D: Hi there, I was just hoping to ask you a few questions today but I was wondering if you could tell me what brought you in today.

P: I am just calling about my daughter. She's been sick over the last few days. She has fever and a cough.

D: I see, OK. When did the fever and cough start?

P: So they started around three to four days ago. And around the same time she was also having like a runny nose.

D: OK, and has the fever and cough been present the whole time?

P: Uh, yeah I would say they started around the same time and ah, they have been going on for the last three and a half to four days.

D: OK, so has there been a period when she hasn't had a fever or a cough?

P: Uh no, every time I've measured it, she has had a fever and she's been coughing for the last few days. Hasn't really changed.

D: OK, can you think of anything leading up to these symptoms?

P: Uh, no, she was she was fine, just three to four days ago. Like before that she was her playful self. No issues. But yeah, it's for the last couple of days just this nonstop cough and the fevers is what's really worrying me.

D: OK, uh, have the symptoms have gotten worse or stayed the same?

P: I would say the fever has been getting a little bit worse over the last like, especially today, but the cough, coughing is about the same as what it was when it first started three days ago.

D: OK. Has she been sick like this before?

P: She's, she often gets sick, like her brother goes to daycare and he brings a lot of bugs from there and every time he gets sick, she also gets sick. The last time she had like a similar cough was
around two months ago, but at that time I wasn't that worried because she didn't have any fevers.

D: OK, um, have you, has there been anything that you've tried to help with the cough or fever?

P: Uh Tylenol, I gave her Tylenol. It did help her a little bit, but then the fever came right back, uhm say like a few hours later.

D: OK, and anything you notice that's made the cough or fever worse over the last three or four days?

P: Not anything that I know of. Her fevers been getting worse, but I don't really know why that is.

D: OK, uh, has she been having any other symptoms?

P: Um, other than like, yeah, she had that runny nose when it first started, and then she's also been having some diarrhea.

D: OK, and when did the diarrhea start?

P: I think I would say it started around two days ago. She's, like every time I change her diaper she would have like 4-5 different diaper changes throughout the day, and they they seem pretty liquid. So I
think yeah, she's been having diarrhea for the last two days.

D: OK, uh you mentioned liquid appearing stool, what would you say say, so I guess, could you comment on the consistency and colour?

P: Consistency, I'd say it's pretty watery, like diarrhea and colour I didn't really think there's any changes in in the colour.

D: OK. So you didn't think there was any blood in the stool?

P: No, no, no, I didn't see any blood.

D: OK, as for the fever, what was the maximum temperature that you noted and how did you check it?

P: So I used, we have just a regular non digital thermometer in her ear and her temperature today was around 103 degrees Fahrenheit.

D: OK. Uh, did you notice any tugging or pulling at her ear?

P: No, no, she doesn't seem to have any irritation there.

D: OK, uh, how about any vomiting or regurgitation?

P: No, she's been keeping food down. No issues there.

D: OK, and notice any discharge from either eye?

P: Uh, no.

D: How about any discharge from ears?

P: Not that I've noticed, no.

D: Notice any rashes?

P: Uh, no, I didn't not know like new rashes, no.

D: OK and how is she been in terms of mood or or behaviour?

P: Oh she's been pretty like she's not herself over the last few days. She's been crying a lot more, just very irritable.

D: OK, would you say inconsolable at times?

P: Sometimes like yesterday like she, I couldn't get her to stop crying.

D: OK and uh, I know you said no vomiting, but has she been coughing up any sputum?

P: Yeah, I would say, uh, this green slimy content. Yeah, it's like green and slimy.

D: OK, um, how much would you say, uhm, like a cup, or more?

P: I would say probably like at least, at least a couple spoonfuls at a time, she would cough up.

D: OK, and did you notice any blood in it?

P: No, I didn't notice any blood at all.

D: OK, and with the cough, have you noticed any difficulties breathing?

P: Uh, I don't know if it's difficulty breathing, but I have noticed sometimes she's like breathing faster than normal, like taking a lot more breaths.

D: I see, OK. Uh, is she having troubles with drooling or your trouble speaking?

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

D: OK, and does her voice sound normal to you?

P: Yeah, I think her note, her voice hasn't really changed that much.

D: OK, um, with the noticing the faster rate of breathing is the breathing noisy at all?

P: Uh, no, like she's not wheezing or anything.

D: OK, and do you notice any like retraction of the skin between her ribs when breathing.

P: Uh so like, uhm, like what do you mean by that?

D: Like just so when she's breathing in and out. Is she generating a lot of force and effort to really kind of suck in and blow out so you can kind of see impressions over the ribs.

P: Uh no, I I don't think I've noticed that, no.

D: OK. And, and, have you noticed any blueish discolouration around her lips or mouth?

P: Uh, no.

D: OK, and any urinary problems?

P: Uh, no, she's peeing fine.

D: OK. And how has she been sleeping the last few days?

P: She hasn't really been sleeping in between the crying and like just being so irritable. I think she's just very uncomfortable when she's trying to get to sleep, so
I would say not, like maybe a couple hours for the last few nights.

D: OK. Any evidence of seizure or limb jerking?

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

D: No, OK. And and have you notice an her being like really lethargic at all?

P: Uh, she's not herself and she's still like pretty active, like she's, she just seems really unhappy and irritated. But no, she still has energy.

D: OK. And uh, is she drinking yeah, a lot more fluids or or a lot less? How is she tolerating oral intake?

P: I would say I think she's more on the dryer side like she, her mouth is very dry. Her lips are like all cracked, and she it seems that she's drinking
less water too.

D: I see, OK. And, uh, how many wet diapers would you say in the last 24 hours?

P: Um? Yeah, it's difficult to say. I think I like yesterday changed four to five times. They were all diarrhea, so not really sure, but maybe around 5.

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

P: No. No, we've been here.

D: OK, so next just some questions about past medical history. Uh, has she had any medical problems in the past?

P: The only thing I could think of was after she was born, she had to be given the light treatment for like jaundice, but after that no other problems.

D: OK. And any prior surgeries?

P: No.

D: Any previous hospitalizations?

P: No, just the light treatment, but other than that nothing.

D: OK, and throughout pregnancy were there any complications?

P: No, my pregnancy was completely normal. No complications during the pregnancy.

D: OK, so no gestational diabetes or hypertension?

P: Uh, no.

D: OK and uh, were you sick at all at any point with infectious symptoms?

P: No, everything came back clear. All the tests were normal.

D: OK, and um. Any allergies to medications?

P: No allergies.

D: OK, and is she currently taking any medications?

P: No, just tried the Tylenol but it didn't really seem to work.

D: OK, and has she been around anybody sick recently?

P: Just her big brother who goes to daycare was also like a bit sick with a cough and some runny nose for the last four days. But, uhm, he didn't have a fever and he seemed to recover pretty fast but seems she may have caught it from him.

D: OK, and anybody in the family um, have any similar symptoms right now? I guess besides her brother?

P: No, just just her and her brother.

D: OK. And, and in regards to birth, birth history, was it a vaginal delivery or C-section?

P: It was a normal vaginal delivery at 38 weeks there were no problems after the delivery or before the delivery.

D: OK, and uh are her immunizations up to date?

P: Yeah uh, all our immunizations are up to date.

D: OK, and um, in regards to growth and development, have you had any concerns?

P: Uh, no, we've been getting her checked regularly. It seems that she's been growing well and developing well.

D: OK, and who is the primary caregiver for at home?

P: Primary caregiver, right now I'm staying home with her and her brother goes to daycare. So yeah, it would be me.

D: OK. Uh, and could you tell me about her eating habits and typical appetite?

P: Uh, so now like she is able to eat like everything like vegetables, fruits, breads and meat, but over the last few days she has been just irritable with everything. So even eating food has just not been great for the last few days.

D: OK, and when was her last checkup?

P: So it was around one month ago and everything was fine then. No concerns from the doctor.

D: OK. Thank you.


D: I was wondering if you could tell me a little bit about what brought you in to the Emergency Department today?

P: Yeah, so nice to meet you. I've been having this pain right in my abdomen. It's kind of like in the upper right area.

D: OK, and so uh, when, where is this painting located exactly?

P: So it's just in the upper right corner of my abdomen, right below where the lungs are, and it, yeah, it's just I have this severe pain that's going on.

D: OK, and how long is it been going on for?

P: So it's been going on for the last few days and it got worse today.

D: OK, and how long is it been since it's like got got worse, has this been a few hours or or how long is that been?

P: So I would say it got worse, just three or four hours ago before I came to the Emergency Department.

D: OK, and does the pain radiate anywhere?

P: Uh no, it stays right in the in the spot that I told you right in the right upper corner.

D: OK, and when did the pain start? Or if you could tell me what were you doing right prior to the pain starting?

P: So I think it started after just three days ago after I had a meal like I I think it was after lunch around half an hour or an hour after lunch.

D: I see OK, has the pain gotten worse, stayed the same, or gotten better since since yesterday?

P: I think it's gotten, it was, it's the worst today, like especially like a few hours ago like 3 hours ago, it was much worse than the other two days.

D: OK, and how would you describe the character or the quality of the pain?

P: So it's like a sharp, I would describe it as like a sharp pain.

D: OK, and on a scale of 1 to 10, 10 being the most severe pain, what would you rate it as?

P: I would rate it as, right now I would rate it as an 8.

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

P: I think it happened to me a few years back, where I had this pain and then it just kind of went away on its own. I didn't go to the Emergency Department then though.

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

P: I tried taking just like Advil and Tylenol, but it didn't really seem to help the pain too much.

D: OK, and have you had any other associated symptoms such as nausea or or vomiting?

P: I've I've had some nausea over the past few days, but I haven't vomited anything.

D: OK, so no blood in your emesis uh or no vomiting at all?

P: Uh, yeah.

D: OK, and have you traveled anywhere recently?

P: Uh no like we haven't traveled anywhere recently.

D: OK, and, how has your energy levels been?

P: Uh, energy uh when it's hurting a lot like today I've been it's been difficult to move around, I've been pretty drained from the pain but uh otherwise over the last few days it hasn't affected me too much, but today I would say my energy levels are down.

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

P: I don't think so. I mean, I don't think I've noticed any kind of skin changes.

D: OK, and how about any changes to urinary habits like painful urination or the color of your urine?

P: No no, no changes.

D: OK, and have you had any changes to bowel patterns such as diarrhea or changes in color of your stool?

P: No, I don't think so. No changes that I've noticed.

D: OK, so  notice any blood in the stool?

P: No, no blood.

