'm I don't know if that's because of this.

D: Have you had contact with anyone who could be sick in the past week or two?

P: Uhm, my my daughter actually had a sore throat, just a, her last week, and she went to see a doctor.

D: Uhm, do you know if she had a COVID test done?

P: Oh yeah, she she did have a COVID test done, that was negative.

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

P: Uh, I just have a high cholesterol and high blood pressure.

D: Do you take medications?

P: Yeah, so I just take umm, it's like a thiazide diuretic for blood pressure and then just Atorvastatin for cholesterol.

D: Any allergies?

P: Uh, no, no allergies.

D: Any medical conditions that run in the family, including any heart conditions or lung conditions or cancers?

P: Uhm, yeah, so hard conditions, both my dad and uncle have had heart attacks in their 50s. But yeah, that's that's it. That's all, that's all that I know and we also have cancer on my mothers side. My uncle from my mothers side had bladder cancer.

D: OK. OK. Uhm, and do you you mentioned that you have a daughter. Do you, who do you currently live with?

P: I live with my two daughters and my wife.

D: OK, and what do you do for, do you work?

P: Yeah, currently I'm working from home. I'm an accounting clerk.

D: Alright, and do you smoke at all or did you smoke in the past?

P: Yeah, I I, I do smoke but I've cut down significantly in the past few years. I currently only smoke, uh, probably two or three cigarettes a day. I was, I was smoking like almost a pack a day a few years back.

D: Oh, that's great. It's great that you're trying to cut down. Do you intend on getting the getting down the smoking even further?

P: Yeah, that's that's the plan. If I can do that, hopefully by the end of this year, that would be great.

D: That's wonderful. Do you smoke marijuana at all?

P: No.

D: Uh, do you smoke any recreational drugs?

P: No.

D: Any alcohol?

P: Alcohol, just, uh, probably just on the weekends or have a couple of beers.

D: OK alright, uhm. So, I guess from the symptoms that you've described, it sounds like you likely have a condition called acute rhinosinusitis where you have inflammation of the sinuses in your face and potentially some inflammation in your nose as well, and often it's caused by a virus and it usually gets better in a couple of weeks. And the best thing to do is just conservative management. Try to rest and, if, if you know taking any medications, over the counter medications is helping you feel better, if you feel like Tylenol, sort of reducing some of that pressure or if doing a, taking a steam bath is sort of helping relieve that pressure, try those. Drink a lot of water to try to sort of lear out all that mucus that's that's building up. I'll also do a physical exam and talk to my attending and confirm all this information with him and we can go from there.

P: Great sounds good, thank you.

D: Uhm, also sorry before for in the call because the symptoms are started recently and they do uhm, overlap with some of the symptoms that if patient with COVID might have, it might be a good idea to get a COVID swab done as well, so we'll do that today and you would have to quarantine and stay away from the people at your home as well, until the results are out, and then if it's positive, public health will let you know what to do.

P: Alright, sounds good. Thank you so much.

D: Welcome.


D: How may I help you?

P: I'm here because um I've been having some pain in my left knee for the past two months and it's not getting better. It feels stiff and um I just haven't been able to uh, you know, use it as well, as well as I was using it before um and it's just limited some of my daily activities.

D: OK, um, and where, uh so it's, the pain is in your left knee. Where are you feeling this pain specifically? Is it at the front of the knee, the sides, or or the the back? Could you point to it?

P: It feels like it's mostly on the front.

D: OK.

P: Like deep within that um kneecap.

D: OK, and you said the pain started two months ago?

P: Yes, well, it's always been a little like tender. Um but now it's more painful.

D: OK. And so, so has it been getting worse?

P: I would say so, slowly getting worse.

D: OK. Uh and when you get uh pain in the left knee, how long does it typically last for?

P: It usually hurts while I'm doing, while I'm moving it, or just after, but if I if I rest, the pain eventually goes away. Um but when I first wake up in the morning, that joint feels stiff. And then when I start using it, using it more, it's less stiff, but it becomes painful.

D: OK, so you have some stiffness in the morning?

P: I do.

D: OK, and how long does it last for? Like 30 minutes, 60 minutes or or longer?

P: The stiffness or pain?

D: Yeah, the the stiffness.

P: Uh the stiffness goes away in like yeah 15 to 30 minutes.

D: OK, and how would you describe the pain, um in terms of its character?

P: It feels, it feels uh, I guess most of the time it's like it's like a dull kind of pain, but it can be sharp.

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

P: Just with a lot of activity it gets worse.

D: And you feel it radiate anywhere else?

P: No.

D: OK, and how would you describe the severity of your pain on a scale of 10 being the worst pain you've ever felt, and 1 being kind of very minimal pain.

P: Uhm, I would give it maybe uh 7.

D: OK. And have you had any injuries to your knee before?

P: No, not that I can think of.

D: No, OK. Um and have you been having any uh any weight loss recently?

P: Uh no, weight gain.

D: Weight gain, OK. How much weight have you gained over the last uh several months?

P: Over the past six months, I'd say I've gained about 20 pounds.

D: OK, have you had changes in your diet and or exercise?

P: Um I guess I've been eating a little bit more, um but no changes in exercise.

D: OK. Um have you been having any fevers or chills?

P: No.

D: OK, how about any night sweats?

P: Uh, no night sweats.

D: OK, um have you had any changes to your vision or hearing?

P: No.

D: OK. Have you had any changes to your uh sense of smell or sense of taste?

P: No.

D: OK, have you had a runny nose or or a sore throat?

P: No.

D: Have you had a cough or or any shortness of breath?

P: Uh no nothing like that.

D: OK, how about any uh wheezing?

P: No wheezing.

D: Alright, any chest pain or heart palpitations?

P: No.

D: Alright have you had any lightheadedness or dizziness?

P: No.

D: Alright, and any confusion or memory loss?

P: No.

D: Alright, and have you had any changes in appetite, like a loss of appetite?

P: Uh no, I, if anything, had a gain in appetite.

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

P: No.

D: How about any abdominal pain?

P: No.

D: Alright. Um and how about any urinary problems?

P: Uh no urinary problems.

D: Um any changes to your bowel habits, like diarrhea or blood in the stool?

P: No.

D: Alright, and have you had any rashes or skin changes or changes to your hair or nails?

P: No, nothing like that.

D: OK, and any other joint pains? Or have you or do you have any joint swelling?

P: Uh I have some joint um swelling. It's it's not very visible, but it's it appears slightly more swollen than my left, sorry, than my right knee.

D: OK. So just a little bit of swelling in your left knee, but no other joints?

P: No.

D: OK, um and have you been diagnosed with any medical conditions before?

P: Um I have um diabetes, high blood pressure and high cholesterol. And I'm overweight.

D: OK, do you take any medications for any of those conditions?

P: I'm on insulin for diabetes. Um I'm on Ramipril for high blood pressure and I'm also on a statin for the cholesterol.

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

P: No.

D: Alright, and uh, have you had any surgeries in the past?

P: No.

D: Alright, and um are your immunizations up to date?

P: I think so.

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

P: Um I live with my husband in a house downtown.

D: OK, um and are you working currently?

P: No, I retired early.

D: OK, um do you drink alcohol?

P: Um I'll have a glass of wine every night.

D: OK, so about 7 drinks per week?

P: Yes.

D: OK, and um, do you smoke cigarettes?

P: Uh no, I don't.

D: Alright, how about the use of any recreational drugs like cannabis or uh or anything else?

P: No.

D: Alright. Um and is there any, uh, like musculoskeletal or like autoimmune conditions that run in the family?

P: Uhm no musculoskeletal issues uh that, I know diabetes runs in the family.

D: OK, um alright, so that was everything I wanted to ask on history. So next I just wanted to do a physical exam, and just looking at the left knee, are you seeing any um swelling or redness uh on the knee?

P: Um it appears slightly more swollen than my right knee.

D: OK, but are you seeing any redness?

P: No redness.

D: OK, and are there any temperature changes? Like does the knee feel hot or or warm?

P: No.

D: OK, and if you um press along the uh joint line, do you feel any pain?

P: Uhm yeah, it feels a little tender.

D: OK. And how about pain over any of the muscles, like the thigh muscles or the hamstrings or the calf muscles?

P: No, those are fine.

D: OK, and then how about any pain over the patella or kneecap?

P: That that's a little bit more painful.

D: OK, and are you able to bend your knee uh like like flex it, straighten it?

P: Uh I can do that, it's just painful when I do that.

D: OK. Um and uh and then how about walking, are you um, do you have an antalgic gait or or or a limp?

P: Uhm no, no, well, I guess I'm I'm putting more weight on my right knee so it might appear to some people that I do have a slight limp.

D: OK. And any issues with moving your hip or your ankle?

P: Uh no.

D: OK, um so I think that was everything I wanted to ask and check today. Did did you have any questions?

P: Um yeah, so um how do you, how can I treat my knee?

D: Yeah, certainly, so it it sounds like um this could be most likely osteoarthritis um of the left knee, which uh is something that would be best treated with uh trying to stay as active as you can, but but also pacing your activities as well, so that you're not um doing so much that the next day you're in significant amount of pain, but it's important to remember that um activity will help um with keeping your knee mobile, but also um actually help with reducing pain as well, and then also uh you could use Tylenol um as a medication for it. I wouldn't recommend ibuprofen or NSAIDs on a long term basis, although you could take those if you're having like an acute flare up of your pain. Um and then also like topical agents such as um like Voltaren or something like that you could put on your knee and um if it's really bad and it keeps um continuing on, we can consider something like a steroid injection as well.

