bhatthars/nbme_qna huggingface dataset:
Patient Note: a 45-year-old female, has come to the outpatient clinic with episodes of nervousness. these episodes started a few weeks ago and they are getting worse. they are more on sunday and monday. she also has decreased appetite. she also has difficulty with starting sleep. she do not has diarrhea, no skin changes or hair changes, no chest pain or shortness of breath, no change in her menstrual periods and they are regular. she is just worried because she is taking care of 2 children and everyone at home, she also has some new stress in her job
ROS: nothing except the above
PMH: none.    PSH : none.
Meds: tylenol .
ALLERGIES: NKA
FH: father died of hear attack at age of 65
SH: nonsmoker, no illicit drug use, socoial drinker . works a ss english professor.


Keywords and phrases relevant to diagnosis:
do not has diarrhea, no skin changes, no hair changes
nervousness
worried she is taking care everyone at home
difficulty with starting sleep
female
decreased appetite
45-year-old
Patient Note: 45 y/o female evaluated at clinec found hemodinamically stable and in NAD, a couple of weeks ago pte starte d with nervousness tht is contant got worst when job required public speaking, no alliviating factor, no associated symtoms, denies, fever, chil, sob, changes in GI. pte refer less apetite but force herself to eat regularly denies wight changes, diet. walks 3 times a week and have trouble getting to sleep but sleeps 7 hours. no headaches, numbness, weakness, fatigue or diziness. 
ROS: NEG EXCEPT AS ABOVE
PMHX NONE
ALL: NONE  MEDS NONE
OBGYN;vaginal delivery, regular period started at age 12, mamograhy and pap done in the last year, 5 days period 5 pads first day then 2-3.  no std. denies smoking or drugs, etoh socialy
PSHX; NONE
FMHX: MOM NONE DAD DIED OF MI, 
SOCIAL: WORKS, MARRIED 2 CHILDREN 17,19 ODER IN COLLEGE  , ETOH SOCIALLY ,DENIES SMOKING OR DRUGS, SEXUALLY ACTIVE WITH HUSBAND NO STD

Keywords and phrases relevant to diagnosis:
denies changes in GI
nervousness
denies wight changes
trouble getting to sleep
female
less apetite
45 y/o
Patient Note: 45 yo female complaining of nervousness for the past few weeks. Attributes this to having so much on her plate because of changes at work and household changes. Its worse on Sunday nights and Monday mornings. Patient has also been having problems falling asleep. Patients mood is good, with no loss of interest. Patient has never used drugs before. No cold or heat intolerance.Patient has less of an appetite but no changes in weight. 

ROS: None
Obys/Gyne: LMP was a week ago, Menarche at the age of 13, regular every 30 days for 4 days. Last pap smear was 9 months ago and was normal.
PMH: None
Allergies: None
Medication: Tylenol
FH: Father died of a heart attack 10 years back
Social: Nonsmoker, social EtOH, sexually active with husband, English proffesor.


Keywords and phrases relevant to diagnosis:
No cold or heat intolerance
nervousness
mood is good, no loss of interest
no changes in weight
problems falling asleep
female
less of an appetite
45 yo
Patient Note: Ms Moore is a 45 year old female with no PMH who presents for feelings of nervousness for the past few weeks. She says it's all the time but is worse on Sundays thinking about work for the week.  Nothing makes it better.  She says it takes her longer to fall asleep, is less interested in sex, and she doesn't have an appetite.  She also reports stress at home as she is caretaker to her mother who lives with her.  She denies headaches, fevers, night sweats, weight loss, SOB, palpitations, racing heart, nausea, diarrhea, constipation, rashes, feeling dizzy or faint. She denies depressed mood or suicidal/homicidal ideations.  FMH for father dying of MI at 65 years old.

