bhatthars/nbme_qna huggingface dataset:
Patient Note: 20 yo F c/o headache since she woke up yesterday, holocranial, 8/10, dull, constant, worsen when walking and bending over, took Tylenol and Ibuprofen without any improvement. Patient reports this it the first time shes had a headache like this. Associated with nause and vomiting, #3 times since yesterday. Reports fever since this morning and feeling fatigued and achy. Disturbed by light and loud noises. Denies rash, recent travel, ill contacts, cough, chest pain, SOB, recent URI, changes in bowel movements, changes in urinary frequency.

ROS: as per HPI. PMH: None. PSH: None. Allergies: NKA. Medications: OCP for the past 2y. FH: Father had hypercholesterolemia; mother has migraines. SH: Works in a sporting good store. Sexually active with boyfriend, uses condoms consistently. Drinks 2-3 drinks/weekend. Smokes 3-4 ciggarettes of marijuana/week. Patient eats a healthy diet and exercises regularly.

Keywords and phrases relevant to diagnosis:
Tylenol without improvement, Ibuprofen without improvement
20 yo
yesterday, yesterday
achy
headache holocranial
vomiting
Denies rash
nause
mother migraines, FH migraines
F
Disturbed by light
Denies ill contacts
fever
Patient Note: 20YO female 
CC: Headache
HPI: pt reports waking up yesterday morning with a severe headache that has worsened. She states her head hurts all over. She has nausea and vomiting that began yesterday with the headache. She also has a rhinorrhea that began at the same time as the headache. The headache is worse when walking or bending over. She denies vision changes or hearing changes but she does have photophobia. She states she occasionally has headaches, but never this severe.
ROS: negative except as noted above
PmHx: none
Meds: birth control pills
FH: dad: high cholesterol; mom: migraines
Social: works at a sporting good store, does not use tobacco products, occasional alcohol use on the weekends; smokes marijuana 3-4x per week, last use a few days before headache began; sexually active with one male partner, uses condoms

Keywords and phrases relevant to diagnosis:
20YO
yesterday, yesterday
headache all over
vomiting
nausea
rhinorrhea
mom: migraines, FH migraines
female
photophobia
Patient Note: 20yo female patient comes to the clinic with complains of headcahe for 2 days, the pain is dull and achy and its very severe, she has sensitivity to light it affected her job, and doesnt radiates, nothing improves it even with tylenol and it gets worse with walking and bending forward, no history of head trauam, she felt nauseated and vomited 3 times, no blood in vomitous, it is her first episode
ROS: negative except as above
PMH: none
PSH: none
Med: none
FH: mom had migraines, dad has cholestrol
SH: works in a sport store, no smoking, drinks 2-3 beers a week, sexually active with BF of 1y, they use comdoms, no std history
allergies
GYN: lmp was2 weeks ago and it is regular and she uses 3-4 pads

Keywords and phrases relevant to diagnosis:
nothing improves it even with tylenol
20yo
2 days
vomited, vomitous
nauseated
mom migraines, FH migraines
female
sensitivity to light
Patient Note: 20 y/o female presents with headache for the past day. She states she woke up with a headache yesterday morning and denies any precipitating factors. Pain is dull and achy, constant, but gradually getting worse. States she also felt warm this morning, fatigued, and has full body aches. Vomitted 3 times since yesterday, not bloody. States emesis was mostly food and last 2 were green. Eye pain, worse with bright lights. Denies any numbness, tingling, weakness, dizziness, lightheadness. 
ROS: Denies any vision or hearing loss. 
Pmhx: none
Surgical history: none 
Medications: OCP x 2 years 
Allergies None 
Fmhx: Mother has migraines, father has hyperlipidemia. 
Social history: Balanced diet, exercises 2-3 times a week, smokes marijuana 3-4x a week, no tobacco use, drinks 2-3 beers/glass of wine on the weekend. Normal caffeine intake. Works at a sports store. Sexually active with one partner. Never been tested for STDs. Uses condoms.

