bhatthars/nbme_qna huggingface dataset:
Patient Note: 67 yo f c/o difficulty sleeping started 3 wks ago after her son passed away discribed as early awakining at 4 am and difficulty falling asleep daily activity difficult to do , assoc w polyphadia but no wight gain no bowel change in bowel habits no urinary symptoms , noe episode of delusion that son was at home but knows its no true (normal insght) no hallusination , no snoring no cough no palpitations no diaphoresis no headache no visual changes no urinary sym no weakness no numbness no tingling no diahrea no vomiting no heartburn 
mood sad normal affect no suicide no homocide judgement intact 
FH father has HTN  and dyslipidemia died of a strok mother has depression 
sexualy active w husband alon no condom use no smoking no recreational drugs no EtOH 
G1P1A0 normal vaginal delivery 
no previous hospitalisation no trauma no surg

Keywords and phrases relevant to diagnosis:
polyphadia
3 wks ago son passed away
f
67 yo
difficulty falling asleep
started 3 wks ago
delusion that son was at home
mother has depression
early awakining
no suicide
difficulty sleeping
Patient Note: Ms. Wicks is a 67 y/o F with a history of hypertension and breast cancer who presents with three weeks of difficulty sleeping. She states that this began after her son died in an accident. She has had increased sleep latency, increased night-time awakenings, and is waking up earlier in the morning. She also complains of loss of interest in usual activities, sadness, and anhedonia, but denies guilt, loss of concentration, suicidality or homicidality.
PMH: Hypertension, breast cancer s/p mastectomy and chemoradiation 10 years ago, remains in remission
PSHx: mastectomy, uncomplicated laparotomy for burst appendix
Fam Hx: father with hypertension deceased from stroke, mother living with history of depression
Social Hx: denies tobacco or illicit drugs, drank wine with meals before son's death CAGE: 0, retired receptionist, scrapbooks and reads in spare time, sexually active with husband - no sexual complaints, good support

Keywords and phrases relevant to diagnosis:
three weeks son died
Ms, F
67 y/o
increased sleep latency
with three weeks
loss of interest, anhedonia
mother history of depression
waking up earlier
denies suicidality
difficulty sleeping, increased night-time awakenings
Patient Note: 67 yo female presents with new-onset trouble sleeping. Starte 3 weeks ago when son passed away. Has difficulty falling asleep and wakes up early. Still able to do daily activities but feels drained and low energy. States she has been feeling sad, has decreased interest in activities she used to enjoy, low energy, and is eating more than usual, but denies guilt, psychomotor slowing or self-harm intent or suicidality. Has been taking ambien, which she gets from a friend, for the past five days but has not helped with sleep. She states she has a good support system at home. Denies any recent illnesses, pain, or palpatations. PMHx hypertension, no past surgeries, takes lisinopril, HCTZ, and ambien. NKDA. Family history of depression (mother) and hypertension, hyperlipidemia, and stroke (father). Lives with husband and feels safe at home, is retired.

Keywords and phrases relevant to diagnosis:
eating more
3 weeks ago when son passed away
female
67 yo
difficulty falling asleep
Starte 3 weeks ago
ambien has not helped
feels drained, low energy, low energy
decreased interest
depression (mother)
wakes up early
denies suicidality, denies self-harm intent
trouble sleeping
Patient Note: Ms. Weeks is a 67 yo female with 3 weeks of trouble sleeping
difficulty sleeping started 3 weeks ago after death of son Leonard in MVA on Jan 31st
has difficulty falling asleep, usually takes 1 hr
early morning awakening, cannot get back to sleep, sleeping total of 4-5 hours per night
endorsed devastated, sad mood
associated with anhedonia, decreased energy, increased appetite, audiutory and visual hallucinations of son leonard and people having a party
denied guilt, decreased concentration, SI/HI, psychomotor agitation/retardation, anxiety, disorganized thinking, paranoia, delusions
denied nause, vomiting, shortness of breath
PMH: lumpactomy for breast cancer and lap appy. HTN. 
FH: father died from stroke, has HTN and HLD. mother still alive, had prior boutsw of dperession
SH: monoganous with husband. retired. social drinker. denied smokin or drug use
Meds: HCTZ and lisinopril

