bhatthars/nbme_qna huggingface dataset:
Patient Note: Ms. Whelan is a 26 y/o F who presents for a follow up visit after going to the Emergency department with severe palpitations. She reports that she feels her heart is racing and her fingers go numb. These episodes have occured for several years but have become worse within the past few weeks. She has a feeling of doom. She has SOB and a feeling of a "lump in her throat", and she feels clammy and has nausea when the episodes happen. No pain. Not sure what brings these episodes on. So has no recent illness, fever, no weight loss, no changes to appetite, no travel, no genitourinary problems. Her cardiac tests and electrolytes came back normal from her visit at the emergency department.

Med Hx: none
surg hx: None
Medications: none
NKDA
Family Hx: None
Social: never drank, smoked, or did illicit drugs. She is sexually active with her boyfriend. 


Keywords and phrases relevant to diagnosis:
Ms, 26 y/o, F
SOB when the episodes happen
palpitations, heart is racing
follow up visit to the Emergency department cardiac tests and electrolytes came back normal
never did illicit drugs
nausea when the episodes happen
worse within the past few weeks
feeling of doom
lump in throat when the episodes happen
clammy
fingers go numb
Patient Note: 26 yo F at clinic for followup visit for palpitaion since her last visit to the ED 2 weeks ago. She had palpitaion or pounding and finger numbness 3 weeks ago and came to ED 2 weeks ago. A/w cold and clamy fingers, SOB, feels like throat closing up and feels like she is dying . All of this came suddenly. she is under a lot of stress as she bought a condo and then  lost her job 2  months ago. Hx similar episode 5 years ago. she says she is feeling more tired and has  decreased concentration as well. denies dizziness, Cp, HA, caffine intake, bowel or bladder changes, menstrural changes 
ROS neg except as above 
PMH none meds none 
PSH none hosp none 
FH NC
SH was a sales consultant, lives alone, denies toxic habits, sexually active with BF and uses protection and no stds, LMP was 1.5 weeks ago and it regular and 4-5 day flow.

Keywords and phrases relevant to diagnosis:
similar episode 5 years ago
F
denies caffine intake
A/w SOB
palpitaion, palpitaion
denies Cp
A/w feels like she is dying
A/w feels like throat closing up
A/w clamy fingers
finger numbness
decreased concentration, feeling more tired
under a lot of stress, bought a condo and then  lost her job 2  months ago
26
Patient Note: 26 yo female w/ unremarkable PMHx c/o heart palpitations over the last 3 weeks associated with SOB, throat tightness, tingling in hands and fingers. Symptoms occur at rest and with activity. Denies inciting or alleviating factor. Seen in ED 2 weeks ago. Work up including EKG negative. denies changes to hairs, eyes, skin or shins. Had prior episode 5 years ago. + life stress, lost job several months after buying condo. Takes no medications. Denies si/hi, reports good support network of friends and family.  Denies EtOH, Caffiene, recreational drugs or smoking.

Keywords and phrases relevant to diagnosis:
prior episode 5 years ago
female
Denies Caffiene
associated with SOB
palpitations
Seen in ED 2 weeks ago. Work up including EKG negative
Denies recreational drugs
associated with throat tightness
associated with tingling in hands and fingers
+ life stress, lost job several months after buying condo
26
Patient Note: Patient is a 26 year old female with no significant past medical history who presents today for follow up after visiting the emergency department 2 weeks ago for palpitations. She states that she has experienced unpredictable episodes of palpitations associated with clammy skin, nausea, dyspnea, and a sense of impending doom over the past 5 years. However, the attacks have become more frequent and concerning in the last 3 weeks. The episodes last for 15-30 minutes. She notes nothing that consistently brings the episodes on or relieves them. She states that she is asymptomatic outside of episodes. She denies drug use, smoking, and alcohol consumption.