Keywords and phrases relevant to diagnosis:
20 y/o
past day, yesterday
body aches
Vomitted, emesis
Mother migraines, Fmhx migraines
female
worse with bright lights
felt warm
Patient Note: Ms. Madden is a 20 y/o F who presents with a headache of 1 day. Started yesterday AM, has been constant since then. It is all over, a dull constant ache. She has tried ibuprofen and tylenol which have not helped, and it is worse with walking and bending over. It does not radiate, but she does describe neck pain/tightness. She describes warmth, but no fever, a runny nose, severe nausea accompanied by vomiting, body aches, and the light hurts her eyes. She denies vision changes, hearing changes, ringing in her ears, and focal neurologic deficit, SOB, cough, chest pain, trouble swallowing, change in bowel or bladder habits, denies any numbness in extremities. 
PMH: no 
Psurgery: no
Meds: OCPs 
Allergies: NKDA 
FH: F - hypercholesterol, M - migraines 
Soc: never tobacco use, drinks 2-3 drinks on weekends, smokes marijuana 3-4 joints/week, is sexually active with one partner, no STDS, no pregnancies

Keywords and phrases relevant to diagnosis:
ibuprofen not helped, tylenol not helped
20 y/o
1 day, yesterday
body aches
headache all over
neck pain, neck tightness
vomiting
nausea
runny nose
FH migraines, M migraines
F
light hurts her eyes
warmth
Patient Note: 20 yo female with complaints of severe HA. No hx of headaches previously. Described as dull, throbbing, bilateral constant ache. She woke up with it yesterday morning and has take 4 ibuprofen, 2 tylenol, and slept without resolution. Sensative to light, not to sound. No changes in vision or aura. Denies ringing in ears or dizziness. Associated with vomitting, denies abdominal pain, constipation, or diarrhea. 
PMH: denies
PSH: denies
Meds: OCP for 2 years. 
All: denies
Fam: dad HLD, mom migraines
Soc: denies tobacco, 2-3 alcoholic drinks on the weekends, smokes 3-4 marijuana joints per week

Keywords and phrases relevant to diagnosis:
ibuprofen without resolution, tylenol without resolution
20 yo
yesterday
vomitting
female
Sensative to light
Patient Note: Ms. Stephanie Madden is a 20 year-old woman presenting with the chief complaint of headache. The headache started yesterday morning. She has associated nausea, vomiting x1, subjective fever, and photophobia. She has never had a headache like this before. She has tried over the counter pain relievers and these did not help. Moving around worsens her headache, and bright lights hurt her eyes. The pain is all over her head and is constant. 

PMH: none
Surgical history: none
Meds: birth control pills
NKDA
FH: Mother has migraine headaches. Father has dyslipidemia.

Keywords and phrases relevant to diagnosis:
over the counter pain relievers did not help
20 year-old
yesterday
pain is all over her head, headache over her head
vomiting
nausea
FH migraine, Mother has migraine
woman
photophobia, bright lights hurt her eyes
subjective fever
Patient Note: CC: Headache
HPI: 20 yo F presents with a headache described as a dull, constant ache that started yesterday morning. She has had nausea and vomiting with the headache. She reports it is the "worst headache of her life" and it is all over. She has photophobia and reports the pain is worse when bending forward or walking. She feels achy and has nuchal rigidity. Felt like she had a fever but did not check it. Tried Tylenol, ibuprofen and sleep all without help. She gets rare headaches in the past but nothing this bad. 
PMH: None, Meds: OCP. NKDA
PSH: None
FH: Mother with migraine headaches. Father with high cholesterol. Others healthy.
SH: Lives at home with a roommate, works as a salesperson in a sport store. Does not smoke, drinks 2-3 cups of wine on weekends. Smokes 3-4 joints a week.

Keywords and phrases relevant to diagnosis:
Tylenol without help, ibuprofen without help
20 yo
yesterday
achy
headache all over, headache all over
nuchal rigidity
vomiting
nausea
Lives at home with a roommate
Mother with migraine, FH migraine
F
photophobia
Felt like she had a fever
Patient Note: Ms. Madden is a 20 y/o F presenting for headache since yesterday morning. Episode occurred suddenly w/ no premonition, aura, visual changes. Pain is dull, constant ache that has worsened since yesterday. Pain is equal on both sides of the head. Patient has never experienced this before. No changes in health except the patient felt more tired than normal. She has vomited 3x since onset, kept down down fluids but no food. Patient felt warm but did not take her temperature. Patient has photophobia and pain with flex/extension of neck. Patient is achy all over, has scratchy throat, no rash or cough. No numbness/tingling, no focal deficits. No prior medical history, patient takes oral contraceptives. Has tried Tylenol and Ibuprofen for headache, no relief. Fhx of migraines in mother. Patient reports no worsening stressors lately. LMP 2 weeks ago, no pain w/ menses. Drinks 2-3 drinks on weekends, smokes marijuana 3-4 times/week.