Keywords and phrases relevant to diagnosis:
denies night sweats, denies palpitations, denies racing heart, denies diarrhea, denies constipation
nervousness
stress at home caretaker to her mother
denies depressed mood, denies suicidal ideations
denies weight loss
takes longer to fall asleep
female
"doesnt have an appetite"
45 year old
Patient Note: 45 yo F presents with persistent nervousness which began a few weeks ago and is getting worse. She feels nervous about everything in every situation. Especially exacerbated when preparing for lectures. No alleviating factors. Reports drinking 5-6 drinks of coffee/day. Reports difficulty falling asleep; it takes 30-60 min to fall asleep but no awakenings. 7 hrs of sound sleep per night. Denies depressed mood, loss of interest, inability to concentrate. Denies increase in self-confidence and flight of ideas. Denies chest pain, palpitation, headache, change in weight, SOB. Occasional loss of appetite. Rarely has headache, relieved by Tylenol. 
PMHx: none. NKA. PSHx: none. Meds: Tylenol, rarely for headache. OBGYN: G2P2. LMP 1 wk ago, regular periods, normal flow, no pain during periods. SHx: no smoking, EtOH occasionally, 1-2/mo. no illicit drug use. sexually active with husband but decreased sexual desire due to anxiety. Professor.

Keywords and phrases relevant to diagnosis:
Denies palpitation
nervousness, nervous
5-6 drinks of coffee/day
Denies depressed mood, Denies loss of interest, Denies inability to concentrate
Denies change in weight
difficulty falling asleep, takes 30-60 min to fall asleep
F
loss of appetite
45 yo
Patient Note: CC: nervousness
HPI: Ms. Moore is a 45 yo woman previously healthy who presents with a 2 week history of increased nervousness. Symptoms began a few weeks ago when she began giving lectures at work to large groups of students. The anxiety is constant, but worsens in the days leading up to lectures. Appetite is decreased, but improves following the end of the week of lectures. Patient also endorses difficulty falling asleep, denies nighttime awakenings. Endorses decreased sex drive during this time. Denies anhedonia, guilt, energy decrease, concentration change, psychomotor slowing, and suicidal ideation. 
ROS: No headaches, no weight changes, no panic attacks, no heat intolerance, no heart palpitations, no chest pain, no diarrhea/constipation.
PMH/PSH: none
MED: tylenol prn for headache
ALL: none
FH: dad died at 65 from heart attack, mom healthy.
SH: English professor. Never smoked or used drugs. Alcohol 1-2x per month socially.

Keywords and phrases relevant to diagnosis:
no heat intolerance, no heart palpitations, no diarrhea, no constipation
nervousness, anxiety, nervousness
Denies anhedonia, Denies concentration change, Denies suicidal ideation
no weight changes
difficulty falling asleep
woman
Appetite is decreased
45 yo
Patient Note: HPI: 45 yo F c/o nervousness lately
- she is under stress especially for increased workload in the last few weeks
- decreased appetite and difficullty falling asleep: however, she sleeps at least 7 hours per night and has no nighttime awakenings
- denies chest pain, palpitations, SOB, skin changes, bowel changes
- no weight changes, fevers or night sweats. No fatigue
ROS: neagtivee xcept as above
PMH: none. PSH: none. allergy: NKDA. Meds: tylenol. FH: father died of AMI at age 65, mother is healthy. SH: no smoke or illicit drugs, occasional alcohol. She is a teacher, lives with her husband, mom and youngest son. Sexually active with husband only. Regularly exercise and follows a healthy diet

Keywords and phrases relevant to diagnosis:
denies palpitations, denies skin changes, denies bowel changes
nervousness
no weight changes
difficullty falling asleep
F
decreased appetite
45 yo
Patient Note: Mrs. moore is a 45yo female who is here due to nervousness.
-endorses anxiety all the time for the last few weeks
-right before this, she switched to teaching students from a research job
-anxiety worst on sunday/monday
-associated with loss of appetite and insomnia
-no panic attacks, chest pain, shortness of breath or palpitations

ROS: -weight loss, fatigue, headache, skin/hair changes, chills, fever, nausea, vomiting, diarrhea, constipation, change in urinary/bowel habits, abdominal pain

PMH and PSH: none. Meds: tylenol. Allergies: none. FH: father MI at 65, mother is healthy. Social: english professor, 2 kiids, married, sexually active with no condom use with husband, no std history. no smoking or illicit drugs. socially drinks about 1-2 glass of wine a month