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks ago death of son
Ms, female
audiutory hallucinations
67 yo
difficulty falling asleep
with 3 weeks, started 3 weeks ago
decreased energy
anhedonia
visual hallucinations
dperession mother
early morning awakening
denied SI
trouble sleeping, difficulty sleeping, sleeping total of 4-5 hours per night
Patient Note: 67 yo F in office c/o trouble sleeping x 3 weeks. Pt reports prior to onset of symptoms her son died.Has tried Ambien with no relief.Pt sleeps 4-5 hours a night, has early morning awakenings, loss of interest, sadness, fatigue, and increase in appetite.Last night patient heard loud music which reminded her of her son , when she asked her neighbor whether there was noise was informed that there was none. Pt also reports seeing son sitting at table a few days ago but was aware that he was not there. Pt denies guilt, change in weight, suicidal ideation, change in skin/hair, intolerances to weather changes. 
ROS NEG except above 
PMH HTN x 15 years, Meds HCTZ, Lisinopril, NKDA
PSH/HOSP/Trauma none 
FH Father Hypertension, hypercholesterolemia, stroke . Mother has hx of depression
SH Pt is retired, lives with husband. Denies smoking, drinks 2-3 glasses of red wine a week, denies illicit drug use.sexually active with husband.NO hx of std

Keywords and phrases relevant to diagnosis:
increase in appetite
prior to onset of symptoms son died
F
Last night patient heard loud music was informed that there was none
67 yo
x 3 weeks
Ambien with no relief
fatigue
loss of interest
reports seeing son sitting at table a few days ago but was aware that he was not there
Mother has hx of depression
early morning awakenings
denies suicidal ideation
trouble sleeping
Patient Note: 67 year old female c.o trouble sleeping for past 3 weeks. 3 weeks ago her son died in a motor vehicle accident. She has trouble falling asleep, it takes over an hour, she awakens early at 4 am, and has multiple awakenings at night. She sleeps 4-5 hours per night. She is tired during the day. She denies day time sleeping. She drinks 1 coffe in the morning.Reports decreased sleep, anhedonia, decreased energy, increased appetite. Denies suicidal thoughts.  Retired and lives with husband, has good support system.  Describes good sleep hygiene. Denies snoring. /denies feeeling hot or cold, no skin or hair changes. 
PMH: HTN, in remission from breast cancer, surgical: lumpectomy, lap. appendectomy, meds: HCTZ, lisinopril, took ambein past 5 nights, counseled not to take prescription meds without doctors supervision, NKDA
SH: retired receptionist, lives w husband, no tobacco, 1-2 glasses of wine at dinner, not any etoh in past 3 weeks

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks ago her son died
female
67 year old
trouble falling asleep
past 3 weeks
tired, decreased energy
anhedonia
awakens early
Denies suicidal thoughts
trouble sleeping, multiple awakenings at night, sleeps 4-5 hours per night, decreased sleep
Patient Note: CC: 67 yo F complains of trouble sleeping
HPI: Sleeps only 4-5 hrs per night, has difficulty falling asleep, waking up early (4-5 am), and nighttime awakenings for 3 weeks. Patient reports dayttime fatigue and urge to nap Patient used to sleep within 15 min of laying in bed and slept for 8 hrs. No relief w/ Ambien. Recent death of son on February 14. Patient also reports feeling sadness, anhedonia, low energy, and increased appetite. No feelings of guilt, changes in concentration, or sucidial ideation or plan. Recent visual hallucination of son 4 days ago and auditory hallucination of neighbor's playing music last night. No changes in urine or BM, cold intolerance, or hoarseness of voice.
ROS: Negative except above
PMH: HTN, Breast cancer remission for 10 years
Meds: HCTZ, Lisinopril, Ambien
Allergies: NKDA
PSH: Lumpectomy 10 years ago, Laparatomy in 20s
FH: Mother had depression. 
SH: Red wine 2-3x/wk. No drug usage. Retired.