D: OK, and how has your appetite been?

P: It's it was around the same before the pain actually started getting worse, so today I didn't really feel like eating. I did have nausea over the past few days, but my appetite I would say is the worst today.

D: OK, and have you noticed any changes to your weight recently?

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

D: OK, and have you had any recent infections?

P: No, not not that I know of.

D: OK, so next just to ask some questions about your past medical history, have you been diagnosed with any medical conditions in the past?

P: Uh so, I think the only thing is my doctor told me that I should lose some weight, but other than that no medical history.

D: OK, and any allergies to medications?

P: Uh no, no allergies.

D: And are there any medications that you take on a regular basis, either prescribed or over the counter?

P: Uh not prescribed, sometimes I take like some antacids when I get heartburn. But this is just like a couple times a month after dinner, sometimes at night, but that's about it.

D: OK, and, uh, any, um, hospitalizations?

P: Just for just when I had my children, at the time of their birth, but that's it.

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

P: No.

D: OK, and have you had any prior surgeries?

P: Nope, no prior surgeries.

D: OK, and any family history of gallbladder disease or cardiovascular disease in the family?

P: Um, so my father died of a stroke when he was in his 60s, my mother does have gallstones.

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

P: So I work in at the bank as a consultant.

D: OK, and do you drink alcohol?

P: Uh, yeah sometimes, maybe one or two glasses of wine every night.

D: OK, and do you feel the need to cut down on your drinking?

P: No, not really.

D: OK, have you ever felt annoyed by people criticizing your drinking?

P: Uh No.

D: OK, have you felt guilty about your drinking?

P: Uh no, so should I be?

D: Uhm no, at the at this time, just wanting to gauge a sense of how you feel about your drinking levels at this time and the follow up question to that would be, have you ever felt the need to have a drink early in the morning?

P: Uh no, no I've never drank, I don't drink in the morning.

D: OK, and do you use recreational drugs?

P: Uh, no never.

D: OK and do you smoke cigarettes?

P: Nope.

D: And um, do, oh, and then, um, who are you living with currently at home?

P: And so I'm living with my two children and my partner.

D: And can you tell me a little bit about the home situation?

P: Yeah, the home situation is fine, like kids are doing great and my partner is very supportive. No, no issues that I can think of at home.

D: OK, excellent.


D: What brings you in?

P: Hi I umm, so I started to have this cough that started like 2 days ago and also these last couple of days I've just had this headache and feeling really achy all over.

D: OK, I'm sorry you said it started a day, two days ago?

P: Yeah, it's more like one to two days. All of this is kind of started. I think the the cough started 1st and then the headache and achiness has come after. I felt a bit feverish as well. I haven't checked my temperature but I, I felt feverish.

D: OK. The cough, is it dry, or are you bringing up any phlegm?

P: It's pretty dry.

D: Dry, OK, so no blood and no sputum?

P: No blood or sputum.

D: OK, do you feel short of breath?

P: No thats I haven't been short of breath.

D: OK, how about wheezing?

P: No wheezing.

D: OK. And any chest pain?

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

D: OK, alright. And the headache one to 10, 10 being the worst head, worst pain you've ever been in. How bad was it?

P: I'd say a four. It's just been kind of there the whole, so it's really annoying. I've tried some Tylenol and it's taken a little bit off the the I mean the edge off a little bit, but it's just been kinda there still.

D: OK. And is it a throbbing kind of pain or is it a dull, achy pain?

P: It's a kind of a dull, achy pain.

D: OK. Uhm, alright and where is it located?

P: Uh kind of in the front of uh I have my over my head and on both sides as well.

D: OK, OK. Any feelings of feeling like your heart's racing?

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

D: OK, any dizziness or fainting spells?

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

D: Confusion or memory loss?

P: No, nothing like that.

D: OK, and any neck pain or stiffness?

P: No, nothing like that.

D: OK, running or stuffy nose?

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

D: Sore throat?

P: No.

D: No, OK, how about that loss of smell or taste?

P: Uh yeah I have actually. Yeah, I have.

D: OK, both?

P: Yeah, both it's uh, I've actually yeah, I notice that in the last day, it's kind of weird. I didn't even think of it until you until you asked there.

D: OK.

P: But yeah, I have haven't really noticed being able to smell or taste.

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

P: No.

D: OK. Weight loss?

P: No weight loss, I've been, that's been stable. I wish.

D: OK and you mentioned you might have had a fever so we'll check your temperature today as well. Any fatigue?

P: Uh, not really. That's been OK, but been achey, so certainly doing less.

D: OK. Any rashes?

P: No rashes.

D: OK, any changes to your bowel movements?

P: No, that, everything has been normal there. I haven't had any diarrhea or no blood in the stool.

D: OK. Any nausea or vomiting?

P: No nausea or vomiting.

D: OK. Changes to your appetite?

P: Yeah, I've been, less interested in food for sure. I think I've been been, been, had a decreased appetite.

D: OK. Changes in your urine?

P: No, I haven't had any any pain or any anything changing to my urinary habits.

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

P: Uh, I I do have high blood pressure and high cholesterol and I take a statin as well as a what is it, an ACE inhibitor, I think, for the blood pressure, yeah.

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

P: Uh, I am yes I think so.

D: Yeah, OK. Alright, and are you allergic to anything?

P: No, I don't think so.

D: No, OK. Alright, and any family history of lung or heart conditions.

P: No, nothing like that.

D: OK, umm, alright. Do you smoke?

P: I don't, no.

D: No, OK. Any other recreational drugs?

P: Uh, no.

D: OK. Do you drink alcohol?

P: Yeah, sometimes I'll have a glass of wine on the weekend or something like that, but that will just be one or two, maybe with dinner.

D: OK. And have you been in contact with anyone sick recently?

P: No, I I don't think so. I mean, I've been working from well, some days I've had to go into the office for work, but I've been mostly just working from, from home.

D: OK. OK. Uhm and where do you live right now?

P: So I live in a house downtown in the city here and I live with my wife and our two sons.

D: OK, any are they, they're ok, they're all healthy?

P: Uhm, yeah they they, they uh, well my son actually had a cough and a sore throat I think like last week or something like that but it just went it went away.

D: OK. Uhm, and do you have any old carpets? Asbestos, mold, anything like that in your home?

P: Uh, no, nothing like that.

D: No, OK. Uhm alright, I think those are all the questions that I had for you. Did you have any questions of your own for myself?

P: I was just well worried about Covid and was just wondering what I should do.

D: Yeah, for sure. So we are, you're a lot of your symptoms do overlap with those of Covid, so we are going to take a swab today and you should hear back in about 24 to 48 hours, but you should isolate for 14 days. And that includes from family family members if possible. Uhm, and basically just keep an eye on your symptoms. If they get worse, or you're having like neurological symptoms, you should seek help from the ER, but otherwise keep yourself hydrated, eat well. If you have a humidifier in the basement, use it, and for your fevers you can take antipyretics like Tylenol. And just it's it's just a lot of supportive care. How does that sound and obviously like if your symptoms aren't going away after like a few weeks, call us back and it could be something like bacterial, in which case we can give you some antibiotics.

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

D: Yeah, no problem.


D: How may I help you?

P: Uh, I, I'm uh, just coming into the clinic uh, today uh, my parents told me to come today. I don't know what this thing is, just mass right below, or kind of like a lump or mass below my right knee and it's not painful or anything, it's a little bit uncomfortable but I just want to check out and see what it might be.

D: Yeah, certainly. Okay, when, when did you first um, notice this mass?

P: So I think I noticed it um, for the first time um probably a couple weeks ago. I would say like, two weeks ago I, I noticed it.

D: Okay, and uh, where specifically is it, is it located?

P: So it's, it's uh, below my knee uh, right on like uh, I feel it on the big big bone right below the knee. It's um, yeah, I just feel like uh, like a hard lump.

D: Okay, and uh, okay Um, and uh, is it, is it associated with any pain?

P: No, it's not really, uh, that painful. It's uh, it's, if I press on it, it's a little bit uncomfortable, but it's not like, I wouldn't call it pain.

D: Okay. And have you had any trauma to the, to the knee, or area, or any injuries there?

P: Uh, no, not that I can remember. I don't think I've had any injuries there, and this lump is like, probably like 2 to 3 centimetres, it's, I don't even know like, when it appeared or why it appeared. I haven't really injured myself or anything.

D: Okay, um, and have you had any, uh, any fevers or chills?

P: No.

D: Okay, have you had any unexpected weight loss?

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

D: Okay, uh, and how about, um, any neurological symptoms like numbness, tingling, sensory loss?

P: No, I haven't felt any of those.

D: Okay, and how about uh, any muscle weakness in the lower extremity or upper extremity?

P: No, no weakness.

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

P: No.

D: Uh, how about night sweats?

P: Uh, no night sweats.

D: Okay, and have you had any infectious symptoms, like uh, like a runny nose or a sore throat?

P: No.

D: Okay. Have you had uh, had a cough or shortness of breath?

P: No, I've been pretty well recently.

D: Okay, that's good. And how about any memory loss or confusion?

P: No, nothing like that.

D: Okay, and any sensory changes like changes to your vision, hearing, smell or taste?

P: Uh, no, nothing like that.

D: Okay, have you had any chest pain?

P: No.

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

P: No.

D: Okay, have you had any lightheadedness or dizziness?

P: No, nothing like that.

D: Okay. Um, and have you had any nausea or vomiting?

P: Um, no, no nausea or vomiting.

D: Okay, uh, have you had any changes or loss to appetite?

P: Nope.

D: How about any abdominal pain?

P; No, no abdominal pain.

D: Alright. Have you had any changes to your bowel habits, like diarrhea, constipation or uh, blood in the stool?

P: Um, no.

D: Okay, and how about any changes to your urinary patterns like pain or, or frequency?

P: No, no changes at all.

D: Okay, and have you had any changes to your skin, like such as rashes, or, or any changes to your hair or nails?

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

D: Alright, so then, how about your energy? Have you had any fatigue?

P: Um, no. My energy's been fine.

D: Okay, and have you had any muscle aches, or body pains or uh, any joint pains?

P: No, I mean like all the other joints and other like, bones and muscles have been fine, it's just, even I wouldn't describe this as pain, it's just uh, I think my parents got a bit concerned um, since there was like a lump. They were scared and I was a little bit scared too, so I just came in to check it out.

D: Yeah, certainly. Okay, um, and uh, have you had, have you been diagnosed with any medical conditions in the past? Or see a doctor for any reason?

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

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

P: Uh no, no medications.

