bhatthars/nbme_qna huggingface dataset:
Patient Note: HPI: 35 year old male complains of intermittent, non-radiating, gnawing, burning epigastric pain rated 5/10 for the past 2 months. Associated with nausea, bloating, and a change in stool color from lighter to darker (possible melena). Alleviated by Tums, no aggravating factors.
PMH: back pain, muscle spasms from construction work
Allergies: denies
Medications: Motrin
Hospitalizations/Infections/Trauma/Surgeries: denies
ROS: denies fever, diarrhea, constipation, urinary changes.
Family history: Uncle: bleeding ulcer
Social: Occupation: construction worker; Tobacco: 1 PPD for 20 years, occasional EtOH, denies illicit drug use; no pets, travel, or sick contacts
Sexual: not active, no history of STI

Keywords and phrases relevant to diagnosis:
Uncle: bleeding ulcer
epigastric pain
stool color from lighter to darker
Motrin
gnawing, burning
bloating
occasional EtOH
male
past 2 months
intermittent
nausea
35 year old, 5 year old
Patient Note: Pt is a 35M w/ no PMH p/w epigastric pain of 2 months duration. Pain lasts 1-2 hours and is a burning, dull pain. No radiation to the back. Tums used to alleviate the pain, but not anymore. 5/10 pain with episodes, 0/10 currently in office. Also endorses nausea with pain and dark bowel movements of 2 months duration. Denies any chest pain, SOB, changes in bladder function. Pain is not related to food intake. 
PMH: none       PSH: none 
Meds: 2 200 mg Motrin tabs for pain weekly. 
Allergies: NKDA
FH: Uncle complains of bleeding ulcer occasionally 
SH: 0.5-1 ppd tobacco since age 15. Cut out alcohol recently since had no desire for it. No illicit drugs. Lives alone. Works in construction.

Keywords and phrases relevant to diagnosis:
Uncle complains of bleeding ulcer
epigastric pain
dark bowel movements
Motrin
burning
M
2 months duration
Tums used to alleviate the pain, but not anymore
nausea
35
Patient Note: 35yoM with 2 month hx of worsening stomach pain
-initally few times a week to 2x/day of gnawing/burning pain in mid-epigastric area
-denies cough, vomiting however endorses darker brown stools as of 2 weeks, never any bright red blood per rectum
-initially alleviated with tums, now less effective; nothing made worse 
-takes ibuprofen 400mg one a week for back pain for 10 years straight 
-denies any unintentional weight loss/gain
pmh: chronic back pain (never diagnoses) 
famhx: uncle with peptic ulcer disease
meds: ibuprofen once a week for 10 year
allergies: nkda
surg/hosp: none
social: works in contruction, takes pain meds for back pain/muscle aches, 20 pack year smoking hx - conteplative quitting stage, no etoh, no illicits/ivdu, lives alone

Keywords and phrases relevant to diagnosis:
uncle with peptic ulcer disease
pain in mid-epigastric area
darker brown stool
takes ibuprofen, ibuprofen
gnawing/burning
worsening, initally few times a week to 2x/day
M
with 2 month hx
never any bright red blood per rectum
tums, now less effective
35yo
Patient Note: 35yo male presents due to mid epigastric pain x2mo. The pain comes and goes, but is getting worse. Never had it before, non-radiating, used to be relieved w/ Tums, now it does not, does not get worse w/ anything. Comes randomly, no associated w/ food, has nausea but no vomiting. Gnawing pain that wakes him at night, 5/10 in severity. He has extra bletching, has noticed dark stools of normal caliber, and bloating after food intake. Denies appetite changes, changes in weight, recent travel, HAs, fatigue, sweats/chills, recent infections, changes/problems w/ urinary habits. 
ROS: negative except as above.
PMH: Back pain due to construction work 
PSH: none FH: uncle has peptic ulcer disease
SH: smoking since he was 15yo, 1/2-1 ppd. Used to drink alcohol until this pain stated. No drug use. Construction worker, going through a divorce w/ extra stress, eats fast food or whats near, used to exercise before pain.
Meds: Motrin, 7-8 coffee