P: OK, yeah, that sounds good. Thank you.

D: Alright, thank you.


D: What brings you in today?

P: Yeah, I've had a sore throat that's been really bugging me the past four days and I've had a cough as well.

D: Mhmm. Uhm, when did the cough start?

P: Yeah, so the the the cough started last week actually, and then and then I I got this sore throat afterwards.

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

P: It's dry.

D: OK. And has it gotten better or worse or stayed the same since last week?

P: Uh, it's it's gotten a little bit, little bit better.

D: OK, that's good. And the sore throat started four days ago, are you having any difficulties swallowing at all?

P: Yeah, it's, it's, it's really sore.

D: OK. Uhm, and I guess going back to the cough, does it make it difficult for you to fall asleep at night or does it wake you up in the middle of the night?

P: No I, it hasn't done that.

D: OK, alright. Other uh, and and I guess this sore throat has just gotten worse over the past four days or has been kind of the same or better?

P: Yeah, it's gotten a little, it's gotten a little bit worse over the last few days.

D: OK, do you have any other symptoms like headaches, stuffy nose, runny nose, uhm any discharge from your eyes, red eyes, any pain in your ears? Anything like that?

P: Yeah, but that you mention that yeah, I I have had like some itchy eyes, that and a runny nose. I was sneezing quite a bit last week, but that has kind of ah, gone away now.

D: OK. Uhm and were sneezing last week, and you had itchy eyes, had and thats gone. OK so all you have right now is that cough and sore throat, uhm, OK.

P: Yeah, and I've been really like achy and and tired as well.

D: Have you had any fevers or chills?

P: Yeah, I've, I've felt feverish these last two days. No chills.

D: Uhm, and have you had any changes in your sense of smell?

P: No, I haven't.

D: Changes in your sense of taste?

P: No.

D: OK, alright, and any chest pain?

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

D: Difficulties breathing?

P: No.

D: Any, uhm, I guess headache or any pressure in your cheeks or your head when you bend down or squat down?

P: No, I haven't felt anything like that.

D: OK. Uhm, any belly pain, nausea or vomiting, any changes in your bowel movements or any urinary symptoms?

P: No.

D: OK. Alright. And do you have any medical conditions that you've been diagnosed with?

P: I've had uhm, like tonsillitis a few times in the, in the past. The last time happened about about six months ago, I'm wondering if I have strep throat.

D: How often do you get that tonsillitis?

P: Uh, so I've had it four times. Yeah, 4 four times in the last few years.

D: Uhm, do you still have your tonsils or have you?

P: I do, yeah I do, yes, yeah.

D: OK, uhm and any other medical conditions?

P: No.

D: OK, any surgeries?

P: No.

D: Have you ever been hospitalized?

P: No.

D: OK. And any when you were younger would you have a lot of infections uhm, when you were a child or when you were born? Were you born prematurely? Were there any complications at birth?

P: Uh, I did have a couple of ear infections when I was, when I was younger, but I haven't had any since.

D: OK. And no pneumonia or anything like that, right?

P: No, nothing like that.

D: OK. Uhm, any history of asthma or eczema or allergic rhinitis?

P: No, I haven't heard of those before.

D: Alright. Are you taking any medications?

P: No, I'm not.

D: Were you given any antibiotics six months ago when you had your tonsillitis?

P: I was yeah, I think I, I think a like amoxicillin.

D: Right and uh, do you have allergies to food or environmental allergies or allergies to any medications?

P: Yeah I, I have allergies to peanuts.

D: What happens?

P: Yeah, I do get anaphylaxis from it. I've uhm, or I'll get yeah like hives and throat swelling. And so I do carry an EpiPen, I haven't had to use it though.

D: Yeah, that's good, that's good. And so couple questions about, uhm, I guess more general questions, do you, who do you live with and where do you live, in a house or an apartment?

P: Live in a house with uhm, with my parents and older sister.

D: OK, and uhm, are you, uhm, are you currently smoking or have you ever smoked in the past?

P: No.

D: OK. Also I just want to remind you that these questions will remain confidential between you and me. In case you're worried, no one's going to find out about what we're talking about unless you, unless there's concern about harm to you or harm to anyone else. Do you feel safe at home?

P: I do, yes.

D: OK, are things going well at school? Any bullying? Are you happy with your grades?

P: Yeah there everything I, I mean school is school, but it's been good.

D: OK, and you said you don't smoke. Have you tried any other any recreational drugs? Any marijuana?

P: No, I haven't.

D: OK, any alcohol?

P: No.

D: OK. And are you so sexually active?

P: No, I'm not.

D: OK. Uhm, alright, have you had contact with anyone who might be sick?

P: I don't think so. I mean, going to, we both I mean, we've been going back to school recently, but nobody's been off.

D: OK. So you've been doing schooling in person, then, OK.

P: Yeah.

D: Alright. Any medical conditions that run in your family, anything related to the lungs, or otherwise?

P: Uh, no.

D: OK, uhm, alright, well those are all the questions I had for you. So it sounds like last week you had itchy eyes runny nose, you were sneezing and you had a dry cough. And then over time some of those symptoms resolved and you continued to have a cough that was also getting better, but you then developed a sore throat. And you have been feeling feverish over the past two days. Did you measure, did you check your temperature last week?

P: I didn't check it last week, but I checked it yesterday and it was 38.2, I think.

D: OK.

P: But yeah, but but those are the symptoms that that I've been having.

D: Uhm, so it sounds like you your symptoms have evolved quite a bit over the past two weeks. It could have, it could be potentially that you had a viral infection initially and might you might have like a superimposed bacterial infection, but we don't know that for sure. Uhm, we, we'll do a physical exam. Have a listen to your chest, have a look inside your mouth, look at your throat. Uhm, we, uhm, I guess the original symptoms you had last week., uhm, were seem a little bit different. It could be pharyngitis, maybe what you have right now could potentially be pharyngitis with a sore throat and the fever that you've developed over the past three or four days. So, I'll definitely have a look inside your throat as well, and if necessary we could do a rapid strep test. Uhm, and we would also have to do a Covid test just in case, and I would recommend that you quarantine at home. The results should come out in the next 12 to 20 for 24 to 48 hours. Just self isolate, stay away from other family members and then you'll find out the results. If it's positive, someone will call you from public health and then let you know what to do.

P: OK, yeah, that sounds good.

D: Alright.

P: Thank you.

D: Yeah, you're welcome.


D: What brings you in?

P: I've had, I've had this cough for the past two weeks. I was just worried about it.

D: OK, past two weeks? Have, is it a dry cough or is it? Are you bringing up phlegm?

P: I'm it's mostly dry, but just sometimes there's like a little bit, I guess, yeah, the flat little bit of phlegm.

D: OK, what colour is the phlegm?

P: It's like whitish, sometimes it's clear.

D: OK, is it ever green or bloody?

P: No.

D: No, OK. Do you have any shortness of breath?

P: No.

D: Any wheezing?

P: Sometimes, yeah.

D: Sometimes, OK. With the cough or outside the cough as well?

P: With the cough.

D: Any chest pain?

P: Um, no not initially, but like since the past few days, especially after I've like coughed a lot, it just kind of hurts me a little bit.

D: OK, OK, any, do you ever feel so it just hurts after coughing.

P: Yeah.

D: So is it kind of like a sharp pain or like a dull achy pain?

P: I don't know, it just feels like like my muscles are hurting like I'm just like coughing so much it's just..

D: OK.

P: Dull pain. In the middle of my chest then it goes away.

D: OK, OK, and do you ever feel like your heart's racing?

P: No, no.

D: OK. And have you noticed any swelling in your legs, arms, or abdomen?

P: No.

D: Any dizziness or fainting spells?

P: No.

D: No, OK. Any headaches?

P: No.

D: Confusion or memory loss?

P: No.

D: Have you noticed any fevers?

P: No.

D: Any weight loss?

P: No.

D: No. Excessive fatigue or tiredness?

P: Uh, no, not really. I've haven't been fatigued. I think I'm I'm fine and feel normal. Other than the cough of course.

D: OK, sure. Any rashes?

P: No.

D: How about changes in your vision or hearing?

P: No, no concerns there.

D: Have you had a stuffy nose or runny nose?

P: No.

D: No, a sore throat?

P: Uhm, no.

D: OK, changes to your smell or taste?

P: No.

D: No. Have your bowel movements been normal?

P: Yeah.

D: Yeah. How about urine?

P: Yep, they've been, no concerns.

D: Any nausea or vomiting?

P: Uhm, no.

D: No. OK. Have you ever experienced anything like this in the past?

P: I kind of had this about, I don't know three or four years ago. I just had this cough, but then it kind of went away on its own in about a week. But now it's been like 2 weeks so I don't know what's happening. If it's something I just want to make sure it's nothing serious.

D: Yeah, for sure. When you had this in the past, were you ever done given a diagnosis?

P: No, I didn't go to see a doctor. I just kind of stay at home.

D: OK.

P: I thought it was just like a mild infection or something.

D: Mhmm. Have you tried anything for the cough this time around?

