D: How may I help you?

P: I'm so I was skiing yesterday and I fell on my arm and now and it's it's my hands very painful and it looks swollen and bruised. So I thought I should come in and get it checked out.

D: Yeah, certainly alright and so you fell while while you're skiing, so did you use your hand to brace the fall, like with your hand kind of with your wrist extended backwards?

P: Yea. Yeah, so I kind of yeah had my arm stretched out and I fell right on it.

D: OK, and did you feel pain right away?

P: Yes.

D: OK, um, and during the fall did you injure any other parts of your body like your elbow or shoulder or even your head?

P: No, I don't think so. I didn't have, I don't have any pain anywhere else.

D: OK. Uhm and like are you able to move your wrist currently?

P: I can, but it's very painful.

D: OK, and so when did this happen, was it yesterday?

P: Ah yes, it was yesterday.

D: OK, and how would you describe the pain, is it's a sharp pain, dull pain, achy?

P: It's pretty sharp.

D: Sharp, OK and are you feeling the pain radiate anywhere else like down into your hand or up into your arm?

P: Uhm no it's pretty local the pain. Yeah, it's pretty, it's right below the thumb area and just kind of on my wrist an on the right side.

D: OK. Is there anything you've done that's made it that made it better? Like, have you tried any medications or any ice or topical creams?

P: I've been taking ibuprofen for the pain and try not to move it too much and that's been helping a little bit.

D: OK. And is the pain constant or intermittent?

P: It's constant.

D: OK. And, have you done anything that's that's made the pain worse?

P: Um, I guess moving it.

D: OK. And what is the severity of the pain on a scale of 1 to 10, with 10 being the worst pain you've ever felt?

P: I give it like a five or six.

D: OK, have you had an injury like this to your wrist or your hand before?

P: No.

D: Alright, and are you having any neurological symptoms, such as numbness, tingling, or or sensory loss over any areas?

P: No.

D: OK, and how about muscle weakness?

P: No.

D: Alright. And so have you been having any fevers or chills?

P: Nothing like that.

D: Um have you been having any headaches?

P: No.

D: How about any sensory changes like changes to your vision or hearing or loss of smell or loss of taste?

P: No, nothing like that.

D: OK, have you had a runny nose or or felt congested?

P: No.

D: Have you had a sore throat or a cough?

P: No.

D: Have you had any shortness of breath or wheezing?

P: No.

D: Have you had any chest pain?

P: No.

D: Have you had any heart palpitations or feeling like your heart's racing?

P: Uh nope.

D: Have you had any dizziness or fainting?

P: No.

D: OK yeah, and so did you lose consciousness at all during the fall?

P: No.

D: OK. And and have you had any nausea or vomiting?

P: No.

D: Any abdominal pain?

P: No.

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

P: Uhm nope.

D: OK. And how about any urinary problems like pain or frequency?

P: Uh no nothing like that.

D: Alright and, have you had any muscle aches or body pains or like any other musculoskeletal pains besides the wrist?

P: No.

D: OK. And have you had any appetite loss or or fatigue?

P: No.

D: Alright, and have you had any night sweats?

P: No.

D: and have you had any unexpected weight loss over the last several months?

P: Uhm no.

D: OK. And have you been diagnosed with any medical conditions in the past or do you see a physician regularly for any reason?

P: Uh no.

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

P: Uh nope.

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

P: No.

D: OK. And you have any allergies?

P: No.

D: Alright and are your immunizations up to date?

P: Um I think so, I think I just need to get the Gardasil.

D: OK. Have you gotten like the first dose of that yet, or are you still still waiting to get that?

P: I'm still waiting to get that.

D: OK. And could you tell me just a little bit about your living situation currently like who you're living with and and whereabouts?

P: I live by myself in an apartment downtown.

D: OK, I'm an are you in school or are you working right now?

P: I'm in school.

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

P: Uh no, no one's been sick around me. I haven't really been leaving my home.

D: I see OK. And have you traveled anywhere recently?

P: Uh nope.

D: Alright. And just staying active, which is good. Do you do any other activities besides the skiing?

P: I do, I like I go snowboarding in the winter, I go camping, I like playing tennis, and volleyball.

D: OK cool yeah it sounds fun. And like do you smoke cigarettes?

P: No I don't.

D: OK, uh, do you drink alcohol?

P: I'll have a beer once in awhile.

D: OK, how often is once in awhile, like how many drinks per week?

P: Oh. Not that many, I'll maybe have like 2 every other week.

D: I see OK and you use cannabis or or any cannabis products?

P: I'll take an edible once in awhile as well, like maybe once a month.

D: OK, and how about the use of any other recreational drugs?

P: No.

D: Alright, and in the family, are there any history of neurological or musculoskeletal problems?

P: No.

D: How about any autoimmune conditions such as hypothyroidism?

P: No.

D: OK so next I will ask you to just have a look at the wrist for the physical exam portion. Are you seeing any swelling or redness?

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

D: OK, and if you touch the joints around the wrist on both sides, is the right wrist, does it feel hot?

P: No, actually. Yes it does.

D: OK. Alright, and but there's no swelling there.

P Uhm. There's maybe a little bit of swelling compared to my left.

D: OK, and are you noticing any muscle atrophy or or any deformity at the wrist?

P: Uh, I guess there's like a slight bruise.

D: OK, and are there any like raised bumps if you put your finger over it over the bony edges?

P: Uhm no bumps but just a general kind of swelling in the area that makes it look raised.

D: Alright, and and if you palpate or press on some areas of the wrist are there any areas that you're feeling pain like at the distal radial head, the distal ulna, uh or any areas of the wrist?

P: Uhm there's some pain at the distal radius for sure.

D: OK, uh, alright and is this on the back of the hand or the that the palm side.

P: It's on the palm side.

D: OK. Do you feel any pain if you push in the what's called the anatomical stuff box, so it's at the base of the thumb um on yeah, the base of the thumb on the back of your hand?

P: Base of the thumb, um no, I don't feel any pain there.

D: OK. And. OK, so no pain at the the dorsal anatomical snuffbox and in terms of range of motion are you able to flex and extend your wrist?

P: I am.

D: OK and then how about move it like side to side, kind of deviating it?

P: Uhm I can do all of these things, it just hurts a lot.

D: OK, are you able to make a fist?

P: Yes.

D: Alright, and do you have any problems at the elbow or are you able to flex and extend the elbow OK?

P: I can flex and extend OK.

D: OK, so I think that was everything that I wanted to check today. Did you have any questions or concerns?

P: Uhm no, just do I need any sort of surgery for this, and do I need an X Ray? How do I go about trying to treat this?

D: Yeah, so I think I it, X-Ray would be the first step here because from what you're describing, and particularly with the mechanism of the injury and where you're feeling pain can be a common cause of a distal radial radial fracture which is one of the forearm bones. And so yeah, we will need an X-Ray to look to see if there is a distal radial fracture. And it's not sounding like this right now, but another thing that will look for on on the X Ray of the hands too is a scaphoid fracture to make sure that that's OK, but you didn't have any pain in the area of the scaphoid, which is reassuring, but we still want to image and make sure, although that most likely thing would be the distal radial fracture an if that's the case, then there will be like we will have to go into a cast for a period of time. And depending on how much joint involvement there is, there might be the possibility of surgery, but cannot comment too much on on that just yet. We will need to get the imaging first.

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


D: Would you mind starting with telling me what brought you in?

P: Sure I have had this cough for the past five days and it doesn't seem to be getting any better so I'm just here to ask you what it what it possibly could be.

D: Has the cough been getting any better, staying the same or getting worse over these last five days?

P: I think it's getting worse.

D: Are you bringing up any any phlegm?

P: No.

D: Okay, are you bringing up any blood?

P: No.

D: OK, have you been coughing at night time as well? Is it interfering with your sleep? Or is the cough just during the day?

P: Um, it is mostly during the day and in the evenings, it doesn't wake me up from sleep.

D: OK, and any triggers that you've notice 5 days ago or anything that changed at that time to bring on the cough?

P: No, nothing.

D: OK. And have you been having any other symptoms with the cough?

P: I have a sore throat and I feel like I can't taste things the same.

D: OK, um, are you having any pain with swallowing either liquids or food?

P: Um, mostly with foods.

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

P: It started up around the same time as my cough.

D: OK, and you can't taste your food as well, and when did you notice that?

P: That was two days ago.

D: OK, have you noticed any any loss of smell?

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

D: OK, and have you had any difficulties breathing or short of breath?

P: No.

D: OK. And have you had any symptoms like this before?

P: No, nothing like this.

D: OK. And how has your energy level been? Have you been fatigued?

P: A little bit, yes.

D: OK. Have you had any changes to your vision or or hearing?

P: No.

D: Any mucous or pain or discharge from either your ears or nose?

P: No.

D: OK, so your nose hasn't been runny, but has it felt congested?

P: umm, no.

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

P: I don't know about fevers. I guess I was feeling a little bit hot last night, but I didn't take my temperature.

D: OK, so possibly a fever. I will certainly check your temperature today to investigate that. Have you had any night sweats?

P: Umm, no night sweats.

D: Alright. And have you had any weight loss in the last few months?

P: No.

D: OK. And have you had any chest pain?

P: No chest pain.

D: Have you noticed any heart palpitations or heart racing?

P: No.

D: Right, OK, have you had any wheezing?

P: No.

D: Alright. And have you had any abdominal pain?

P: No.

D: Any nausea or vomiting?

P: No.

D: OK, how about any urinary problems?

P: No.

D: Problems like diarrhea or constipation?

P: No.

D: OK, and any muscle aches or or body pains?

P: No.

D: Have you had any rashes?

P: No.

D: OK, so the cough started 5 days ago, you had a sore throat, you've been feeling a bit more tired and haven't been able to taste your food for the last couple of days.

P: Yes.

D: OK. Have you been diagnosed with any medical conditions before?

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

D: OK, nothing you see a physician regularly for?

P: No.

D: Alright, do you take any medications?

P: No.

D: Alright, do you know if you have any allergies to medications?

P: Umm, possibly penicillin.

D: OK, do you know what the reaction was?

P: I think I had a rash.

D: OK. Are your immunizations up to date?

P: I think, yeah, I think so.

