bhatthars/nbme_qna huggingface dataset:
Patient Note: 44 year old female presenting with chief complaint of irregular periods
- ongoing for the past 3 years, reports irregular periods, coming at unpredictable times, lasting anywhere from 2 to 6 days, flow is variable ranging from light to heavy
- reports nothing has made her symptoms better or worse; have been stable in unpredictablility over the 3 years
- last period 2 months ago
- periods prior to 3 years were normal
Review of systems: no fevers, chills, chest pain, shortness of breath, abdominal pain, diarrhea/constipation, dry skin, dysuria
PMH: hypertension, no surgeries
Medications: HCTZ
NKDA
Social: office manager, rarely drinks alcohol, no drug use or smoking, sexually active with husband 20+ years
ObGyn: menarache at 14, regular periods every 28-29 days, lasting 5 days, moderate flow, would also get breast tenderness, cramps with periods, G2P2 (two sons 10, 14)
no oral contraceptive use, no hormone replacement therapy

Keywords and phrases relevant to diagnosis:
periods prior to 3 years were normal
sexually active
irregular periods, irregular periods
female
last period 2 months ago
flow is variable ranging from light to heavy, coming at unpredictable times, lasting anywhere from 2 to 6 days
ongoing for the past 3 years
44
Patient Note: CC: irregular periods
HPI: 44 yo F presenting to the clinic with irregular periods since 3 years. Menstrual cycles have lasted various lengths of times. Associated sx include hot flashes, breast tenderness, PMS, and one episode of lower back pain. Pt has not seen any clots in her menstruation. Pt currently is using an IUD which was placed by her gynecologist but is currently seeing her primary care for her GYN care. Mammograms and Pap smears have been all normal. Denies headaches, dizziness, chest pain, SOB, abdominal pain, dysuria, NVDC, fevers, night sweats, weight loss.
PMH: HTN
PSH: None
Meds: HCTZ
Fam: Brother has HTN, mother has osteoarthritis
Allergies: NKDA
Social: Pt is happily married and lives with her family. Drinks wine only on social occasions. Denies smoking, illicit drug use, recent travel. Sexually active with husband and she uses an IUD

Keywords and phrases relevant to diagnosis:
IUD, IUD
Sexually active
irregular periods, irregular periods
F
hot flashes
lasted various lengths of times
since 3 years
night sweats
44 yo
Patient Note: Dolores Montgomery is a 44 yo F with irregular periods for the past 3 years.  She describes them previously as very regular 28-29 days, medium flow, lasting 5 days, preceded by breast tenderness, lower back soreness and cramps.  3 years ago, these became unpredictable with no pattern, 2-6 days in length, bleeding could be light to heavy, without typical PMS symptoms until once recently. She notes 1 year hot flashes, sweating, vaginal dryness needing lubricant, 1 night last week of drenching night sweats.  
No changes to energy, weight, appetite. Rest of ROS neg
PMHx: HTN diagnoses 6 years ago, well controlled
PSHx: None
Medications: HCTZ. IUD in place
Allergies: None
FH: Older brother HTN, mom overweight osteoarthritis.
SH: Office manager.  Lives with husband and 2 sons, feels safe at home, sexually active, IUD replaced 4 years ago, used for 20 years. No prior STIs. No tobacco, illicit drugs. EtOH extremely rarely, 1-2 drinks/mos

Keywords and phrases relevant to diagnosis:
previously regular, previously 28-29 days, previously medium flow, previously lasting 5 days
IUD, IUD
sexually active
vaginal dryness, dryness needing lubricant
irregular periods, became unpredictable
without PMS symptoms
F
hot flashes
2-6 days in length, could be light to heavy
for 3 years, 3 years ago
sweating, night sweats, drenching sweats
44 yo
Patient Note: Patient is a 44 year old female presenting with a three year history of irregular menstruation. Patient's last menstrual period was two months ago. Periods last 2 - 6 days, however patient reports that this varies. Also reports using 5 to 6 pads when periods are regular but fewer than this during light periods. Patient reports hot flashes and sweating along with vaginal dryness. Has two previous pregnancies (spontaneous vaginal delivery). Menarche 14y. Reports nausea and vomiting one week ago. Reports that she took a pregnancy test which was negative
ROS: no cramps, no vaginal discharge, no history of STIs no weight gain, no appetite changes, no visual disturbance. 
Allergies: none
Medications: HCTZ (compliant with medications)
PMH: HTN for six years
PSH: no surgeries
FH: mother had oesteoarthritis
SH: works as an office manager, ETOH (glass of wine) on special ocassions, no tobacco or drug use, sexually active with husband only.