D: Okay, uh, and do you have any allergies?

P: No.

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

P: Yeah, all my immunizations are up to date.

D: Okay, uh, and have you had any hospitalizations or surgeries?

P: No, I haven't had uh, any hospitalizations or surgeries.

D: Okay. Um, and uh, could you tell me a little bit about your living situation currently? Like who you're living with and uh, where.

P: Yeah, so I'm living um, with my parents and older brother, um, and we live in a, just a house um, right outside of the city.

D: Okay, and are you currently in school and working, or, or working?

P: No I, I don't work. I'm currently in school right now. So yeah, too busy with school and then just extracurricular activities.

D: Yeah, absolutely. Okay, um, and uh, have you been around anybody who's been sick?

P: No.

D: Okay, and have you traveled anywhere recently?

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

D: Okay. Um, and uh, and do you smoke cigarettes or uh, or use any cannabis products?

P: No, I haven't tried um, any drugs or anything like that.

D: Okay, well that's good. And um, are you currently sexually active?

P: No.

D: No, okay. Have you been sexually active in the past?

P: No I haven't.

D: Okay. Um, and uh, any concerns for safety at home with either physical violence or um, verbal abuse, either to yourself or anybody in the home?

P: Uh no, we, like um, me and my brother, feel safe at home. School is going well too. Um, I'm pretty, pretty athletic at school like uh, I have good friends, so no bullying or anything like that. Feels pretty safe overall.

D: Okay, now that's good. I'm happy to hear that. And uh, is there any um, conditions in the, in the family? Uh, either like musculoskeletal or neurological things that you can think of.

P: Um, I don't think anything related to this, but um, I know my, my dad has diabetes. Um, and my mom has uh, some anxiety.

D: Okay, and anybody in the family ever um, have any cancers or, or any bone tumours or soft tissue um, tumours or growths?

P: Um, I don't think anyone's had like a bone tumour or anything like that. I, I know my uncle, um he, he does have a, he had like melanoma, which he had to get surgically removed.

D: Okay. Um, and any genetic diseases in the family or, or congenital diseases?

P: Um, not that I've been told, no.

D: Okay, um, so um, next I just wanted to move on to the physical exam component and um, firstly, are you having any issues with uh walking?

P: No, I've been like, uh, no, no pain, no. I can walk just fine, no issues there.

D: Okay, excellent. So no antalgic gait. And when looking at um, the area, are you seeing any swelling or, or redness, or skin discolouration?

P: No, no, nothing like that. It's just, uh, I can tell there's like a lump there, and if I press it, I can feel like the hard lump, but um, no changes in the skin above it.

D: Okay, and are you seeing any um, muscle atrophy around the area?

P: No um, nothing like that.

D: Okay, and are you seeing any, uh, like joint deformities or, or anything like that?

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

D: Okay, um and, uh you don't have any, any pain, so if you press on the area or on the the knee joint, you can just feel the mass and no pain there?

P: Yeah, it just feels weird. I don't, I'm not in any pain or anything, but it's like, it's weird to look at and then weird to feel uh, as well.

D: Okay. Um, and um, uh okay, then no limitations with uh, with like range of motion of any of your joints including like uh, knee and ankle?

P: Yeah no, I can move everything just fine.

D: Okay, awesome and so that, that was everything that I wanted to ask today and uh, uh check on the physical as well. Um, so was there anything else that I maybe forgot to ask about or anything you wanted to add?

P: Yeah no, I um, nothing else I wanted to add, but I, I think my parents and I were just scared about it being like uh, cancer, or like a tumour, um, so I just don't know what I should do, if I need to get any tests done, or x-rays, or anything like that.

D: Okay, um, yeah, we, so um, the first thing we will want to get uh, an x-ray um, of the knee and also of the uh, long bones, so of your femur um, as well as your leg too. Uh, and because right now we, um, most likely think is called something, um, an osteochondroma, um, which is the most common uh, primary benign bone tumour. Um, however, there are other things that it, it could be, um, and so, such as like an osteoma, or um, an endochondroma, um, so we'll, we'll want to um, get that x-ray and um, kind of go, go from there.

P: Okay, uh, yeah that, that sounds good.

D: Alright, so we'll get that, we'll get that ordered.

P: Alright perfect, thank you so much.


D: What brings you in here today?

P: Yeah, so over this past five days I've had um worsening shortness of breath and uh some discomfort in my chest um and this cough that that's been getting worse as well.

D: OK, so it's just been for the past uh past week or five days?

P: Yeah, I mean I've had um a cough and uh in the in the in the past, and and and shortness of breath in the past. But yeah, just over these past five days it's been there um at all, like it's been there all day and it's been getting uh worse as well.

D: OK, and what is the cough like? Is it wet or dry?

P: Yeah, I'm bringing up sputum uh pretty much um like every time I'm coughing up I'm bringing up some yellowish or greenish uh sputum.

D: OK, and have you noticed at all any blood?

P: No, no, no blood.

D: No blood, OK, um and how much sputum are you bringing up like uh every time you cough?

P: I I would say its um would would be the like just the little inside of my uh palm each time.

D: OK, and uh is this uh, and then what about the shortness of breath, is it uh are you having trouble taking deep breaths or do you find yourself breathing faster? Like how would you describe it?

P: It's um yeah, I'm just really feeling like I just can't, uh catch my breath even with um some small things around the apartment uh that normally I can do, it's any type of exertion, I just can't catch my breath. I'm OK right now just sitting here though.

D: OK yeah, so at rest you're fine but like when you exert yourself, it gets worse.

P: Yeah, well I'm I still have this like uh chest discomfort. Um so while while sitting here, it doesn't feel um like my breathing is normal.

D: OK, and when do you get that chest discomfort? Is it when you're breathing in or breathing out or it, can it be just due to exercise?

P: It's it's kind of just always, it's just kind of been there over these past uh like four or five days.

D: OK, and how would you describe uh, is it pain at all or is it like sharp stabbing or pressure like pain?

P: Um no, nothing like that. I kind of I just I feel congested I guess.

D: OK, um so just discomfort. Do you do your symptoms get worse at all when you're laying down flat?

P: No.

D: No, OK. Uh, do you wake up at night gasping, gasping for air?

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

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

P: Yeah, uh now that you mentioned, I do think I I feel a bit feverish. Um uh yeah, and I I've noticed that actually over the last uh couple of days.

D: Oh, have you had a chance to take your temperature at all?

P: No, I just felt feverish.

D: OK, um do you have any other symptoms like um sore throat, runny nose, anything like that?

P: No, I don't.

D: OK, um have you traveled at all recently?

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

D: OK, have you tried anything to help you with your symptoms?

P: Yeah, I I did try uh, using an inhaler. I have um a couple up those and um usually that that helps, but hasn't really been able to um help much this time.

D: OK, um how often are you having to use it?

P: Um so uh I I used it um I I took three or four puffs this morning and um and that was about it. I was using it last night as well, uh but typically I will use it maybe two or three times a week.

D: OK. Um and have you had any headaches or changes in your vision or anything like that?

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

D: OK. Any nausea or vomiting?

P: No.

D: Um any increased fatigue?

P: I, I mean, I haven't been able to do as much with uh being so short of breath, but my energy has been been OK.

D: OK, and how about um, do you have any sensation of palpitations or your heart is racing at all?

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

D: OK. Um and any kind of diarrhea or constipation?

P: No.

D: OK. Any issues with urination?

P: No, uh no problems there.

D: Uh any changes in your sleep or appetite?

P: Um no, that that's been pretty good.

D: OK, any night sweats?

P: Uh no, I haven't had any night sweats.

D: OK. Um any kind of uh significant weight change recently?

P: Um I I I might have, uh no, I think my weight's been about the same.

D: OK, um any exposure to anyone sick around you recently?

P: No, I don't think so. Um but I I've had I've had a couple of uh chest colds over the last year that I needed um antibiotics for uh and it, they they went away after that, I got that, those from a walk in clinic.

D: Sorry, you got antibiotics from the walk in clinic?

P: Yeah, the last time was uh probably about about four months ago.

D: OK.

P: So I haven't been around anybody sick recently, but um but I mean I I've had similar symptoms um before, I feel like this time might be just a bit worse though.

D: OK. Um and do you have any past medical history? Uh any conditions you've been diagnosed with?

P: Um yeah, so I I have been I've been diagnosed with COPD uh as well as uh, high blood pressure and uh GERD.

D: OK, and when were you diagnosed with COPD?

P: Uh about three years ago.

D: Three years ago, OK. Do you take any medications for any of these conditions?

P: Yeah, so I have a medication uh Ventolin, I take Symbicort daily um which is like a steroid type medication. And then um I take an ACE inhibitor I think for blood pressure and just Tums or something like that if my reflux is bad.

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

P: Um, no.

D: No, OK. Any past hospitalizations or surgeries?

P: Um, no.

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

P: Uh nothing like that, no.

D: OK. Um and any cancers in the family?

P: Um, no.

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

P: Yeah, so um I'm living with um with just my uh daughter in a in an apartment.

D: OK. Um and currently do you work?

P: Yeah, so I I've been working at the um at the grocery store. Uh yeah, I've been at the grocery store.

D: OK, and do you smoke currently?

P: I do, yeah. Uh I smoke about a pack a day. Um and I I've smoked for, now well, probably like 30 or 40 years. I used to smoke more.

D: OK. Um you have cut down, that's good. Um yeah, definitely the more you cut down, and if you need to talk about quitting, there's a lot of resources that we can go through. Um do you use anything else besides uh cigarettes, like any marijuana or any other drugs?

P: Uh no, no, just just cigarettes.

D: OK, um and any alcohol?

P: Uh yeah, I mean I'll have some uh wine with dinner on the weekends, but that's about it.

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

P: No, that was, uh, about it I was uh I was wondering if you think I I have an infection or is this uh COPD acting up, or what's going on?

D: Yeah, so definitely with your history of COPD and um these symptoms, it can just be an exacerbation of your COPD and that can happen sometimes when you have COPD and then you get a either viral or bacterial infection and that makes your symptoms worse, and you've also had a fever, so we'll do like a full physical examination, get your vitals, everything, but uh and then we'll give you some uh like nebulized like um for your home puffers too, but all just in the hospital and monitor your response to them. Uh and then we'll also get like your, some of your blood work and chest X-ray just to see if there's any like pneumonia. And lastly we'll just get like a Covid swab done since some of these symptoms also overlap with Covid symptoms. Um and yeah so we'll, so that's what we'll do um and I'll let the emergency department know that you're on your way. I think you'll need to get all those tests there, and then they'll decide whether or not you need any kind of admission or you can just go home on antibiotics um from there, OK?