D: Excellent and any surgeries before?

P: Umm, no.

D: And have you been in the hospital for any reason?

P: Umm, no, no.

D: OK. And are you in school now?

P: I'm in grade 6.

D: OK, cool, what's your favorite class?

P: I would say it's math.

D: Awesome and has there been anybody in your class who's been sick?

P: No, everything's virtual right now.

D: OK cool, so have you traveled anywhere?

P: Umm, no.

D: Alright, and who are you living with?

P: I live with two of my younger siblings and my mom and dad.

D: OK, and is there any physical or verbal abuse in the home?

P: No.

D: OK, so you do feel safe in the home?

P: Yes yes.

D: OK. And do you smoke cigarettes?

P: I don't.

D: OK and I know some people in your age group might even start using other types of substances. Have you noticed anything like that, or have you used anything like that?

P: Umm, no.

D: OK. And so do you drink? do you drink alcohol?

P: I have had a sip of wine, but that's that's about it.

D: OK, great. And has anybody in your family had had similar symptoms?

P: No, I don't think so.

D: OK, um and anybody in the family have asthma or lung conditions?

P: I think my aunt has asthma but I was I was checked for asthma when I was younger and it turns out I don't have it.

D: OK, and any diseases that run in the family like genetic or congenital?

P: I think Crohn's disease.

D: OK, and umm, who in the family has that?

P: My father.

D: OK, so that was everything that I wanted to ask today, was there anything else you wanted to tell me?

P: No, that's it. What do you think I have?

D: Well, it is sounding like it could be most likely an infectious type of process going on with the possibility of having a fever with a cough and sore throat. So we'll do a physical exam and also some investigations which will include a covid test today. Because some of these symptoms do overlap, but it could be something like the common cold. I don't know the virus that's bringing this on but it's not necessarily covid. But because we're doing the test, it will require 14 days of self isolation. We'll get back to you with the results as quickly as we can.

P: OK, sounds great, thank you.


D: What brings you in?

P: Um, hi, I'm here with my daughter. Uh, we noticed that uh, since yesterday she's been having this pain just in her elbow. Um, and like today, we've noticed right after she woke up, she's been in pain and also just keeping her elbow like protected, um, kind of like just flexing it and just holding on to it. So I think it's uh, giving her a lot of discomfort and she's been crying as well.

D: Oh yeah, for sure. Um, when did this start?

P: I think it started, uh, after we went for a walk last uh, evening. Um, and we just went to the park and since then like she's been having that pain.

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

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

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

P: She says it's aching a lot.

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

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

D: Okay. Um, and then, is the pain just in the elbow, or does it radiate down into her hands or up to her shoulders?

P: Um, it kind of goes into her upper arm, like from her elbows to her upper, upper arm.

D: Okay, have you tried anything for this pain?

P: Uh, no, I haven't tried any medications or anything. I just wanted to come in before I tried anything.

D: Yeah, 1 to 10, 10 being the worst type of pain, how bad is this pain for her?

P: I would say it's probably, at least a 7.

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

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

D: Okay. Um, and then does she have any numbness or tingling in the area?

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

D: Okay, how about memory loss or confusion?

P: No.

D: Um, any headaches?

P: Nope.

D: Um, dizziness or fainting spells?

P: No.

D: Any weight loss recently?

P: No.

D: Fevers or chills?

P: Nope.

D: Uh, rashes?

P: Uh, no.

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

P: No.

D: Uh, any coughing, shortness of breath, or wheezing?

P: Um, no.

D: Uh, any chest pain or heart palpitations?

P: No.

D: Uh, any changes in bowel movements?

P: Uh, no.

D: Um, how about changes in urine?

P: Um, no. No, no changes.

D: Okay, and is she otherwise healthy? Does she have any longstanding medical conditions?

P: She's been healthy so far, no concerns at all.

D: Okay, and um, with her mother's pregnancy with her, were there any complications at that point?

P: Um, no, it was like a normal pregnancy, no complications. She was born at 39 weeks, like with vaginal delivery, didn't have to stay in the hospital or anything like that.

D: Okay, and no issues as a neonate?

P: Uh, no, she, we were able to bring her home pretty quick.

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

P: No, no surgeries or hospitalizations.

D: Alright, his she on any medications?

P: No, no medications.

D: Okay, um, is she up-to-date with her immunizations?

P: Yeah, we've had, we've got all the immunization.

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

P: Um, no allergies.

D: Okay, any uh, family history of musculoskeletal issues?

P: Nope.

D: Uh, lung or heart conditions?

P: Nope.

D: Um, autoimmune conditions?

P: No.

D: Cancers?

P: Um, nope.

D: Um, is she like on par with her peers in terms of developments and reaching milestones?

P: Uh, no, like she's been meeting, all her milestones have been on par with her siblings and other children. No concerns from the doctor whatsoever.

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

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

D: Okay, um, and does anyone at home smoke?

P: Nope.

D: Any concerns for her safety at home?

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

D: No, okay. And how are things at school for her?

P: Schools been well, like it's been difficult with the pandemic, but um, she's doing well.

D: Okay, that's good. Has she come in contact with anyone sick recently?

P: Um, no.

D: Have you done any travel recently?

P: Nope.

D: Okay. Alright, and those are all the questions I had for history taking. Let's move on to the physical exam part of this interview. Um, I'm just going to get you to take a look at both her elbows and arms. Do you see any, um, redness or swelling in the right elbow compared to the left?

P: No, I don't see that. No, I don't see any changes.

D: Okay, how about um, any muscle atrophy, deformities, or skin changes, like bruises?

P: Um, no, I don't see anything like that.

D: Okay. How about, um, when you palpate her elbows, does, is she in pain?

P: Um, she doesn't really let me, but if I try to, I think that does cause her some pain.

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

P: Um, no, not as much.

D: Okay, how about her biceps and triceps?

P: Um, no, not really.

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

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

D: Okay. Yeah, it seems like someone of her age and just the kind of history that you're giving me, it sounds like she has something called a radial head subluxation. Um, and that's usually caused in young children when they're like pulled or lifted by the hand or wrist while their arm is held straight, um, which can kind of pull the bone out of its socket a little bit. Um, so um, in terms of like a management plan, you can try conservative things like ice packs, um, over the counter painkillers. Um, otherwise, we can try to um, put the radius back into its normal position here, which will just take uh, like a few minutes. Um, and, and then after we reduce it back into its place, um, she should have normal function of her arm again. Um, if she's still experiencing pain, we can continue keeping it on a splint, um, but otherwise, I don't think we need any imaging for this at this um, at this time. So did you have any questions or any concerns about that?

P: No, I think that's, um, that's a good plan.

D: Okay, great. Um, thank you.

P: Thank you.


D: What brings you here today?

P: I've had uh a new cough that started um this week, it's been going on the last like three or four days and um I've had a headache and um but yesterday I just noticed that I haven't been able to to smell, so I wanted to come in this morning.

D: OK, yeah, so it's been going on for the last uh four days. Is it kind of like a dry cough or a wet cough?

P: It's dry.

D: It's dry, OK. Are you at all bringing up any kind of sputum or blood at all?

P: No, I haven't been.

D: OK and um have you been experiencing any kind of uh fevers or chills?

P: Yeah, I feel, uh, I have felt feverish. Uh and I think that yeah, that's kind of started uh like within the last day.

D: OK, and did you um get a temperature at all?

P: No, I've just been really feeling, yeah feverish and feeling really hot.

D: OK and um besides the um cough, are you having any other symptoms like muscle aches or headaches?

P: Uh yeah, I've been having a headache like I dont know, on and off for this past three or four days as well, and I have had muscle aches, my whole body kind of aches.

D: OK, um and when did this start?

P: That's been over the past um like 3 days or so, yeah, I woke up and I've just been feeling uh yeah achy and just not feeling good.

D: OK. Yeah, so it all just kind of started in the last four days. Uh are you having any kind of fainting or dizziness episodes at all?

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

D: OK and any uh, are your symptoms getting worse at all?

P: No, they, well I, initially they did but um they've kind of stayed the same.

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

P: Yeah I had, I have, I've had a loss of um smell and taste now that you mention it, yeah.

D: And when did that happen?

P: Um within the last uh two days.

D: OK, and are you having any runny nose, congestion, sore throat, any of those symptoms?

P: Uh no, not really. Nothing like that.

D: OK, have you traveled at all recently?

P: No, I I haven't traveled um, haven't traveled anywhere. But I I've just been going to work and and being at at home.

D: OK and um, where do you go for work?

P: Um I'm a nurse actually at the at a um a walk in clinic.

D: OK, and have you uh at all been exposed to anyone who's been sick? Uh anyone who has tested positive for Covid?

P: Uh no, nobody that I'm aware of that's that's tested positive, but there has been people uh recently um that within the past week, that we've seen come in with with cough and um things like like that so.

D: OK. Um are you having any nausea or vomiting?

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

D: OK, any um night sweats?

P: No.

D: Any chest pain or shortness of breath?

P: No.

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

P: No.

D: Any um changes in your urination?

P: No, nothing like that.

D: Um no burning sensation or pain at all?

P: No, nothing like that.

D: OK, any changes in your sleep or appetite recently?

P: Uh yeah, just these past couple of days, I haven't really felt like eating much. Um my sleep has been OK, but I think that's just because I haven't been feeling well so just haven't really wanted to eat.

D: OK, any weight changes recently?

P: No I, I wish.

D: OK. And have you been diagnosed with any medical conditions in the past at all?

P: No, I've been. I've been, I've been healthy.

D: OK. And do you take any medications on a regular basis?

P: Um just the uh the multi vitamin and then a like a greens supplement.

D: A green green supplement?

P: Yeah, it's just sort of like a like a green um powder. It's supposed to replace uh I don't know one of your servings of vegetables for the day.

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

P: I I had like a scope on my knee when I was um like a teenager, I injured it playing soccer, but that's it.

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

P: Um my my grandfather had had lung cancer, um but he smoked his whole life

D: OK. Um and currently, so you work as a nurse, uh what's your living situation like? Do you live with anyone, do you live in house or apartment?

P: Yeah, so I live in a house with my wife um we we have a a young um a daughter.