Keywords and phrases relevant to diagnosis:
- skin changes, - hair changes, - diarrhea, - constipation, - bowel habits, no palpitations
nervousness, anxiety, anxiety
-weight loss
insomnia
female
loss of appetite
45yo
Patient Note: 45yo F presents to clinic with a few weeks of nervousness and anxiety. She recently began lecturing more for her job, which is a change from her previous position as a researcher. In addition, she helps to take care of her two sons and aging mother and in-laws at home. Along with her nervousness and anxiety, she occasionally has a loss of appetite. In addition, she has difficulty falling asleep, stating she will lay awake for an hour before being able to sleep. Her bedtime routine involves getting things ready for the boys for the next day and reading on the couch. She denies diaphoresis, palpitations, chest pain or tightness. No headaches, vision changes. No abdominal pain or bowel or bladder changes. No skin rashes or hair loss. 
PMH: none
Meds: Tylenol for occasional headaches
Allergies: none
SHx: none
Family Hx: father - MI age 65
Social Hx: EtOH - 1 beer socially, tobacco - none, illicit drugs - none, sexual - w/ husband

Keywords and phrases relevant to diagnosis:
denies diaphoresis, denies palpitations, No bowel changes
nervousness, anxiety, nervousness, anxiety
elps to take care of aging mother and in-laws
difficulty falling asleep
F
loss of appetite
45yo
Patient Note: Mrs. Moore is a 45 yo woman who presents with 3-4 weeks of nervousness "alltheh  time'. Nothing makes it better. She has trouble getting to sleep, but sleeps well once she falls asleep. She has taken no medications to treat it. The nervousness is worse when she gives lectures to her students, a practice which just started a couple weeks ago and which she only recently found out she would have to do. 

She has no other medical problems and has had no surgeries. She takes acetominophen only for occasscional headaches. Otherwise, she takes not meds. She has no allergies. Her family history is signficant for MI in her father at 65. She consumes 1-2 alcoholic beverages per week. She does not use tobacco or other drugs. She works as an English professor. She is married (20years) and is monogamous.

Keywords and phrases relevant to diagnosis:
nervousness, nervousness
trouble getting to sleep
45 yo
Patient Note: HPI:A 45 YO\F COMPLAINS OF NERVOUSNESS FOR FEW WEEKS ,SHE STATES THAT SHE HAS ALOT OF STRESS IN WORK AS SHE SHIFTED FROM THE DEPARTMENT OF RESEARCH TO THE LECTURING PEOPLE. SHE WORK AS TEACHER AND WORRIED ABOUT EVERYBODY IN HER HOME , SHE ALSO REPORTS DRINKING ALOT OF COFFIE 5-6 CUPS A DAY ,SHE DONT FEEL SAD BUT SHE'S OVERWELMED , SHE HAS DIFFICULTY SLEEPING BUT SHE HAS NO LOSS OF CONCENTRATION , INTEREST OR SUICIDAL THOUGHTS, SHE WALK A MILE FOR 3 - 4 TIMES A WEEK.
PMH\PSH; NONE
MEDICATION; TYLENOL
ALLERGIES: NKDA
SH: NO SMOKING, OCCASIONAL ETOH, ENGLISH PROFFESSOR,MARRIED AND LIVES WITH HUSBAND WHO HAD VASICTOMY

Keywords and phrases relevant to diagnosis:
NERVOUSNESS
DRINKING ALOT OF COFFIE, COFFIE 5-6 CUPS A DAY
DONT FEEL SAD, NO LOSS OF CONCENTRATION, NO LOSS OF INTEREST, NO SUICIDAL THOUGHTS
DIFFICULTY SLEEPING
F
45 YO
Patient Note: Patient is a 45 year old female presenting for "nervous episodes" for the past few weeks. She denies any associated trigger. She reports it to be constant and worse in the evenings the night before her lectures. She works as a teacher and has recently been assigned to lecturing 2 weeks ago, her normal assignments are related to research. She notes for the past 2 weeks she has not been as hungry and has had insomnia. She consumes 5-6 cups of coffee for a "long time". Her periods have been regular.
PMH: Denies
PSH: Denies
Allergies: NKDA
Meds: Tylenol PRN
FH: Father passed away 65 yo from MI; Mother is healthy
SH: Alcohol 1-2 drinks on special occasions; Denies smoking, drugs; Sexually active with her husband but not as much since the episodes of nervousness; English professor
ROS: Negative headache, chest pain, palpitations, SOB, Abdominal pain, changes in urination, constipation, diarrhea, weight change, social anxiety, mood chan