P: OK, that sounds good. Thank you.

D: Yeah yeah alright take care.

P: Bye.


D: What brings you in?

P: So I've just I had some sinus problems in the past. I've had some sinus infections and I just feel like I have one right now and I know that like I know that you know, a lot of the time I I've done all the things that I've been told to do in the past like I've been doing, like Saline rinses and just doesn't feel like it's helping very much right now. When I rinse, I'm getting like this greenie gross kind of mucus coming out. And it's just like giving me this like headache. It just feels crappy.

D: Yeah, I'm sorry you're feeling that way. So this runny nose, OK, do you have a cough at all?

P: Uh, no I don't have a cough.

D: Any shortness of breath?

P: Uhm, I don't have a real like shortness of breath, but it does feel congested.

D: OK, how about wheeziness?

P: Uh, no wheeziness.

D: No wheeziness, OK. And how about, how about like sore throat or loss of taste?

P: Uhm, uh so my throat not sore in like the way that you get catch a sore throat but I get a lot of post nasal drip and it makes it like stingy. So it's like it's sore in that way, but it's not like you know if you have like strep throat or something.

D: OK. How about changes in your vision or hearing?

P: No, nothing like that.

D: Weight loss?

P: No.

D: Fevers or chills?

P: I, I took my temp last night. It was pretty high. It was like 99 point like something, uhm 99 like 7 or something.

D: Ah, OK.

P: So my thermometer said that's high, I don't, I don't really know, but yeah.

D: OK and how about like, facial pain or pressure or feeling like it's full?

P: Oh yeah, I have that. It's like yeah, all on the front part of my face.

D: OK. And then you mentioned some nasal obstruction, some discharge and you said no loss of smell, right?

P: No, I didn't lose any smell. Like sometimes it's kind of hard to smell because it's so plugged up.

D: Right.

P: I still have like I'm able to smell like, especially after I do the rinses. It helps a little bit.

D: OK, how about like a chest pain?

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

D: No, OK. Any issues with bowel movements or have those been normal?

P: Those have been normal.

D: OK. Any changes in your urine?

P: No.

D: No, OK. Any headaches?

P: Yeah, like I get that like sinusy headache that you know, it's pretty common for me, like kind of just all in like the front of my face and sometimes it kind of feels like it goes all over.

D: How about umm, how about like dizziness or fainting?

P: No.

D: No, OK. Are you otherwise healthy or do you have any longstanding medical conditions?

P: No, this is pretty well, pretty well the only thing. I had some problems with my knee like I had some problems with the ACL, so like I see like an orthopaedic person for that, but otherwise, otherwise I'm healthy.

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

P: No, like I I sometimes like I used this saline rinse.

D: OK.

P: For a bit. I used to use the nasal steroid spray and I I hadn't had an infection for awhile and things were feeling OK, so I haven't been using it recently. Umm, and then I occasionally will use like, like an Advil if my knees sore.

D: OK. OK, and no hospitalizations or surgeries?

P: Uh, so I had an ACL repair surgery.

D: Oh right, yeah, OK.

P: And like I went to the emergency department once when I had a bad sinus infection, but I didn't like stay over at the hospital.

D: OK, OK. How about immunizations? Are you up to date?

P: I think so. I never really didn't get any.

D: OK. Any allergies?

P: Uh, like a little bit to cats but nothing else.

D: OK. Any family history of lung or heart conditions?

P: No, not that I know of.

D: OK. How about smoking, do you smoke?

P: No, no.

D: No, OK. Do you drink alcohol?

P: I drink a few beers on the weekend.

D: OK.

P: You know five or six per weekend.

D: OK. And then, five or six for weekend. OK and any recreational drugs?

P: I will occasionally take like a cannabis, like a capsule like the oil in the capsule.

D: OK, and what is that for?

P: Just like recreational. Also like I mean my knee, my knee pain. Sometimes it helps.

D: Mhmm, OK.

P: But essentially that that might be like once like per month or something.

D: OK. OK. Alright, and, any sick contacts recently?

P: No, no. I've been working from home.

D: OK. OK, and any travel recently?

P: No.

D: No, OK. And where do you live?

P: I live here in town with my wife and our teenage son.

D: OK. Is anyone at home sick?

P: No, they're fine.

D: They're fine. OK, and what about.. Sorry?

P: They're both working from home like doing school from home too. So we rarely don't go anywhere like my wife goes to get groceries and that's about it.

D: OK, I see. And any old carpets, smoke, asbestos, mold anything like that at home?

P: No, no, it's a pretty new house.

D: OK, alright, any pets at home?

P: We have a dog. It's a labradoodle.

D: OK, yeah.

P: And that's it, yeah.

D: How long have you had him?

P: Oh, like, he's like 3 now. Like my sinus infections and that have been going on for longer than we've had him.

D: OK, alright. Those are all the questions that I had for you. Did you have any questions of your own for me?

P: I don't think so. I just I hope you know, we can do something about this. Because you know, I tried all this stuff that is supposed to be like, you know, conservative like the first steps and it just doesn't seem like it's getting better. It's been like few weeks. So, I thought it was probably time to come see you.

D: Yeah, sorry. What have you tried at home again?

P: So I use the, the rinses the saline rinses. I used a little bit of nasal decongestant but I know like I know I've been told I'm not supposed to do that for more than a few days, so I don't. Yeah, that's, I think that's pretty well it 'cause they said there's not much we can really do.

D: OK, yeah. So your symptoms, OK because some some of these things overlap with Covid, we're going to have to swab you and they'll notify you of your results in like 24 to 48 hours. But what it sounds like is something called Sinu, Sinusitis and it sounds like acute bacterial rhinosinusitis because of some f the symptoms that you have, and it's been going on for more than a week and it's, it's not going away with the rinse, saline rinses and these decongestants. So we will prescribe some antibiotics for you. Probably amoxicillin. Take those for five to seven days and see if some of your symptoms clear up. If they continue to be severe, umm, actually, at this will also prescribe you some inhaled corticosteroids because I think those can help as well, so will give you both of those for now and then just follow up with us in a week after you've tried both things and we'll see how your symptoms are holding up at that point. Does that sound like a good plan to you?

P: Yeah, I think that sounds that sounds fair. Yeah, thank you.

D: OK, yeah no problem.


D: What brings you in today?

P: So, just for the past, like 3 days I've been coughing. It's I I don't feel particularly sick. I'm just kind of dry like annoying call that won't go away and then today I took my temp in it It's pretty high. It was like 99 point like 9. I didn't really take it the other days, so I guess so I just thought I'd better come get it checked out because I, I am on like a biologic medication, so, for my Crohn's disease.

D: OK, yeah. Yeah, thank you for coming in. I think it's good that you are getting this checked out as early as possible. So just to rewind a little bit. When did your dry cough start?

P: Uh, like 3 days ago three days ago.

D: 3 days ago, OK. And when did your fever start?

P: So I didn't take my temp, but like the other days, but like for sure this morning.

D: OK um, OK, so the cough is it always a dry cough or do you sometimes bring up sputum or blood?

P: Yeah, it's always a dry cough. It's really just annoying.

D: Yeah, yeah. Do you feel wheezy at all?

P: Uh, no.

D: No wheeziness, OK. How about short of breath?

P: No.

D: No OK. Uhm, any chest pain?

P: No.

D: No. Do you ever feel like your heart is racing?

P: No, I can't say that I do.

D: OK, any swelling in your limbs?

P: Um, no.

D: OK, how about um, um a sore throat?

P: No.

D: No sore throat, OK. Any issues with taste or smell?

P: No.

D: Do you have a runny nose or a stuffy nose?

P: Maybe a bit of a runny nose.

D: OK. And any issues with vision or hearing?

P: Ah, no.

D: OK, how about, uh, fevers or chills?

P: No, no fever. I mean I I took my temp was high. I guess I felt hot but I didn't, there were no chills.

D: OK, OK, how about weight loss? Oh that's OK. How about weight loss?

P: Weight loss? No, no, nothing, nothing new.

D: OK. Any changes in your hair, nails, or skin? Like rashes?

P: No.

D: OK. Um, any issues swallowing food?

P: No.

D: Nausea or vomiting?

P: No.

D: Um, changes in your bowel habits?

P: Well, like I said I have Crohn's disease. I'm not like in a flare right now or anything, so I'll say no, but like my baseline is not like totally normal.

D: OK yeah, that makes sense. Umm, alright. Do any changes in your urine?

P: No.

D: No changes in urine.

D: How about dizziness or fainting spells?

P: No.

D: Any confusion or memory loss?

P: No.

D: OK, and are you otherwise healthy? I know you mentioned you have Crohn's disease. Do you have any other longstanding medical conditions?

P: Oh, not really. Just that, and, uh, eczema.

D: Eczema, OK.

P: Tends to get pretty bad, like I don't really have any right now, but I really stay on top of it with like my moisturizers and like I always have like a hydrocortisone cream on hand just in case.

D: Yeah, for sure. How long have you had eczema for?

P: Oh, like when I was, started when I was like a kid and then I feel like when I was a teenager I didn't really, and then part of it as an adult I really have to take care of it or else it gets bad.

D: OK OK. Um, have you ever been hospitalized or have you had any surgeries in the past?

P: Uh, like when I was first diagnosed with Crohn's maybe 20 years ago, when I was like 20, I was in the hospital for a little bit 'cause I was really dehydrated and I couldn't really like, I just couldn't I wasn't feeling well at that time, but since then I've been pretty on top of it.

D: OK, that's good to hear. You mentioned you're on biologics for Crohn's disease? Are there any other medications that you're on?

P: Um, just like the hydrocortisone, cream on occasion.

D: Right. OK. Um, OK and. Do you have any allergies?

P: Ah, like I have some seasonal allergies, like ah, its ragweed, which is not like right now, is not the time for it. And like cats and dogs.

D: OK. OK.

P: It's just like this environmental, it's not like not like the really dangerous allergies, you know?

D: Right, OK. Um, how about immunizations? Are you up to date?

P: I think so.

D: Alright, and in terms of family history, are there any lung conditions or heart conditions?

P: Oh, like my dad had high blood pressure, but other than that I don't think there is anything that stood out.

D: OK. And how about your smoking history? Do you smoke at all?

P: Um, like I did for a couple years when I was like 18 and then I haven't ever since.

D: OK, how about marijuana?

P: Uh, no.

D: No marijuana? OK. Um? How about other recreational drugs?