Keywords and phrases relevant to diagnosis:
uncle has peptic ulcer disease
epigastric pain
dark stools
Motrin
bloating after food intake
getting worse
Used to drink alcohol
male
x2mo
wakes him at night
comes and goes
used to be relieved w/ Tums, now it does not
nausea
35yo
Patient Note: A 35 Y M CONSTRUCTION WORKER C/O EPIGASTRIC PAIN X 2M, STRTED GRADULLY,GETTING WORSE,5/10 INTENSITY,BURNING TYPE,ON &OFF,OCCURS EVERYDAY ,LASTS FOR 1 HR,INITIALLY RELIVED WITH TUMS,BUT NOW NOT RELIVING
H/O MALENA X 2 WEEKS,NO BLOOD IN IT
H/O BLOATING AFTER EATING,NAUSEA,NO VOMTINGS,APPETITE IS DECRESED
H/O BACK PAIN X 10 Y,USING MOTRIN FOR PAIN
NO H/O CHEST PAIN,SOB,WATER BARSH,CHANGE IN TASTE OF MOUTH,FEVER,WT CHANGES,
NO H/O RELATIONSHIP BETWEEN FOOD INTAKE AND PAIN,ASSO WITH SPICY FOOD
ROS:AS PER HPI,PMH:AS ABOVE,PSH:NONE,ALLERGIES:NKDA,MEDS:TUMS AND MOTRIN
FH:UNCLE HAS PUD
SH:SMOKES 1PPD X 15 Y,ETOH OCCATIONALLY,NO ILLICIT DRUGS




Keywords and phrases relevant to diagnosis:
UNCLE HAS PUD
EPIGASTRIC PAIN
MALENA
USING MOTRIN, MOTRIN
BURNING
BLOATING AFTER EATING
GETTING WORSE, OCCURS EVERYDAY
ETOH OCCATIONALLY
M
X 2M
NO BLOOD IN IT
ON &OFF, LASTS FOR 1 HR
INITIALLY RELIVED WITH TUMS
NAUSEA
35 Y
Patient Note: Mr. Hamilton is a 35 y.o. male with 2 month history of epigastric pain, 6/10, described as burning, gnawing. Pain is not worse at night or atrributable to a specific food. Pain comes and goes and patient does not know what makes it better or worse. Tums helps previously but no longer help. Pt also reports dark stools but no blood in stools. Under a lot of stress with work and splitting up with wife. 
ROS: denies dyspepsia constipation, diarrhea, chest pain, shortness of breath, hematuria

PMH: back pain and muscle spasm
PSM: none
Meds: motrin, 2 pills once a week
Allergies: NKDA
Fam Hx: noncontributory
Soc Hx: smokes 1/2 pack to one pack per day for 20 years, high stress life with work and currently splitting up with wife, no drug use, alcohol during week but not every day

Keywords and phrases relevant to diagnosis:
epigastric pain
dark stools
motrin
burning, gnawing
alcohol during week but not every day
Mr., male
with 2 month history
no blood in stools
comes and goes
Tums helps previously but no longer help
35 y.o.
Patient Note: Chad Hamilton, a 35-year-old male, has come to the physician's office today because of stomach problems. The patient has experienced middle sense of burning and gnawing pain that is localized to the epigastric region for 2 months.  He has not experienced any radiation of pain and desribes the severity as 5 out of 10. The pain is on and off and for a few weeks taking tums made the pain better.  At this point he has not noticed any exacerbating factors .  He has noticed no change in bowel habits, but has been nauseous and eats less because of the pain, the pain also wakes him up at night occasionally.  He denies fever/chills, weight loss or any othe constitutional symptoms.  
ROS: see HPI 
Past medical history  back pain, muscle aches 
Meds:  motrin 
fam hx: uncle with ulcer 
allergies: none 
Social hx:  1/2-1 pack for 20 years.  not interested in quitting.  Works in construction.  No alcohol use or sexually active. eats fast food.

Keywords and phrases relevant to diagnosis:
uncle with ulcer
pain that is localized to the epigastric region
motrin
burning and gnawing
male
for 2 months
wakes him up at night
on and off
nauseous
35-year-old
Patient Note: Mr. Chad Hamtilton is a 35 y/o M presenting with abdominal pain. Reports that he started experiencing epigastric pain 2 months ago. Occured 1x/week but now occurs 2-3x/day and alsts 1-2 hrs. The pain is 5/10 and localized to the mid-epigastric region. During these episodes he also has nausea and feels bloated. No emesis, no radiation. Has had darker stools during this time but no frank blood in stool or diarhea. His only other complaint is back pain he has from work that he takes Motrin for. Otherwise in his normal state of health.