D: OK, has anyone in the house had similar symptoms or been feeling sick lately?

P: No, it's just been me. Yeah my wife and daughter have been both uh staying home. I've been the one, only one really kind of leaving the house for well going to work and then uh getting most of the groceries and that that sort of thing, since I'm already out.

D: OK. OK, and currently do you smoke at all?

P: Uh no cigarettes, um well I uh smoke weed every once in awhile.

D: OK, and how often would you say you smoke weed?

P: Uh probably like, uh probably once a week. Just yeah, just on the weekend, maybe once.

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

P: Um I had some like a couple of beers on the weekend, like one or two.

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

P: Um just a bit concerned possibly about uh Covid.

D: OK, yeah, so that's definitely uh with you working in the in the hospital clinical setting, um there is definitely a possibility, and a lot of the symptoms that you're having overlap with Covid symptoms. Uh, so we will definitely get a Covid swab test done for you today. It usually comes back in the next 24 to 48 hours and until then uh I would recommend that you isolate either in a room separately, wear a mask around your family members, um isolate to the best of your abilities, not go outside, see if someone else can get groceries for you guys uh as well. And then um depending on the test, public health will contact you with further instructions.

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

D: You're welcome. Take care.

P: Take care.


D: How may I help you?

P: Hi, um, I'm here because I, I had this cough for a couple days and now my voice still hasn't recovered. It sounds really hoarse and I can't speak as well, so I was just wondering if you can give me something for that.

D: Possibly we will see just gotta ask a few questions first, and we'll, we'll do a physical exam as well afterwards, but certainly, we'll look into what is causing your symptoms. So you mentioned a cough. When did that exactly start?

P: That started three days ago.

D: Okay, and have you had a cough before?

P: Um, like before the three days you mean?

D: Yeah.

P: Um, no, I was pretty healthy before then.

D: I see and uh, with the cough, are you producing any phlegm or sputum?

P: No, it's pretty dry.

D: Okay, have you noticed any blood?

P: No.

D: Alright, and have you had a wheeze?

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

D: Alright, and have you had any uh, chest pain with the cough?

P: No.

D: Alright uh, and you noticed that your voice is, voice changed, and that was about 3 days ago as well?

P: Yeah, that, so, well no, actually that started about yesterday. Yeah, yesterday in the afternoon.

D: Okay, and uh, any triggers for this? Like were you at any events that you had to be uh, kind of speaking loudly or talking a lot or anything where you're straining your voice?

P: Um no, no, I wasn't. I was like, I had school, I came home, I didn't do anything like that.

D: Okay. Yeah, so it sounds, yeah, just sort of came on on its own. Alright, and have you had any like, eye redness, or discharge, or a runny nose?

P: I have had uh, I've had a runny nose before, but no eye discharge.

D: Okay. With the runny nose, what, what, what could you describe the uh, mucus that was coming out?

P: Uh, it was, it was clear.

D: And has that gone away now and then when was the runny nose?

P: Yeah, that's gone, yeah that's gone. That went away but like, um, yeah, two days ago maybe.

D: I see, and have you had a sore throat or do you have a sore throat?

P: Um I have, so, it hurts because I'm coughing, but it doesn't seem like it's my actual throat.

D: Alright, is there any pain with swallowing food or liquids?

P: No.

D: Okay. Um, and have you had any fevers or chills?

P: No.

D: Or any, any night sweats?

P: No.

D: And any changes to your weight recently?

P: Um, I've had some weight gain over the past like six months.

D: Okay, well that's great. And about how much?

P: Uh just, maybe like 5, 10 pounds. 5 to 10 pounds, somewhere around there.

D: Okay, well that's good. And um, have you had any nausea or vomiting?

P: No.

D: How about any abdominal pain?

P: Uh no.

D: Any uh, diarrhea?

P: No.

D: Or any urinary problems?

P: No.

D: Have you had any muscle aches or, or joint pains?

P: Uh, no.

D: Okay, and have you had any loss of your taste or sense of smell?

P: No.

D: Okay, um, and any skin changes or rashes?

P: Nope, nothing like that.

D: Okay, uh, and um, so you've been experiencing, so you had a runny nose that's gone away um, and now you've been having this cough for the past, dry cough, past three days and lost your voice yesterday. Have you been experiencing any other symptoms?

P: Um no, no other symptoms.

D: Alright, in the past, have you been diagnosed with any medical conditions?

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

D: That's great, and u, have you been, um, have you had any allergies before?

P: No.

D: Okay, and uh, do you take any medications regularly?

P: Uh, I just take some multivitamins.

D: Okay, and uh are you aware if your immunizations are up to date?

P: Uh, so I have everything except for that HPV vaccine.

D: Okay, um, is it, do you have a plan to get that one or?

P: I think so. I'm just uh, waiting to follow up with my family doctor about that.

D: Okay, well that, that's a good idea for sure. So it's great that you have a plan for that, um, for that. Yeah, it can be really helpful for preventing cervical cancer, as, as I'm sure you'll talk to the, with the family doctor about. Yeah, and have you had any hospitalizations or any surgeries?

P: Uh no.

D: Okay, um, where about are you living right now, and who are living with?

P: I live uh, with my parents um, and my two younger siblings. We live in a house.

D: Has anybody else been sick or have similar symptoms?

P: Uh no, no one at home's been sick.

D: Okay, and uh, how about anybody at school or, or work, or anything like that that you've been around who's been sick?

P: So one of my friends actually had like a runny nose and a cough as well a couple of days ago, but uh, she seems to be better now and her voice is okay.

D: Okay, and um, have you traveled anywhere outside of the city or province?

P: No, no, not recently.

D: Alright, and, um, in the home, is there any uh like, are you exposed to any violence of any sort, like physical or emotional, either yourself or, or witnessing?

P: No.

D: Okay, and what grade are you in?

P: I'm in grade 7 or, yeah grade 7 now.

D: Oh awesome, and uh, I don't, is there any smoking in the home?

P: Uh no, no one smokes at home.

D: Okay um, and then, um, anybody in the family uh, have any heart or lung conditions?

P: Heart or lung? I know, um, like, heart disease, runs on my father's side of the family. I'm not really sure like exactly what, what kind of diseases though.

D: Okay, um, and I, sometimes people that, kind of in this age group, might experience with either drugs or alcohol. Have any of your friends done that or, or yourself?

P: I know like some of my friends have uh, tried alcohol and try marijuana, but I haven't experimented yet.

D: Okay, that's good and um, I, that's all I wanted to ask today on history. Was there anything else that you wanted to add?

P: Oh, nothing that I want to add. I just, what do you, how do you think I can make this, make my voice better? And how long will I have, have this horse voice?

D: Yeah, so uh, right now it's sounding like um, a viral type illness where there's inflammation of the vocal cords, uh, with having the cough and the runny nose a couple of days ago. Actually, this reminds me that. Have you, I'm not sure if I asked about fevers or chills, if you have any?

P: Uh no, I haven't.

D: Okay, um, and so for, if it is a viral infection then, um, it's just supportive kind of management. So that will mean trying to stay as hydrated as you possibly can over these next um, next few days and then also you can use things like, if they help, like lozenges or something along those lines. Um, but it will, it will just take some time for it to come back on its own, a few days to a couple of weeks sometimes. And the cough could possibly last for um, two to four weeks after um, after having a viral type illness.

P: Okay.

D: Yeah, so it could be quite a few weeks that the symptoms last for. But since you're having a cough, and these symptoms could overlap with COVID we'll want to get a COVID swab today as well um, and kind of go from there.

P: Okay. Okay, that sounds good, thank you.


D: What brings you in?

P: Hi I'm here with my son and he's just been feeling awful. He just has this runny nose and he's been sneezing all the time and uh I don't know maybe he has allergies or something? I just came in 'cause I wanted to get him checked out and maybe get some medications. He's just feeling horrible.

D: Yeah, for sure when did when did the sneezing and runny nose start?

P: He he's had it for um, he's just always kind of, you know he's always having that runny nose. You know kids always do but it's just been pretty bad over the past um two weeks.

D: Past two weeks. OK. What started first, the sneezing or runny nose?

P: Uh the runny nose kind of just got worse a little bit over the past uh two weeks and then the sneezing kind of started at about the same time.

D: OK and and the runny nose is he having um like what colour is it?

P: It's just clear like.

D: Clear. OK. Does he ever feel like he's uh, do you ever feel like he's stuffy?

P: Uh yeah, kind of. He's just been snorting and sniffing and um I don't think he knows how to blow his nose yet. But he's like clearing his throat, so I think he's he's a little bit stuffy.

D: Okay.

P: But he hasn't complained about difficulty with breathing or like, he's been, like he sleeps with his mouth closed. So I think he he should be able to breathe OK.

D: OK, good, so you said no shortness of breath or trouble breathing. Has he had any coughs?

P: Kind of. In the morning, so I I see that whenever he wakes up in the morning, he just has to like clear his throat a lot and like cough and then um gets better.

D: OK, OK. Is he bringing up phlegm when he coughs?

P: Um, a little bit.

D: What colour is it?

P: It's the same stuff that comes out of his nose.

D: OK yeah, so no blood or pus?

P: No, no.

D: No? OK. Have you, do you think he's lost his like sense of smell or taste?

P: Uhh no.

D: No? OK. Any changes in his vision or hearing?

P: Um I don't think so.

D: No? Did like, um, have you noticed any discharge from his eyes?

P: No, no. Sometimes he does have that, but no, not in the past two weeks.

D: OK so his like eyelids aren't swollen or his eyes aren't red?

P: No, no, no.

D: No? OK. And does he, have you noticed any swelling in his, either like face, neck, like belly area, or his limbs?

P: No, no I haven't. It's just his nose is like a little bit red.

D: OK.

P: And uh yeah, he's just he's just itching all the time, just itching his nose, itching his um ears, yeah but no, no swelling.

D: No swelling. Have you noticed any rashes on him?

P: No, I checked yesterday night very carefully.

D: OK, good. Any weight loss?

P: No, he's been gaining weight so um good that he's been eating well.

D: Yeah, that's good. Any fevers or chills?

P: No.

D: No, does he look like he's like excessively tired?