P: Uh, no.

D: No, OK. Uhm, alcohol?

P: Ah, I like I might have like a couple beers on the weekend, but not a lot.

D: Sure, um. And where do you live right now?

P: So I live in a townhouse in London here. I live alone, but my I have my kids every, I have my kids like Wednesdays and Thursdays and then every other weekend.

D: OK, any concerns for old carpets, mold, asbestos, anything like that in the home?

P: No, it's like a pretty new build.

D: OK, and have you been around any sick contacts recently?

P: Ah I mean, my kids just left this weekend. Uhm, there's really only people I've been around. I can, I maybe I should have asked him before coming here if they like knew they had seen anyone but they were fine, over the weekend.

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

P: No.

D: No, OK. Those were all the questions that I had today were there was there anything else that you wanted to add? Anything that I missed perhaps?

P: I don't think so. I think that's it.

D: OK.

P: You know, I hope I hope I just wanted to come in in case it was something bad because I you know I have those other health problems. I just want to make sure. Yeah.

D: Yeah, yeah for sure and I think it's a good thing that you came in, so thank you. Right now, I guess top on the list of things that you could possibly have is COVID, so we'll get you tested for that and we'll get you a swab and you should have the results of the that swab in about 24 to 48 hours and then you should isolate for 14 days regardless though because your symptoms do overlap with symptoms of COVID. And, and that includes isolating from your your children as well.

P: Oh ok.

D: And yeah, and if it's not COVID, it could be another viral illness that's going around at this time of year, just so just make sure you're staying hydrated, you're eating nutritious foods and getting good sleep. If your symptoms do become worse, and if they become uhm, severe like you have a really high temperature, you have trouble breathing or you have any neurological symptoms like seizures or fainting spells, please do go to the ER and seek help. How does that sound?

P: Ah yeah, I guess that sounds good. This is how it's gotta be, right?

D: Yeah, unfortunately, or yeah. Well, thank you again.

P: No, thank you. Have a good day.

D: You too.


D: What brings you in?

P: Yeah so I'm bringing in my year old son here with, I because he's had a fever and and a cough and a runny nose. These symptoms have been going on now for the last two days.

D: Last two days. OK. Uhm, all of these symptoms have been going on for the last two days or just like one or two?

P: I think, I think the cough and runny nose started 1st and then he then he kind of had some fever and had some chills as well last night. Kept saying that, like he was just cold, even though he had a had blankets on.

D: OK. OK. Alright, so the cough is it a productive cough or is it a dry cough?

P: It's dry.

D: Dry, OK. So no sputum, no blood?

P: No no no sputum or blood.

D: Any shortness of breath with that?

P: No, his breathing has been been good.

D: OK, wheeziness?

P: No.

D: Chest pain?

P: No, no.

D: OK. The fever, did you measure it yourself?

P: I did. Yeah it was 38 point, ah point 8.

D: OK, and the runny nose is it clear? Or does it have like a colour to it like yellow or green?

P: It's pretty, yeah it's more clear.

D: Clear, OK. Alright and does he feel like he also has a stuffy nose or is it just a runny nose?

P: More just runny. Yeah he doesn't mention anything about feeling stuffy.

D: OK. Any symptoms like redness, any discharge?

P: Uh, no, yeah, uh, he hasn't had any any eye symptoms.

D: OK, how about hearing wise?

P: Uh, hearing has been been normal.

D: And visions been normal?

P: It has, yeah.

D: OK. Any ear pain or discharge?

P: Ah, nope, no ear pain or, or discharge.

D: OK, how about a change in smell or taste?

P: No.

D: No, OK. Weight loss?

P: He he's been gaining weight, hasn't had any weight loss.

D: OK, any rashes?

P: No.

D: No. Sore throat?

P: Yeah, yeah, he's had a bit of a sore throat.

D: OK.

P: But he hasn't he's just kind of mentioned it. He said it wasn't too bad. He's still been been eating. Eating is that hasn't been eating as much, but he's got a poor appetite, but he, so this sore throat isn't bugging him that much that much.

D: OK. And how about dizziness or fainting spells?

P: No.

D: No, OK. Numbness or tingling?

P: No.

D: Muscle ache or joint pains?

P: Yeah, yeah he has had uh, he did mention that he just feels like a key a little bit all over.

D: OK, any changes in his bowel movements?

P: No diarrhea.

D: No, OK. Natural vomiting?

P: No, he hasn't had any nausea or vomiting.

D: OK, uhm how about changes to his appetite?

P: Yeah, his appetite's been a bit down, yeah.

D: Is he still eating solids?

P: He is, yeah, he's still eating solids just a little bit. Probably just just smaller portions though.

D: OK, yeah. And ah, are there any changes to his urine?

P: No, there there hasn't been any any changes to his hearing.

D: OK. Uhm, any past medical illnesses or any longstanding medical conditions that he has?

P: No, he's he's been um he's been pretty healthy. Yeah, I mean, he's got got gets a cold every once in awhile maybe in the winter, but that's about it.

D: OK, any hospitalizations or surgeries?

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

D: OK. Any complications with his mother's pregnancy with him?

P: No, it's been ah it was normal pregnancy throughout it was to term and it was a C-section delivery but that went well and he was a normal weight.

D: OK. And was it an emergency C-section?

P: Ah no. I think it was like Labor was taking, it was prolonged, I mean so it they ended up deciding to just convert throughout. It wasn't an emergency, but like they could have waited a bit longer they were saying but just kind of what went made the decision.

D: OK, OK. And is he on any medications?

P: Uh, no he's not.

D: No, OK. And developmental wise has he been hitting all his milestones for like motor movements, speech, behaviour, social, socialization wise?

P: He has yeah, he's been meeting all of his milestones for that, for that.

D: OK, good. Is he up to date with his immunizations?

P: He is, yeah.

D: OK. Does he have any allergies?

P: Uh, no, no allergies.

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

P: Uh, no, it his grandfather had high blood pressure and like high cholesterol, but that's that's it.

D: OK. And has he been in contact with sick, sick people recently.

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

D: No, OK. And and any travel recently?

P: No, he he he's been doing some schooling, some schooling online and some some in person. And but, but otherwise they've just been at home.

D: OK. Uhm, alright and does anyone at home smoke?

P: No smoking at home.

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

P: So he lives with myself as well as his his mom and then he's got a younger brother and a younger sister as well.

D: OK. And at home. any reason to think that old carpet, dust, mold, asbestos, anything like that could be making his symptoms worse?

P: I don't think so, yeah, it's been all that's been OK.

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

P: No, I I I just wanted to figure out what this was.

D: OK, yeah, so it sounds or actually I should start by saying we should get a Covid swab on him just in case it is Covid because some of his symptoms overlap with those symptoms of Covid. Umm, you should hear back in about 24 to 48 hours with the results of those swabs. And in the meantime, it could be another viral infection that's going around at this time of year. And from the sounds of it, you said he has a fever. He's coughing and he has a runny nose and has muscle aches. It could also be the flu. Regardless of what kind of viral and viral infection he has, the best way to manage it right now is just supportive care, so making sure he's hydrated, eating foods with a lot of nutrition and just keep an eye on his symptoms. If it gets worse or if it's very severe and he has focal neurological deficits like weakness or seizures, take him to the ER right away. How does that sound?

P: Yeah, that sounds good. Thank you.

D: Yeah no problem.


D: Can you just tell me a little bit about what brings you in here today?

P: Yeah, I I have a cough.

D: OK, and uh, what kind of cough is it like a dry cough? Or is it more like productive cough?

P: I always seem to bring up some gunk on my when I cough.

D: OK, and what what colour is this gunk?

P: It's green, sometimes yellowish.

D: OK, and have you noticed at all any kind of blood in the cough?

P: Well, no blood.

D: No, OK, and how much of the gunk or the sputum would you say you bring up every day?

P: Uh a couple of kleenexes. Um, I'll use, but so not that much.

D: OK. an and when did this start?

P: It's really hard to say I've had a cough for the past few years now, but I feel like it's getting worse.

D: OK, and is your cough just constant or does it come and go?

P: I do cough throughout the day, but I find it's worse in the morning.

D: OK, and is there anything that brings on your cough?

P: I can't think of anything that triggers the cough, just worse when I get up in the morning.

D: OK. And you mentioned you've been having this cough over the past few years. Has it been getting worse at all?

P: Yeah, I would say the coughs were getting worse the last few years. Slowly though.

D: OK, and have you had any previous episodes of this cough with sputum like gunk, gunky material before?

P: Yeah, I've been having this ongoing for the last few years.

D: OK And is there anything that you do or have tried that's made your coughing get either better or worse?

P: If I take a deep breath, then it seems to make the cough worse and uh nothing really helps the cough go away though.

D: OK, um and other than that, have you been having any other symptoms, like a runny nose, sore throat, difficulty breathing, anything like that?

P: Uh, no.

D: OK, and have you recently traveled outside of the country?

P: I haven't traveled anywhere.

D: OK, and have you noticed any other symptoms like fevers or chills?

P: No fever and no chills.

D: OK, any night sweats?

P: No night sweats.

D: OK, any increased fatigue or just feeling tired overall?

P: Yeah, these last few months by energy has been low. I I've been feeling a lot more tired than usual.

D: OK, and have you noticed at all any kind of swelling in your hands, feet, ankles?

P: Uh, I think they're always a little swollen, but I might have just gained a few pounds over the years.

D: OK and, have you been having any palpitations like a racing heart or any chest pain at all?

P: Um, no chest pain.

D: OK, and how about shortness of breath?

P: Um. I only have trouble breathing if I walk a few blocks or go up a few flights of stairs into my apartment.

D: OK. Have you been having any kind of urinary issues?

P: Ummm only at night time I seem to have to get up a lot to use the bathroom.

D: OK, and how about your bowel movements, any constipation or diarrhea?

P: Um no bowel issues.

D: OK and have you been getting enough sleep?

P: Uh yeah I would say or sorry no my sleep has been has been poor

D: OK, and do you find that you wake up during the night to take a breath or anything like that?

P: No, I haven't had to wake up in the middle of the night short of breath or anything like that.

D: OK, and do you ever have to use a multiple pillows?

P: Um no I just used one pillow.

D: OK. And have you noticed you've had any significant weight loss or weight gain in the last few few months?

P: Um I maybe lost 5 pounds in the last few months. I wasn't even, I haven't been trying to lose weight but doesn't hurt though as I've I've gained a few pounds over the years so I don't mind.

D: And how is your appetite been like?

P: Uh appetite's been good I feel like I've been eating normally.