Keywords and phrases relevant to diagnosis:
over the past 5 years
female
associated dyspnea
palpitations, palpitations
denies drug use
associated nausea
more frequent in the last 3 weeks
sense of impending doom
last for 15-30 minutes
clammy
26 year old
Patient Note: pt is a 26 yo f with no significant pmh that present with 3 week heart palpitation. 2 week ago she went to the ER and they recommended she come see doctor. nothing make better, nothing make  worst. tried nothing for it. no specific situation induce the heart palpitation. sh experience somethign similar 5y ago when in college. recently bought condo and lost job.
positive symptom: shortness of breath, cold, clamy, nausea, heart race and she feel like she going to die, also report havign tingling in fingers
negative symptom: no weight loss, no history of depression or anxiety, no chest pain, no fever, no agoraphobia, no sleep change, 
ROS: as per above 
A: none 
PMH: none 
PSH: none 
FH: non contributory 
SH: unemployed (sale consultant in past), no smoking, no drinking, no illegeal drug. no cahnge in diet 
menstrual:30d, 4-5d , normal flow, 


Keywords and phrases relevant to diagnosis:
somethign similar 5y ago
f
positive symptom: shortness of breath
palpitation, palpitation, heart race
no chest pain
no illegeal drug
positive symptom: nausea
feel like she going to die
positive symptom: clamy
tingling in fingers
unemployed, recently bought condo and lost job
26 yo
Patient Note: 26F with no PMH presents for follow-up of palpitations. Since 5 yrs ago, pt has had episodes of palpitations, SOB, throat tightness, nausea, and feeling hot then cold+clammy, which have increased in frequency recently to 1-2x per day. 2 weeks ago, in addition she experienced numbness of her fingers but denies any color changes at the time; she was seen in the ED and found to have normal CBC, BMP, cardiac enzymes, and ECG at the time. Episodes typically last 15-30mins. No alleviating or exacerbating factors. Reports that she bought a condo 3 months ago but lost her job 2 months ago. Reports good support system with friends and family. Denies weight loss, fever, changes in bowel movements.
ROS: negative other than HPI
PMH/PSH: none
Meds and allergies: none
FH: healthy
SH: worked as sales consultant but currently unemployed, no smoking/alcohol/drugs, healthy diet and exercise, lives alone
Sexually active with boyfriend, - STD and HIV

Keywords and phrases relevant to diagnosis:
Since 5 yrs ago
F
episodes of SOB
palpitations
2 weeks ago seen in the ED and found to have normal CBC, BMP, cardiac enzymes, and ECG
no drugs
episodes of nausea
increased in frequency recently, increased in frequency 2 weeks ago
last 15-30mins
episodes of throat tightness
feeling hot, feeling clammy
numbness of her fingers
bought a condo but lost her job, unemployed
26
Patient Note: Ms. Whealon is a 26yo F with no PMH who presents today with complaints of intermittent palpitations for last 5 weeks, worse over the last 3 weeks. Reports increase in frequency of palpitations to the point that her fingers went numb 2 weeks ago. Episodes last 15-30 minutes and are associated with SOB, throat swelling, and nausea. Also reports feeling cold and clammy during episodes. She denies recent illness, fevers/chills, or vomitting/diarrhea. No hair loss, weight loss, or appetite changes. She reports recently losing her job after a recent housing purchase that has led to increased stress and anxiety.
Of note, ED workup from 2 weeks ago revealed a normal CBC, metabolic panel, cardiac enzyme level, and ECG.

ROS negative otherwise.
PMH: None
PSH: None
Allergie: None
Medications: None
FH: None
SH: Denies smoking, etoh use, drug use. Sexually active with boyfriend, uses condoms.


Keywords and phrases relevant to diagnosis:
Ms, F
associated with SOB
palpitations, palpitations
ED workup from 2 weeks ago revealed a normal CBC, metabolic panel, cardiac enzyme level, and ECG
Denies drug use
associated with nausea
worse over the last 3 weeks, over the last 3 weeks increase in frequency
last 15-30 minutes
associated with throat swelling
clammy
fingers went numb
recently losing her job after a recent housing purchase, increased stress, increased anxiety
26yo
Patient Note: 26 yo f with presents with palpitations that started 5 years ago. they used to occur rarely but now occur 1-2 times per day. Associated with feeling clammy, hot throat tightening, SOB and nausea. No LOC. She "feels like something bad is going to happen." She has not noticed a pattern or any precipitating events. No weight loss, diarrhea, or flushing. used to work as a sales consultant but lost her job shortly after buying a condo. She is under significant stress. ECG at Ed was normal, but she is not sure if this was done when she was having an episdode of palpitations.
PMH none, Meds - none. allergies - none. FH - none.
SH - no smoking, alochol, drugs. Sexually active with her boyfriend, uses condom regularly. feels safe with him. LMP 1 week ago.