Keywords and phrases relevant to diagnosis:
increased appetite
Recent death of son on February 14
F
"auditory hallucination of neighbors playing music last night"
67 yo
difficulty falling asleep
for 3 weeks
No relief w/ Ambien
dayttime fatigue, low energy
anhedonia
visual hallucination of son
Mother had depression
waking up early
No sucidial ideation
trouble sleeping, Sleeps only 4-5 hrs per night, nighttime awakenings
Patient Note: Pt is 67 yr female presenting with trouble sleeping for 3wks. Has problem falling and staying asleep with tossing/turning. Wakes up early in the morning. Doesn't feel refreshed when waking up. Gets 4-5hrs of interuppted sleep. Normaly got 8hrs. Son died Jun19th. Describes mood as sad. Saw image of son last night and heard music from neighbors when there was no music. Hallucinations not frightenining. Tried Ambien last 5 nights-no relief. Increased appetite for carbs. Drinks 1cup coffee in the morning. No guilt/hopelessness. Low energy. Lack of interests. No suicidal ideation. Has good support with husband/friends. PMH:HTN/remission from breast cancer 10 yrs. MEDS: HCTZ/lisinopril/ambien. Allergy:none. Surghx: lumpectomy Famhx: Father-htn, high cholesterol, died of stroke. mom-hx of depression. Retired from receptionist. Likes to read/scrapbook. etoh-2-3glasses wine/week. No tobacco/drugs. No sick contacts/travel. ROS: pertinent listed.

Keywords and phrases relevant to diagnosis:
Increased appetite
Son died Jun19th
female
heard music from neighbors when there was no music
tossing/turning
67 yr
problem falling asleep
for 3wks
Tried Ambien no relief
Low energy
Lack of interests
Saw image of son last night
mom-hx of depression
Wakes up early
No suicidal ideation
trouble sleeping, problem staying asleep, Gets 4-5hrs of interuppted sleep
Patient Note: 67 yo F presenting with trouble sleeping for the past 3 weeks. Reports difficulty falling asleep, early awakening, and feeling as if she is tossing and turning at night. Denies snoring. She lost her son three weeks ago, and since then she has been experiencing problems with sleep, depressed mood ("devastated"), loss of interest in scrapbooking. Has also had auditory and visual hallucinations related to son. Denies guilt, thoughts of hurting self or others. Has had increased appetite, but no weight gain. 
ROS: no fever, chills, abdominal pain, nausea, vomiting, diarrhea, constipation, blood in stool
PMH: breast cancer in remission for 10 years, HTN
PSH: lumpectomy, appendectomy 
Meds: hydrochlorothiazide, lisinopril, ambien (from friend)
Social History: never smoker, a couple glasses of wine 2-3 times per week (has not had a drink for past few weeks), no illicit drugs. Previous receptionist, retired for 2 years. Lives with husband

Keywords and phrases relevant to diagnosis:
increased appetite
lost her son three weeks ago
F
auditory hallucinations
tossing and turning
67 yo
difficulty falling asleep
past 3 weeks
loss of interest
visual hallucinations
early awakening
Denies thoughts of hurting self
trouble sleeping, problems with sleep
Patient Note: HPI: patient is a 67 yo F who presents with 3 week history of unable to sleep. Patient reports son passed away 3 weeks ago. Notes she usually sleeps from 11pm-6am and practices good sleep hygiene. Lately has been falling asleep at 12am, with tossing and turning at night, and waking up an hour earlier. Denies any apneic episodes, excessive use of caffeine, or naping during the day. Has tried alking ambien without alleviation. Notes sadness, lack of energy, and feeling tired. Reports visual disturbances. Denies any feelings of guilt, impairment of concentration, or changes in appetite. Denies any suicidal ideation. 
ROS: as stated in HPI
PMH: HTN and Breast cancer (in remission)
PSH: lumpectomy, abd laparotomy
Meds: HCTZ 25mg, lisinopril 20mg
Allergies: NKDA
FH: father had HTN, deceased of stroke, mother 90yo had depression
SH: good support system, retired, lives with husband, no tobacco, alcohol, or drug use

Keywords and phrases relevant to diagnosis:
son passed away 3 weeks ago
F
tossing and turning
67 yo
usually sleeps from 11pm falling asleep at 12am
3 week history
tried alking ambien without alleviation
lack of energy, feeling tired
mother had depression
waking up an hour earlier
Denies any suicidal ideation
unable to sleep
Patient Note: Ms. Loraine Wicks is a 67 y/o F who presents with a chief complaint of "trouble sleeping" for the past 3 weeks.
- Difficulty falling asleep and staying asleep. 
- Coincided with son dying in an MVA (3 weeks ago).
- Lost interest in normal activities, describes a depressed mood and decreased energy. 
- Reports good social support network - husband and many friends.