D: OK. And have you had any recent infections at all?

P: No recent infections.

D: OK and I think I mentioned this before, but any know any runny nose sore throat, any of those viral symptoms?

P: Um, no runny nose, no sore throat, been feeling good.

D: Awesome, and have you had have you been exposed to anyone with tuberculosis in the past?

P: Um no, I actually had a tuberculosis test for work and it was normal.

D: OK. And have you been diagnosed with any medical conditions at all, like high blood pressure, diabetes?

P: Um my blood pressure has been high and that was diagnosed in the last few years.

D: OK. And do you take any medications for your blood pressure?

P: Yes, I take um, Lisinopril.

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

P: Nothing I can think of.

D: OK, and have you been hospitalized at all before?

P: Uh, no.

D: And do you have any ill contacts near anyone that has been sick around you recently?

P: No ill contacts. And sorry I for hospitalizations I I did have a c-section for the birth of my daughter and I was in the hospital for a few days for that.

D: OK, but nothing else?

P: No.

D: OK and have you had any other surgeries other than your c-section?

P: No just the c-section.

D: OK, in terms of your family history has anyone had any cardiovascular issues or any cancers?

P: Uh, my father had a heart attack when he was 78. And um he unfortunately passed away from it, but had no cancer in the family.

D: OK, any like asthma in the family?

P: Not that I can think of.

D: OK, and currently, where do you live? Do you live in apartment, in a house?

P: I live in an apartment with my husband and our daughter.

D: OK, and do you currently work?

P: Yeah, I I work at the local grocery store.

D: OK. And just in your daily routine, how would you say, how is your diet and exercise like?

P: Um diet I'll usually eat one or two meals a day and sometimes snack throughout the day as well but we eat a variety of meats and vegetables, and so I think our diet is pretty good. But exercise don't have time for for that currently.

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

P: Um noo, I would never use that.

D: OK, how about alcohol?

P: A glass of wine. I have three or four nights a week.

D: OK, and is it like a full glass of wine or like just, how much would you say?

P: Glass of Wine is for me. I would say is like 5 or 6 ounces like a typical glass of wine.

D: Do you smoke at all?

P: I do smoke cigarettes, yes.

D: OK, and how much are you smoking an average day?

P: Um over a pack, one to two packs of cigarettes per day for the last nearly 40 years.

D: OK OK alright.


D: Could you start by telling me what brought you in?

P: So like I don't really feel sick. I just I lost. I can't. I for the past two days I can't smell anything. I can't taste any of my food. It's super weird I like live with my boyfriend and he was like here take a bite of this onion and I like bit into it and I literally didn't taste anything. Otherwise, like I feel totally fine. I just heard that this happens sometimes like with COVID and. I'm just kind of worried that I have COVID.

D: OK, for sure I will we will, um definitely look into that today and you are right, it is a symptom that can occur with with covid. But we will want to make sure that it isn't something else, and so I wanted to just ask you a few more questions about how you've been feeling. So you said you haven't felt sick, so have you been experiencing any other symptoms?

P: I mean, I may be even a bit tired, but really. Otherwise no. I guess maybe I felt like a little dry, but I haven't actually been coughing.

D: OK. So no cough have you felt a like short of breath at all?

P: No.

D: OK, and have you brought up any like, sputum or any blood?

P: No.

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

P: No.

D: OK, any feeling like your heart is ready racing?

P: No.

D: Alright, um, any nausea or vomiting.

P: No.

D: Any diarrhea or constipation?

P: No.

D: OK, any changes to urinary habits. Any painful urination or needing to go more often?

P: No.

D: Alright, and have you had any headaches?

P: Mmm no.

D: Uh, how about any fevers?

P: I don't, like I don't have a thermometer, I like maybe felt a little hot, but like like I don't really know.

D: OK, and have you had any chills?

P: Uh, no.

D: Alright, or how about any night sweats?

P: No.

D: And recently, over the last several months, have you had any changes to your weight?

P: Uh, no.

D: OK. And in the last several days, have you had a sore throat?

P: Like I said, it felt like dry, but I don't think it's been sore.

D: OK um. And have you had a runny nose?

P: No.

D: Or felt congested at all?

P: No.

D: OK, and then any eye pain or ear pain?

P: No.

D: OK, and then any rashes on your skin?

P: Like I have eczema, but nothing new.

D: OK, and in regards to your past health do you have any medical conditions that you're followed for,

P: Like the eczema, like I have like a peanut allergy. That's it.

D: I see OK, do you have an EpiPen?

P: Yeah.

D: OK, do you keep that with you regularly?

P: Yeah, yeah, always.

D: OK, excellent um, and do you take any other medications or?

P: I take birth control. An like sometimes like I had, I had like eczema cream like the the steroid one for when it's really bad.

D: OK, and when did you start birth control?

P: Maybe like three years.

D: OK, and how often are you using the cream?

P: It's kind of like goes in like flares, so like this, 'cause it's winter I've been using it like maybe a couple times a week.

D: OK, um and. Any allergies to medications?

P: No.

D: And have you had any surgeries in the past?

P: Nope.

D: OK, any reason reason for hospitalization?

P: Nope.

D: OK.

P: Sorry I went to the Emergency Department like when I had my peanut like the first time I realized I was allergic to peanuts. But that was it.

D: Oh, did you have an anaphylactic reaction?

P: Yeah, like I was a kid. So. I don't really remember that much, but that's when they told me I was allergic.

D: I see OK, so important to have the EpiPen then for sure.

P: Yeah

D: And so you mentioned that you're living with your boyfriend?

P: Yeah.

D: OK, anybody else?

P: No, just us.

D: OK, and as your boyfriend been sick at all?

P: No.

D: OK. And at like have you been around anybody who's been sick at work or school?

P: Um no like all my classes are online, so I don't really see anyone besides him right now like we don't even officially like together. He's just been essentially staying at my apartment, 'cause like we don't see anyone else.

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

P: No.

D: Do you smoke marijuana?

P: Like occasionally we will like. Do an edible or something, but I don't smoke it.

D: OK, and any other recreational drugs like cocaine, MDMA?

P: No.

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

P: Yeah, just like with my boyfriend.

D: OK, and um. Any sexually transmitted infections in the past?

P: No.

D: OK um. And then do you drink alcohol?

P: Like maybe a couple of beers on the weekend.

D: OK, and in your family, has anybody ever lost their smell before?

P: I don't think so.

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

P: No.

D: Alright and then I have anybody in the family had cancer before?

P: Like my like my Uncle um had like prostate cancer.

D: OK, do you know, breast cancer, ovarian cancer?

P: No.

D: OK. So that that was all I wanted to ask about on, uh, the history today. Was there anything else that I maybe forgot to ask about?

P: Mmm I don't know that's it.

D: OK, so, uh, yeah with, uh, the symptoms of losing your smell over the last day or so we will certainly look into. Whether or not this is caused by COVID and so that will require a nasal swab test for that. Usually the results are coming back now within 48 hours hopefully, but still will be required to self isolate now for the next 14 days after your symptoms are gone, so we will let you know when the results come back from this test though.

P: OK. OK, geez OK. Thank you.

D: Alright, you're welcome.


D: What brings you in here today?

P: Um, I'm just, I'm here because I've had this cough for the past two weeks and uh, it's just not going away.

D: Okay, and um, is it getting worse at all really?

P: Not really, it's just been the same.

D: How would you describe the cough? Is it a wet cough or a dry cough?

P: It's a dry cough.

D: Okay, are you bringing up any uh, sputum or blood at all?

P: Uh no.

D: Um, would you describe it as like a, a barking cough, a harsh cough, or a muffled cough?

P: Not really.

D: No, okay. Um, before you started uh, coughing, did you have any other symptoms, like runny nose, congestion, sore throat, anything like that?

P: Uh, no.

D: Okay, so it's just the cough?

P: Yeah.

D: Okay. Any fevers or chills?

P: Nope.

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

P: It, uh, I guess it's just, it's there throughout the day.

D: It's there throughout the day, okay. And is it brought on by any activities or, or does it just come on by itself?

P: It comes on by itself.

D: Okay, and has it gotten any better at all or stayed around the same?

P: It's stayed the same.

D: Okay. Has this happened to you before, where you had a cough for a long time?

P: No.

D: No, okay. Um, do you have any other symptoms like chest pain, sore throat?

P: No.

D: Okay. Um, any recent travel or contact with anyone that's been sick?

P: I don't think so, no. I just went to my, I went to see my family doctor um, for some prescriptions.

D: Okay.

P: Um, three weeks ago.

D: Three weeks ago, okay. Any headaches at all?

P: No.

D: Okay, nausea or vomiting?

P: No.

D: Any night sweats?

P: Um, no, nothing like that.

D: Any fatigue at all?

P: No.

D: No. Any shortness of breath?

P: No.

D: And no chest pain?

P: No.

D: Any diarrhea or constipation?

P: No.

D: Okay. Um, any wheezing at all?

P: No.

D: Okay, any changes in your weight recently?

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

D: Any changes, sorry, any issues with your urination?

P: No.

D: Are you sleeping well or does the cough keep you up at night?

P: Um, it's, it's not so, it hasn't interrupted my sleep.

D: Okay, and how's your appetite been like?

P: No, everything's okay.

D: Okay, and any uh, loss of your sense of taste or smell?

P: No.

D: No, okay. Um, any exposure to any fumes or dust within your environment, or animals or pets?

P: No.

D: Um, and otherwise, do you have any medical conditions like asthma, COPD, anything like that?

P: Um, I went in for, I went in for a checkup three weeks ago, and uh, I found out I had high blood pressure. You know, who would have thought and then my doc started me on this pill called ramipril and uh, I've just been checking my blood pressure on a regular basis, and it's yeah, it's been good. But other than that, I'm very healthy.

D: Okay, and no asthma?

P: No asthma.

D: Okay. And any allergies to any medications or any environmental allergies?

P: Um, just penicillin.

D: Just penicillin. And have you taken any antibiotics or penicillin recently?

P: No.

D: No, and um, what medications are you on?

P: Just, just that one.

D: Just the ramipril?

P: I also take, I also take a multivitamin.

D: Multivitamin, okay. Have you been hospitalized before or had any surgeries?

P: No.

D: No, okay. Um, any family history of any lung or heart conditions?

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

D: Okay. Any cancers?

P: Yeah, uh, pancreatic cancer and colon cancer runs in the family.

D: Okay, and is that uh, any direct relatives, like your mom or dad or kids?

P: My, my grandparents on my mom's side.