Keywords and phrases relevant to diagnosis:
started 5 years ago
f
Associated with SOB
palpitations, palpitations
no drugs
Associated with nausea
Associated with feels like something bad is going to happen
Associated with throat tightening
clammy, feeling hot
under significant stress
26
Patient Note: Patient is Edie whelan a 26 year old female with no significant PMH presenting for a follow up from an ER visit 2 weeks ago from "heart racing". She describes the pain as being like a pounding feeling in which she hasnt really felt it in the past. She gets it every few days since 2 weeks ago and comes and goes and each episode last about 15-30minutes. She also states she feels nauseas, SOB cold and calmy with this episodes. She hasnt noticed if anything worsens it but usually tries to make it go away by sitting but there is no specific factor bringing it on. She has no pain and no pain anywhere else. 
ROS-negative except above 
PMH - no current med condition
PSH-no surgies
Meds-none
immunizations-UTD
Fx-mom(54) and healthy
dad(53) and healthy
Sx - works as a sales consultant in retail. she lives alone. she recently bought a condo 3 months ago but lost her job which has been very stressful on her life and is worried.

Keywords and phrases relevant to diagnosis:
female
she feels SOB
presenting for a follow up from an ER visit 2 weeks ago from "heart racing"
no pain anywhere else
she feels nauseas
last about 15-30minutes
she feels cold and calmy
she recently bought a condo 3 months ago but lost her job which has been very stressful
26 year old
Patient Note: Pt is a 26 yo female who presents to clinic for follow up of heart palpitations. These occur as episodes and are not constant and the symptoms first started 5 years ago but in the last three weeks have increased in severity. She now also gets short of breath, nauseous, feels like her throat is tightening, feels cold and clammy during these episodes. She is not able to attribute this to any triggers, no aggravating nor relieving factors. She was recently seen in the ED 2 weeks ago for the same symptoms and her work up of CBC, metabolic panel, EKG, and cardiac enzymes was all within normal limits. Continues to have symptoms

ROS: Denies headache, chest pain, dizziness, problems with sleep, no feelings of sadness or anxiety.
PMHx: none
Medications: none
Allergies: none
PSH: none
FM: healthy parents, no siblings
SH: Lives with self, no pets. No smoking, no illicit drug use, sexually active with boyfriend and uses condoms every time

Keywords and phrases relevant to diagnosis:
started 5 years ago
female
also gets short of breath
palpitations
recently in the ED work up was normal, in the ED 2 weeks ago work up was normal, recently in the ED CBC, metabolic panel, EKG, and cardiac enzymes normal, in the ED 2 weeks ago CBC, metabolic panel, EKG, and cardiac enzymes normal
Denies chest pain
no illicit drug use
also gets nauseous
last three weeks have increased
also feels throat is tightening
feels clammy
26 yo
Patient Note: A 26 Y./O F COME TO THE CLINIC C/O OF PALPITATIONS. FIRST TIME WAS 5 YEARS AGO, BUT SINCE 3 WEEKS AGO  STARTED AGAIN PALPITATIONS EOPISODES LIKE TWICE PER DAY, LASTING 15 TO 30 MIN ASSOCIATES WITH NUMBNESS OF FINGERS, NAUSEA, NARROWING OF THE  THROAT, FATIGUE AND LAST OF CONCENTRATION. 
ROS NEG EXCEPT AS ABOVE
PMH NONE
PSH NONE
ALL NKDA
MEDS NONE
FH NONE
SH ETOH OCASIONALLY, NO SMOKING, NO ILLICIT DRUGS, SEXUALLY ACTIVE W BOYFRIEND, CONDOM USE, NO HX OF STD'S, LMP 1 WEEK AGO, LAST PAP SEMAR 6 MONTH AGO, NORMAL