Keywords and phrases relevant to diagnosis:
Tylenol no relief, Ibuprofen no relief
20 y/o
yesterday
achy all over
pain neck
vomited
no rash
scratchy throat
Fhx of migraines, migraines in mother
F
photophobia
felt warm
Patient Note: pt is a 20 yr female with 1 day of head ache of entire head and neck stiffness. positive subjective fevers, nausea, and vomiting. feels achy all over. lethargic. pain is dull ache and 8/10. no vision change. sensetive to light. worse with walking and bending over. tried ibuprofen, tylenol, and sleep that did not work. No aura.  nosicik

Keywords and phrases relevant to diagnosis:
ibuprofen did not work, tylenol did not work
20 yr
achy all over
head ache of entire head
neck stiffness
vomiting
nausea
female
sensetive to light
subjective fevers
Patient Note: 20 yo F presenting to clinic with complain to headache. Patient describes that the headache "hurts all over" and began yesterday morning. It has been a constant dull/aching pain. She states that the pain hurts "really bad" and is very worried.  She reports trying Tylenol, ibuprofen, and sleeping it off without any improvement in the pain. Walking and bending forward makes the pain worse. She endorses associated photophobia, subjective fever, and N/V. She also recently experienced rhinorrhea and sore throat. She denies any chills, dizziness, vision changes, cough, SOB, chest pain, numbness/tingling, or changes in urination/bowel movements.
Denies any sick contact or recent travel.
Denies PMH.
Denies any PSH.
NKDA.
Meds: Birth control pill.
Fam Hx: Mom - migraines. Dad - HLD.
Soc Hx: Lives with roommate in apt. Works in sales. Drinks 2-3 beers/weekend. Denies smoking. Uses MJ 3-4x/wk. Sexually active with males.


Keywords and phrases relevant to diagnosis:
Tylenol without any improvement, ibuprofen without any improvement
20 yo
yesterday
headache all over
V
N
rhinorrhea, sore throat
Lives with roommate in apt
Mom - migraines, migraines Fam Hx
F
photophobia
Denies any sick contact
subjective fever
Patient Note: HPI:a 20 yr old F pt c/o headache , generalised, x 1day, worsening with walking and bending forward, fever x1 day, vomiting x3 ep with food particles, h/o runny nose and sorethroat
no tearing eye, asso with discomfort to briht lights
ROS:-ve except above
ALL: none
MEds: none
PMH/PSH: none
FH: migraine in mother, hpercholesterolemia in father
SH:marijuana on weekends, sexuallly active with boyfriend

Keywords and phrases relevant to diagnosis:
20 yr old
1day
headache , generalised
vomiting
runny nose, sorethroat
migraine in mother, FH migraine
discomfort to briht lights
fever
Patient Note: Stephanie Madden is a 20 yo f who woke up yesterday morning with a headache. She says it is dull, non-pulsatile and constant. It was a level 2/10 at first but has risen to a 8/10 currently. This is the first time this has happened. Walking and bending over make it worse. She has tried ibuprofen, Tylenol, and sleeping with no improvement. She also has photophobia, nausea, vomiting, neck pain with movement, and feels warm. Denies changes in vision, aura, confusion. Denies trauma. 
ROS: denies diarrhea, numbness, tingling, lightheadedness, dizziness, or syncope
PMH: none
Meds: OCPs (2 yrs)
Allergies: none
FH: mother with migraines, dad with HLD, sister is healthy
SH: drinks 2-3 beers/weekend, 3-4 joints per month, no tobacco use, sexually active with boyfriend (uses condoms and OCPs), works at a sporting good store


Keywords and phrases relevant to diagnosis:
ibuprofen no improvement, Tylenol no improvement
20 yo
yesterday
neck pain
vomiting
nausea
mother migraines, FH migraines
f
photophobia
feels warm
Patient Note: 20 Y/O F pt attending with headache, one day Hx, 8/10 in severity ,  no similar episodes before, not radiating, all over the head, no increased lacrimation.
+ve Temperatures, +ve photophobia, +ve Vomiting,+ve Neck stiffness. No night sweats. No weakness or numbness or blurring of vision. No weight loss. No recent travel or camping. 
Recent history of runny nose and sore throat. Generalized body aches.
ROS: Nil
PMH : nil
PSH: nil
No allergies.
Meds: OCP for 2 years.
SH : works in sports shop, non smoker, ETOH socially. sexually active with men.
Gyn Hx: LMP 2/52, no reecent pap smear, no pregnancies.