D: Um, and currently, do you work um, or are you retired?

P: I'm a lawyer.

D: Okay. And, uh, do you work from home right now? Or do you go in person?

P: Yeah I've been working from home.

D: You've been working from home, okay. Um, and what's your home situation like right now? Do you live with anyone? Do you live in a house or an apartment?

P: Um, I live, I live in an apartment. I, um, I live alone I just got, I had a divorce two years ago and since then I've been, I've been living alone.

D: Okay, I'm sorry. Um, and is, in your home environment, is there any kind of allergens like dust or any mold or anything like that?

P: No, nothing like that.

D: Okay, and currently do you smoke at all?

P: Um, sometimes.

D: Sometimes, how often would you say you smoke?

P: Um, maybe uh, two or three cigarettes. Maybe three or four days a week.

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

P: Um, so I, I used to smoke a lot when I was young and then I quit. And then I started again two years ago.

D: Okay. Um okay, and do you use any recreational drugs like marijuana?

P: No, I don't.

D: Okay, um, and do you drink alcohol?

P: Yeah.

D: How much would you say you drink on an average day?

P: More than I would like to mention. I, yeah, I, maybe 5 or 6 beers a day.

D: Okay, and um, is this something that's new for you, or has been going on for years now?

P: Again, that started about two years ago, so.

D: Um, and uh, do you use, so no other recreational drugs, right?

P: No, nothing else.

D: Yeah, so we can definitely talk more about alcohol usage definitely, especially when there's uh, people going through stressful times. There can be increasing substance use, including alcohol, so we definitely have a lot of resources that we can um, discuss today if you would like.

P: Yeah, I would really like that. Thank you.

D: You're welcome. Um yeah, but those are all the questions I had for today. We'll definitely do like a physical examination, but it seems you've just been having a cough for the last two weeks.

P: Yeah.

D: Without any other symptoms. Um, okay, so do you have any questions at all for me?

P: Um no.

D: So what we'll do is, since you've had this cough for the last two weeks, we definitely want to do a COVID swab, just in case. You've been uh, working from home, but if there was any potential contact, they usually, it comes back in 24 to 48 hours.

P: Okay.

D: Other than that, sometimes uh, with a history of smoking, you can have something called uh, COPD. We can, like after the physical examinations and everything, we can potentially discuss doing pulmonary function tests as well. Um, and yeah, but other than that, it can also just be like a dry cough, can be just a viral upper respiratory tract infection that takes two or more weeks to resolve. In that case we wouldn't really.

P: Sure.

D: Um, yeah, so we'll do the physical examination and then go from there.

P: Sounds great.

D: Alright, take care.


D: How may I help you?

P: Hey, I've just been feeling kind of ill over the past two days and uh, I thought I'd just come in to see what's going on. So I've had um, um, I was feeling very achy and I had a cough and then I think yesterday night I developed a fever.

D: OK, and so um, last night you developed a fever. What, uh, did you check your temperature?

P: Um, I didn't, but I'm pretty sure I have a fever and like I can feel it.

D: OK. Have you had any chills or night sweats?

P: I had chills last night.

D: OK. Uh, so you mentioned you've had a cough as well, and when did that start?

P: Two days ago.

D: And is the cough been, um producing any phlegm or sputum?

P: No, it's kind of dry cough nothing

D: alright. How about any any blood?

P: No.

D: OK. And you've had muscle aches. Has this been like a whole body type of feeling, or is it any particular muscles that hurt?

P : It's all over.

D: OK, have you had any headaches?

P: No.

D: Alright. And have you had a cough before or is this a new cough?

P: It's a new cough.

D: Have you had any wheezing with the cough?

P: A little bit.

D: Yeah, so you've had wheezing as well. Are you able to to hear it?

P: Yeah, it's just like I can kind of like tell, when I'm breathing like it just, yeah. It sounds different. I don't know what a wheeze sounds like, but it just sounds different.

D: OK, um, and have you had any chest pain?

P: Uh, uh, sorry, can you say that again?

D: Sorry um, did you have any chest pain?

P: Uh, no.

D: OK. Um, have you had any, uh, um, symptoms such as red eyes or or itchy eyes or runny nose?

P: No.

D: OK, have you had a sore throat?

P: No.

D: Any nausea or vomiting.

P: No.

D: OK, how about a loss of taste or loss of smell?

P: Uh yeah, I kind of just foods have just been tasting little bland, since yesterday.

D: OK, so yeah, I lost of taste today. Have you had a runny nose at all?

P: No

D: OK. Any abdominal pain or diarrhea?

P: No.

D: Any urinary problems like uh pain or frequency.

P: Uhm? I uh, I I've had that for a while like it's just I think my prostate's kind of large so it's it's hard for me to, like I pee very frequently.

D: OK. And OK. Have you noticed any skin changes or rashes?

P: No.

D: Uh. And how is your energy been?

P: I've been feeling a little tired.

D: Alright, so you've had this dry cough that started two days ago. Been feeling feverish, have had some muscle aches, been tired and also a loss of taste. Have you been experiencing any other symptoms?

P: No, that's I think that covers it all.

D: OK. Oh sorry, I asked about chest pain, but have you had any like dizziness or feeling like you're going to faint or even like your heart's racing really fast?

P: No.

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

P: Um, just a large prostate. It's not cancer or anything, it's just kind of large.

D: OK so I have you heard of BPH before?

P: Yeah, I think that's what the doctor said.

D: OK, and do you take any medications for that or for any other reason?

P: Yeah, I do. I do take a I think a medication for that. Uhm? It's called tamsulosin.

D: OK yeah call me what is like Flomax or or tamsulosin, but there are there are others for sure.

P: Yeah I think I think it's called Flomax.

D: OK yeah it's the brand name for it but lots of yeah lots of different namings can be hard for the medication sometimes. And have you had any surgeries or hospitalizations?

P: Nope.

D: Do you have any allergies?

P: Nope.

D: OK um, and can you tell me a little bit about where you're living and who you're living with?

P: I just live with wife in an apartment.

D: OK. And has she had any symptoms or been sick at all?

P: Oh no, she's feeling good.

D: Have you had any sick contacts?

P: I don't, no I haven't. I don't think so. I mean potentially. I was. I was actually out with my friends, but no one was sick.

D: OK. Have you traveled anywhere?

P: Nope.

D: OK. And do you smoke cigarettes?

P: I used to, I quit. I quit 10 years ago. I used to smoke about two or three cigarettes a day for 20 years.

D: OK, well congratulations on quitting, that's great.

P: Thanks.

D: Do you smoke cannabis or use cannabis products?

P: Nope.

D: Do you use any recreational drugs?

P: No.

D: And do you drink alcohol?

P: Yeah, maybe sometimes once or twice a month, maybe a glass or two at a time.

D: OK, uh. And anybody in the family have any heart or lung conditions.

P: Uhm? Yeah, I think it's called Hypertrophic cardiomyopathy where people kind of die early. People get like people in my family got heart attacks very early on in their 30s. My brother died and when he was 15.

D: Oh wow, sorry to hear that and uh, has that been looked into for yourself?

P: Oh yeah, I see a cardiologist. I get regular checkups done.

D: OK. And. OK, and uh, so that was everything that I wanted to ask about on history today. Did you have any anything else that you wanted to mention or anything you were concerned about?

P: No.

D: OK, um so with your your symptoms today, they do overlap potentially with covid, and So what we'll need to do or will well, it'll be important to do a swab to test for covid. It could be something else like the common cold. Like another type of viral illness, but because of the pandemic it will be important to self isolate, including from your wife, for the next 14 days and we'll get back to you with the results as soon as we can.

P: Sure, thank you.


D: I was wondering if you could tell us what brought you in to see us.

P: Yeah, so I just came in. I was a bit worried because I've been having this cough for around two years, which has been getting worse. But recently I've noticed that I see streaks of blood in the sputum that I'm producing. Before it just used to be like white but now I'm seeing over the last, I would say two months occasionally some streaks of blood.

D: OK, and the cough started two years ago.

P: Yeah.

D: OK. And, it's been gradually getting worse over that time?

P: Yeah, I would say so. It's getting more frequent and worse in nature.

D: OK. And how much sputum are you bringing up an in a day?

P: Probably like a, a couple teaspoons.

D: OK, and uh, is are you seeing like bright red blood when you're when you're coughing it up?

P: Uh. In this it's kind of mixed into the sputum. I would say like, but it definitely is red.

D: OK. And how much blood would you say that you're you're bringing up would be teaspoons? Or a Cup? Or?

P: No. It's just like a little streaks. It's not really significant, it doesn't feel like the whole production of the sputum, but just like little streaks that I've noticed.

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

P: Um, it definitely gets worse when I'm doing more activities and then also when I get like some viral infections. But other than that, it's pretty much always there.

D: OK, anything that that makes it worse? You said some viral infections. Have you had a viral infection recently?

P: Yeah, like in the last two years, I've probably had two or three viral infections, just just just cold cold symptoms.

D: Has there been anything that you've tried to make the cough better?

P: I've tried the Tylenol Cold, hasn't really worked. Tried just other over the counter medications, haven't really worked.

D: OK. And prior to two years ago um, were you experiencing any similar symptoms like, uh, like this cough or bringing up blood before?

P: In the past, I've always had a somewhat of a cough like I have COPD. So I've always had a little bit of a cough here and there, but over the last two years I feel that it's been getting much worse.

D: OK, have you been diagnosed with chronic bronchitis before?

P: Yeah I think so.

D: OK. Um and so with with this cough and now blood tinged sputum, have you been experiencing any other symptoms?

P: Um, I do feel sometimes I get like more tired than I used to throughout the day.

D: OK.

P: Um, sometimes I also feel more breathless on when I'm exerting myself more.

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

P: No, no I haven't.

D: How about any night sweats?

P: No.

D: Have you lost any weight?

P: Yeah, I've actually lost a significant amount of weight. I would say within the last 1 and a 1/2 months probably lost like 8 to 10 pounds.

D: OK, have you been trying to lose weight?

P: No, not really I've just been sitting around like I can barely walk that much anymore too. I used to be able to walk at least 400 meters around the block, but now I can barely even go to the kitchen.

D: OK, is this because of the shortness of breath when you are are exerting?

P: Yeah, that and I just start coughing so much that I just have to sit down.

D: OK. Um, and have you been having any headaches?

P: No headaches.

D: Alright, and how about and how is your appetite been?

P: Um, I think it's been pretty much the same. Sometimes when I'm coughing a lot, I don't feel like eating, but other than that it's been around the same.