P: He's a little bit fatigued because of the sneezing and the, and the runny nose. You know, he's not going out to play as much.

D: Mhmm.

P: Um but it's not, you know he's still, he's still cheerful. He's not irritable or anything.

D: OK, OK. Um and then have you noticed that he's like, taking in like, rapid breaths?

P: No, no, his breathing has been good.

D: OK. How about his bowel movements? Have those been normal?

P: Yeah.

D: Yeah OK, any nausea or vomiting?

P: No.

D: Um, how about his urine?

P: No, no problems there.

D: OK, how about like dizziness or fainting spells?

P: No, no, no. I didn't notice anything like that.

D: No? Any confusion that you noticed?

P: No.

D: Headaches?

P: No.

D: No, OK. Um has he been like excessively itching anywhere?

P: Um just his uh, just his nose and I think his like, I think his mouth is itchy too, 'cause he keeps doing this thing with his tongue just kind of, I don't know, just kind of like
itching the top of his mouth with his tongue or something.

D: OK.

P: Um yeah just like his face is itchy.

D: Hmm, OK. Um, has he come into any contact with sick people recently?

P: Um, I don't, maybe. So, two weeks ago he was playing outside, um and I know that he, he does, his symptoms do get worse when he's outside, so I don't know, maybe.

D: OK.

P: He was playing with uh, with his brother but then this other kid from the neighbourhood also came around.

D: OK, OK. How about um travel to anywhere?

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

D: OK, OK good. Um is he an otherwise healthy kid at the moment?

P: Yeah, yeah, he's an, he's a healthy kid.

D: OK, um any complications when you were pregnant with him?

P: No.

D: No? Um how about at birth?

P: No, no complications.

D: OK. Did he need to be hospitalized after birth for any reason?

P: No.

D: Any surgeries?

P: No.

D: Um, any allergies?

P: Um I don't think so. I know he's not.

D: No? He's never been diagnosed with like eczema or asthma?

P: Oh he's, he's had eczema. He had it.

D: OK.

P: Yeah, comes and goes.

D: His eczema comes and goes?

P: Hmm.

D: OK, um is he on any medications?

P: No.

D: No? Even for his eczema?

P: It's pretty mild.

D: OK. Um has, have you ever like given him um Reactine or like any of the, those anti allergy medications in the past?

P: I've tried the, uh, yeah, the ones over the counter, um, they do help. Um, I tried it this time, but uh it didn't do much.

D: OK. OK. And, I was gonna ask you something else. Um, his symptoms, like the sneezing and the, and the runny nose, like has he experienced this before?

P: Oh yeah.

D: OK.

P: It usually gets worse um uh I guess like around this time, uh I can tell when spring is coming up. Um, it gets pretty bad, but he always has a runny nose um and he sneezes sometimes here and there.

D: OK, and you mentioned this has been going on for more than four days this time around?

P: It's been, it's been going on for the past uh two weeks.

D: OK. OK, and is it like um impairing his like daily activities or like his ability to um like, sleep?

P: Uh it does affect his sleep sometimes he doesn't like um, just the itching really bothers him.

D: Mhmm.

P: So he can't uh, he finds it hard to fall asleep. That's like, I usually, that's when I give him the the medications. To help him fall asleep.

D: OK. OK. And uh is he up to date with all his immunizations?

P: Yeah.

D: OK. Any family history of asthma, eczema, or something called allergic rhinitis?

P: Uh I have asthma.

D: OK. And is your asthma severe?

P: Uh no, it's it's pretty well controlled. I used to, actually, I used to have asthma as a child.

D: OK, I see.

P: It's pretty well controlled right now. I don't even need medications.

D: OK, OK.

P: I remember I used to, I used to get allergies as well as a child.

D: Oh I see.

P: But very similar, lots of sneezing and yeah.

D: Mhmm, alright. Were you ever, did you ever take like an allergy test?

P: No. I didn't think about it, I just never, like my my my parents didn't take me to get that testing done.

D: OK, how about your son? Has he been allergy tested?

P: No, but I feel like he probably should.

D: Yeah, OK. And then, does anyone at home smoke?

P: No.

D: No, OK. Um do you have any, like old carpets, dust, mold, or asbestos at your place?

P: Uh we've got all of, we got our carpets uh removed uh two years ago. That's actually helped uh with his symptoms. Uh and I know, we tried it, we removed the curtains as well and we've used blinds. So yeah.

D: OK.

P: And I don't think so, I don't think there's any spores or things like that.

D: OK, good. Um, is he an otherwise healthy child like developmental wise, like he's growing, gaining weight OK, like he's, his motor skills and like social behaviours are all up to par with his peers?

P: Oh yeah he's doing great.

D: OK OK good um those are all the questions I had for you today. Did you have any questions of your own?

P: No.

D: No, OK. So for him um it sounds more in keeping with something called allergic rhinitis than an infection, but because his symptoms do overlap with that of Covid,  we'll probably get him a swab anyways, and those results should come back in 24 to 48 hours. In the meantime, rhinitis is, allergic rhinitis is caused by allergies to certain things, so we can get him allergy tested um and that will give us a better understanding of like what his triggers are and the way to treat that is to avoid those triggers, those allergens. And if his symptoms are persistent, um we will prescribe him also like an intranasal corticosteroid. Um and there are like, there are like second line treatments as well, like antihistamines and leukotriene, like leukotriene receptor antagonists, but those are like second line. We'll we'll see how he does with the inhaled corticosteroids at first. How does that sound?

P: Sounds great.

D: OK, great.

P: Thank you.

D: No problem.


D: How may I help you?

P: Yes, I just came in here today. I I've just been. Really getting like the soreness in my throat for the past, I would say four days and I also had a fever for the last two days as well.

D: OK. So the sore throat, have you been having  pain with swallowing foods or liquids?

P: Uhm maybe a little bit with solids, not so much with liquids. But yeah, I definitely been feeling more sore.

D: OK. Have you noticed any changes to your voice?

P: Uhm, no, not really, not. I haven't really notice any changes.

D: OK, uh, have you noticed any redness in the back of your mouth?

P: Yeah, I've noticed some redness and then I also feel like there's like some material, like whitish material coming up from the back of my throat.

D: OK, this could be a uh, what they call a tonsillar exudate possibly, we'll look on physical exam. OK, does it look like there's swelling in the back of your mouth?

P: Yeah, it definitely looks angry.

D: OK, have you noticed any swelling in your neck as well like either on on the sides, like, or any lumps there?

P: Yeah, definitely like more on the front side of my neck on both sides. I feel kind of like some swelling and lumps.

D: OK. And you've had a fever as well these last couple of days, so have you had any chills?

P: Yeah, I've had chills and then also been feeling warm during the day. I think yesterday I took a temperature at night and it was 38.4 degrees Celsius.

D: OK, so yeah, certainly a fever. Have you had any night sweats?

P: No.

D: OK. Uhm, and have you had any headaches?

P: No headaches.

D: Have you had any eye redness or eye discharge?

P: No.

D: Any changes to your vision or hearing?

P: No.

D: OK, any ear pain?

P: No.

D: Have you had a runny nose or felt congested?

P: Last week I did have a little bit of a runny nose and a little bit of a cough as well, but this week I'm not really having any cough or runny nose, it's just a sore throat.

D: OK, so the running nose and cough have gone away completely?

P: Yeah.

D: OK, and how long did those last for?

P: Uhm probably like 5 days so it's I think it started two weeks ago.

D: OK. And you're an are you having a cough now?

P: No, no cough right now.

D: OK, uhm, and uh, OK, and have you had any changes to your sense of smell or sense of taste?

P: Uh, no they've both been the same.

D: OK, and have you had any loss of appetite?

P: Uhm, no, my appetite's been pretty much the same I, I still try and I I do get hungry and I try to make sure, even though it hurts a little bit, to keep eating.

D: OK. Uhm, and when you did have a cough, or during this time as well, have you coughed up any sputum or any blood?

P: No, nothing like that.

D: OK, uh, have you had any wheezing?

P: Uhm, no wheezing.

D: OK, now have you had any shortness of breath?

P: No, no shortness of breath.

D: OK, and then how about any chest pain?

P: No, no chest pain.

D: Alright, so have you had any dizziness or lightheadedness?

P: No.

D: OK. Have you had any heart palpitations?

P: Uh, no.

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

P: No.

D: Have you had any diarrhea?

P: No.

D: Have you had any constipation?

P: Ah no.

D: OK and have you had any urinary problems like pain with voiding or urinary frequency?

P: No, nothing like that.

D: OK, and have you had any abdominal pain?

P: No.

D: OK. Uhm, have you had any rashes?

P: No.

D: Have you had any muscle aches or or joint pains?

P: Uh, no not that I know of.

D: OK. Uhm, have you had any confusion or memory loss?

P: No.

D: OK and have you had any changes to your energy? Like any fatigue or malaise?

P: Uhm no, I don't think so. I'm still I still feel like pretty energetic.

D: OK. In the past have you been diagnosed with any medical conditions?

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

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

P: No.

D: OK. And do you have any allergies?

P: No, not that I know of.

D: OK, and do you have any? Are your immunizations up to date?

P: Yeah, as far as I know.

D: OK. And, can you tell me a little about your living situation? So like where you're living and who you're living with?

P: Yeah, I I live with my parents right now in a, in a house just in the city. And I also live with my older brother.

D: OK, have you been going to school?

P: Yeah, right now it's online school right now due to the pandemic.

D: OK, and has anybody at home been sick or have you been around anybody who's been sick?

P: My brother did have like similar sore throat symptoms, I think maybe two weeks ago and he did get some medications from the doctor.

D: OK, so did he get antibiotics?

P: I think so. I think he got some antibiotics.

D: OK. Have you traveled anywhere recently?

P: Uh, no.

D: Alright and, I know if some people in your age group might experience with smoking or or alcohol. Have you or any of your friends tried anything like that before?

P: No, no, nothing like that.

D: OK, and everything that we talk about is always confidential, so you can feel safe sharing with me, and so has there been any concerns with physical or emotional violence at home?

P: No, I feel pretty safe. My parents are pretty caring and loving.

D: OK, well that's excellent. And are you sexually active?

P: No.

D: OK, have you been sexually active in the past?

P: No, not at all.