Keywords and phrases relevant to diagnosis:
sexually active
vaginal dryness
irregular menstruation
female
last menstrual period was two months ago
hot flashes
Periods last 2 - 6 days, reports using 5 to 6 pads when periods are regular but fewer than this during light periods
a three year history of
44
Patient Note: Ms. Montgomery is a 44 yo F w/ irregular periods. She has been having irregular periods for the past 3 years. Periods have been very unpredictable with no consistent pattern. When she has periods, she can bleed for 2-6 days and the flow may be light or heavy. Her last menstrual period was 2 months ago, and she had some pain menstrual cramping for 2 days prior. She has also been having nausea with 3 episodes of non-bloody non-bilious vomiting last week, vaginal dryness, discomfort during sex, hot flashes, diaphoresis and 1 episode of night sweats last week.
PMH: HTN diagnosed 6 years ago
PSH: None
Allergies: NKA
Medications: Hydrochlorothiazide
FH: Brother: HTN, Mom: Obesity, arthritis, Dad: Healthy
SH: Works as office manager, sexually active with husband, rare EtOH use, no history of tobacco or drug use
ROS: + Nausea, vomiting, vaginal dryness, hot flashes, diaphoresis, night sweats
NO Irritability, chest pain, SOB, headache

Keywords and phrases relevant to diagnosis:
sexually active
vaginal dryness, vaginal dryness
irregular periods, Periods have been very unpredictable
vomiting last week
F
last menstrual period was 2 months ago
hot flashes, hot flashes
can bleed for 2-6 days, flow may be light or heavy
for the past 3 years
diaphoresis, night sweats, diaphoresis, night sweats
44
Patient Note: 44 yo F with a history of controlled HTN here with irregular periods for 3 years. Periods have been irregular and unpredictable, with menses lasting 2-6 days with variable light to heavy flow. Menarche was at age 14, and menses were previously regular every 28-29 days with moderate flow and predictable premenstrual symptoms (abdominal pain, bloating). No history of sexually transmitted infections. 
ROS: Endorses episode of night sweats, vaginal dryness x 1 year. Denies headaches, vision changes, tremors, abdominal pain, peripheral edema, breast pain, discharge
PMH: HTN, controlled.
PSH: None
FH: No known menstrual irregularities. Mother's age of menopause unknown. Brother has HTN. Mother was overweight , OA.
Meds: HCTZ 12.5 mg/d x 6 years
Allergies: None
SH: Never smoker, rare alcohol consumption, never illicit drug use, walks 3-4 times per week. Healthy low fat, low salt diet. Has 2 childrenNo change in mood. No acute stressors

Keywords and phrases relevant to diagnosis:
menses were previously regular, previously every 28-29 days, previously with moderate flow
vaginal dryness
irregular periods, Periods have been irregular, Periods have been unpredictable
F
menses lasting 2-6 days, variable light to heavy flow
for 3 years
night sweats
44 yo
Patient Note: Pt is a 44 yo female with increasingly unpredictable periods. Her periods were regular, occurring every 28 days, lasting 5 days with moderate abdominal cramping. Her periods are now irregular and lasts 4-6 days with light to heavy bleeding. She is experiencing hot flashes and sweating and some discomfort due to vaginal dryness that is relieved with lubrication. She has no significant gynecological history, has had 2 prior pregnancies with no complications. She is experiencing no joint pain or fatigue. She has had no weight loss or gain. 

Allergies: NKA
Meds: HCTZ
PMH: HTN
PSH: none
FH: older brother with HTN, mom with osteoarthritis
SH: works as an office manager, does not smoke or use illicit drugs. Drinks rarely 1-2 glasses a month. Exercises by walking 3x a week. Is sexually active with husband. 



Keywords and phrases relevant to diagnosis:
periods were regular, periods were occurring every 28 days, periods were lasting 5 days
sexually active
vaginal dryness
unpredictable periods, periods are now irregular
female
hot flashes
periods with light to heavy bleeding
sweating
44 yo
Patient Note: 44 YO F with 3 years of irregular periods. Patient reports getting her period at age 14 and having regular periods up until 3 years ago when they became unpredictrable. Periods now last from 2-6 days, her flow has alternated. She had one epidose of cramping and premenstrual symptoms on her last period. She has regular pap-smears and they have always been negative for any abnormalities. She is G2P2, both vis SVD without any complications, she is seually active only with her husband. Patient recalls having a few episodes of night sweats and hot flshes, but denies any changes in her mood or ability to concentrate. No urgency, frequency or dysuria. 