P: I had some like lozenges and I haven't, and those have been helping me.

D: OK.

P: Yeah.

P: OK, good. If you were to describe your cough, is it barky, harsh, muffled, like what what would you say the sound of it is?

P: Uhm, I don't know. It's kind of like, like a normal cough, you know, like when you're clearing your throat or something, or when you're like when something gets stuck in your throat, just like like a normal cough. I don't think it's barky.

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

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

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

P: I have my wisdom teeth removed.

D: OK, when was that?

P: About 8-9 years ago, when I was 17 years of 16 years old, ah, 17 years old.

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

P: I'm just taking this birth control pill.

D: OK, which one?

P: Uhm, yeah, it's called, uhm, I forget the name.

D: Ah, no worries. And when did you start it?

P: I started three years ago.

D: Three years ago, OK. And no side effects, no issues with it?

P: No, no, it's all good.

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

P: Uh, yeah, I think so.

D: OK. Did you get the flu shot this year?

P: No I didn't.

D: No. OK yeah, we recommend getting it out once a year. Just yeah, for your safety and for everyone else's and even if you get the flu, maybe your symptoms won't be as severe and then, do you have any allergies?

P: Uh, I don't, no.

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

P: Uhm, My mom has diabetes.

D: OK.

P: And my dad has high blood pressure.

D: OK. Uhm, and then any cancers in the family?

P: No.

D: No, OK. And have you been in contact with any any sick people recently?

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

D: OK. Uhm, any travel recently?

P: No.

D: No, OK. How about umm smoking, do you smoke?

P: Uhm, once in awhile.

D: OK, what's once in awhile?

P: Maybe when I'm out with my friends I might sometimes, have a cigarette or two. I used to smoke a lot more, but I'm trying to cut it down.

D: OK. How long have you been smoking for?

P: I started smoking in high school, so when I was 18 years old.

D: Mhmm.

P: And at that time I would have about 6 cigarettes a day, but then I like I, I knew that smoking wasn't good for me, so I'm trying to cut it down, but my friends still smoke, so sometimes when I go out with them, I'll just have a cigarette or two, maybe like once a month, I would say.

D: Once a month, OK. OK. And then any other recreational drugs like marijuana or cocaine or anything like that?

P: I tried a few in high school but not since then. I had, yeah, I had cocaine once.

D: OK, and do you drink alcohol?

P: Yeah I have a glass at night.

D: OK. Glass of wine or beer?

P: Glass of wine.

D: And, and where do you live right now?

P: Uh, I live, I live in an apartment with my boyfriend, about 20 minutes from here.

D: OK. Any old carpets at home? Dust, mold, asbestos, anything that would be triggering your cough?

P: I don't know. I have not really had a problem but been here at this place for about a year and a half.

D: OK.

P: It is an old building but it's been OK so far. No recent changes.

D: OK, OK, good. So those were all the questions that I had for you today. Did you have any questions of your own?

P: No, I was just worried this cough isn't, isn't serious, right? You don't think I have Covid?

D: So because your symptoms do overlap with that of Covid, we're going to get a swab on you done and you should get those results in about 24 to 48 hours. And if it's positive, public health will be in touch umm, to do some contact tracing. In the meantime, because you have a cough, it is recommended that you isolate for 14 days. And if it's not Covid, but it's probably something like acute bronchitis or some other viral infection that's going around at this time of year, so for that we can, you can just treat it with like supportive treatments. You know, like staying hydrated, uhm, good nutrition, good sleep and just keep an eye on your symptoms. If they become worse or really severe like you're having neurological symptoms and just seek help from the ER.

P: For sure. Thank you.

D: Yeah, take care.


D: What brings you in here today?

P: Yeah, I've had this cough and it's just not going away.

D: OK, and how long have you been having this cough for?

P: I think it started about a month ago.

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

P: I I'm bringing up some phlegm if that's what you mean.

D: Yeah, so you're bringing up phlegm when you cough?

P: Yeah.

D: And is it, what color is it?

P: I it looks pretty dark and and sometimes red.

D: OK, so do you think there's blood in your phlegm?

P: Yeah, the dark it does kind of look like blood, so that's what scared me and wanted me to come in today.

D: OK, and, how much phlegm would you say you're putting out like per every time you cough?

P: I'd say every time I cough, I'm bringing up at least a teaspoon of of the dark sputum.

D: OK. And so this started four weeks ago. It has it been a constant like you've been constantly coughing or does it come and go?

P: I it it's there pretty much all the time, but especially bad in the morning.

D: OK. And do you remember if anything changed or you did something differently, or anything that happened before you started having this cough?

P: Uh, I had a cold a few weeks back, but, it was just a runny nose and it seems that the cough has been kind of lingering around.

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

P: Yeah, the cough has been getting worse.

D: And have you had any previous episodes of this?

P: I I've had a smokers cough now for several for several years, but it's really just this past month that that it's gotten really bad and I have it all day long.

D: OK. And, uh, are you coughing every day or every other day? Like, how often would you say you're coughing?

P: Uh daily.

D: Daily? OK, is there anything that makes your cough go away or get worse?

P: Uh, nothing that seems to really make it any worse or better.

D: OK, and do you have any other symptoms like shortness of breath or runny nose, sore throat, anything like that?

P: Uh nothing I can think of, just just this cough that's been bugging me.

D: OK. And have you traveled outside of the country at all recently?

P: Yes, I've been working in the Philippines for the last three years.

D: And, uh, have you been experiencing any fevers or chills or night sweats?

P: I felt like, uh, a little bit hot. I might have a fever now so yes, no chills though.

D: How about night sweats?

P: I have been sweating more at night too. Yeah, I have to get up and  change my pajamas sometimes.

D: OK. And how often has this been happening?

P: Um, I'm changing my pajamas and it's sometimes the sheets, uh, maybe a couple of times per week.

D: OK, and have you been feeling more more tired, more fatigued at all recently?

P: Yeah, my energy has just been really down. I've been really fatigued.

D: And do you find that you ever have any chest pain or shortness of breath?

P: I sometimes I do have some pain over on the right side of my chest.

D: Is this pain, what kind of pain is it?

P: I'd say it's kind of like a, uh it's a stabbing kind of, uh, uh pain and I only really notice it when I take a deep breath.

D: OK. And how about shortness of breath, have you been experiencing anything like that?

P: I only really get short of breath when I'm going for a hike or up to my 4th floor apartment.

D: Any changes in your skin that you've noticed, like any rashes at all?

P: No rashes.

D: And how about your sleep? Have you been getting enough sleep on a daily basis?

P: Uh just the, uh sweating at night has been annoying because it wakes me up sometimes, but other than that sleep has been OK.

D: OK, and how about your appetite?

P: I feel like I've been eating OK. Regular diet.

D: And have you had any significant weight changes recently?

P: Uh yeah I'm down like 15 pounds over the last few months and I haven't really made any changes to my diet or exercise, so I haven't really been trying.

D: OK. Um, any recent infections at all?

P: Just the cold that I was talking about it a few weeks ago, and that's where the runny nose kinda went away.

D: OK, um, and have you at all, either here or when you were working in the Philippines have been exposed to someone with tuberculosis?

P: I believe some of the, uh people I was helping over there did in fact have tuberculosis.

D: OK, and have you had a TB skin test done at all?

P: I've had one in the past, but I can't really remember the last time and it was normal though, when when I had it a few years ago.

D: OK, but nothing since you've been back at all?

P: No, the last test must be at least a few years ago.

D: OK. And in terms of just in your environment, at work and at home, are you exposed to any mold or any pets?

P: No pets at home, and, uh, I don't think there's any mold in the home either.

D: Do you notice any kind of tingling or numbness in your limbs or any muscular weakness?

P: I I, I mean, I'm really tired all the time and kind of feel weak that way, but, no muscular weakness.

D: And have you previously been diagnosed with any medical conditions like high blood pressure, diabetes, anything else?

P: Uh just a chronic bronchitis with a smokers cough.

D: OK. And do you take any medications?

P: Yeah, I take, uh, a beta agonist inhaler, an inhaled corticosteroid and another type of anti muscarinic inhaler.

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

P: No allergies.

D: Any allergies at all to any environmental exposures?

P: I don't think so, no.

D: Any hospitalization in the past?

P: No.

D: And any surgeries in the past?

P: No surgeries.

D: And have you been in contact with anyone who is ill? I know you mentioned in the Philippines, you were exposed to some people with TB, but anything since then?

P: Not that I can think everybody's been healthy.

D: OK, and and in your family, has there been any history of any cancers or heart attacks? Any any medical conditions?

P: No heart attacks, but uh my father died of lung cancer when he was 67.

D: And currently do you live in an apartment building? Is there anyone you live with?

P: Yeah, I live with my girlfriend in an apartment.

D: OK, and do you work currently?

P: Yeah, I've been doing some housing work in the Philippines, the last seven, several years.

D: OK. And do you currently drink?

P: Uh no I don't drink alcohol.

D: Any recreational drugs like marijuana?

P: No.

D: Uh, any and you smoke cigarettes at all?

P: Yes, I I do smoke cigarettes, I I've smoked most of my life, similar to my my father, probably 1 to 2 packs per day.


D: What brings you in today?

P: Uh, yesterday, right after leaving work I started to not feel well and this morning I woke up with fever, ah, this like bad headache and just feeling really really sore all over.