D: OK. And now in the family, are there any conditions such as heart problems or lung problems that run in the family?

P: Uh, no. Like my parents are pretty healthy.

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

P: No.

D: OK, and how's school going?

P: School is going pretty well, no real issues. It took some time and adjusting to the new online curriculum, but it's going pretty well now.

D: OK, well that's good. I'm glad that you been able to, uh, adjust. So I think that was everything I wanted to ask about on history today. Did you have anything else that you maybe wanted to add? Or that I maybe forgot to ask about?

P: No. I think that those are all the questions I had.

D: OK, so with your current symptoms right now with no cough, tonsillar exudate, a fever, also your age and the like swelling and redness that you notice in the back of your throat is likely a group a strep pharyngitis that's causing this. And with your exposure to your brother who also received antibiotics, could be potentially be a sick contact for you that you were around, so this would require antibiotics as well for yourself and we'll do a rapid strep antigen test to check for this and wait on the result for that because it it still could possibly be a viral illness and so that passes negative and we're thinking it's a viral illness then we might hold off on antibiotics for now and monitor symptoms. And if at any point things get worse like you start to get shortness of breath or your fever's getting worse and it's not, not being controlled, then we'll reeassess the situation.

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

D: Thank you.


D: It sounds like that you're experiencing some chest pain.

P: Yeah, so this chest pain has just been coming on for the last couple of weeks now.

D: OK, uhm. So 2 weeks, and can you tell me kind of where you're feeling that pain?

P: Um yeah, I'm I'm just feeling this chest discomfort, sort of over on the left side.

D: The left side, OK. Does does it stay just in one spot or does it kind of spread anywhere else?

P: No, I don't really feel it anywhere else. Yeah, I just feel it in that one spot on the left side.

D: OK, does it feel dull and achy, or does it feel more sharp?

P: It feels pretty sharp.

D: OK, and is it constant like on all the time, or do you feel like it kind of comes and goes?

P: It comes and goes. I would say I it might last for um 20-30 minutes at a time and then it goes away.

D: OK, and over the last two weeks since you said it started, has it gotten any worse?

P: Uh, no. It's been about the same.

D: About the same, OK, and has it gotten more frequent, these like 20 to 30 minute episodes?

P: No, it's happened about two or three times during the 2 weeks.

D: And if you were to rate it on a scale of zero to 10, zero being no pain and 10 being like the worst pain you've ever felt, where would it fall?

P: I would say a 4 out of 10.

D: OK. Uh, can you think of anything that that you've done differently recently that could have brought it on or is there any kind of common factor between the times that you had the pain?

P: Um,  I don't know I've separated from my husband 2 two years ago which has been really stressful but other than that I mean I can't really think of any changes to my health or anything like that recently.

D: OK, but do you feel like you have been more stressed out in general?

P: Uh, yeah the last couple of years have been a lot more stressful because of those issues in my personal life.

D: OK, I'm sorry to hear that, but I'm glad that you're coming in and we can hopefully get to the bottom of this. Not that I think that's necessarily the source of your pain, and we definitely want to look into everything, but it is really helpful to know that. So when you've had these episodes, have you taken anything to help with the pain or done anything that's that you felt it made it go away?

P: Uhm, I've tried some Advil, some Tylenol and actually some Tums as well, and it hasn't really helped.

D: OK, do you think it's worse when you're moving around, if you're if you're kind of doing more exercise, or is it kind of just the same no matter what you're doing when you get the episodes?

P: Oh, it actually I I feel like it happens most of the time when I'm either at work or or driving.

D: OK. OK, and before this two week period, have you ever had anything like this before?

P: No, I haven't had anything like this happen before.

D: Do you have any chronic conditions that you see your family doctor for?

P: No, previously healthy.

D: And just jumping back to these pain episodes when you have them, do you experience anything else? Do you get any nausea or vomiting?

P: No.

D: OK, do you get any, do you have any difficulty breathing during these times?

P: No, I haven't.

D: OK, and have you noticed any fevers?

P: Uh, no, no fevers.

D: OK, have you been in contact with anyone that's been sick recently?

P: Uhm, no, I haven't.

D: And have you traveled anywhere outside of Canada?

P: No, I've been home.

D: OK so you have, you said you have been previously healthy, nothing that you've been seeing your family doctor for on a regular basis. Do you take any medications?

P: Uhm, I do not, no medications, just the Tylenol and Advil I tried for the pain.

D: OK, do you have any allergies?

P: No allergies.

D: And is there any history of heart problems in your family?

P: Yeah, my father had a heart attack when he was 60 just last year and it's actually one of the reasons what concerns me about the chest pain that I thought I was having.

D: For sure, it always feels very concerning when when you have these these symptoms and that and you know people in your life that have had issues like similar issues in the past. I don't know that this is related to that. I I personally don't think so at this point, but we're definitely going to do everything to look into it and and rule out something that would be scary like that. I'm going to ask you few more questions about your lifestyle in general. Do you smoke cigarettes?

P: Yeah, I smoke about half a pack to a pack per day. I've been trying to quit and I was smoking more one pack per day, but so it is down a little bit, but, It's still something I'm trying to work on.

D: Congratulations, that's a really tough thing to do so, good for you. That's that's really exciting. Step in the right direction, right? Do you drink alcohol?

P: Um, I do, but, uh, I'll have maybe one or two glasses of wine on the weekend.

D: Do you use any other substances?

P: Uh no.

D: I know that you said you don't see your family doctor for anything regularly, but I just want to check a couple of specific things like have you ever been told you have high blood pressure?

P: No, I've never been told I've I've had high blood pressure.

D: And have you ever been told you have like high cholesterol?

P: I haven't, but I've actually never been tested either.

D: OK, and do you exercise regularly?

P: Yeah, actually, I'll either do some running or cycling, probably three or four days per week and I haven't had any chest pain or or problems exercising.

D: OK, that's good to hear. And have you ever had problems with heartburn?

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

D: OK. OK, so just to kind of summarize what we've talked about, over the last two weeks, you started having these 20 to 30 minute episodes of chest pain that's on the left side, it feels more sharp, is that correct?

P: Yeah.

D: And it's kind of constant when it comes on, there's nothing really that makes it better or worse, it just kind of goes away on its own after half an hour or so, it has kind of stayed the same over over the last two weeks, hasn't really gotten worse or better, it hasn't gone away either?

P: Right, yeah exactly.

D: You never had anything like that before and you have been, it sounds like experiencing some stress in your life, it definitely can play into that as well. OK, is there anything else that you wanted to to tell me about that I didn't ask you today?

P: Uh, no, I think that's um, yeah, I think that's all that I wanted to talk about today.

D: OK, so what I'm going to do is bring all this information to your family doctor and we can come back together and talk to you about the next steps.

P: Awesome, thank you.

D: Thanks for coming in.


D: What brings you in today?

P: Yeah, I brought my son here. I'm a little bit worried about him because like yesterday he had he had this temperature of like 38.5 um so he's been feeling a little bit hot and he's not swallowing his food, like we've been feeding him some mashed up food but he's not swallowing it. He's just kind of throwing throwing it back out there. Um he's drooling now uh and he sounds kind of muffled um and he's been very short of breath.

D: That doesn't sound good. Um uh yeah, I'm I'm currently looking at him and he doesn't uh look great. While the uh while the doctor's um taking his vitals and examining the baby, I'll just ask you a couple of questions.

P: Sure

D: So you said that all of this started about a day ago. How was he doing before that?

P: He was fine before that, he had like a an infection, like some sort of viral infection recently, like about a week back, he had like a runny nose and a cough, but that went away.

D: Um OK, so he had these symptoms about a week ago. Did he see any, did you take him to the hospital or to a clinic?

P: I took him to our family doctor um and they just suggested some supportive treatments um which we've been doing at home like we try to keep him well hydrated, and we've been keeping an eye on his like um diapers and things like that.

D: OK, has he been um has he been, how many diapers is he um, are you changing a day?

P: Usually like about 5, 6, but yesterday it was like 2.

D: OK. Um and uh has he been uh irritable or agitated?

P: Uh he has been very irritable and fussy.

D: Has he been sleeping OK?

P: I um no you know what last night he didn't sleep well at all. He was crying the whole night.

D: Um and uh in terms of uh, so how much has he has he had to eat or drink in the past uh day or two?

P: Uh he's had about like maybe a bottle of his milk, like of that.

D: OK.

P: Yeah.

D: That's it?

P: Yeah, he's not taking. He's not he's not taking anything else like he's been so fussy and so like he's unwilling to try anything.

D: OK, um and, OK. Do you feel like he's been drowsy uh and um lethargic?

P: Um yeah, I feel like he's been a little bit lethargic. Like today, he's more lethargic. All of yesterday, he was very fussy and irritable, but today seems like, he's very slow.

D: OK, and just a couple of questions about um his past medical history. Does he have any uh medical conditions uh that he was diagnosed with?

P: Uh no, he's been healthy otherwise.

D: How was your pregnancy with him?

P: Normal, yeah no complications there.

D: Did did you have GBS or gestational diabetes?

P: No.

D: No, OK. Did you have any viral infections during that time, during pregnancy?

P: No, no.

D: Was he born via Caesarean section or uh C-section or a vaginal birth?

P: Uh vaginal.

D: OK. Any complications during birth?

P: No.

D: Was he um kept in the hospital for a couple days in the NICU after he was born?

P: No.

D: Did he develop jaundice?

P: No.

D: OK, and and he's been OK for the past two years? Any concerns about his growth, his height and weight, and his head circumference? Has your family doctor uh said anything about that?

P: No, he's been pretty good. Um he's been growing and gaining weight OK.

D: Any um developmental issues?

P: No.

D: OK, alright, and any medical conditions that run in the family?

P: Uh no, just like some heart issues.

D: Um OK, and uh does he, I forgot to ask, has he had any hospitalizations in the past?

P: No.

D: Any surgeries?

P: No surgeries.

D: Uh has he been on any medications? Any antibiotics recently?

P: No.

D: OK. Has um has he been vaccinated? Uh has his vaccinations, immunizations up to date?

P: Yeah, they're all up to date so far.

D: OK, alright, that's that's good. Um OK, and does he have any allergies that you're aware of?