ROS: As stated in HPI
PMH: Back pain with spasms
Meds: Motrin 1x/week PRN back pain
Allergies: none
Surg hx: none
Fam hx: Ulcer had a bleeding ulcer
Sox hx: Works in construction. EtOH use on average 1-2x/week but less recently, smokes 1/2-1 pack per day tobacco (not interested in stopping at this time). No drug use. No sexually active but uses condoms regularely when he is.

Keywords and phrases relevant to diagnosis:
Ulcer had a bleeding ulcer
epigastric pain, pain mid-epigastric
darker stools
takes Motrin, Motrin
feels bloated
now occurs 2-3x/day
EtOH 1-2x/week
Mr., M
2 months ago
no frank blood in stool
nausea
35 y/o
Patient Note: Patient is a 35 y/o M with no PMH presents with epigastric pain for 2 months. The pain is described as burning pain, no radiation, 5/10, partially relieved with Toms but not helping recently, associated with nausea, bloasting and stomach fullness. Denies food regurgitation, vomiting, diarrhea, constipation, weakness , numbness, fever, headache, chest pain, SOB. Pt has been using Motrin excessicvely for back aches and muscle pain. He works in construction. He also takes 5-6 cups of coffee every day.
ROS: -ve except HPI
Allergy : NONE
Meds: Motrin, toms
PMH: NONE
PSH: None
FH: uncle had PUD
SH: Drinks alcohol, few beers a week but has decreased intake, Smoking 1/2-1 packs per day since age 15, no illicit drug use, exercises regularly

Keywords and phrases relevant to diagnosis:
uncle had PUD
epigastric pain
using Motrin, Motrin
burning
bloasting, stomach fullness
few beers a week
M
for 2 months
relieved with Toms but not helping recently
nausea
35 y/o
Patient Note: 35 Yo M c/o epigastric  pain since 2 months ago, scale 5/10, progressive, intemittent pain, use to occure every week for 1-2 hours but now it occurs 2-3 times per day. it is a burning pain, does not radiates anywhere, TUMs used to make it slightly better but not anymore and nothing aggravates the pain, he has cut down on his eating due to bloating after eating. his diet is mostly Fast food. he lifts heavy stuff at work and because of muscle aches he has been  taking  Motrin once a week for 9 years. he recently has night time awakening due to the pian, positve for nausea but no vomiting. he feels tired. no diaphoresis, no weight loss. no Hx of similar episode in the past .  pain is not related to any specific food. 
ROS: negative excpet as above 
allergies: nkda
 medication: motrin , TUMS
PMH/SH ; none
smoking 05-1 PPD since he was 15, oocasional ETOH, no illcit drugs 
not sexually active 
FH: probable PUD in uncle

Keywords and phrases relevant to diagnosis:
PUD in uncle
epigastric  pain
taking  Motrin, motrin
burning
bloating after eating
progressive, occurs 2-3 times per day
oocasional ETOH
M
since 2 months ago
night time awakening
intemittent
TUMs used to make it slightly better but not anymore
nausea
35 Yo
Patient Note: Mr. Hamilton is a 35 yo male with no PMH who reports 2 months of intermittent, worsening epigastric "burning" and "gnawing" pain. Pt also endorses "darkened stool" for the last 2 weeks as well. The epigastric pain has increased in frequency over last few weeks, not associated with food or activity, and was originally partially relieved by tums and motrin, but these no longer help. Pain does not radiate and pt rates it as a 5/10. Pt also endorses nasua and bloating. Pt denies weight loss, fevers, night sweats, sick contacts, or recent travel. The darkened stools began 2 weeks ago. No changes in stool consistency or frequency. Denies hematochezia
ROS - wnl except as above
PMH - none
PFHx - uncle with peptic ulcer
PHosp - none
Social - 1/2-1 ppd for 20 years, drank 1-3 12 oz beers weekly prior to symptoms, currently does not drink, no illicit drugs, construction worker, no stress at home or work
allergies - none
meds - tums, motrin