D: I'm sorry that's doesn't sound good. So all this started yesterday or I guess yesterday was just with you were, not feeling too good and then just noticed all these symptoms this morning. Did you measure your temperature?

P: Yeah, I checked it this morning and it was 38.5.

D: And uh, did you, can you tell me about your headache?

P: Yeah, so I I started to get a little bit of a headache last night, so I tried some Tylenol. It helped relieve the pain a little bit so I can sleep then. And this morning I woke up but I uh, didn't have a headache at first, but it came on maybe an hour after waking up and it feels like a there's a band around squeezing my head.

D: Is it on both sides or only one side?

P: It's on both sides. Kind of feel that real wrapping around.

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

P: About a five.

D: OK. Uhm and do you have any other symptoms, such as a runny nose or a stuffy nose?

P: Yeah, my nose has been, been runny. I started noticing, noticing that a little bit yesterday too actually, now that you mention it.

D: And what was the discharge? Or what was the discharge like?

P: It's pretty runny in in. Yeah, it's pretty running clear.

D: OK. Uhm, and do you have a cough?

P: No.

P: OK.

D: Any sore throat?

P: No.

D: Uhm, have you had any difficulties with breathing?

P: No.

D: OK, any chest pain?

P: No.

D: OK, uhm, uh any, I guess itchy eyes or itchy nose or any sneezing?

P: Yeah well, well my nose has been itchy and I, I have been I have been sneezing.

D: Alright, and have you had any diarrhea or constipation?

P: No.

D: Any nausea or vomiting?

P: No.

D: OK, any belly pain?

P: No.

D: OK. Have you been around anyone who could have been sick?

P: Uhm, maybe. I, there was a, one of my colleagues at work was off last week. I think he was sick, with something.

D: Did you get tested? Do you know if you went to see a doctor? Or was he tested for Covid?

P: Uhm, I'm not sure, I just don't like well he wasn't there on Thursday and Friday last week and he hasn't been there, been here, this week and I, I just heard that that he was sick.

D: OK, alright. Uhm, and have you have you had any medical conditions that you've been diagnosed with?

P: Yeah, I've been told I have high high high cholesterol and high BMI. Uh, yeah and so I I take a statin medication for for that and yeah I've been told I have pre-diabetes as well so I've been trying to work on diet.

D: Are you taking any other medications?

P: I take vitamin D and a multivitamin.

D: And do you have any allergies?

P: No.

D: OK. Uhm, and you do you live alone or do you live with other people?

P: Yeah, I I live with my, with my wife.

D: OK, and since you've been feeling sick, have you, been maintaining social distance, maintaining some distance from her?

P: Yeah, yeah we have. We we have separate, ah rooms that we've been able to distance for the last few days.

D: OK, that's good. And do you ah, have you traveled anywhere recently, outside the province?

P: No travel.

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

P: No. I I don't.

D: And marijuana?

P: No.

D: Any recreational drugs.

P: No.

D: Have you ever had or do you currently consume alcohol?

P: Yeah, have a few beers on the weekend, but I've been trying to cut down after I was told I have, uh, pre diabetes.

D: Ok, that's really good. Umm, and, and OK, let's see, do you have any family history of any heart problems or any lung issues or any cancers?

P: My grandfather had lung cancer. He smoked his whole life and yeah, I know my dad had you had a heart attack when he was in his 70s.

D: OK. Alright, well those are all the questions I had for you. We will do a Covid test today simply because your symptoms overlap with some of the symptoms of Covid. It's also possible that you just have a, just the common cold and that would get better over time. You might have caught something from your colleague who was sick last week, so it's great that you've been, instead of isolating yourself and staying away from your wife, I would also recommend, if you haven't already done so to not, I know that the you have symptoms started yesterday evening, but just to try to work from home or take some time off of work for the next couple of days at least until you recover, test results are back in the next 24 to 48 hours and then from there on, follow the advice that you'll be getting from public health.

P: That sounds really good. Yeah, thank you.


D: I was wondering if you could start by telling me what brought you in.

P: Sure, you know I've been feeling a little hot for the past two days. I've had this awful cough and I just feel so tired.

D: OK and, this started two days ago?

P: Ah yes, two days ago.

D: OK. Yeah, you've been feeling hot, have you checked your temperature?

P: Um no, I haven't actually checked my temperature, I just kind of put my hand on my forehead and I just feel really, really hot.

D: OK, so we'll we'll check it right now and. OK, so we're seeing that it's your temperature is elevated at 38.3 right now, so it does sound like you you have a fever. OK, and you mentioned that you had you have a cough?

P: Yeah, I do. It's it's a dry cough and it's awful. I've been hacking for the past two days.

D: Oh no, that doesn't sound very nice. Has it been any blood or any sputum?

P: No blood and no definitely no sputum. OK.

D: Anything that's like triggered the cough?

P: Um I don't, I don't think so. Um, No, I don't think so.

D: No. OK, have you had a cough like this before?

P: Maybe like 10 years ago when I had some sort of viral infection, they said um. I had a dry cough, but nothing to this extent.

D: OK, um have you had any infections recently, like in the last month or so, like a viral illness? Um, like where you had maybe like a runny nose sore throat and and a cough?

P: No, no not not recently.

D: OK, so you've been feeling well recently?

P: Yeah.

D: OK, and you've you been fatigued. Can you tell me a little bit about about how you been feeling?

P: Ah yeah, like you mean in terms of my fever or cough?

D: Oh sorry I mean in terms of your energy.

P: Oh my energy yeah, I've just been feeling so tired, it seems like I can't do normally would be. I would normally have no issues doing.

D: I see OK, and any changes to sleep or any kind of stressful events happen in the last few days that, might be causing you to be more tired.

P: I don't think so. Nothing, nothing big has happened in my life. No big changes.

D: OK um. And so you've had a fever, cough, and being tired. Have you experienced any other symptoms these last few days?

P: Um yep, fever, cough, fatigue. But um I don't have anything any other symptoms besides those.

D: OK, so you you do you have any headaches?

P: Oh headaches? No, no.

D: OK, how about any eye or or ear symptoms like discharge or pain?

P: No, nothing like that.

D: OK, have you had a loss of taste or a loss of smell?

P: No.

D: Alright, and have you had a runny nose or sore throat?

P: No.

D: OK. Have you had any chest pain?

P: Nope, no chest pain.

D: And how about difficulty breathing or shortness of breath?

P: Nope, no.

D: OK, and any wheezing or whistling noises while you're breathing?

P: No.

D: OK, and have you felt like your heart's racing at all?

P: Ah no.

D: Have you had any like fainting spells or feeling as though you might pass out?

P: Um nope, no.

D: Alright, and how about any dizziness?

P: Oh no no dizziness either.

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

P: No.

D: Alright, and how about any diarrhea or constipation?

P: No.

D: Alright, um any abdominal pain?

P: No.

D: And any like, painful urination or or like going to the bathroom frequently?

P: No.

D: Alright. Any night sweats

P: No.

D: And how about any chills or rigors?

P: No.

D: Have you had any weight loss over the last several months?

P: None.

D: Alright, have you noticed any rashes or skin changes over this past week?

P: No.

D: Alright, and how about any muscle aches or or joint pains?

P: Um no.

D: Alright, so is there any reason that you see a physician regularly for, or been diagnosed with any medical conditions?

P: Mmm, I have rheumatoid arthritis.

D: OK, uh, are you taking medications for that?

P: Um, yeah, you know they put me on some sort of DMARD.

D: OK, so you're you're seeing a rheumatologist for that?

P: Mmm, I am.

D: OK, great um, any other diagnoses?

P: No.

D: OK, and so uh. Are there any other medications that you that you take, either over the counter or prescription besides the DMARD?

P: I take iron and vitamin D, as well as biotin.

D: OK, uh, what's the reason for taking iron?

P: Uhh at one point or another they said my iron levels were low, but it went back to being normal, but I just take it now to maintain those levels.

D: OK, um do you have like heavy menstrual periods?

P: No.

D: OK, and have you noticed any blood in the stool, either either being red or or your stool being really dark, kind of like a black colour?

P: Nope.

D: OK, um, and do you have any allergies?

P: No allergies.

D: Alright, uh, and then. Can you tell me a little bit about your living situation?

P: I live with two of my children. They are five and three, as well as my new boyfriend.

D: OK, great and for either of your pregnancies, were there any complications?

P: No.

D: OK, great um and are there any concerns for safety in the home?

P: No.

D: OK, excellent. And what do you do for work?

P: I work as a secretary for an accounting firm.

D: OK, that sounds like a great job. And. Uh, do you smoke cigarettes?

P: I used to. I quit five years ago.

D: Alright, and do you smoke marijuana?

P: No.

D: OK, and do you use any other recreational drugs?

P: No.

D: OK um. And. Has anybody in the house been sick? Either your boyfriend or or your children?

P: No.

D: OK, are they going to like daycare right now or in school?

P: They are in daycare, yeah.

D: OK. Um, any kids in their daycare that have been sick?

P: No. I checked no one's been sick.

D: Alright, excellent is that anybody in the office where you work been sick?

P: No.

D: And have you traveled anywhere?

P: No.

D: OK, and then anybody in the family have a heart condition or or lung condition?

P: No.

D: OK, no. An any cancer that that's runs in the family?