Keywords and phrases relevant to diagnosis:
FIRST TIME WAS 5 YEARS AGO
F
PALPITATIONS, PALPITATIONS
NO ILLICIT DRUGS
ASSOCIATES WITH NAUSEA
LASTING 15 TO 30 MIN
ASSOCIATES WITH NARROWING OF THE  THROAT
ASSOCIATES WITH NUMBNESS OF FINGERS
FATIGUE, LAST OF CONCENTRATION
26
Patient Note: Ms. Whelan is a 26yo female coming for follow-up regarding episodes of heart palpitations. She has had episodes for 5 years, but they have recently become more frequent the past 3 weeks. These episodes are brief and associated symptoms include feeling of doom, heart racing and pounding, SOB, throat tightness, nausea. She recently visited the ER two weeks ago for these symptoms in addition to numbness of her finger in both hands, but workup at that time including CBC, metabolic panel, cardiac enzymes, and ECG were unremarkable. 
ROS: She denies depressive symptoms, feeling anxious, excessive worrying, history of trauma, nightmares, hallucination, delusions. No syncope is mentioned.

PMH: unremarkable; Meds: none; Allergies: none
FH: unremarkable
SH: unemployed for 2 mo previously in retail, no alcohol, nonsmoker, no ilicit drugs


Keywords and phrases relevant to diagnosis:
has had for 5 years
Ms, female
associated SOB
palpitations, heart racing
visited the ER two weeks ago workup were unremarkable, recently visited the ER workup were unremarkable, visited the ER two weeks ago CBC, metabolic panel, cardiac enzymes, and ECG were unremarkable, recently visited the ER CBC, metabolic panel, cardiac enzymes, and ECG were unremarkable
no ilicit drugs
associated nausea
more frequent the past 3 weeks
feeling of doom
associated throat tightness
numbness of finger, numbness of hands
unemployed
26yo
Patient Note: 26 year old woman with 3 week hx of racing heart. It has happened infreqwuently over 5 year and worseing over the last 3 weeks. She also has SoB with the racing heart as well as nausea and one episode of numbness in her hands. She went to the ER 2 weeks ago due to the numbness with regular ECG, CBC, metabolic panel. She has felt clammy recnetly. Episodes occur 1-2 times daily over the last 3 weeks, nothing makes them better or worse.
ROS: No recent illness, no Chest pain, no change in bowel movements, no weakness or tingling
PMH: none
No allergy
no meds
SH: lives alone, looking for work and feeling very stress, no smoke or drugs or etoh

Keywords and phrases relevant to diagnosis:
over 5 year
woman
SoB with the racing heart
racing heart
no Chest pain
no drugs
with the racing heart nausea
worseing over the last 3 weeks
clammy
numbness in her hands
feeling very stress
26
Patient Note: HPI: 26yo F with 5 years of episodic palpitations increasing in frequency over the last 3 weeks. Episodes last 15-30 minutes, no alleviating or aggravating factors, characterized by SOB, nausea, sensation of cold/clamminess, throat tightening. Sense of tiredness with difficulty concentrating after. Over the last 3 weeks have occurred 1-2  times/day. Went to ED during episode with finger numbness two weeks ago. Denies loss of consciousness, headaches, blurry vision, chest pain, extremity pain, changes in bowel or bladder function, intolerance to temperatures, weight changes, tremor. Reports some recent stress losing job, describes mood as good, no problems with sleep. Denies history of trauma/abuse.
PMH: none. LMP 2 weeks ago, regular cycle. No meds, no allergies. FH: none. SH: unemployed, lives alone, good support. Denies alcohol, tobacco, other recreational drugs.