Keywords and phrases relevant to diagnosis:
uncle with peptic ulce
epigastric pain, epigastric pain
darkened stool, darkened stools
motrin
burning" and "gnawing
worsening, increased in frequency
drank 1-3 12 oz beers weekly
Mr., male
reports 2 months
Denies hematochezia
intermittent
originally partially relieved by tums, tums no longer help
nasua
35 yo
Patient Note: Mr Hamilton is a 35M w/ PMHx of bain pain and muscle spasms who presents w/ 2 month epigastric pain
- described as burning sensation lasting 1-2 hrs, accompanied by nausea and wakes him from sleep at night
- no vomiting, no related to foods, no recent weight loss, pain does not radiate, no cough or chest pain
- eats mostly fast food, drinks coffee and water
- tried tums for relief, but no longer effective
- also reports occassional dark stools, but no blood per rectum, no diarrhea
ROS: negative except as above
PMHx: back pain, muscle spasms; PSHx: none
Meds: motrin 2 pills/wk for body aches; All: NKDA
FHx: uncle w/ bleeding ulcer
SocHx: currently divorcing wife, works in high-elevation construction, smoked 1/2pack -1pack/d since age 15, not interested in quitting, no recr drug use, no history of STIs, normally drinks beer occassionally, but stopped since onset of symptoms
PsychHx: never seen psychiatrist

Keywords and phrases relevant to diagnosis:
uncle w/ bleeding ulcer
epigastric pain
dark stools
motrin
burning
drinks beer occassionally
Mr, M
w/ 2 month
wakes him from sleep at night
no blood per rectum
tums no longer effective
nausea
35
Patient Note: 35 yo M presents wtih stomach problems. Pt states a burning gnawing epigastric pain comes and goes and lasts for about 1-2 hours in duration. He states the pain does not radiate anywhere but he noticed an increased in frequency over 2 months now feeling symptoms 2 times a day instead of every week initially. Pt states tumes initally helped alleviate the pain but now nothing helps and nothing makes it worse. Pt states the pain is 5/10 in severity and noticed feeling nausea, burping more, pain that wakes him up at night, dark stools for 2 weeks and decreased appetitie with abdominal bloating and increased saitey with small portions of food. 
ROS: negative for fever,night sweats, chest pain, sob, hematura diarrhea,constipation
allergies: none 
pmh: none
psh: none
Meds: motrin PRN
FH: uncle bleeding ulcer
SH: construction, stress with recent divorce, 20 smoking pack year hx, stopped EtOH 3 weeks ago (prior 2 beers/wk) deneis drug use

Keywords and phrases relevant to diagnosis:
uncle bleeding ulcer
epigastric pain
dark stools
motrin
burning gnawing
abdominal bloating
increased in frequency, symptoms 2 times a day
2 beers/wk
M
over 2 months
pain that wakes him up at night
comes and goes
tumes initally helped alleviate the pain but now nothing helps
nausea
35 yo
Patient Note: 35 yr old male , previously healthy , coming with history of Burning central abdominal pain for 2 months . Non radiating and associated with decreased intake , but didn't affect the appetitie or wt . There's ALSO BLOATING SENSATION AND increased burping . There's hsitory of caffiene intake 
No fever , nausea or vomiting , diarrhea
ROS body aches and back aches related to his work  
PMH and PSH : unremarkable 
Family Hx : Both parents are healthy . 
Social Hx : construction worker . Going through a divorce with good social support .
Diet is Unhealthy , mainly junk foods  
Drinking only on weekends , but cut down on drinking since his current problem 
Smokes since he was 15 yr old , half to 1 pack per day

Keywords and phrases relevant to diagnosis:
Burning
BLOATING
Drinking only on weekends
male
for 2 months
35 yr old
Patient Note: Chad Hamilton, a 35-year-old male, has come to the physician's office today because of stomach problems for 2 months. Patient states that he had the pain before, but the pain was more frequent than before. it occurred twice a day/ 
the pain is 5/10. getting with TUM but it didn't improve the problem recently. 
the pain is not associate with food or meal. He felt nauseated but didn't vomit. His stool was dark brown w/o blood. He denies diarrhea.
He had chronic back pain from his job as a construction worker, and he took mortrin 2*200 mg. He sometimes took it w/o food.
Hospitalization Hx: NONE
FMHx: bleeding ulcer from parental uncle
Social history: Patient is under the process of divorce with his wife and he felt stressed. Not sexually active now.
                     smoking 1/2 pack per day for 20 year, alcohol : 2-3 beers CAGE neg. no drug use
Allergy NDKA