Keywords and phrases relevant to diagnosis:
Negative palpitations, Negative constipation, Negative diarrhea
nervous, nervousness
5-6 cups of coffee
Negative mood chan
Negative weight change
insomnia
female
has not been as hungry
45 year old
Patient Note: 45 yo, F, c/o of feeling nervousness it started few weeks ago, no preceding events noted, gradually deveopled, always feels nervousness all the time,  she has a lot of stress due to work changes, son in last yr of college, and mother need care for her health, also some family in law issues, it gets worse on sunday nights and monday morning, no relieving factors noted, she has no fever, fatigue, she feels her appetite is sometimes decreased although no changes seen in her weight, no changes in bowel and urinary habits, no cold intolerance or hot flashes, no hairloss or headcahes, no palpitaions or tremor
PMH: @ NVD, PSH;none, FH: father died og MI at 64yrs, mother healthy, MED tylenol for occasionla headaches, all;NKDA
SH: english professor, sexually active with husband only, husband has vasectomy after 2nd son, no STD, occasional use of ETOH on weekends, CAGE0/4, no smoking ot other illicit drug use, 1 miles walking 3 times a week,


Keywords and phrases relevant to diagnosis:
no changes in bowel habits, no cold intolerance, no hairloss, no palpitaions, no tremor
nervousness, nervousness
stress due to mother need care for her health, stress due to in law issues
no changes seen in her weight
F
appetite is sometimes decreased
45 yo
Patient Note: HPI: Mrs. Moore is a 45yo F who complains of nervousness that started a few weeks ago and has been getting worse. It is constant to where she has decreased appetite and difficulty falling asleep. Nothing has made it better or worse. She denies hx of cardiac or thyroid issues. She does have many changes in home life ie. changing jobs, taking care of in laws with health problems next door with little support. She also has decreased appetite. 
ROS: Negative except stated in HPI
PMH, PSH, ALL: None
Meds: Tylenol 
FH: Father died of MI
SH: No tobacco or drug use. Ocasional EOTH use, walks a mild 3x/week. Sexually active with husband. Feels safe at home. Works as English Lit teacher.

Keywords and phrases relevant to diagnosis:
denies thyroid issues
nervousness
taking care of in laws
difficulty falling asleep
F
decreased appetite, decreased appetite
45yo
Patient Note: Ms. Moore, is a 45 yo female who presents with nervousness.
-Started 3-4 weeks ago.  Is constant and has not progressed.
-Related to the stress in her life, ie caring for mother children job
-aggravated by public speaking
-associated decreased sleep

ROS: no skin changes, no palpitations, no diaphoresis

PMH: none
Allergies: nka
Medications: PRN tylenol (rare)
FH: father passed at 65 MI, mother healthy
Social: english professor, EtOH 2-3 per month, no tobacco, no recreational drugs, walks 3x/wk