P: Pardon me?

D: Any allergies?

P: Oh, uh no allergies.

D: OK alright um well it looks like um I, it's great that you brought him into the emergency room. Um if he hasn't been eating, drinking well, hasn't slept well, has been fussy, and and has been lethargic and tired, uh and is having difficulty swallowing food, um that's definitely very um serious. Uh we'll have a look inside his mouth and see what's going on. It could be that he has an infection or an inflammation of some sort. Um given his fever, he probably has an infection, um and uh we'll likely start him on antibiotics and put in an IV drip just to get in get some fluids inside him, just to get him hydrated, uh and monitor him very closely. We'll also check his vitals and um we'll do uh, yeah, we'll go from there. Do you have any questions?

P: Uh no, thank you.

D: OK.


D: What brings you in?

P: Hi there, I, I've had this cough that started um, three days ago, and over these past couple of days, I've just been really achy all over and so, I've had a headache as well.

D: Okay, well I'm sorry to hear that you're not feeling well. Um, the cough, when did that start?

P: Yeah, so that, about three or four days ago um, it started to come on, yeah.

D: Okay, and then how about the headache?

P: That's been more in the last two days.

D: Two days, okay, and then the uh, muscle ache?

P: Yeah, it's been there for about two, yeah about two or three days. I wake up in the morning and I've been feeling like really fatigued and achy.

D: Um, the cough, is it dry or you're bringing up phlegm?

P: It's, it's dry, but it's gotten a little bit worse since it started. It's just been happening more often.

D: Okay, and does it sound harsh?

P: Uh, maybe a little bit, yeah.

D: Okay. Is it getting worse do you think?

P: Yeah, I think so.

D: Okay, are you experiencing any shortness of breath along with the cough?

P: Uh, a little bit after, um, if I have like a coughing fit that's bad enough, but um, for the most part, I've been okay.

D: Okay, any wheeziness?

P: Um, no.

D: No. Chest pain?

P: No.

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

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

D: Okay. Um, any dizziness or fainting spells?

P: No.

D: Uh, numbness or tingling?

P: No.

D: Uh confusion or memory loss?

P: No.

D: This headache, is it always there?

P: These past couple of days, yeah, it's kind of, it, it's been there. It's been a little bit more mild after using some Tylenol or Advil to help settle it down, but I just have this, yeah, achiness in the front, front of my forehead and kind of sides of my head.

D: Yeah um, sides of your head, okay. And 1 to 10, 10 being the worst pain you've ever felt, how, how would you rate it?

P: A 4.

D: A 4 okay, so it's not the worst headache you've ever had in your life?

P: No, it's not that bad, it's just been pretty annoying.

D: Yeah um, okay. And have you like, do you usually get headaches?

P: Not really it, yeah I don't get them that often. I guess they come when I, I, well, get sick.

D: Okay yeah, that makes sense. Um, have you had any fevers recently?

P: Um, I have felt a bit hot um, and, but I, I didn't check my temperature and um, yeah.

D: Okay. How about weight loss, have you experienced any weight loss recently?

P: No, I've been, my weight's been pretty stable.

D: Okay. Um, any rashes?

P: No, I haven't noticed any rashes.

D: Okay, um, and any changes in your hearing or vision?

P: No.

D: Runny nose or stuffy nose?

P: No.

D: Sore throat?

P: Um, yeah, now that you mention it, I have had a little bit of a sore throat as well. Hasn't been too painful with um, like swallowing uh, foods or anything like that. It's kind of worse in the morning and it's not so bad later on.

D: Okay um, alright. How about changes in your smell or taste?

P: No, nothing like that.

D: Um, changes in your bowel movements?

P: No, I've been uh, regular.

D: Okay um, and then nausea or vomiting?

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

D: Okay um, changes in your urine?

P: No, I've had UTIs, like one or two in the past, um, so I know what that's like. So yeah, everything's been normal.

D: Okay, good. And are you otherwise healthy or do you have any longstanding medical conditions?

P: Uh, I have asthma, which I will like, asthma and allergies, and I'll use um, just Ventolin for that every like once in awhile, but it hasn't bugged me too frequently.

D: Okay. Um, do you also take anything else for that asthma or is it just the Ventolin that use?

P: Yeah just Ventolin.

D: Okay. Have you had any hospitalizations or surgeries in the past?

P: No, well I, I've had my, my wisdom teeth taken out and, actually yeah I had my tonsils out as well when I was 12.

D: Okay. Um, are you on any medications besides Ventolin?

P: Yeah I, I currently, I think a birth control.

D: Okay, how long have you been on that for?

P: Uh, since high school, so I, yeah since I was 18 so eight years.

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

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

D: Okay, okay, good. Any allergies?

P: Uh yeah, to cats and um, like, I think environmental triggers. No medicines.

D: No medicines, okay. Any family history of lung or heart diseases?

P: Um, my grandfather had, had a stroke when he was in his 70s and um, but he was like, a smoker and a drinker, and didn't really look after himself very well unfortunately, and uh, but that's about it.

D: Okay, um and do you smoke?

P: No, I don't

D: No, okay. Any other recreational drugs like marijuana, cocaine, heroin or anything like that?

P: No, I don't use anything like that.

D: Okay. How about um, alcohol, do you drink?

P: Yeah, sometimes, I'll have a or maybe a cocktail on the weekend, or um, a glass of wine with dinners.

D: Okay. Are you currently sexually active?

P: I am, yeah with uh, with my boyfriend. Um, we use uh, condoms as well.

D: Okay, so you use both condoms and you're on birth control so, okay good, that's a lot of protection. Um, how long have you two been together?

P: Um, uh six months.

D: Okay, okay, good. And um, any sick contacts recently?

P: Um, not that I'm aware of.

D: No, okay. Any travel recently?

P: Nope, just been um, going to, or just been doing online uh, classes. I'm finishing up my masters right now.

D: Okay, okay wow, congrats.

P: Thank you.

D: Um, and where do you live and who do you live with?

P: Yeah, so I live in an apartment downtown here um, just with uh one of, one of my friends who's a roommate.

D: Okay, and is everyone at home healthy?

P: Yeah, she hasn't had any any symptoms, any symptoms either.

D: Okay. Okay, well those were all the questions that I had for you. Did you have any questions um, or anything that you wanted to bring up that I haven't covered?

P: No, that's it. I was just uh, I mean concerned about COVID. I've been hearing about this new variant and stuff on the news so, a little bit worried.

D: Yeah for sure. We will definitely um, take a swab from you today and we'll see um, what the results are. You should hear back in about 24 to 48 hours, but in the meantime you should self isolate for 14 days um, and if it's not COVID, if that comes back negative, and um yeah, some of your symptoms also sound like other typical viral symptoms, so you could have one of the common strains that's going around this time of year. So for that just, it's um, you should just um, do some supportive care, you know, staying hydrated, eating well. And if your symptoms become worse, uh, you're running a really high fever, you have any neurological symptoms like weakness or seizures, then you should seek help from the ER. How does that sound?

P: That sounds good. Thank you.

D: Okay great, thank you.


P: I've been having issues with just a cough that's just been constantly like bothering me for the past few bit.

D: OK, um, when did this, what can you tell me a little bit more about the cough itself? Any any sputum?

P: So yeah, it it does have some like dark yellow greenish mucus material every time I cough. That's not doesn't always happen, but it's been worse like that keeps happening over the last few days.

D: OK, and any blood in the sputum?

P: No.

D: OK, and how much have you been bringing up would you say?

P: I would say every time I bring it up it's around like one teaspoon, usually one teaspoon in the day.

D: OK, and when did this cough start?

P: Um, so I think it started around like I would say six months ago and it's kind of just coming it just keeps coming and going here and there, but it's recently just starting to get very irritating.

D: OK, and um any triggers or uh precipitating events for for the cough?

P: So like six months ago I remember I was in just in Phys.Ed and we were just doing some laps and that's when I just really started coughing. And yeah, nothing else was really going on. I just feel like when I started running sometimes I start to cough.

D: OK, um, and has the cough been getting worse or staying the same, getting better?

P: I think it was pretty it was pretty much the same over the last few months, but then over the last week I would say just got really bad and over the last few days it's just been getting worse and worse.

D: OK, um so it's been the cough has been happening on and off up until four days ago, it sounds like. Uh, is the cough happening daily now?

P: Oh yeah, I would say like I'm coughing especially the last few days coughing several times a day. Um, it's pretty random, but like I would say throughout the day, I'm coughing.

D: OK, anything you've tried to make the offer better?

P: Um, I mean, really, I, I didn't really know what to try, um, so no, I haven't tried anything.

D: OK and anything you've noticed that that so I guess, yeah, anything you notice that makes it worse?

P: So yeah, just like when I'm doing more activities, especially running, I find, uh I just get like these coughing fits and it just gets worse when I'm running. Yeah, it's pretty annoying because even sometimes when I'm just in class I just start coughing randomly, but I would say it's the worst when I'm doing activities.

D: OK, so exercising brings out the cough? Any other symptoms you've been experiencing besides the cough?

P: Uh the only thing that sometimes, uh, like I panic sometimes when uh when I have like a really bad coughing fit especially in gym class. It almost feels like I can't breathe and that's when I get really scared.

D: OK um, have you been having any nausea or vomiting?

P: Oh no, no nausea or vomiting.

D: OK. How about any headaches?

P: No, no headaches.

D: OK and have you had a fever?

P: Uh I think I felt like a little bit warmer in the past few days, but I didn't I didn't really check.

D: OK, and have you had any chills?

P: I don't think so, no.

D: OK, and have you traveled anywhere recently?

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

D: OK, uh any night sweats?

P: No.

D: Have you had any racing of your heart?

P: No, nothing like that.

D: OK, and have you had any symptoms of fatigue?

P: Uh no I, I think my energy levels are fine.

D: OK um, do you have any chest pain?

P: Um, sometimes when I cough, like when it's really bad, I sometimes feel like I get some pain in my chest when I'm coughing, but that's only been the case for the last few few days, I would say.

D: OK, um any urinary problems?

P: No, I've been peeing alright, no issues there.

D: OK, any bowel problems?

P: Uh, no.

D: OK, any issues with your appetite?