P: Um, one of my aunts had pancreatic cancer.

D: OK, any relatives have breast cancer?

P: No.

D: How about any relatives with ovarian or colon cancer?

P: No.

D: OK. And so I think that was all of the questions that I wanted to ask. Actually I just remembered one. Have you had any prior surgeries?

P: No. No priors.

D: OK, sorry, so that was the last question that I wanted to ask about on on history um was there anything that you wanted to tell me that I maybe I didn't ask about?

P: No, I think you covered it all.

D: OK, excellent, so with your symptoms of having a kind of a fever, cough, and being tired, definitely concerned of viral infection and possibly COVID-19 or something more common, like the common cold, like an adenovirus. And so will do some testing for for COVID-19 with a nasal PCR swab as well as run some blood work. Um because there is a possibility that there's a bacterial infection, such as like a pneumonia or lower respiratory tract infection that would be treated with antibiotics so. We uh yeah, we'll order those investigations along with a chest X Ray. And we will go from there.

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

D: You're welcome.


D: What can I do for you today?

P: Hi, yes. Thank you for seeing me. I just came in today because I've been having for the last week this cough and recently also started noticing that I've been having some diarrhea as well.

D: Hm, when did the cough start?

P: The cough started around 5 days ago. And it's it got worse, but now I think it's a little bit better.

D: What about the diarrhea?

P: The diarrhea started just two days ago and I'm having to go like almost 8 to 10 times in the last two days.

D: And what is, what does your stool look like? Is it completely watery?

P: Yeah, it's mostly watery.

D: And what colour is it?

P: Just normal colour, no, it's not dark or anything like that.

D: OK, any blood that you've noticed, anything red?

P: No blood.

D: And you've had this cough, but your cough is getting better. What's the cough like? Is it a dry cough or wet cough?

P: It's uh, it's more of a dry cough.

D: Have you coughed up anything at all, like blood or any, any mucus?

P: No, no I haven't coughed up anything.

D: OK. And other than the cough, have you had any other like flu like symptoms? Have you had like a runny nose or stuffy nose? Sore throat? Any of those symptoms?

P: No, none of those. But I, I have also been having like a little bit of a headache as well in the last few days.

D: Where is, where is your headache?

P: Just in the like on my forehead, on both sides.

D: What does it feel like?

P: Aching sensation.

D: And how bad is your headache from 1 to 10, with 10 being the worst headache ever?

P: Right now, probably a 5, but it was probably like a 7 yesterday.

D: So do you feel like your headaches getting better?

P: Right now, like today I took Tylenol so I don't know if it's just better because of that.

D: I see. And have you taken any other medications to help with your symptoms?

P: No.

D: OK, uhm, have you had a fever or chills?

P: Uhm, I know I haven't felt any fever, chills.

D: OK and have you had any chest pain or any difficulties breathing?

P: No.

D: OK, uhm, have you had any nausea or vomiting?

P: Uh no, nothing like that.

D: OK, any pain in your belly?

P: Um just like a little discomfort with going to the washroom so much.

D: And any muscle aches in your body?

P: No.

D: OK, any numbness or tingling in your arms or feet?

P: Uh, no, nothing like that.

D: Any change in your sense of smell?

P: Uhm, maybe a little bit, I haven't really.. Yeah, I would say in the last few days, maybe a little like I've been able to smell less.

D: Any change in your sense of taste?

P: Uh no.

D: OK. Have you have you been in contact with someone who you think could potentially be sick?

P: Uh, no, not that I know of. I do I do go to work in, like in person. Unfortunately I'm I can't work from home. But I've been noticing anyone sick around me though.

D: And what do you do for work?

P: So I work at like a car shop.

D: OK. And do you wear a mask and maintain social distancing?

P: Yeah, most of the times I would say we're pretty strict, strict with that. Uhm, sometimes when we're in our office I take off my mask, but usually when we're seeing other people or within close proximity, we keep the masks on.

D: OK. And, uh, do you, I, I guess, who do you live with at home?

P: I just live with my wife.

D: Do you think she might have had any exposures?

P: No, she's been fine and she doesn't have any symptoms. And she's, she's a school teacher. Right now that she is working from Canada.

D: OK, and do you, smoke at all? Or have you smoked in the past?

P: Oh yeah, I do, or I used to smoke in my 20s and 30s, but I quit smoking.

D: How much did you smoke back then?

P: Probably half a pack a day.

D: And for how many years?

P: Only like 15, 15 years.

D: OK do you, do you smoke marijuana or have you smoked in the past?

P: Uh, I've tried it a couple times. I don't really like it, so no.

D: Any recreational drugs?

P: No.

D: Alcohol?

P: Uh, I probably have a beer every day.

D: Do you have any medical conditions that you've been diagnosed with?

P: Uhm I, I take uh, medications for blood pressure and high cholesterol.

D: What do you take?

P: Uhm, I take this medication called, I think it's it's like a Lipitor. And then I take uh, Ramipril for the blood pressure.

D: Any allergies to food, environmental allergies or any medication allergies to medications?

P: Not that I know of, no.

D: Any medical conditions that run in the family?

P: Uhm so I think, uh, diabetes, and for my family, but I I I don't have it so and I think that's pretty much about it on my dad's side. On my mom's side and there was someone, like my aunt did have ovarian cancer.

D: OK, and have you, I guess have you, I forgot to ask earlier, have you had any surgeries or hospitalizations?

P: Uhm I had a surgery to remove my appendix in my 20s and since then, no. No surgeries or hospitalizations.

D: OK.  Alright, and I guess that's all the questions I have for you. You haven't had any difficulties breathing right?

P: No,

D: No, OK. Do you OK? And you've had diarrhea for two days. How's your appetite and have you been eating and drinking OK?

P: Uhm appetites pretty OK, like I feel like, I've been more hungry, with the carry I feel like I, need to eat more.

D: Uhm, It's also important with the diarrhea to drink lots of fluids and to make sure that you're not losing important minerals and you're not losing like sodium or potassium in diarrhea and other things like calcium that could create problems. So, continue to eat well and continue to drink lots of water. I guess so what we'll do is we'll do a COVID swab just to just to check if you have COVID or not. We'll also do a few labs to see how your electrolytes are, do your vitals to see if you have fever, measure your heart rate and do a physical exam and then go from there. And I'll off - I'll talk to my attending as well and we'll come back and discuss the management plan with you.

P: OK, sounds good. Thank you so much.


D: What brings you in today?

P: Yeah, so I've had this cough that started within the last day and uhm, I've also been particularly short of breath as well.

D: OK. Can you tell me about the, the cough, how, is it dry cough or wet cough?

P: It's wet, I've been bringing up, uh, sputum that's uh, It's just, it leaves a really bad taste in my mouth when bringing it up.

D: What color is the sputum?

P: It's kind of, uh, like, yellowish green, type color.

D: Havey you noticed any blood?

P: No, I haven't seen any blood.

D: And it only started yesterday. What about the difficulties breathing, when did that start?

P: Yeah, that started really within the last twelve hours or so.

D: And can you tell me if it's gotten better or worse since then?

P: Yeah, it's been, it's been getting worse, uhm, and the phlegm, also smells really bad.

D: OK. When do you have difficult, like, is there anything that makes the, shortness of breath, worse?

P: Yeah, if I, uhm, when I was having a cigarette earlier today, it got a bit worse and when I went out to get the Mail today I, I just couldn't do it. I, I had to just sit down.

D: And that what happened to you before, right?

p: No, I usually uhm, am able to go out and get the mail, no problem, yeah.

D: OK. Uh, and say two days ago, were you feeling perfectly fine?

P: I was yeah, I wasn't sick at all.

D: OK, so you've had this bad cough and you've had some difficulties breathing since yesterday. Have you had a headache at all?

P: No, no headache.

D: Any, uh, runny nose?

P: No, it's really, no.

D: Any congestion?

P: No.

D: No, OK. Have you had any pain in your chest?

P: Uh, no pain.

D: When you're breathing in or breathing out any pain at that time? or deep breathing?

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

D: OK, have you had any palpitations or you feel like your heart's racing?

P: Uh, yeah, I do. I feel like my heart has been beating a little bit faster.

D: OK. And any pain in your belly?

P: No.

D: Nausea or vomiting?

P: Uh no, but, well I guess I have felt a little nauseous with the, uhm, bad taste in my mouth.

D: OK, and any uh diarrhea or Constipation?

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

D: OK, any sore throat?

P: Uhm, no.

D: OK alright uhm, any other symptoms that I haven't talked about, that you experienced over the past day?

P: No, it's really been, uhm, yeah, this cough and bringing up this, this sputum and being short of breath.

D: OK, uhm, can you tell me about your past uh, medical history, do you have any medical conditions?

P: Uh yeah, I have uhm, high blood pressure.

D: Mhm.

P: I also have acid reflux, so uh, gerd I think, think it's called?

D: Yeah.

P: And, uhm, high cholesterol as well.

D: OK, ok.

P: And I've also been, had issues with anxiety in the past as well.

D: In terms of medications, are you taking any?

P: Yeah, I take uhm, an ACE inhibitor, statin, uhm, and uh, medication for my stomach, I think, like Pantoprazole.

D: OK, and uh, how well has your gerd been controlled?