Keywords and phrases relevant to diagnosis:
5 years of
F
characterized by SOB
palpitations
Denies chest pain
characterized by nausea
increasing in frequency over the last 3 weeks
last 15-30 minutes
characterized by throat tightening
sensation of clamminess
finger numbness
tiredness, difficulty concentrating
recent stress, losing job, unemployed
26yo
Patient Note: 26 year oild female with no PMH who presents with a 5 year history of episodes of palpitations which have recently occurred more frequently in the past 3 weeks. FOr the past thre weeks she has had palpitations which occur every couple of days to 2x a day. Patient says that the episode lasts about 15 to 30 minutes, and is associated with feeling hot then cold and clammy. SHe also feels nauseous, SOB, and feels like her throat his tightenig up. During these episodes she has fear taht something bad is going to happen. Patient has no psychiatric history and denies social anxiety and fear of being in crowded or big spaces. 

PMH: none 
Surgical history: none 
Allergies: none 
Sexual history: sexually activy with boyfriend and uses protection 
Social: denies alcohol, drug, or tabacco use; currently unemployed, looking for work, lives in condo in the city 


Keywords and phrases relevant to diagnosis:
with a 5 year history
female
associated with SOB
palpitations, palpitations
drug denies
associated with nauseous
recently occurred more frequently in the past 3 weeks
During these episodes she has fear taht something bad is going to happen
lasts about 15 to 30 minutes
associated with feels like her throat his tightenig up
feeling hot, clammy
26
Patient Note: 17 y/o male with ches pain. Pt woke up yesterday morning with pain in right upper chest, described as sharp, stabbing, constant. Pain is 5/10 but can be 8/10 with deep inspiration or with movement. Pt tried tylenol (4x yesterday) and albuterol but no relief Pt also recently had running nose, feeling febrile, and diffuse muscle pain prior to symptom onset that is resolving. Pt denies headaches, swelling in neck, SOB, abd pain, nausea vominting. 
ROS: negative except as above
PMH: asthma
Meds: albutero, tylenol
Surg: none
Fam: father asthma, HTN
Soc: works as carpenters assistant (denies dust exposure), no smoing, occasional marjuana (last use over week before symptoms), occasional EtOh 1-2 beers 1-2x monthy, sexually active with girlfriend and consistent condom use
All: NKDA

Keywords and phrases relevant to diagnosis:
feeling febrile
male
17 y/o
recently had running nose
8/10 with deep inspiration
asthma
ches pain
woke up yesterday morning with pain
denies SOB
albuterol no relief
sharp, stabbing, 8/10
Patient Note: 17 y/o M comes to the clinic for chest pain that is sudden in onset and present on the left side since yesterday morning. It is sharp pain that is 4/10 on rest and increases to 7-8/10 on deep breathing and movement. It is localized to the upper left chest. Tylenol and albuterol inhaler do not help. No relieving factors. There is no precipitating factor or trauma. He has felt warm and had nasal congestion since 3-4 days. He denies sore throat or cough/palpitation.
ROS-negative except above
PMH- excercise induced asthma
PSH/allergy-none
Med- tylenol and albuterol inhaler. last used inhaler 6 mo ago.
FH- father has HLD and asthma. 
SH-occasional drinker. no smoking tobacco. smokes weed occasionally. Student. sexually active with GF and uses condoms regularly. monogamous.

Keywords and phrases relevant to diagnosis:
felt warm
M
17 y/o
nasal congestion since 3-4 days
increases to 7-8/10 on deep breathing
excercise induced asthma
chest pain
since yesterday
albuterol inhaler do not help
sharp, 7-8/10
Patient Note: CC: chest pain
HPI: 17 yo male with history of exercise-induced asthma treated with albuterol here today with 1 day history of sharp chest pain. Never had this pain before. Pain worse with inspiration. Has taken Tylenol and used inhaler without alleviation. Had 5 days of nasal congestion, subjective fever, and muscle aches prior to chest pain. No cough or headache, no eye or ear drainage, no loss of appetite. 
ROS: Negative except as above
PMH: exercised induced asthma
PSH:none
Meds: albuterol inhaler, tylenol Q4H PRN
Allergies: none
FH: father with asthma and hypercholesterolemia, mother A&W, grandfather with MI 2 years ago
SH: drinks beer at parties, CAGE 0/4, no tobacco, no drugs, sexually active with girlfriend and uses condoms, avid rock climber