Keywords and phrases relevant to diagnosis:
no skin changes, no palpitations, no diaphoresis
nervousness
stress in her life, ie caring for mother
decreased sleep
female
45 yo
Patient Note: A 45 y o f C/O NERVOUSENSS FROM PAST 2-3 WEEKS THAT IS CONSTANT, PROGRESSIVE AND WORSENING AND IS ESPECIALLY PRESENT ON SUNDAY NIGHTS AND MONDAY MORNINGS AND IS RELATED TO THE RECENT INCREASE BURDEN OF WORK AT HOME AND AT THE JOB. (TAKING CARE OF DISABLE MOTHER AND INC WORKLOAD.)
ALONG WITH THAT SHE HAS DEC APPETITE AND DIFFICULTY FALLING SLEEP (NORMAL LATENCY AND DURATION) AND IS ANXIOUS AND OVER WHELMED ALL THE TIME.
SHE DENIES FEVER, RACING OF HEART, CHEST PAIN, TREMORS, HEAT INTOLERANCE, SKIN, BOWEL/WEIGHT CHANGES, LOW MOOD.
ROS: NEG EXCEPT ABOVE
PMH/MEDS: N/C    PSH/HOSP: N/C   ALLERGIES: NKA
FH: + FOR MI IN FAMILY    
OBGY: LMP 1 WEEK BACK, MENARCHE AT 13, CYCLE 4/30 R.
SEXUAL: MONOGAMOUS WITH HUSBAND X 2 yrs
SH: DENIES SMOKING/ILLICIT DRUGS, ETOH OCCASIONALLY

Keywords and phrases relevant to diagnosis:
DENIES RACING OF HEART, DENIES TREMORS, DENIES HEAT INTOLERANCE, DENIES SKIN CHANGES, DENIES BOWEL CHANGES
NERVOUSENSS, ANXIOUS
INCREASE BURDEN TAKING CARE OF DISABLE MOTHER
DENIES LOW MOOD
DIFFICULTY FALLING SLEEP
f
DEC APPETITE
45 y o
Patient Note: Ms. Moore is a 45yo Female with a 2-3wk history of progressively increasing nervousness 
- Increased stressors over few weeks: taking care of her inlaws, taking care of her children (age 17 and 19) and working as a full time english literature professor 
- Feels nervous 24/7, has difficulty falling asleep, sleeps 7hrs/night 
- Decreased appetite, but forces herself to eat so has not lost weight 
- Worse on Sunday night/Mon morning when she has upcoming lessons for her job 
- Support from husband but he is busy with work
- Denies palpitations, chest heaviness, dyspnea; denies changes in hair or skin, joint pain 
- Has not tried anything to cope with stress (yoga, meditation
PMH: none ; meds: occasional tylenol for headaches (very rare) 
Fhx: no relevant fhx; father died of MI 
Social hx: working as english lit professor; 2 kids age 17 & 19;  Lives w/ husband and 17yo; denies tobacco, drug use; ETOH 1x/month; walks 2-3x/week

Keywords and phrases relevant to diagnosis:
Denies palpitations, denies changes in hair or skin
nervousness, nervous
stressors taking care of her inlaws
not lost weight
difficulty falling asleep
Female
Decreased appetite
45yo
Patient Note: cc: 45 year old female c/o nervousness for the past 3-4 weeks.
hpi: 45 year old female c/o nervousness for the past 3-4 weeks. There is no perticular precipitating factor. It is consant, nothing makes it better, stress and giving lectures makes it worse. She has palpitation, poor sleep, but denies any sweating, visual problem, depressed mood, skin change, heat intolerance, weight or appetite change. She reports she is experiencing stress at work lately. SHe is taking are of her mom for the past 2 years and feeling stressed out with it. 
ros; negative
pmh: none
med: tylenol
allergy: none
sh: no smoking , occasional alcohol use, no illicit drug
fh: father died of heart attack at age 65 . mother is healthy

Keywords and phrases relevant to diagnosis:
denies any sweating, denies skin change, denies heat intolerance
nervousness, nervousness
taking are of her mom for the past 2 years and feeling stressed
denies depressed mood
denies weight change
poor sleep
female, female
45 year, 45 year
Patient Note: 45 yo F comes to the clinic complaining of nervousness. started few weeks back, feels nervous and overwhelmed all the time, recent job change few weeks back; had more research initially now more teaching. nervousness is more esp on sunday evenings and monday morning as she is worried about her lectures on monday. has stress regarding her mom and her sons and in laws. no alleviating factors or diurnal variation, constant. a/w difficulty falling asleep. drinks 5-6 cups of coffee throughout the day, decreased appetite
denies any night time awakenings, nightmares, depressed mood, loss of interest, guilt, suicidality, menopausal symptoms, heat intolerance, changes in bowel bladder habits, fever, chest pain, n/v, palpitations, weight changes
ROS neg except as above
PMH none, no meds, NKDA
PsH none, no travel/ trauma
FH father died of MI 10 yrs ago
SH teacher, lives with husband, sons and mom, occassional EtOH, no smoking/ drugs,