Keywords and phrases relevant to diagnosis:
bleeding ulcer from parental uncle
stool was dark brown
mortrin
more frequent, occurred twice a day
2-3 beers
male
for 2 months
stool w/o blood
"TUM didnt improve the problem"
nauseated
35-year-old
Patient Note: Mr hamiton is a 35 year old male presenting with abdominal pain that has been occuring for the past 2 months. He states that the pain is waxing and waining and is unrelated to food intake. He describes the pain as a 7/10 and states that it has been increasing in severity over the past 2 months. Pain does not radiate  anywhere and is localized to the middle of the abdomen. He states that tums used to make it better but it has no longer been affective. patient is burping throught interview. Patient eats hoggies and burritos on a regular basis. He relates mild nausea and no vomiting. Bowel movements have been regular. 
ROS: no weight loss, patient also reports lower back pain

Allergies: none
medications: tums
PMH: none
PSH: none
SH: constrution worker, smoker half/pack a  day for 20 years. stopped drinking. poor diet of hoggies and burritos 
FH: uncle with Peptic ulcer disease

Keywords and phrases relevant to diagnosis:
uncle with Peptic ulcer disease
Pain localized to the middle of the abdomen
increasing in severity
Mr, male
past 2 months, past 2 months
tums used to make it better but it has no longer been affective
nausea
35 year old
Patient Note: 35 yo Chad presents with stomach problems. Started two months ago. Nawing/epigastric pain. Experiencing nause without emesis. It was worsened due to increased frequency. Tums initially helped. Denies diarrhea or constipation. Stools appear darker. Feels tired and pain wakes him up at night. Denies fevers, night sweats or chills. Takes motrin for back pain.
PMHx: back pain- takes motrin
No other medication
No surgeries
Family history: uncle with bleeding ulcer
Single, works in constuction. 1/2-1 pack smoking history (20 years). Denies being stressed. No new changes in his life. Occassional drinks 2-3 beers a week. no other drug use

Keywords and phrases relevant to diagnosis:
uncle with bleeding ulcer
epigastric pain
Stools appear darker
Takes motrin, takes motrin
Nawing
increased frequency, worsened
2-3 beers a week
Started two months ago
Tums initially helped
nause
35 yo
Patient Note: 35 yo M complains of epigastric abdominal pain that started 2 months ago. Pain in nonradiating, intermittent, "gnawing and burning" in nature, with an intensity of 5/10. Initially, pain was relieved by Tums, but does not seem to relieve it now. Sometimes the patient is awaken in the middle of the night with the pain which last 1-2 hours.  Pain does not worsen with food intake.  Episodes occur 2-3x/day. Denies chest pain, dyspnea, vomitting. 
ROS: Negative except as above. 
PMH: None.
PSH: None.
Allergies; NKDA. 
FH: Paternal uncle with bleeding ulcer.
SH: Contruction worker; smokes half to 1 ppd/day, 2-3 beers/ week. Not sexually active.

Keywords and phrases relevant to diagnosis:
uncle with bleeding ulcer
epigastric abdominal pain
gnawing and burning
occur 2-3x/day
2-3 beers/ week
M
started 2 months ago
awaken in the middle of the night with the pain
intermittent
Tums does not seem to relieve it now
35 yo
Patient Note: HPI: 35 yo M c/o stomach pain
-started 2 months ago, epigastric region, nauseated. pain is 5/10, nagging, burning, it comes and go. No assoaciatio with intake of food. 
_ no fever, headache, travel, SOB. 
H/O bodyache x 20 years and takes Motrin for it. associated with back pain and muscle cramps.
Assoaisted with dark colour stool, decrased appettie, disturbed sleep, and stooped excercise. 
ROS: no chnge in urinary habits. Meds: Motrin x 20 years, No Rx All: NKDAPMH: None, PSH; none
FH: non contributory Occupation: heacy elevation lifting worker SH: Alcohol occasionally, Tobacco x 1 PPD x 10 years. No active sexually due to break up.