D: OK, any nausea or vomiting?

P: No.

D: Any runny nose or sore throat?

P: No.

D: OK. And then how about a loss of smell or a loss of taste?

P: No, nothing like that.

D: OK, have you been having any chest pain?

P: No.

D: Any heart palpitations?

P: Nope.

D: Any wheezing when you're breathing?

P: Sometimes I would say like when when, it gets worse when I'm exerting myself more, I I can get some wheezing.

D: OK, and have you noticed any swelling in your feet or ankles?

P: No, nothing like that.

D: Alright. And have you woken up at night extremely short of breath?

P: No, I'm pretty fine during the night.

D: Alright And, uh, have you been having any abdominal pain?

P: No.

D: Any urinary problems?

P: Uh no.

D: Any bowel problems like diarrhea or constipation?

P: No, nothing like that.

D: Alright, any skin rashes?

P: Nope.

D: Any joint pains or or muscle pains?

P: No.

D: Any weakness?

P: Not weakness, I'll just say more fatigue.

D: Alright so I know you told me a COPD, but do you have any other medical diagnosis?

P: Yeah, I have high blood pressure as well.

D: Alright.

P: I think I have high cholesterol too.

D: I see, OK. Do you take any medications regularly?

P: Yeah, so for the cholesterol taking Rosuvastatin and I forget what I'm taking for the blood pressure, but it's pretty well under control.

D: OK, do you use any inhalers for COPD?

P: I used to. I used to have I think like 3 different inhalers but haven't had to use them for more than 10 years now.

D: OK, and what was the reason for not needing them anymore?

P: I just didn't have any symptoms for a pretty long time and my doc said like if I don't really need them then I could just stop.

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

P: No.

D: Any allergies to medications?

P: Nope.

D: Any surgeries that you had in the past?

P: No surgeries.

D: OK, And are your vaccinations up to date?

P: Yup.

D: OK, and could you tell me a little bit about your social situation or living situation?

P: Yeah, so currently I'm just living by myself in an apartment. I've been there for more than 10 years now. Um, I am retired so I'm not working anymore. But yeah, that's that's me.

D: OK, great um. What did you do previously for for work? Did you have any exposures for two chemicals or dusts or asbestos? Things like of that nature?

P: Oh yes, I worked in the steel factory for most of my working life. I think yeah, there might have been some exposures to chemicals and dust particles. Asbestos I don't think there was exposure, but definitely I may have lived in places that had asbestos. I mean, yeah.

D: OK, how long have you been living where you you've been now?

P: So this this is like the one I'm living in is a new place, but before that, I lived in another apartment for around five years and that was a pretty old building.

D: OK, do you have any pets?

P: No pets, no.

D: OK um. And do you smoke cigarettes?

P: Yeah, I smoke, I'd say around 20 cigarettes a day right now.

D: Alright, and did you smoke more previously?

P: Yeah, I think I've been smoking for almost like 40 years now and I used to smoke up to 30 cigarettes a day.

D: OK, do you smoke cannabis?

P: No.

D: Alright. Do you drink alcohol?

P: Um just maybe a couple times a month. Nothing, nothing throughout the week.

D: OK, so do you use any recreational drugs like IV drugs or opioids or cocaine?

P: No, nothing like that.

D: Alright. And anybody in the family have any similar symptoms before like coughing up blood or?

P: No. Not that I know of. My father passed away from a heart attack when he was in his 60s. And I think my mother had a, um like I think one of the like, an arthritis. But yeah, like, but I think that was just like the one that you get with old age.

D: OK, like osteoarthritis?

P: Yeah that that was the one.

D: OK. Any cancers in the family?

P: Um, not that, one of my uncles had like um bladder cancer, but that's that's that's about it.

D: OK, and have you have you traveled anywhere recently or been around any sick contacts? Possibly people anybody who's had tuberculosis or any infections?

P: No, I've been pretty much to myself over the last few months, so not really.

D: OK um. Was there anything that you're worried that this could be?

P: Um Yeah, just the blood I kind of got scared maybe I thought like you know what if it's a cancer? One of my friends had lung cancer and I I know I've been smoking for most of my life, so that's something I was worried about.

D: Um, I can certainly see that the concern and I understand where you're coming from. I think it would be very reasonable to investigate that today. So we'll start with a chest CT along with some lab work and we will get a CBC and some electrolytes, also get an ECG as well to just check your heart and we will see what what the investigations show

P: Sounds good.

D: OK, and um, other things that um to think about this could be, uh, also like to COPD I know it's been going on a long time, but possibly could have a pneumonia that's been lingering on, particularly if it's a fungal type of infection and as well as things like you mentioned you possibly unsure if you've had an asbestos exposure in the past and stuff like that can possibly lead to scarring of the lung, and so all of these factors will be looked into.

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

D: Alright, you're welcome, thank you.


D: What brought you in today?

P: Yeah, so I've just been feeling a bit off over the last week. First I started having like, just a scratchy throat and that was probably I think 5 days ago that happened and then over the last 3 days I've been having diarrhea and also my whole body is just hurting.

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

P: I'd say like 5 days ago it started and it first began like kind of a tickle, but now it's more like, even swallowing food hurts a lot.

D: OK, have you been eating or drinking less than usual?

P: Uhm, yeah my appetite's been a bit less over the last few days just because of how much it hurts.

D: OK, have you noticed any neck swelling?

P: Uh, no, not really.

D: OK, how about any redness in the back of your throat?

P: I checked, I didn't see too much.

D: OK, And have there been any changes to your voice?

P: Uhm, a little bit, I wouldn't say too significant.

D: OK, and muscle aches, like, when did those start?

P: Yeah, so that started just 3 days ago. I remember waking up and my thighs were hurting, then my upper arms and then it kind of went into my upper back and now it's kind of just general pain in all of the muscles.

D: OK, are you having any muscle weakness?

P: Uhm, I would say it's mainly pain, I don't really feel weakness.

D: OK, and how has your energy been? Have you been having fatigue?

P: Yeah, I would say, uh, I don't know if it's because of the pain, but I definitely feel a lot more tired.

D: OK, and you mentioned diarrhea as well. When did that start?

P: Yeah, diarrhea also started around 3 days ago. I normally go 1 or 2 times a day, but now I'm going like 6 or 7 times a day and it's all usually pretty watery.

D: OK, have you noticed any blood in the stool?

P: No, I don't think I noticed blood.

D: OK, and have you noticed any, really like, dark or tarry looking stool?

P: No, it's usually just been loose watery stools.

D: OK, and have you been experiencing any other symptoms besides the sore throat, muscle aches, fatigue, and diarrhea?

P: Uhm, no, I don't think so. Those are probably all of the symptoms.

D: OK, so quickly to run through a review. Have you been having any fevers or chills?

P: No, not that I've noticed.

D: OK, how about any headaches?

P: Uh, no.

D: OK, and have you had a runny nose?

P: No.

D: Have you had a loss of smell or taste?

P: I don't think so. I haven't been really eating too much recently, but I don't think so, no.

D: OK, have you had a cough?

P: No.

D: Shortness of breath?

P: No.

D: A wheeze?

P: No wheezing.

D: OK, you said you haven't had a cough, but have you brought up any sputum?

P: No.

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

P: No chest pain.

D: Alright, any dizziness or lightheadedness?

P: Nope.

D: Any feeling as though your heart is racing.

P: No.

D: OK, have you had any abdominal pain?

P: Uhm, maybe just a little bit with all the diarrhea, I feel like I do have some, Just, tenderness in my abdomen.

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

P: No, not really.

D: OK, have you had any urinary problems?

P: Uhm, no.

D: OK, and any rashes anywhere?

P: No, not that I've noticed.

D: OK, and have you had any changes to your weight recently or over the last several months?

P: No, my weight has been around the same.

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

P: Yeah, so I have high blood pressure and high cholesterol.

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

P: Yeah, so for the cholesterol I'm taking this medication called Crestor. For the high blood pressure I'm taking this medication called Ramipril.

D: OK, uhm, and do you take any other medications like over the counter or supplements or prescribed?

P: Just multi-vitamins.

D: OK, have you been hospitalized before?

P: Just, like, in my teens I had my appendix removed but that's it. I have been pretty good otherwise.

D: OK, have you had any other surgeries besides the appendix removed?

P: No, that's the only surgery.

D: OK, and any allergies to medications?

P: No, not that I know of.

D: OK, and can you tell me a little bit about your living situation?

P: Yeah, so I currently live with my wife and son. We live in a house just in London, and like, I made sure to just isolate myself to one room and I wear a mask around them just in case.

D: OK, well that's good. Yeah, it's important to be socially distancing, especially when having symptoms. Has anybody else in that house been sick?

P: No, no one has been sick recently, at least in my house, but uh, just two weeks ago I did attend a family event, and just last week I found out, uhm, someone was having symptoms. They just got tested two days ago and their test result hasn't come back.

D: OK, I see. And have you traveled anywhere outside of the province or outside of the country?

P: No, it was just here in London, so nothing other than that. I haven't left the province.

D: OK, and what was the approximate number of people?

P: It was just five peaople so we satyed within the limits stated for the city and they were people, in like, my circle as well, so yeah, I don't think I was doing anything wrong.

D: OK, just to give an idea of like, risk and contact tracing as well if we need to. And, uh, do you smoke cigarettes?

P: No, I don't smoke.

D: OK, and do you drink alcohol?

P: Yeah, maybe a one or two beers a week.

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

P: No, never.

D: OK. And, uh, in terms of family history, does anybody in the family have any heart or lung conditions?

P: No, no, not that I know of. I Do you think my brother, my older brother, has high blood pressure.

D: OK, nobody's had a heart attack or a stroke?

P: Uh, no.

D: Or any cancer in the family?

P: Oh yeah, cancer, uh, so my father has. It's not the bad skin cancer, it's the one where they can just zap it off.

D: OK, uh, and so, he hasn't needed surgery for it?

P: No?

D: OK, and I think that's all the questions that I wanted to ask today. Was there anything else that that maybe I forgot to tell you or forgot to ask about?

P: Yeah, I was just wondering, I don't know the results of the contact that I had, uh, so should I also get tested today?

D: Yeah, certainly with nonspecific symptoms such as what you've been experiencing, we will do a test for covid today. However, we will do some lab investigations as well, because it could be something else, so we'll wait for some of those results to come back, and it's great that you've already taken the initiative to isolate from family members and whatnot. And so I ask you to continue doing so, and we will get back to you when the results are in.

P: OK, yeah, that sounds good, thank you so much.