P: Uh, it kind of, it bugs me most days, its not so bad, I mean, sometimes I'll get a little bit of heartburn and acid in the, in my mouth, but it depends on what I eat so I really try to stay away from some, some foods.

D: So the PPI hasn't completely curbed the, the acid reflux, you still get it?

P: Yeah, I still get it. It's definitely helped though it was a lot worse before, uh starting it. I've been on been on it now for a few years.

D: OK, and as for your anxiety, do you ever get panic attacks?

P: No, I haven't had any, any panic attacks.

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

P: No.

D: OK, so you said that these symptoms started yesterday and they were quite sudden, uh, was there anything that you were doing yesterday or the day before that was different or unusual?

P: Well, yeah, I mean yesterday I, or, yeah, I had a bit more to drink than, uh, usual, more alcohol I mean. So, I mean, could that have something to do with it? I'm not sure.

D: It could potentially. Did you, were you, were you drunk and did you pass out?

P: Yeah, I think so. My, my friends, uh yeah, that's what my friends were, were saying anyway.

D: OK, and uh, talking about alcohol, how much do you usually drink?

P: I usually, like, like four to six beers a day, but uh, yeah, yesterday was certainly more than that.

D: Have you considered reducing the amount of alcohol you drink? Has it affected you in any way?

P: I mean I, I'm retired now so, uhm, I don't know, I, I feel like it's been fine maybe, uh, I feel like it's been fine.

D: OK, OK, I suppose we could talk a little bit more about that later if you want uhm, as four to six beers is quite a lot actually, and it can affect your health in certain ways, but we can, we can chat more about that later.

P: OK.

D: And, uh, do you smoke?

P: Yeah, I smoke, uhm, a half a pack of cigarettes per day. It was well over a pack before, so I've cut down a little bit.

D: No, that's great. OK, do you plan on cutting it down further or do you wanna stay right there?

P: Yeah I have been, have been trying, just too, too darn expensive these days, so, been trying to cut back.

D: Yeah, yeah, that's fair, alright. What about marijuana? Do you consume marijuana?

P: No, I don't.

D: Any recreational drugs?

P: Nope.

D: Alright, do you have any family history of any medical problems?

P: Uh yeah, my, my father had, uh, he ended up having liver disease actually, he passed away from that I think. And he had heart problems too. He was a lifelong smoker and didn't really, didn't really take care of himself.

D: Hmm, I see. Do you, do you have a family doctor?

P: Uh, I do. I haven't seen my family doctor in a number of years now though.

D: Yeah, well, you know it's, it's a good idea to see your family doctor on a regular basis, specially when you're getting older, because sometimes you might need changes in your medications, or there might be checkups or screenings that they might want to do. It's for your own benefit, you know, maybe even just seeing them once a year would be a good idea. I would definitely recommend that you book an appointment with them just for a checkup in the next couple of weeks. Is there a reason why you don't see your family doctor too often?

P: I just haven't been, uhm, sick and I've been able to, to refill my prescriptions, mostly from just calling in, so.

D: OK, ok, I see, uhm, alright, and do you live alone or do you live with other people?

P: Yeah, I live with my wife.

D: OK, alright, and are you able to take care of things like groceries or finances, or shoveling snow or cleaning the house, or do you need any assistance with those sort of household activities?

P: Yeah, we moved, uhm, actually into an apartment last year. It's made it a lot easier in terms of the housework and that sort of thing. But I've been able to, uhm, I do the the grocery shopping and share the the chores around, around the house. I do, I'll use a cane sometimes. I, I injured my knee a number of years ago, but other than that, things are OK.

D: OK, OK, good to hear. That reminds me, have you had any surgeries in the past?

P: Just on my, my left knee. I had a left knee replacement a few years ago.

D: OK alright and have you any had, had any hospitalizations?

P: No.

D: OK, alright, uhm, so sounds like you've had a day of this wet cough with the, this, a bad smelling sort of sputum that's, that's yellowish green in color, and you've also had difficulties breathing for the past twelve hours, uh, so much so that you can't even go out to get mail and your hearts been racing. It's possible that while you were drunk that you might have, and given that you have acid reflux, that you might have accidentally have something go inside your breathing tube from, from your mouth or something that came up from your stomach and sometimes when that happens, food items can or other things can get lodged in your lungs and can become, uhm, can attract bacteria to, uh, to replicate and cause a bacterial infection, so it's possible that, that's what happened But it could also be a viral pneumonia or a viral infection in your chest. we'll get a chest x-ray done, we'll have some labs done as well, and we'll likely start some antibiotics. Have you recently been on any antibiotics?

P: No, I haven't.

D: And you don't have any allergies to any, correct?

P: Correct.

D: Alright, OK, we'll also do a physical exam just to give a listen to your, to your lungs and see how they're doing and then go from there. Do you have any questions for me?

P: No, that sounds good. Thank you.


D: What brings in here today?

P: Hi there, I've just last night I was, I went for a run and I twisted my ankle. I think I stepped on something and it it really hurts.

D: OK, and so when did you have the injury?

P: It was just yesterday.

D: OK.

P: Yeah it was just just yesterday that it happened.

D: OK, and do you remember if you twisted it so you twisted your ankle, like did did it twist inwards or outwards?

P: Inwards yeah, I feel like I inverted my ankle.

D: OK. And, so since then, were you able to stand up and or were you not able to bear any weight?

P: No, I was able to, uh, kind of finish the I I I just finished the walk. I was able to walk home 'cause it didn't hurt that bad immediately. It was a bit painful, but the pain really started a few hours later and has been pretty much constant ever since.

D: OK, OK so it kind of got worse over time over the last day?

P: Yeah.

D: And do you notice any kind of bruising, redness, swelling, any skin changes?

P: No, I haven't really noticed I uh, really, any swelling or I or or skin changes. Yeah, no skin changes and no swelling.

D: OK, and how would you describe the pain? Is it like a dull, aching pain or sharp stabbing pain?

P: Dull and achy.

D: OK. OK. And has this happened to you in your ankle before?

P: I'm I, I feel like I've maybe I I've done something like this when I was younger, maybe playing basketball or something like this when I was a kid, I twisted my ankle before.

D: OK, and does this pain just stay, where's the pain exactly on the right side of your ankle or on your left, like interior side?

P: It's on the right kind of outside of the ankle.

D: OK, and which ankle is this just to clarify?

P: On the right ankle.

D: OK so so it hurts on the right side of the right ankle.

P: Yeah, exactly.

D: OK, and does the pain radiate or move anywhere in your feet?

P: I can kind of feel it around on the the sole of my foot as well, but mostly on the outside though.

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

P: Alright, it gets worse really to if if I move my ankle or if I'm standing on it.

D: OK, and anything that makes it better?

P: Alright, just if I rest and avoid moving it.

D: OK, have you notice any fevers or chills?

P: No.

D: OK, any pain in any other joints besides your ankle?

P: No, just my my right ankle.

D: OK, any appetite or weight changes?

P: No, I've been I've been just training for this race coming up, so I mean I've been just trying to work on my fitness a little bit, but my weight has been relatively stable.

D: OK, any weakness in your right right extremities or any kind of numbness or tingling sensation?

P: No numbness or tingling and no muscle weakness either.

D: Ok, right. Have you been diagnosed with any medical conditions in the past?

P: I'm uh, I had diarrhea a few months ago and I was given a fluoroquinolone as an antibiotic.

D: OK, that's two months ago. OK. And any medications that you're on currently?

P: I I take a Vitamin D and some other vitamins too. Vitamin A as well I guess that just helps my my skin and and then the vitamin D for my my bones.

D: OK, any allergies to medications or any environmental issues?

P: No allergies, no.

D: OK, any hospitalizations or previous surgeries?

P: No.

D: OK. Any family history of any musculoskeletal conditions, any rheumatological conditions. Anything that you know of?

P: My grandparents have arthritis, so and my like my dad had had gout before.

D: OK, and do your grandparents have rheumatoid arthritis or osteoarthritis, do you know?

P: I think osteo yeah osteoarthritis.

D: OK, and do you currently work?

P: I do, yeah, I work as a software engineer.

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

P: Right now I'm actually just living alone in a in an apartment.

D: Ok, and do you smoke at all?

P: No, never I can't with the with all this like training for yeah at the race and stuff like that.

D: OK, that's good. Any recreational drugs like marijuana, cocaine, heroin, anything like that before?

P: No, I've never used anything like that in the past.

D: OK, and how about alcohol?

P: Uh rarely I'll have maybe a glass of wine like once every couple of months, but it's pretty infrequent.

D: OK. Alright, so I just have a few questions. Right now over your right ankle, do you have, so you mentioned you don't have any swelling, but do you notice any kind of redness or warmth at all?

P: No, nothing like that.

D: OK, and if you press down on your ankle, does it hurt a lot?

P: Uh a little bit of pain now that right, uh, like outside, but it's not uh, it doesn't hurt that bad. Yeah, I'll say no.

D: OK, and if you kind of, uh, are you able to move your ankle at all?

P: I can, yeah I can move it around a little bit. I'm trying to avoid that though, just because it it does hurt, but I can move it around.

D: OK. And are you able to stand up and walk or are you not able to do that right now?

P: I can, yeah, just for short periods of time 'cause it's just 'cause of the pain, but I can walk on it.