Keywords and phrases relevant to diagnosis:
subjective fever
male
17 yo
nasal congestion
worse with inspiration
exercise-induced asthma, exercised induced asthma
chest pain
1 day history
rock climber
used inhaler without alleviation
sharp
Patient Note: Pt is a 17 yo male hx of exercise asthma on inhaler w 1 day history of "chest pain." He was in his usual state of health until yesterday morning when he noticed an abrupt presentation of chest pain on his left side. He said while it is present at rest, it worses with breathing and gets severe, but unable to rate it on a 1-10 scale. He says motion makes it worse. Does not radiate anywhere. He has tried Tylenol and his inhaler, but those have not helped him. He says he has never had something like this happen before. No falls/trauma, LOC 

Of note, he went rock climbing 3 days ago; also endorses stuffy nose, muscle aches, and "warmth" for the last 3 days. Denies headache cough, SOB, palpitations, reflux, abdominal pain, nausea, diaphoresis. PMH/PSH non contributory. FH + heart attack grandfather. No medications/allergies. 1 female sexual partner for the past year. Non smoker, social-drinker, no IVDU. Concerned about rock climbing.

Keywords and phrases relevant to diagnosis:
male
17 yo
stuffy nose
worses with breathing
exercise asthma
chest pain
1 day history, yesterday
Denies SOB
rock climbing 3 days ago, rock climbing
inhaler have not helped
Patient Note: 17M with a hx of exercise induced asthma who presents with chest pain. Patient is unaccompanied by mother.

- Chest pain is substernal, sharp without radiation. pain is worse with deep breaths. pain staryed yesterday morning and is constant and worsening. Tylenol and albuterol has not helped the pain. First time having this type of pain. Does not feel like asthma attack
- 3-4d ago, had fever (? Tm), runny nose, muscle aches. Sx have improved. No sick contacts. No cough. No sore throat. No nausea, vomiting, leg swelling, no SOB with exercion, no smoking at home, no feelins of anxiety. No ear tugging;  mood is "good"
- Feel safe at home
- No surgery
- no tobacco; social drinker; social MJ user; 
- No sig fam hx
- Up 2 date on immunization
- No recent travel hx

Keywords and phrases relevant to diagnosis:
fever
M
17
3-4d ago runny nose
pain is worse with deep breaths
exercise induced asthma
chest pain, Chest pain
staryed yesterday
no SOB
albuterol has not helped
sharp
Patient Note: 17 YO M, WITH VERBAL CONSENT FROM MOTHER, C/O CHEST PAIN x 1 DAY. THE PAIN IS ON THE LEFT SIDE OF CHEST, WAS SUDDEN, CONTINOUS, 5/10 AT REST AND 8/10 INTENSITY WITH RESPIRATION, WORSENS WITH MOVEMENT. PT ALSO REPORTS LOCAL TENDERNESS ON LEFT SIDE OF CHEST THAT INCREASES ON PALPATION. PT DENIES SOB, SWEATING, ILL CONTACTS, PND, ORTHOPNEA, TRAVEL, TRAUMA AND RASH.
ROS -VE EXCEPT AS ABOVE.
PMH- EXERCISE INDUCED ASTHMA ON ALBUTEROL
ALLERGY- NKDA
FH-N/C
SSH- SEXUALLY ACTIVE WITH GIRL FRIEND x 6 MONTHS AND USES PROTECTION, ETOH-NO ALCOHOL USE, DRUGS-WEED x 1 WEEK AGO, OCCUPATION -STUDENT AND CARPENTER PRT TIME


Keywords and phrases relevant to diagnosis:
M
17 YO
8/10 INTENSITY WITH RESPIRATION
EXERCISE INDUCED ASTHMA
CHEST PAIN, PAIN CHEST
x 1 DAY
DENIES SOB
8/10