PMHx: Hypertension
PSHx: None
FH: Brother with hypertension, mother with osteoarthritis.
Meds: HCTZ
Allergies: NKDA
Gyn: G2P2

Keywords and phrases relevant to diagnosis:
regular periods up until 3 years ago
seually active
irregular periods, they became unpredictrable
F
hot flshes
flow has alternated, last from 2-6 days
3 years of
night sweats
44
Patient Note: HPI= 44yo F c.o irregular period, x 3yrs, worse w/nothing, better w/ nothing. Before 3yrs ago, Her cycle was 25-28days, duration was range from 4-5days, with moderate flow.
Current cycle range from 3weeks- 2mos, duration range from 2-6days, flow range from light to heavy. On a heavy days, she uses 6-7pads/day.
She also has vaginal discomfort during sex, so that she uses lubricant.  She has PMS symptom, Lower back pain, SOB, Hot flashes, sweating 1-2x /mos. 
She is sexually active with her husband.
She denies spotting/ mood change/ dyspareunia/ STD hx/ weight change/ breast discharge. 
ROS= negative except as above
PMH= no similar episode,  HTN x6yrs.     
Allergy= NKDA
Meds= HCTZ x6yrs.     
FH= mother overweight, father healthy
Ob/Gyn as in HPI  G2P2A0
 SH= no cigs. Etoh 2,3times/year.  no rec drugs.

Keywords and phrases relevant to diagnosis:
Before cycle was 25-28days, Before cycle range from 4-5days, Before cycle with moderate flow
during sex, sexually active
vaginal discomfort uses lubricant
irregular period
F
Hot flashes
Current range from 3weeks- 2mos, duration from 2-6days, flow range from light to heavy
x 3yrs
sweating
44yo
Patient Note: Ms. Montgomery is a 44 y.o F that presents with irregular preiods for the past 3 years. She has always had regulr periods in the past (28-29 day interval, moderate flow, mild cramps, breast tenderness, LBP a few days before) but since 3 years has had unpredictable patterns 2-6 days flow from light to heavy periods. Last period was 2 months ago and had premenstrual symptoms then as well.  She also had hot flashes, sweating symptoms recently and last obgyn vist was a year ago with nml papsmear and no STDS in the past. She has a stomach flu symptoms 2 days last weeks with associated vomiting and went away on its own. Denies any feverm n, vomiting bowel bladder issues, cold/heat intolerance. 
Meds: HCTZ/ allergies
Allergies: none
Fhx: Father has HBP, mother obestiry and OA
Shx: Married 20 years, 2 kids, in home
PMH: 2 pregancies both baginal 



Keywords and phrases relevant to diagnosis:
always had regulr periods in the past
a year ago papsmear
irregular preiods
has a stomach flu symptoms 2 days last weeks
F
Last period was 2 months ago
hot flashes
has had unpredictable patterns, 2-6 days, flow from light to heavy
for the past 3 years, since 3 years
sweating
44
Patient Note: 44 yo R presenting with irregular periods for 3 years. LMP was weeks ago, gets period in irrgeular intervals, lasts 2-6 days, sometimes heavy (5-6 pads/day) or light. Not associated with pain. Of note, sexually active exclusively with husband, uses copper IUD as contraception, 2 negative pregnancy tests at home last week. Last PAP smear last year that was normal. Last seen by OBGYN 3 years ago. No PMH of fibroids, cysts, polyps, bleeding disorders, endocrinopathies, GYN malignancy. No FH of bleeding disorders, GYN malignancy. Unsure of age of menopause in women of family.

Keywords and phrases relevant to diagnosis:
IUD
sexually active
irregular periods
gets period in irrgeular intervals, lasts 2-6 days, heavy or light
for 3 years
44 yo
Patient Note: 44 y/o female with history HTN who prsents with irregular bleeding over the last several years. Her periods are irregular with no predictable pattern, sometimes heavy or light, last from 2-6 days. Last period 2 months ago, normal. Menarche age 14, regular at that time. 2 sons aged 14 and 10, no pregnancy complications, vaginal birth. Hasn't seen gynecologest for 3 years as they retired. Also noticed drenching night sweats last week, vaginal dryness requiring lubricant for intercourse, hot flashes, early morning wakenings several times over the last several months. Denies vaginal discharge, pain with urination or intercourse. Sexually active with husband only. She does note an illness 1 week ago with nausea and vomiting that lasted two days. Family history significant for overweight, hypertension. No weight changes, changes in mood, changes in bowel habits, abdominal pain.