D: Ok, yeah, so definitely what we'll do is we might need to get like a proper physical examination done to make sure there is no fracture. Most likely though, it seems that this may just be an ankle sprain uh, due to you inverting your ankle the other day. Uhm, what we can do is usually we just immobilize the ankle and then recommend applying ice. You can take some NSAIDS like Advil for pain to help you. And it should it should get better on its own, with some physiotherapy later on as well. However, if we find that on physical examination you are having significant pain on palpation or any kind of bony pain, we might also require you to get an X Ray of the right foot and ankle, as well as just your lower leg. So yeah, we'll have you come come in in person and then go from there and see if you need an X Ray.

P: OK, that sounds good, thank you.

D: Alright, take care bye.


D: What brings you in?

P: So yeah, I've just been having a cough for the last week and I think I had a little bit of a fever in the last few days.

D: OK, so you said the cough started a week ago?

P: Yeah, around a week ago OK and the fever started two to three days ago. Yeah, I haven't really measured it, but like I definitely have been feeling chills.I've been wearing like multiple blankets over the last few days.

D: Ok, have you taken your temperature? You said you haven't taken your temperature right?

P: No.

D: OK. So let's focus on the cough. Is it persistent or does it come and go?

P: I think the cough is pretty persistent over the last week.

D: OK, and does it get worse with like cold air or dust? Like maybe pets or anything like that?

P: No, I think it stays around the same.

D: OK, umm, does it get better with anything? Have you tried any over the counter cough syrup?

P: Yes, I tried tylenol cold and liked it. I think it made it a bit better, like it helped me sleep. Other than that, during the day, it's still around the same.

D: OK, and how would you describe this cough? Is it barky? Is it harsh? Does it sound muffled?

P: How I would say is that it's kind of like it's not too harsh. It's more like a wet cough. I'm definitely bringing up some some sputum.

D: OK, um, what color is the sputum?

P: It's usually like a, uh like a white and sometimes like a little bit yellow as well.

D: OK, is it ever green or do you ever see blood in there?

P: No, I haven't seen any of that.

D: OK. And have you ever had a cough like this before?

P: Umm, yeah, probably like in the last year, maybe I have gotten sick like once and had a similar cough.

D: OK, do you have a sore throat?

P: No, I don't have a sore throat.

D: Is this cough getting worse?

P: It's, I think not really, it stayed around the same and I definitely feel a bit better with the tylenol cold.

D: OK, good. Any changes in your taste or smell?

P: No, no changes.

D: OK, any changes in hearing or vision?

P: Nope.

D: And did you have in the past week a runny or stuffy nose?

P: No.

D: OK, any weight loss over the past month?

P: Umm, no, not really.

D: How about changes in your hair, nails or skin like rashes?

P: No, no changes to the skin.

D: OK, any shortness of breath?

P: No, no.

D: How about wheezing?

P: No, I don't think I've recently.

D:OK, chest pain?

P: No chest pain.

D: How about swelling? Have you noticed any swelling in like your legs or arms or your belly area?

P: No, I don't think so.

D: OK, how about you feeling like your heart's racing?

P: No, no, nothing like that.

D: OK, how about a calf pain?

P: No, no.

D: Any dizziness or fainting spells?

P: No, nothing like that.

D: Headaches?

P: No.

D: Confusion or memory loss?

P: I don't think so.

D: Have your bowel movements been normal?

P: Yeah, I like go three times a day and I don't have any diarrhea or anything.

D: OK, how about urinating wise?

P: Everything normal there. Yeah, no trouble.

D: OK,nausea or vomiting?

P: No.

D: Joint pain or muscle ache?

P: No, I don't think so.

D: OK. Any Contacts with sick people around you recently?

P: My wife was actually just sick last week, but she recovered. She did have a fever for one of the days and she also had a cough.

D: OK, did she get it checked out in a clinic?

P: No, I don't think so. She did get that COVID test done, but it came back negative and she didn't go to the doctor or anything. It kind of just went away on its own.

D: OK, any travel recently?

P: No.

D: Are you otherwise healthy? Do you have any longstanding medical conditions?

P: Just as a child. I had, probably in my teens, had my appendix removed, but nothing other than that.

D: OK. OK, no hospitalizations other than that too, right?

P: No, No.

D: Are you on any medications?

P: No, I just take some multi vitamins.

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

P: Yeah, as far as I know.

D: OK, how about allergies?

P: I do have like some, I get some runny nose around spring time probably I think I'm allergic to pollen.

D: OK. And any family history of lung conditions?

P: No, not that I know.

D: How about heart conditions?

P: No, I think my father has high blood pressure if that's like a heart condition.

D: OK, sure. And how old was he when he got that?

P: He's around like 60s right now, so probably like in his 40s.

D: OK. Any cancers in the family?

P: I do have an aunt on my mother's side who had ovarian cancer.

D: OK, how old was she when she was diagnosed with ovarian cancer?

P: I think probably in her 50s.

D: OK, and do you smoke?

P: No, I don't smoke.

D: How about marijuana?

P: Marijuana just maybe like one or two joints in a month, just when I'm feeling that I need to relax a little.

D: OK, sure and by joint, you said once a month right?

P: Yeah, once per month.

D: OK, any other drugs?

P: No, no other drugs.

D: And where do you live right now?

P: I live in London right now. I live with my wife in an apartment.

D: OK, any reasons to think you have old carpet mold or asbestos?

P: No, it's a fairly new apartment.

D: OK, and well those are all the questions that I had for you today. Did you have any questions for me?

P: You don't think it could be COVID right? Like my wife got tested and it was negative.

D: Are you concerned about that?

P: Yeah, for sure.

D: Honestly, some of your symptoms do seem to be overlapping with that of COVID, especially the cough and fever. So we are going to do a COVID swab just to rule that out. So you will get those results in 24 to 48 hours and you should isolate for 14 days because your symptoms overlap. Public health will be in touch with you if it's positive just to do some contact tracing. But if it's not COVID, it could be another viral infection that's going around at this time of year so keep an eye on your symptoms. If they become worse, or if you're experiencing symptoms like neurological deficits or weakness or seizures or anything like that, get help from the ER right away and if your symptoms are persisting beyond like seven days to 10 days, also you should give us a call back to see what's going on because it could be something like a bacterial infection, in which case we can give you some antibiotics. Does that sound OK?

P: OK, great. Thank you.

D: Thank you.


D: How may I help you?

P: Hi, I've had um I've had a cough for the past um three days and uh I also developed a fever, um I think, so I checked it yesterday night, it was um 38. And uh I just decided to uh come into the walk in clinic just to um just to get myself checked out.

D: Yeah certainly, it it sounds like you um have had a fever as well, so uh with the cough, you said that started three days ago, has it been getting uh any better or any worse?

P: It's gotten a little bit better, I'd say.

D: OK, that's good. Um and and prior to three days ago, um did you have a cough before or was it a new new cough?

P: It's a new cough.

D: Alright, and uh are you bringing up any sputum?

P: No.

D: Um are you bringing up any blood?

P: No.

D: And have you had any shortness of breath?

P: Uhm no, I haven't.

D: OK, um how about any wheezing?

P: Yeah, I guess a little bit.

D: A bit, OK. Um is it uh, are you having any chest pain?

P: Uhm, no.

D: OK, um and so you mentioned um, with a fever have have you had any chills?

P: Yeah I did. Um I had the chills yesterday.

D: OK. And have you had any night sweats?

P: Uhm, no.

D: Alright, and um have you had any eye redness, runny nose, or even a sore throat?

P: No, I haven't.

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

P: Uh no.

D: Uh a loss of taste or loss of smell?

P: No.

D: OK and any um abdominal pains?

P: Uhm, no.

D: Any uh diarrhea?

P: No.

D: You got any urinary problems?

P: No.

D: OK, and have you had any skin changes or uh rashes?

P: No.

D: And how has your energy been? Have you had fatigue?

P: Um a little bit.

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

P: Uhm, not much. No, but yeah, it's just I've been feeling, yeah, I guess a little bit. I have been feeling achy, uhm but I just thought it was my fibromyalgia acting acting up, but yeah, it's it's been worse over the past three days.

D: OK. Uh so you've had um this cough, a dry cough, a fever, chills, and uh been more tired and and been a little bit more achy these past uh three days. Have you had any other symptoms?

P: I don't think so.

D: OK, and have you tried anything to make it better?

P: Uh I just took a day or two off of work and I just rested and um had a lot of uh hot water. It helped me, uh It helped with the cough.

D: OK great, and um have you had any uh like symptoms like this before?

P: Yeah, um, yeah I mean, when I I guess I get sick I do get similar symptoms like when I get the cold or the flu, but I usually have like a runny nose um or like a stuffy nose, but that's kind of different this time, a little bit.

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

P: I have fibromyalgia and uh I um also have schizophrenia.

D: OK, and are you taking medications currently?

P: Uh yeah. Uhm, I take um quetiapine and uh I just I take Advil um when my uh joint pains are really bad.

D: OK, and do you have a um somebody that follows you along for either uh fibromyalgia or or schizophrenia?

P: Um my family doc. And then um yeah, it's pretty much just him. Um he, yeah.

D: OK. And uh do you have any allergies to medications?

P: No.

D: Alright and um are you aware if your immunizations are up to date?

P: Um yeah.

D: Alright, and could you tell me, alright then sorry actually, uh have you had any hospitalizations or uh previous surgeries?