PMH: HTN
PSH: none
FamHx: Dad- stroke, HTN, hyperlipidemia. Mom - depression.
SocHx: Retired, receptionist. Never smoker, occasional alcohol, no drug use.

Keywords and phrases relevant to diagnosis:
Coincided with son dying 3 weeks ago
Ms, F
67 y/o
Difficulty falling asleep
past 3 weeks, 3 weeks ago
decreased energy
Lost interest
Mom - depression
trouble sleeping, Difficulty staying asleep
Patient Note: 67 y/o F presenting to clinic for 3 weeks of trouble sleeping, both in falling asleep and staying asleep
-Son died in MVC Oct 25th of this year. Pt has been "devastated" since then
-no hx of difficulty sleeping in the past
-no aggravating or relieving factors. No relief from Ambien she got from a friend
-admits to decreased interest, decreased energy, decreased appetite, and an overall "sad" mood
-denies SI/HI
-says she has a good support group (husband, family)
Denies fevers, chills, weight loss/gain, N/V, shortness of breath or chest pain
PMH: HTN 
PSH: denies
Meds: Ambien from a friend, HCTZ, Lisinopril
Allergies: NKDA
FH: denies mental health disase in family
Social: occasional wine 2-3x/week, less so recently, denies tobacco or drug use. Is married and lives with husband and children

Keywords and phrases relevant to diagnosis:
Son died Oct 25th
F
67 y/o
trouble falling asleep
for 3 weeks
No relief from Ambien
decreased energy
decreased interest
denies SI
trouble sleeping, trouble staying asleep
Patient Note: Mrs. Wicks is a 67yo F presenting with 3 weels of insomnia. She reports difficulty falling asleep and wakes up at 3:30-4am. She reports 4-5 of sleep nightly. Caffeine intak is 1 cup of coffee/day.  Excessive daytime sleepiness but unable to fall aleep for a nap. Tried taking a friends Rx of ambien with no imporovemnt. assocaited symtpoms of anhedonia, decreased energy, increased appertite, and "devastation". She report a stressor caused by her son's death 3 weeks ago. Denies feeleing of guilt, SI, changes in weight, concentration or phychomotor movement. Reports a "great support system" by husband and friends
PMH: HTN
MEdications: HCTZ and lisinopril
Past Surgical Hx: None
Allergies: None
FH: Father - HTN and hyperlipedmia. mother- depression
social: reitred, regular diet, regualr exercise but recently none, denies tobacco and illicit drugs. drinks glass of iwne 2-3 times/week. sexually active with husband

Keywords and phrases relevant to diagnosis:
increased appertite
"sons death 3 weeks ago"
Mrs, F
67yo
difficulty falling asleep
with 3 weels
unable to fall aleep for a nap
Tried ambien with no imporovemnt
Excessive daytime sleepiness, decreased energy
anhedonia
mother- depression
wakes up at 3:30-4am
Denies SI
insomnia, 4-5 of sleep nightly
Patient Note: 67 F with c/o trouble sleeping x 3 weeks.  She admits to drinking only 1 cup of coffee in the morning, but sleeps only 4-5 hours per night, difficulty falling asleep, and early awakening, decrease interest in daily activites, decreased energy.  She denies snoring, SOB, chest pain, palpitations, no weight changes.  She states that her son passed away 3 weeks ago, no suicidal ideation.

PMH:  hypertension, remission breast CA 10 years
Allergies:  NKDA
Medications:  HCTZ, lisinopril, ambien
Hospitalization:  lumpectomy, laparoscoy appendix burst
FH:  Father has hypertension & died of stroke, mother still living
SH:  retired, admits occasional walking as exercise, still sexually active with husband, non smoker, no illicit drugs, drinks red wine 2-3 week 0/4 CAGE