Keywords and phrases relevant to diagnosis:
Sexually active
vaginal dryness, requiring lubricant for intercourse
irregular bleeding, periods are irregular, periods with no predictable pattern
1 week ago with nausea and vomiting
female
Last period 2 months ago
hot flashes
sometimes heavy or light, last from 2-6 days
over the last several years
night sweats, drenching sweats
early morning wakenings
44 y/o
Patient Note: The patient is a 44 yo F who came in due to irregularity in her menstruation. This started 3 years ago and the pattern has been unpredictable and irregular. Flow varies from light (1-2 pads a day), moderate (3-4 pads a day) or heavy (up to 6 pads a day). The patient has experienced one episode of menstrual cramps. There is associated hot flashes, sweating, sleeping problem (wakes up early and unable to fall back to sleep) and vaginal dryness for the past few months. Her last menstrual period was 2 months ago. She denies any mood changes, changes in her skin or hair, chest pain, headache, dyspnea,changes in bowel movement or urination.
OB hx: G2P2. Both vaginal deliveries with no complications
ROS: Neg except as above
PMH: HTN for 6 years
PSH: None
Meds: HCTZ
FH: Mother has osteoarthritis. Brother has HTN.
SH:Office manager.Drinks occasionally.No smoking and drugs. Low fat low salt diet.Sexually active with husband. Uses lubricant

Keywords and phrases relevant to diagnosis:
Sexually active
vaginal dryness
irregularity in her menstruation, pattern has been unpredictable, pattern has been irregular
F
last menstrual period was 2 months ago
hot flashes
Flow varies from light moderate or heavy, Flow varies from 1-2 pads a day 3-4 pads a day up to 6 pads a day
started 3 years ago
sweating
sleeping problem, wakes up early, wakes and unable to fall back to sleep
44 yo
Patient Note: Dolores Montgomery is a 44 year old previously healthy female who presents to clinic to discuss irregular periods. States this has been going on for the past 3 years. LMP was 2 months ago and lasted 4 days. Describes tenderness, low back pain, and cramping prior to this period. Also endorses hot flashes, sweating, and vaginal dryness over the past year. Dryness has improved with estrogen cream. Denies hx of STDs. Is sexually active with her husband. Has Copper IUD which was placed 4 years ago. Denies weakness, weight changes, fevers, chills, lower extremity edema, or cardiac problems. 

MEds: HCTZ 
Allergies none
PMH HTN
PSH none
OB 2 pregnancies normal vaginal delivery
FH: does not know family menstrua hx
SH: Office manager. Lives w/ husband. 
Denies smoking, drug use. occassional champagne

Keywords and phrases relevant to diagnosis:
IUD
sexually active
vaginal dryness
irregular periods
female
LMP was 2 months ago
hot flashes
for the past 3 years
sweating
44 year old
Patient Note: 44 yof with history of irregular menstrual bleeding. Last period 2 months ago. lasted 4 days and used 2-3 pads daily. Before that last period was 3 weeks before and lasted 5 days with 5-6 pads daily. And before that last period was nother 4 months. Before irregular periods started, patient normally had period every month lasting 5 days and used 2-3 pads daily. She denies any headache, fever, chills, vision changes, fatigue, galactorrhea, pain with sex (although mentions vaginal dryness). Meds: HCTZ. No known drug allergies. FH. mom w/ osteoarthritis nad brother with hypertension. Social Hx: Denies tobacco, social alcohol, no recreational drug use. Surgical history: 2 vaginal deliveries. PMH: hypertension. 
Denies any history of STDs, abortion, is sexually active with jsut her husband, and this has never happened before

Keywords and phrases relevant to diagnosis:
Before normally had period every month, Before normally had period lasting 5 days, Before normally had period used 2-3 pads daily
with sex, sexually active
vaginal dryness
irregular menstrual bleeding, irregular periods
f
Last period 2 months ago
44 yo
Patient Note: Dolores Montgomery is a 44 yof c/o irregular periods. Meses in past have been regular every 28-29 days, lasting 5 days with moderate flow, mild PMS symptoms of breast tenderness, back pain, and mild cramping. Menses for past 3 years have become unpredictable in pattern lasting 2-6 days with light to heavy flow. Patient has also been experiencing hot flashes and sweating, vagina dryness, and discomfort during intercourse during past year and woke drenched in sweta for 2 days last week. Denies weight change, fatigue, palpitations, abdominal/pelvic pain, vaginal discharge, skin changes, or hair growth. 
OBGYN: G2P2 normal pregnancies full term.
ROS: otherwsie negative
Allergeis: none
Meds: HCTZ
PMH: HTN
PSH: none
FH: older bother HTN, mother osteoarthritis, overweight
SH: lives with husband and 2 sons, monogmaous sexually active with husband, rare alcohol, no tobacco,no recreational drugs. works as office manager.