P: Uhm well, I uh I've been hospitalized. I I was kept in the psych unit for a couple of days, um two years ago. But nothing other than that.

D: OK. Um and it's been stable since then?

P: Yeah.

D: OK, great. And I um I just wanted to ask a little bit about um your personal history. I was just wondering if you could talk a little bit about uh where you're living and and who you're living with.

P: Uh sure, so I'm living with my um I'm living with my husband and uh we live in an apartment.

D: OK, and has he been sick or has anybody you've been around been sick?

P: Uhm, he was sick last week but he got better on his own.

D: OK, and were were his symptoms similar to yours or or uh or were they different?

P: Um they were kind of different, I would say. He just had a um he had a sore throat and uh that kind of lasted for three or four days, and then he just got better.

D: OK, and um are you currently working or um?

P: Um I uh no, I'm a I'm a stay at home, I just stay at home, I don't work.

D: OK, and so and have you traveled anywhere or any other uh potential exposures?

P: Uh no.

D: OK, um and do you smoke cigarettes?

P: I do.

D: OK yeah, how much?

P: Uh two or three a day.

D: And and for how long or for, when did you start smoking? Sorry.

P: Uh so I've been uh smoking since I was uh 20 years old, so about 30 years ago was when I started.

D: OK and and have you could, have you thought of, have you tried to quit before?

P: Uhm I did, but then I just didn't. Uh I just went back to it. Um but I'm trying to cut down.

D: OK, uh it's good that you've been able to cut down, so congratulations on that. Um and do you drink alcohol?

P: Uhm I I do. Uh, I'll drink um sometimes with my friends maybe uh once a month or once in two three months. Um but I haven't been going out with them since the pandemic started, so I haven't had much to drink. I haven't had anything to drink um since the past year.

D: OK. Um I see. And uh have you had any um history of heart or lung conditions in the family?

P: No.

D: OK, yeah, and I think that that was all the questions that I wanted to ask on on history today before we go ahead on to the physical exam. Uh did you have anything that you wanted to add maybe before um that I forgot to ask about?

P: Uh no.

D: OK, um so we will start with um some investigations, including a a Covid swab today, just because of your uh general symptoms which do overlap with with Covid, um although it could as you mentioned uh be something like the common cold um as well. Um and so we will uh be sure to test for Covid and in the meantime we ask you to self isolate um for for 14 days, um and we will get back the results um as soon as we can, and if your symptoms get worse at any point, um then we will uh act accordingly.


D: What brings you in?

P: Yeah, so I just came in today, I actually had asthma as a kid and I used to be on the puffers and it pretty much resolved by the time I was around like 18 years old, and I've been pretty good since then. I haven't even been really using the puffers for the last five years, but just recently, just during the winter I started noticing some of my symptoms coming back and now, especially over the last few months whenever I'm doing something like going to the gym or exercising, I do get that shortness of breath and I feel my throat closing in again and recently for the last, I would say a week I've also been having some wheezing as well. So yeah, I just wanted to come back and make sure everything is alright.

D: OK sure, so just to rewind a little bit. When were you first diagnosed with asthma?

P: So I was diagnosed when I was, I think it was like when I was 13 years old.

D: 13, OK, and you've been using Puffers since?

p: Yeah so from then to like maybe when I was 18 I was using Puffers, and then I continued using them on and off like, just the blue one whenever I needed it. But for the last five years, I haven't even had to use any puffers at all.

D: OK, OK. So can you tell me a little bit about the symptoms that you're experiencing right now? OK, so you said some shortness of breath, when did that start?

P: So yeah, in the last, I would say two months I've noticed it, similarly to when I was younger, especially when I'm on the treadmill or running, I get short of breath very easily. But at rest I'm fine, I don't have any trouble, but I've noticed it for the last few months.

D: OK, so it's mostly when you're exercising or with activities?

P: Mhm.

D: OK. And do you feel wheezy as well?

P: Yeah, in the last one to two weeks I would say I'm also wheezing as well. Mainly during like, if I'm running or still, with exercise, I feel myself wheezing. Yeah, so that's been an issue for the last couple of weeks.

D: So once you stop activity, does your shortness of breath and wheezing eventually resolve?

P: Yeah, yeah, so I just have to kind of sit down and relax for a bit and then it goes away on its own.

D: OK, how long does it last before it goes away?

P: Probably, at least, like I would say 10 to 15 minutes.

D: OK, OK.

P: Until I'm fully kind of recovered.

D: Ok, Ok. Are You coughing as well?

P: Uhm, yeah, when I'm exercising, that's when all of that happens. The wheezing, the coughing, but throughout the day otherwise, I'm not coughing.

D: OK. And, when you cough, do you bring up phlegm or is it more like a dry cough?

p: It's mostly a dry cough, sometimes I do bring up some clear, whitish material, but usually it's dry.

D: OK. Alright, and do you feel like your heart's racing?

P: No, no, nothing like that.

D: No, you don't feel like you're breathing a lot more than usual?

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

D: OK, Do you still have puffers at home?

P: I actually, like I haven't used them for a while so no I don't have any puffers.

D: OK. Any weight loss recently?

P: No.

D: No, fevers or chills?

P: No, nothing like that.

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

P: I do, I have just, uh, eczeme, I've had it for most of my life now, so especially during the winter I do get some irritation, especially on my hands. So yeah, some rashes, but that's about it.

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

P: No, no changes.

D: Stuffy nose, runny nose, changes in your taste?

P: No.

D: Changes in smell?

P: No.

D: Chest pain?

P: No chest pain.

D: Do you find you get short of breath when you're laying down or it wakes you up at night?

P: No, just when I'm exercising, especially running.

D: OK, sure, any dizziness or fainting spells?

P: No.

D: Any headaches?

P: No headaches.

D: Any like, reflux, heartburn?

P: No.

D: Nausea, vomiting?

P: No.

D: Changes to your bowel movements?

P: Nope.

D: OK, so you mentioned you were diagnosed with asthma and eczema in the past, any other longstanding medical conditions that you have?

P: Uh, no those those are the only ones.

D: OK, any allergies?

P: I do have, I think like, just seasonal allergies. I don't know if I'm allergic to pollen, but during the spring time I get allergies and then during the winter now I'm getting some of these symptoms that I'm talking about. So yeah, but none to any medications that I know of.

D: OK, so you're not getting any night time symptoms, and you're only getting day time symptoms with activity, right?

P: Yeah.

D: Has this prevented you from going to work or school?

P: Oh yeah, so I, just this past week, I usually do my running, like morning workout right before work, and just one of the days after I worked out, I felt just terrible, with this coughing and short of breath so I just decided to take a day off work that day. But then I realized it kind of goes away on its own, so for the other days I have been going to work.

D: OK, OK, good. And, alright, and then any medications that you're on?

P: I'm on a, Just one of those steroid creams for my eczema.

D: OK, OK. Are you up to date with all your immunizations?

P: Yep.

D: OK, uhm, how about family history of lung conditions or heart conditions?

P: No heart conditions, but yeah asthma is pretty big in my family, as well as eczema, like my mom has it, my sister has it, so yeah asthma is pretty big.

D: OK, how about cancers?

P: Uhm, no, I don't think anyone in the family has any cancers.

D: OK, and do you smoke?

P: No, I've never smoked. I'm pretty health focused and I can't even take if someone else is smoking, so no.

D: No, OK. Do you drink alcohol?

P: No, I don't drink alcohol, no drugs, yeah, I'm pretty, I like to stay very fit and healthy so nothing like that.

D: OK, and have you been in contact with any sick people recently?

P: No, not that I know of. I live by myself in my apartment. I've been working from home. I work as a programmer and so I only go outside for runs and stuff for groceries, so I haven't really seen anyone sick around me.

D: Yeah, and have you traveled anywhere recently?

P: No, I've mainly been at home.

D: OK, good, and where's home?

P: Home is in Hamilton Ontario and I've just been working from home.

D: OK, do you live in a house, apartment, who do you live with?

P: I just live in an apartment by myself. I did have a roommate, like uh, that moved out just a couple of months ago. But yeah, right now I'm just by myself.

D: OK, OK, any old carpets, pets, mold or asbestos in the house?

P: No, nothing like that.

D: OK, good. So those are all the questions that I had for you. Did you have any questions of your own for myself?

P: Yeah, I was just wondering if I should go back on the puffers. I don't have any right now, I just don't know if my asthma has just uh, come back.

D: Yeah so, what we're gonna do is, we're going to do a PFT, so pulmonary function test on you, cause it's been a while since you've had one of those done. And that's just to check how well your lung is functioning, so we'll do that. We'll also maybe get a chest X-ray as well for baseline and depending on what those two come back as, we'll probably get you to use your short acting beta agonist puffer again and we'll also give you a long acting.

P: OK.

D: As well as an inhaled cortico steroid. So, actually, you know what, we'll give you an inhaled cortico steroid and a short acting beta agonist because you can't use both the steroid and the long, so we'll start with those two. We'll start with the short acting as well as inhaled cortico steroid. And if we find that your asthma is just based on like, exertion or like something called athletic asthma, we can also try something called Cromolyn instead but we'll discuss that more. Right now our priority is to get your symptoms under control, so we'll start with the short acting as well as the inhaled cortico steroid. How does that sound?

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

D: Yeah, no problem.