Keywords and phrases relevant to diagnosis:
pain epigastric
dark colour stool
Motrin, Motrin
nagging, burning
Alcohol occasionally
M
started 2 months ago
comes and go
nauseated
35 yo
Patient Note: 35 yo M presents w/ c/o epigastric pain, nonradiationg, burning, intermittent, worseing, at least 2x/day, not associated with food. assoicated with bloating with each meal and nausea with pain, and darker stools.  uses nsaids 1x/wk 200 mgx2 pills for aches and pains r/t job. expresses high stress and going through a divorce. denies fatigue, vomiting, recent sickness, fever, hx GERD, bleeding disorders, diarrhea, constipation, or joint pains.ros: denies headaches, changes in vision, chest pain, sob, weakness, nubness or tingling. pmh: back pain fh: uncle bleeding ulcer sh: used to drink a few beers/wk but stopped a few weeks ago, smokes 0.5-1 ppd since age 15, no rec drugs, not sexually active

Keywords and phrases relevant to diagnosis:
uncle bleeding ulcer
epigastric pain
darker stools
uses nsaids
burning
bloating with each meal
worseing, at least 2x/day
few beers/wk
M
intermittent
nausea
35 yo
Patient Note: 35 yo M presents c/o abd pain
-began 2 months ago, gradual onset, has gotten progressively worse, no previous episodes
-occurs 2x/day, lasts 1-2 hrs, epigastric, no radiation, 5/10 in severity, also occurs at night
-alleviated by Tums (no longer helping), no aggravating factors
-has nausea, no vomiting, darker stools (no noticeable blood), bloating with meals, increased stress (d/t divorce, work)
PMH/PSH: occasional back aches and spasms / none
Meds/Allergies: Motrin, Tums / none
SH: smokes 0.5-1 ppd since age 15, drinks couple beers per week, no illicit drug use
FH: uncle with bleeding ulcer



Keywords and phrases relevant to diagnosis:
uncle with bleeding ulcer
abd pain epigastric
darker stools
Motrin
bloating with meals
progressively worse, occurs 2x/day
drinks couple beers per week
M
began 2 months ago
also occurs at night
stools (no noticeable blood
lasts 1-2 hrs
alleviated by Tums (no longer helping)
nausea
35 yo
Patient Note: Patient is a 35 year old male presenting with a 2 month hx of epigastric pain
pain is sharp and stabbing in nature and occurs 2-3x a day 
described as 5/10 in severity, no radiation
tums originally made the pain better but no longer help
pain not related to eating, sometimes occurs at night
endorses some dark stools, no constipation, diarrhea, no vomiting
endorses occasional nausea
PMH: back pain and spasms, no surgeries
Meds: motrin 2 pills/week for pain
FH: uncle with ulcer
SH: works as construction worker, not sexually active, smokes 0.5-1 pack pr day
no allergies

Keywords and phrases relevant to diagnosis:
uncle with ulcer
epigastric pain
dark stools
motrin
occurs 2-3x a day
male
2 month hx
tums no longer help
nausea
35 year old
Patient Note: Chad Hamilton, a 35-year-old male, has come to the physician's office today because of stomach problems.
HPI: 35 y.o. M stomach discomfort and pain, worse 5/10, located in epigastric area, non-radiating, 2 months duration seems to be progressing, described as burning. No precipitating events noted, tums helped at first now nothing seems to relieve it. Assoicated with nausea and feels like he has to vomit but no emesis, and notes stools are darker. Denies fevers, chills, weight loss or gain, travel, changes in diet. He is getting a divorce and stressed with that but feels supported by family.
PMH: Back pain longstanding, no illnesses, hosp/surgeries
Meds: motrin, no rx, no otc
NKDA
SH: used to drink 1-2 etoh per night now stopped due to stomach pain. no tobacco or other drug use. 
FH: peptic ulcer disease father side

Keywords and phrases relevant to diagnosis:
peptic ulcer disease father side
pain in epigastric area
stools are darker
motrin
burning
progressing
male, M
2 months duration
tums helped at first now nothing seems to relieve it
nausea
35-year-old, 35 y.o