P: No, I think I've been eating the same amount.

D: OK, any changes to your weight?

P: Uh no, still the same.

D: OK and any problems with, uh, sorry, uh, any recent infections?

P: Like I feel like I might have a cold but I think I maybe a week ago I had like a little bit of a runny nose, so I don't know, I might have a cold.

D: OK. Um, and these symptoms, cold symptoms, you've been feeling for the last few days?

P: Yeah, it's almost up to a week now.

D: OK, and any problems with sleep?

P: I feel like sometimes just in the past few weeks, like I started coughing at night and woke myself up, so sleep has been a little bit disturbed over the past few weeks.

D: OK, uh, any exposures to tuberculosis?

P: Oh no, no, not that I know.

D: Any exposures to inhalants like smoke or or dust or fumes?

P: Uh no I don't have any pets like there's no like moss or anything in my home. No fumes, dust, yeah, nothing like that.

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

P: Just just like with the skin I I I have eczema but nothing else.

D: OK. Are you allergic to any medications?

P: Uh, so, I for my eczema like I do have like a hydrocortisone cream that I apply. But yeah, I don't think I'm allergic to any medications.

D: OK, um do you have allergies?

P: I I do have allergies like sometimes around like animals. Like if I go to the farm or if I'm like at a zoo and just petting animals, I get my eczema gets really bad.

D: OK, and any hospitalizations?

P: No, no, no, never been hospitalized.

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

P: No, I've been I've been pretty much been at home, so no one.

D: Alright, and any surgeries?

P: No surgeries.

D: OK, any family history of asthma or or eczema?

P: I don't know bout asthma. My mom does also have like similar like eczema to me. But yeah, nothing, nothing else that I know of.

D: OK, uh, and what are you doing right now for work?

P: So currently like I'm not working. I'm a student just doing some online studying. I'm actually going to college to learn about how to make video games, but yeah, it's all just been at home right now.

D: OK, and um, where are you from? Like are you living at home right now or are you away for school?

P: Yeah, so I mean right now it's all online so I'm living at home with my mom.

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

P: Uh not often like just when I'm at like parties and like when I was at school, just maybe sometimes on the weekends, but nothing regularly.

D: OK um, and have you tried any other drugs besides marijuana?

P: Um, just just marijuana I I try sometimes at parties but nothing like regular. Uh other than that, like just sometimes I've been offered like some pills at parties, but other than that, nothing else.

D: So it sounds occasional.

P: OK, nothing like it, I'm not addicted or anything to any drugs.

D: OK, do you smoke cigarettes?

P: I don't smoke cigarettes, but I do have marijuana once or twice in a week.

D: OK and and uh, can you tell me a little bit about your diet and exercise?

P: I feel like I'm fairly active even though like I cough when I'm exercising, I still play soccer with my friends and on a team. Other than that, I like to go biking. Um, yeah, I feel like I'm still pretty active, but it is getting more difficult with my cough. Other than that, my diet has been pretty pretty good like at home. Especially, I'm getting three meals a day and having a balanced diet. So yeah, I feel I'm doing well there.

D: OK, great


D: What brings you in?

P: Uh I just came in today I think I broke my leg or something, it's something that was, I heard a snap, I was in um just a dance class um and we have like these long uh dresses, it it was a traditional dance class and my foot uh slipped right onto, it got caught in my dress and it just kind of slipped and I I felt right on my, my leg kind of twisted and I fell down and I just stayed down. I knew something was not right and something was broken.

D: When did this happen?

P: Just uh I would say like an hour ago

D: Hour ago, OK. Are you able to bear any weight on it at all?

P: No, not really. I I had to come in the ambulance.

D: OK, OK, and um if you were to localize this pain, where exactly is it?

P: It's pretty much my whole lower leg is painful, but I think where it looks like it broke is like the middle part of my lower leg.

D: The middle part, OK middle part of your lower leg, so kind of where your shins are?

P: Mhmm.

D: OK, so in the shin area, OK. Um have you tried anything for it? I know it's only been an hour.

P: Uh no nothing. I just like I just want to make sure I keep it as still as possible um I didn't wanna even try anything.

D: OK yeah, that makes sense, if you were to describe this pain, would you say it's um sharp, dull, achy throbbing?

P: It's like sharp and throbbing. It's like probably one of the worst pains that I've felt in my life.

D: OK, OK. And 1 to 10, 10 being the worst pain ever, how bad is it?

P: At 10 for sure.

D: Ten, OK, have you, so you said you've never experienced this before, um do you feel like it's getting worse, the pain, or has it been pretty much the same since it started, or is it getting better?

P: Uh I would say it's the same, it's like I'm in as much pain as I was earlier.

D: OK. OK and um so yeah, OK, um do you know how you felt like on the floor? Like did you uh go like leg first or was it, did your um, kind of like the mechanism of your fall, did you break the fall at all with your arms?

P: Uh no, I didn't break, it kind of, so I was kind of uh, I feel like when I was slipping it was at first my leg was hyper extended but it kind of just felt like it snapped and it went straight down, so there was some kind of twisting as well as some hyperextension. Um but it just kind of slipping on my dress and then just straight down.

D: OK, OK. Um otherwise, do you have any pain elsewhere in your body?

P: No.

D: How about any numbness or tingling in the area?

P: Um I do feel some numbness, tingling just below where it happened, um but it like comes and goes.

D: OK um and then how about how about any um like feelings of like losing sensation or feeling cold in that area?

P: Um no, I I can feel everything in that area.

D: OK.

P: But it's hard to tell like it's just very painful right now.

D: OK, yeah, that's understandable. Um how about headaches?

P: No, no headaches.

D: Uh any fainting or dizziness.

P: No.

D: Um confusion or memory loss?

P: No.

D: Um weight loss recently.

P: No.

D: Fevers or chills?

P: No.

D: Uh changes to your hair, nails, or skin, like rashes?

P: No, nothing that I've noticed.

D: No, any changes to your vision, hearing, smell, or taste?

P: No.

D: Um how about coughing, shortness of breath, or wheezing?

P: No, no, nothing like that.

D: No, OK, um how about chest pain or palpitations?

P: No.

D: No, any changes to your bowel movements?

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

D: Uh nausea or vomiting?

P: Nope.

D: Abdominal pain?

P: No.

D: Changes to urinary habits?

P: No, nothing like that.

D: No, OK, um and are you otherwise healthy?

P: Yeah, I've been pretty healthy, I um don't take any medications regularly, I don't have any medical conditions.

D: OK, that's good. Any hospitalizations or surgeries in the past?

P: No, um just just for like my pregnancies, I had two pregnancies, both of them delivered vaginally, but no issues with that, just after that no hospitalizations or surgeries.

D: OK, OK. Um and then um are you up to date with all your immunizations?

P: Yep.

D: OK, that's good. Um do you have any allergies?

P: No, not that I know of.

D: OK, um and then is there any family history of like musculoskeletal issues?

P: Um so my mother has something called osteoporosis.

D: OK, yep.

P: Um but that's that's all that I can think of.

D: How old was she when she was diagnosed with that?

P: Um probably in her fifties.

D: In her fifties, OK.

P: Late fifties I would say.

D: Um have you been, have you ever like been tested for that?

P: No, I've never, I've never had testing.

D: OK, all right. Um and then any family history of lung or heart conditions?

P: No.

D: Uh how about autoimmune conditions?

P: Uh no, not that I know of.

D: Any cancers?

P: Uh, I think one of my aunts has uh ovarian cancer.

D: OK, OK, um how old was she when she was diagnosed with that?

P: Um like pretty uh recently, so probably like in her sixties.

D: OK, OK, um and then have you been in touch with anyone sick recently?

P: No.

D: No, OK, have you done any travel recently?

P: No.

D: OK. Um those are all the questions I had for you. Did you have any questions of your own or anything you wanted to add before we move to the physical exam component?

P: No, I just want to get this fixed as soon as possible.

D: OK, that sounds good, yeah we'll, we'll try our best.

P: Thank you.

D: Um OK, so now looking at your legs like side by side, do you notice any uh redness or swelling in your right leg compared to your left?

P: Yeah, it's all, it's all swollen and red and just looks so much different than my other leg.

D: OK, yeah, um do you notice any obvious like breaks in the skin?

P: No, there's no breaks in the skin but like when I fell like I, I can definitely see like the bend, there is like a bend in the bone, so I definitely do think it's broken.

D: OK, and do you notice any like bony pieces that are pushing on the skin?

P: No.

D: No, OK. Uh any bruises in the area?

P: Yeah, the whole area seems bruised up and angry.

D: OK. Um does uh, besides the bruising and the misalignment, do you notice any other obvious deformities, any muscle atrophy in the area?

P: No.

D: No, OK, and then uh placing your hand on one leg compared to the other, does it seem warmer?

P: Yeah, I feel like it's it's warmer.

D: OK um and then I'm gonna try to get you to do some movements, um can you move your right leg at all, like can you flex and extend your knees?

P: No, not not at all like I I'm I'm too scared to try.

D: OK, and how about weight bearing, are you able to stand up at all on that leg?

P: No, I just I just got time to call the ambulance, I knew I knew it was just not possible.

D: OK, alright, um I guess those were all the questions that I had for you. Um I think you may have a tibial fracture. So we'll start with some X Rays um to be sure and to try to take a look at like where the fracture is and how we can approach that. Um because everything is swollen and angry down there, we'll probably try and um apply a splint um until the swelling goes down. And then um we can uh refer you to an orthopaedic surgeon for a surgic, for the surgery itself. So that could um involve, like uh  you know them doing like and intramedullary nail, plates and screws, and um like some sort of fixation. Um but after the surgery, your fracture will probably take about four to six months to heal completely, uh so in that period um we can talk about like pain management and physiotherapy as well, just to keep the muscles in that area strong and to increase your range of motion. Does that sound OK?

P: That sounds good. Alright, thank you so much.

D: OK, yeah, no worries.


D: What brings you in here today?

P: Yeah hi, I'm I I have a pain in my belly. It started a couple hours ago.

D: OK, and where exactly in your belly do you have this pain?

P: It's mostly up here on the right side.

D: The right side, OK and can you describe what kind of pain is it? Is it like a dull pain or sharp pain, an aching pain?