Keywords and phrases relevant to diagnosis:
son passed away 3 weeks ago
F
67
difficulty falling asleep
x 3 weeks
decreased energy
decrease interest
early awakening
no suicidal ideation
trouble sleeping, sleeps only 4-5 hours per night
Patient Note: MS. WICKS IS A 67 YO FEMALE PRESENTING WITH TROUBLE SLEEPING. SHE HAS DIFFICULTY FALLING ASLEEP. USED TO TAKE 15 MINUTES, NOW TAKES AN HOUR. TOSSES AND TURNS AND WAKES EARLIER AT 4-5 AM. FEELS DRAINED AND TIRED THROUGHOUT DAY. GOOD SLEEP HYGIENE. 1 CUP OF COFFEE IN MORNING. SON DIED RECENTLY. MOOD DEVASTATED, EATING MORE, UNINTERESTED IN ACTIVITIES SHE USED TO ENJOY. hAS GOOD SUPPORT SYSTEM WITH HUSBAND. SEEN LENORD IN KITCHEN FEW DAYS AGO. AUDITORY HALLUCINATIONS OF NEIGHBOR HAVING PARTY AT NIGHT. NO SUICIDAL IDEATION.
PMH: HTN, 10 YR REMISSION FORM BREAST CANCER
MEDS: HCTZ, LISINOPRIL, AMBIEN- STARTED 5 DAYS AGO, NOT HELPED SLEEP
FMH: DAD-HTN, HLD, STROKE. MOM-DEPRESSION
SEXUALLY ACTIVE WITH HUSBAND, NO PROTECTION. NO TOBACCO, DRUGS. GLASS OF WINE WITH DINNER 2-3 TIMES A WEEK.

Keywords and phrases relevant to diagnosis:
EATING MORE
SON DIED RECENTLY
FEMALE
AUDITORY HALLUCINATIONS OF NEIGHBOR HAVING PARTY AT NIGHT
TOSSES AND TURNS
67 YO
USED TO TAKE 15 MINUTES, NOW TAKES AN HOUR, DIFFICULTY FALLING ASLEEP
AMBIEN- STARTED 5 DAYS AGO, NOT HELPED SLEEP
FEELS DRAINED, TIRED THROUGHOUT DAY
UNINTERESTED
SEEN LENORD IN KITCHEN FEW DAYS AGO
MOM-DEPRESSION
WAKES EARLIER AT 4-5 AM
NO SUICIDAL IDEATION
TROUBLE SLEEPING
Patient Note: 67 y/o F c/o of difficulty sleeping for the past 3 weeks. She reports difficulty falling asleep, difficulty staying asleep, and waking up early in the morning without feeling rested. She denies that she snores. She reports drinking 1 cup of coffee daily and only 2-4 glasses of wine daily. She also report that her son died a few weeks ago and she has had difficulty dealing with his death despite a good social support system. She says last night she thought she heard voices from a neighbors' party despite that a party never occurred. Also days 4 days ago she "saw her deceased son in the kitchen." She denies nausea, vomiting, shortness of breath, chest pain, joint pain, new rashes, or trouble urinating or defecating. She takes Ambien for trouble sleeping but does not find it to be helpful.

ROS: otherwise -
PMH: breast cancer (in remission), hypertension
Meds: HCTZ, Lisinopril, Ambien
Allergies: NKDA
SH: social drinker, non-smoker

Keywords and phrases relevant to diagnosis:
son died a few weeks ago
F
"thought she heard voices from a neighbors party despite that a party never occurred"
67 y/o
difficulty falling asleep
for the past 3 weeks
takes Ambien but does not find it to be helpful
"saw her deceased son in the kitchen."
waking up early
difficulty sleeping, difficulty staying asleep
Patient Note: cc trouble sleeping
HPI 67 year old female presents with sleeping diffuculuties, loss of interest, feeling of saddness and visual hallucinations since her son passed away 3 weeks ago. Having trouble going to sleep and reports early morning awakening. Patient denies changes in psychomotor response or feelings of guilt. she has tried talking ambein for sleep but with no relief. She reports increased appeitite. Patient denies cold intolerance skin and hair changes, fatigue. 
ROS negative except for abvove
PMH HTN
Meds HCTZ lisinopril ambien 5 mg
Allergies none
HF HTN and stroke in father and MDD in mother
SH is retired lives with husband , decreased amount of walks recently since son passed loss interest, drinks alcohol 3x/weekly and denies tabacoo and illicit drug use. regular diet