Keywords and phrases relevant to diagnosis:
denies heat intolerance, denies changes in bowel habits, denies palpitations
nervousness, nervous, nervousness
stress regarding her mom, stress regarding in laws
5-6 cups of coffee throughout the day
denies depressed mood, denies loss of interest, denies guilt, denies suicidality
denies weight changes
difficulty falling asleep
F
decreased appetite
45 yo
Patient Note: Patient is a 46 yo F with no PMH who comes in today with nervousness.
- Lot on her plate - taking care of elderly mom, two teenagers, her work
- Feels nervous about everything in the past few weeks; in business and personal life
- Difficulty sleeping and decreased appetite, still pushing herself to eat
- nothing seems to improve her situation. can't place her finger on what may have caused increased nervousness as of lately
- never had this in the past
- No heart palpitations, sweating, shortness of breath, nausea. 
PMH: N/A
PSH: N/A
Meds: Tylenol - occasional Headache
ROS: pertinent listed above.  
Obstetrical: 2 children, 17, 19. LMP was last week. Regular periods with moderate flow. 
Social: English lit. professor. Lives with mother, husband, younger son. Sexually active with husband. Husband had a vasectomy. Walks 3x a week, eats a balanced diet. 
No smoking, drug use. Couple drinks a month.


Keywords and phrases relevant to diagnosis:
No heart palpitations, No sweating, No nausea
nervousness, nervous, nervousness
taking care of elderly mom
Difficulty sleeping
F
decreased appetite
46 yo
Patient Note: CC: nervousness
HPI: Ms. Moore is a 45 year old woman who presents to clinic today with nervousness for the last couple of weeks. She notices that her symptoms are worse Sunday evening, before her Monday lecture. She recently changed her job from research work to more lecture based. She also states some life stressors at home which include taking care of her mother and two kids. She states that her sleep is affected, taking over an hour to fall asleep. She denies changes in interest, energy levels, and concentration. She has had a decrease in appetite for the last two weeks, but has not had any weight loss. 
ROS: negative for palpitations, heat intolerance, sweating, changes in urinary habits, changes in eating habits
PMH: hostpitaliztions following the births of her two children, tylenol PRN for occasional headaches
Social: denies tobacco or recreational drug use; states she drinks socially occasionally
family: father MI age 65


Keywords and phrases relevant to diagnosis:
negative for palpitations, negative for heat intolerance, negative for sweating
nervousness, nervousness
stressors taking care of her mother
denies changes in interest, denies energy levels, denies concentration
has not had any weight loss
sleep is affected, taking over an hour to fall asleep
woman
decrease in appetite
45 year
Patient Note: Pt is a 45 yo F with a CC of two weeks of "nervousness" 
-pt reports that symptoms began after recent change in job description. used to do research now giving lectures every monday. considers this stressor. also reports that pt's mother is living with her and that this is very stressful for her. 
-one week history of decreased appetite. 
-pt reports that she has had difficulty falling asleep at night
-pt 3/8 SIGECAPS difficults sleeping decreased appetite and psychomotor agitation- denies others
ROS no jiterness, palpatations, LOC, light headedness, dyspnea, SOB, weight loss or gain,, sweating, heat or cold intolerance, changes in hair skin or nails, rashes or recent cough rhiorhea fever.
Med tylenol for occasional HA
allergies denies
PMH/SH denies 
FH drinks ETOH only socially 1-2 drinks
denies cigarettes and drugs use
english professor doing research recently lectures, grandma living with her is stressful.

Keywords and phrases relevant to diagnosis:
denies palpatations, denies sweating, denies cold intolerance, denies heat intolerance, denies changes in hair, denies changes in skin, denies changes in nails
nervousness
mother is living with her very stressful, grandma living with her is stressful
denies weight loss, denies weight gain
difficulty falling asleep, difficults sleeping
F
decreased appetite, decreased appetite
45 yo