P: Oh I guess it's a, it's an aching pain I'd say. It kind of just, um, it would initially just come and go, but now it's just it's staying. It's not going away.

D: OK, and so it's in the right area and does it travel anywhere elsewhere besides on from the right side?

P: No.

D: OK. And on a scale of 1 to 10, one being the least amount of pain you felt in your life, and 10 being the worst, how much would you rate it right now?

P: It's about to a 10, an 8 maybe.

D: An 8, OK and so just to clarify, when did it start?

P: About 8 hours ago.

D: 8 hours ago, OK. And were you doing anything before? Like, did you have a meal or how were you sleeping before it woke you up, what was going on before you had the pain?

P: I was just about to go to sleep. I wasn't doing anything in particular at the time.

D: OK. And has it been getting worse since it first started?

P: Oh yeah, definitely it would come and go, but now for the past I'd say five to six hours, it's been constant, just there all the time.

D: OK. And have you had any similar pain like this in the past?

P: Yeah, uh I I have the same pain that sort of comes and goes after I eat. Usually after I've had something like a something fatty, something from outdoors, maybe like a burger or fries or something. I initially thought it was indigestion, but I don't I don't know what's going on now.

D: OK, and does it, does anything make it better or worse or anything that you've tried?

P: Well, I guess eating sometimes makes it worse, um, but I don't I don't think there's anything that's making it better.

D: OK, have you tried any medications at all?

P: I tried Tylenol but that didn't do anything.

D: OK. And besides, uh, the pain that you're having, do you have any nausea and vomiting?

P: I am a little nauseous, but no, I didn't, haven't had I haven't vomited yet, no.

D: OK, and have you been having any fevers?

P: I don't think so. I haven't checked. I don't feel feverish.

D: Any sweats or like chills?

P: No,  I don't think so.

D: OK, any changes in your bowel movements like constipation, diarrhea?

P: No.

D: OK. Have you traveled anywhere recently?

P: No, I haven't.

D: Have you been feeling at all, very tired, not your usual self, fatigued?

P: Well the pain is making it difficult for me to do things, um, but I I guess I'm not, uh a little fatigued  maybe.

D: OK. Um, have you been having any changes in your urinary patterns?

P: No.

D: No? Any changes in your skin and you rashes, any yellowing of your skin?

P: Nothing that I've noticed, no, I don't think so.

D: OK. Any changes in your urine color?

P: No.

D: OK, have you noticed blood in your stools at all?

P: I have not, no.

D: OK, and how about your appetite, has this changed at all?

P: Well, I guess because it's this thing happens usually happens after I eat, I think I've been eating less than usual, just because I don't, I don't want to, you know, I don't like the pain.

D: Any significant weight loss recently?

P: I don't think so.

D: OK, any recent infections recently at all?

P: No.

D: Um, and otherwise are you, do you have any other medical conditions like diabetes, high blood pressure or anything else?

P: I do have diabetes but that's about it I think.

D: And you take anything for your diabetes?

P: I take metformin.

D: OK, um do you take any other medications at all?

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

D: No worries. Do you have any allergies to any medications, any environmental allergies?

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

D: OK. And have you been hospitalized in the past?

P: No, no I haven't ever. I've been very uh healthy. No hospitalizations.

D: Any past surgeries?

P: I got my wisdom teeth removed when I was a teenager.

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

P: No, I don't think so.

D: OK. Hmm, and in terms of your family history, has anyone had any cancers or um any err um IBD like Crohn's disease or ulcerative colitis?

P: No, not that I know of.

D: OK. And anything that runs in the family at all?

P: My dad had a heart attack when he was in his 60s. But that's it.

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

P: Oh no, I'm I'm laid off because of COVID.

D: OK. And currently, what is your home situation like?

P: What do you mean?

D: So do you live in an apartment, house and do you live with anyone?

P: I I I live in an apartment, I live alone.

D: Um, and in terms of your daily routine, do you feel that you get enough exercise? Do you go outside for walks or runs or anything like that?

P: I usually go out for a run, especially when it's a little bit warmer, which it now is.

D: And do you do you drink alcohol?

P: Uh, sometimes.

D: How much would you say you drink in an average week?

P: One to two drinks a day.

D: OK, and what do you usually drink?

P: I'll just drink a glass of wine at night, just helps me relax.

D: OK. And do you smoke cigarettes?

P: I don't, no.

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

P: No, I don't.

D: OK. Alright, so um, that's all the questions I have and just to clarify, does your pain come and go, or is it constant?

P: Yes, so initially it would come and go, but now, so for the first 2 hours it would come and go. And when I would have this pain when I was eating, it would come and go. But over the past six hours it's just been constant.

D: OK. Alright.


D: What brings you here today?

P: I just had uh, well, it was just uh, I came from football practice I, uh, just felt like somebody fell on me while, like while I was on the ground and it's like, I've had this shoulder pain immediately afterwards and I can see a, like lump, um, kind of pointing out like in my skin here on my, on my, um, clavicle or shoulder bone.

D: Okay, is it the right side or the left side?

P: Uh, it's the right side.

D: The right side, okay. Um, okay, and how long ago did this happen?

P: It happened about, just a couple of hours ago. Yeah, just about 2 hours ago.

D: Okay, um. Um, did someone, did someone fall onto your side? Okay, uh, so, your main, are you having mainly pain in that, in that area, or is it going to other places?

P: It's mostly just the pain like right in that area. I'm not feeling it anywhere else.

D: Okay, and um, what kind of pain are you feeling? Is it sharp, stabbing, or is it aching?

P: It's really sharp. It feels like I'm, I'm getting stabbed in the shoulder.

D: Okay, I see, and on a scale of 0 to 10, 10 being the worst pain you've felt in your life, how much would you rate it?

P: Uh, this is like a 10. It hurts really bad.

D: Okay, and um, are able to do any movements, or are you just kind of holding your arm up with your other other arm?

P: I, yeah I've just been holding my arm up by, uh, I kind of made a sling out of, yeah, like the coaches helped make a sling out of one of the, uh, what we, like a shirt or something like that at the practice. And so I've been just kind of holding my arm against my chest with my elbow flexed. I haven't really moved it at all.

D: I see, okay. Um, and if you were to describe just what it looks like right now, does your shoulder kind of seem like it's sagging?

P: Yeah it does.

D: Okay, and do you notice any point near your shoulder like clavicle area that has any bruising, swelling looks, like red? Anything like that?

P: Um, like maybe a little bit of bruising and swelling like over the area where I can see like my, my skin pointing up, but um, yeah, that's the only area.

D: Okay, I see. Okay. Any other symptoms, like any pain in any other joints, muscles?

P: No, just the pain right there.

D: Okay. Alright um, and uh, other than that, have you previously had any popped joints before?

P: Uh, I, no, I haven't.

D: Okay, and no other trauma or anything in the same region?

P: No, I haven't had any pains there before or anything like that.

D: Okay, I see. Okay, um and have you been diagnosed with any medical conditions in the past?

P: Uh, no I haven't.

D: Okay, alright, and did you hurt yourself anywhere else? Like did you hurt your head at all? Um, suffer any loss of consciousness or anything like that?

P: No, no, I, I didn't. I was kind of just like laying on my side and they fell like on my left shoulder and I, I just got squished.

D: Okay, and did it have any impact on your chest like you do you feel short of breath or anything like that?

P: No shortness of breath, kind of knocked the wind out of me at at first, but I'm okay now.

D: Okay, I see, that's good. Um, okay, and other than uh, so no medical conditions? Do you take any medications at all?

P: Um, yeah, I'll take like uh, just some allergy medication every once in a while. When it's like, just seasonal allergies, I think to just some environmental triggers is all.

D: Okay, and and do you have any allergies to any medications at all?

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

D: Okay, anything that you've tried that has helped or made your pain worse?

P: No, I haven't, I haven't taken anything yet, I just uh, like basically came right from practice to the, to the hospital.

D: Okay, um, have you had any kind of fevers or chills?

P: No.

D: Any skin changes, like rashes?

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

D: Okay, any weakness in your upper or lower extremities, besides like the area that's affected?

P: No.

D: No, okay. Um, any dizziness, fainting episodes?

P: Uh, no, nothing like that.

D: Okay, and your hearing and vision is alright right now?

P: It is, yeah. I haven't had any problems with that.

D: Okay, and have you had any kind of concussions or anything in the past?

P: Um, no, I haven't had any.

D: Alright. Uh, have you been hospitalized or had any surgeries in the past?

P: Um, no, not, not ever.

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

P: Uh, no. No, nothing that I can think of. Everybody's pretty healthy.

D: Okay. Um, and what's your living situation like right now?

P: So I live with both of my parents and um, I have a younger brother and a younger sister as well. We live in a, in a house.

D: Okay, alright, and um, do you work currently? Or are you a student?

P: Yeah, I'm in high school and, um, I, I work part-time at the grocery store as well, but uh, it's not that often though, because I've just been been playing sports, on the football team, we have a lot of practices and games and stuff.

D: Okay. Um, do you drink alcohol?

P: Uh I, sometimes I, with friends. Um, we've had a couple of beers here and, here and there, but I mean it's, it's not something that I've done very often. Yeah, we've been pretty safe, I feel like.

D: Okay, and do you smoke cigarettes or marijuana, or use any recreational drugs?

P: No, nothing like that.

D: Okay, alright, so those are all the questions I had for you today. We'll do a full physical examination of the area. Um, we, we will definitely get an x-ray of the shoulder and clavicle to see what kind of, it seems like you have a clavicular fracture from just the mechanism of the injury, as well as everything you were describing. Um, but it is important to understand how, like what kind of clavicle injury it is and where it's affected, if it's in the middle area, on like the outer areas of the clavicle, um, and how much it's displaced because that will determine if we just need to reduce it here, and then give you a sling, and then you can go home. That's usually the case, but sometimes you may require surgery as well, and we would need to refer you to an orthopaedic surgeon. So yeah, we'll, we'll get the x-ray done, and if you need anything for pain currently, we will give you some medications here, um and then we'll go from there.

P: Alright, thank you.

D: You're welcome. Um, I'll be here with you shortly.

P: That sounds good. Thank you so much.