Keywords and phrases relevant to diagnosis:
Meses in past have been regular every 28-29 days
sexually active
vagina dryness
irregular periods
yof
hot flashes
lasting 2-6 days, light to heavy flow, unpredictable in pattern
sweating, drenched in sweta
44
Patient Note: 44 YO G2P2 female with irregular periods
- patient reports a 3 year history of irregular periods (no pattern to occurence, 2-6 days in length when they do occur, light-heavy flow) 
- her previous menstrual history was regular, every 28-29 days, and moderate flow
- she also experienced occasional breast tenderness, mild cramps before her periods which disappeared when her periods became irregular but returned last week
- does not know when mother had menopause

- LMP: 2 mo ago, has a copper intrauterine device placed 4 yo ago w/o complications, had 2 uncomplicated term pregnancies
- patient is sexually active with her husband and does not use condoms
- does not smoke and uses alcohol socially, no other drugs 
- takes HCTZ for hypertension, NKDA

- in addition, she reports occasional hot flashes/sweats which interrupt her sleep, menstrual cramps, and nausea
- she denies any diarrhea, irregular uterine bleeding, chest pain

Keywords and phrases relevant to diagnosis:
previous menstrual history was regular, previous menstrual history was every 28-29 days, previous menstrual history was moderate flow
intrauterine device
sexually active
irregular periods, irregular periods, periods (no pattern
breast tenderness, mild cramps before her periods disappeared when her periods became irregular
female
LMP: 2 mo ago
hot flashes
2-6 days in length, light-heavy flow
3 year history of
sweats
interrupt her sleep
44 YO
Patient Note: Dolores Montgomery, a 44-year-old female, has come to the doctor's office today to discuss her irregular periods.
- Has been having irregular periods for the past three years
- periods have been unpredicatble , they have been heavy and light, last two to six days
- two months ago has experienced hot flashes with sweating
-has been getting up earlier 4-5x in the past three months
- currently sexually active with husband, no barrier protection, has iud
- has hypertension
-has had breast tenderness, back pain and one episode of menstrual cramps
-no skin changes

Keywords and phrases relevant to diagnosis:
iud
sexually active
irregular periods, irregular periods, periods have been unpredicatble
female
hot flashes
they have been heavy and light, last two to six days
for three years
sweating
has been getting up earlier 4-5x in the past three months
44-year-old
Patient Note: 44 y/o F w/ 3 year h/o irregular periods. Patient previously had regular 28-day periods w/ regular flow onset of menses at age 14. No h/o pelvic pain, abnormal bleeding before. Patient c/o irregular flow (heavy/light) and hot flashes, sweating, and one episode of night sweats. She also endorses 1 episodes of N/V. She denies and F/C, recent travel, abnormal exposures, or h/o STDs. She is sexually active w/ husband only.

PMH: HTN
PSH: none
Meds: HCTZ
All: none
FHx: none
SHx: no smoking, social drinker

ROS: as per HPI, o/w neg

Women's health:
Regular PAP, most recent 1 year ago, all normal


Keywords and phrases relevant to diagnosis:
previously had regular periods, previously had 28-day periods, previously had regular flow
PAP 1 year ago
sexually active
irregular periods
F
hot flashes
irregular flow, flow (heavy/light
w/ 3 year h/o
sweating, night sweats
44 y/o
Patient Note: Dolores Montgomery is a 44yo F coming in for irregular periods of 3yr duration. Periods occur anywhere from 3 weeks-4 months apart, and last for 2-6 days, with variable bleeding from 1-6 pads per day. No triggers. She has had 2 pregnancies with uncomplicated vaginal deliveries. She used to have pain/cramping when she had regular periods but does not have any pain with periods anymore. She reports hot flashes and sweating. Her menarche was at 14, LMP 2 months ago. Mother's age at menopause is unknown. Has used IUD for 20 years, last insertion was 4yo. 
PMH: HTN on HCTZ. No hospitalizations other than childbirth. No surgeries, no allergies
Family hx: Mother has osteoarthritis, obesity. Brother has HTN. 
Social: lives with husband and 2 children, works as office manager. 
Sexual: active with husband. Birth control is IUD. No hx of STIs. Reports dyspareunia and vaginal dryness, uses lubricant. Never smoker, alcohol rarely, no drugs

Keywords and phrases relevant to diagnosis:
when she had regular periods
IUD, IUD
Sexual: active
vaginal dryness
irregular periods
does not have any pain with periods
F
LMP 2 months ago
hot flashes
occur 3 weeks-4 months, last for 2-6 days, variable bleeding, from 1-6 pads per day
of 3yr, 3yr duration
sweating
44yo