Keywords and phrases relevant to diagnosis:
increased appeitite
son passed away 3 weeks ago
female
67 year old
trouble going to sleep
tried talking ambein for sleep but with no relief
loss of interest, loss interest
visual hallucinations
MDD in mother
early morning awakening
trouble sleeping, sleeping diffuculuties
Patient Note: CC: trouble sleeping
HPI: Loraine Wicks, a 67yoF c/o trouble sleeping for the last 2 weeks. Pts only son died on May 14th last month. Pt has feelings of sadness, loss of interest, decreased energy, increased and appetite. Denies feelings of guilt, loss of concentration, and also denies suicidal ideation. Sleep has been lasting about 4-5 hours a night. she has taken ambien the last few nights to try to improve sleep, but it has not been effective. She has trouble falling alseep, and trouble staying asleep, despite proper sleep hygiene.
Pt practices good sleep hygiene. Drinks only 1 cup of coffee/ day and has well balanced diet.
ROS a
PMH: HTN
MEDs: ambien recently.
ALLERGIES: n/a
FH: Dad: HTN, Hypercholesterolism, COD:stoke. Mom: depression
SH: no tobacco, social drinker, no recreational drug use. Married to husband and has friends and brothers locally - good support system.

Keywords and phrases relevant to diagnosis:
increased appetite
son died on May 14th last month
F
67yo
trouble falling alseep
last 2 weeks
ambien has not been effective
decreased energy
loss of interest
Mom: depression
denies suicidal ideation
trouble sleeping, trouble sleeping, Sleep has been lasting about 4-5 hours a night, trouble staying asleep
Patient Note: 67 y.o. F presents with difficulty sleeping. Started 3 weeks ago following the death of her son. Ambien did not help her sleep. She goes to bed at 11 and wakes up at 4-5 sleeping only 4-5 hours per night. She complains of waking up early, tossing and turning, and feeling fatigued throughout the day. Since her son passed away, he has lost interest in doing anything, been fatiged, and has been eating more. She states that she has been seeing and hearing things that are not there including her son at the kitchen table, and muffled voices and music at a neighbors party.

ROS: Negative except for above
Vitals: Hypertensive, otherwise WNL.
Surg: Lumpectomy, appendecotmy.
PMHx: HTN for which she takes HCTZ + lisinopril
Allergies: none

Soc Hx: Pt lives w/ husband, retired, no tobacco or illegal drug use. Drank wine 2 glasses 3 times per week prior to son passing away. Good support system. Sexually active with husband.

Keywords and phrases relevant to diagnosis:
eating more
3 weeks ago following the death of her son, 3 weeks ago following the death of her son
F
hearing things that are not there including muffled voices and music at a neighbors party
tossing and turning
67 y.o
Started 3 weeks ago
Ambien did not help her sleep
feeling fatigued, been fatiged
has lost interest
seeing things that are not there including her son at the kitchen table
wakes up at 4-5, waking up early
difficulty sleeping, sleeping only 4-5 hours per night
Patient Note: CC: Trouble sleeping
Loraine Wickws, 67 F presenting w trouble sleeping for the past 3 wks. Difficulty getting to sleep, staying asleep, and wakes up earlier than usual. Son died 3 weeks ago. She feels devasted. Has lost interest in hobbies (romance novels). Eating more. Has been hearing voices and seeing her son for the past 2 weeks. No guilt, no psychomotor agitation, No suicidality, Feels drained, no memory changes. ROS: No hair changes, no cold intolerence.
PMH: HTN, breast Ca 20 y/o tx w bilateral mastectomy (PSH)
Medications: HCTZ, lisinopril, Ambien
FH: Dad - high cholesterol, HTN, died at 75 of stroke, Mom 90, depression.
SH: Regular diet, used to exercise by walking, Used to drink 1-2 glasses of wine per day, 2-3x/wk, No cigarettes, or drugs, sexually active w husband.

Keywords and phrases relevant to diagnosis:
Eating more
Son died 3 weeks ago
F
hearing voices
67
Difficulty getting to sleep
past 3 wks
Feels drained
lost interest
seeing her son
Mom depression
wakes up earlier than usual
No suicidality
Trouble sleeping, trouble sleeping, Difficulty staying asleep