Keywords and phrases relevant to diagnosis:
20 Y/O
one day Hx
Generalized body aches
headache all over the head
+ve Neck stiffness
+ve Vomiting
Recent runny nose, Recent sore throat
F
+ve photophobia
+ve Temperatures
Patient Note: Ms. Madden 20yoF w/ HA of 1d duration. "Really bad" hurts all over, dull ache, getting worse, not relieved by sleep, tylenol, ibuprofen. Worsened with walking. Sensitive to light and neck stiffness. Vomitusx3 yesterday. No prior episodes. No sick contacts. NKDA. On OCP, no other Rx. Non-contributory PMHx. No hospitalizations, UTD immunizations, no trauma, no surgeries. ROS: + subjective fever, + nausea, - syncope, - dizziness, - abd pain, - rashes, - discharge, -dysuria. FamHx: Migraines, HLD. Ob: G0. Sex: Active with 1 male, never been treated for STD, consistent condom use. Soc: Denies tobacco, drinks 2-3 beers on weekends, frequent marijuana use, counselled.

Keywords and phrases relevant to diagnosis:
not relieved tylenol, not relieved ibuprofen
20yo
1d duration
HA all over
neck stiffness
Vomitus
- rashes
nausea
FamHx: Migraines
F
Sensitive to light
No sick contacts
subjective fever
Patient Note: a 20 year old F with a 2 day history of the worst headache shes every had. She reports taht is started yesterday when she woke up at 3/10 and has steadily progressed to 8/10. The pain is all over her head and she describes it as a dull ache. The headache gets worse with walking or bending over and has not been improved by ibuprofen, tylenol, or sleep. She has had headaches before but this is much worse. She endorses photophobia and nausea with 3 episodes of emesis yesterday. She denies any aura and endorses a subjective fever. She endorses general fatigue and soreness in neck and shoulders.
ROS: negative except as above
PMH: negative
PSH: negative
Medications: oral contraception
Allergies: NKDA
Family Hx: mother has migraines, father has hyperlipidemia
Social Hx: denies Tb use, endorses EtOH 2-3 drinks on weekend, endorse marijuana use 2-3 smoking it 2-3 times per week, she is sexually active with one male partner

Keywords and phrases relevant to diagnosis:
not been improved by ibuprofen, not been improved by tylenol
20 year old
2 day, yesterday, yesterday
headache all over her head
emesis
nausea
mother migraines, Family Hx migraines
F
photophobia
subjective fever
Patient Note: 20 YEAR OLD FEMALE WITH A HISTORY OF HEADACHE SINCE YESTERDAY MORNING ACCOMPANIED WITH NECK STIFFNESS. Tylenol and motrin did not help, pain worsened with walking and bending forward. Endorses nausea, vomtiing, warm to the touch, photophobia. Denies blurred visions, vision changes, sick contacts, head trauma, urinary symptoms, bowel movements changes, palpitations, shortness of breath, chest pain, weight changes, or eye discharge. There is no previous medical or family history or previous surgeries. Mom has a history of migraines, dad has high cholesterol. Takes oral contraceptives for the last two years. Patient smokes 3-4 joints of marijuana every week, no tobacco use. Works as a sales person

Keywords and phrases relevant to diagnosis:
motrin did not help, Tylenol did not help
20 YEAR OLD
YESTERDAY
NECK STIFFNESS
vomtiing
nausea
Mom migraines
FEMALE
photophobia
Denies sick contacts
warm to the touch
Patient Note: 20 y o F c/o sudden onset of severe headache when she woke up from sleep, the worst of her life like a bad hangover  since yesterday, dull constant, worsened by walking and bending , not relieved with Ibuprogen, Tylenol not providing much relief. She has associated photosensitivity, and has had 3 episodes of vomiting since yesterday.  A/w runny nose. She feels achy all over, feels warm but hasnt mesaured her temperature. She denies ill contacts, LOC, seizures, weakness, numbness, tingling, rash or drowsiness. ROS is otherwise neg
PMH / PSh - nil
NKA
Meds - OCP x 2 years
FH - migraine in mother, Dyslipidemia in fatehr
Obs / Gyn NC
SH - NO smoking, No EtOH,  4 joints / week
Sexually active with bf

Keywords and phrases relevant to diagnosis:
not relieved with Ibuprogen, Tylenol not providing much relief
20 y o
yesterday
achy
vomiting
denies rash
runny nose
migraine in mother, FH - migraine
F
photosensitivity
denies ill contacts
feels warm
Patient Note: Patient is a 20 year olf female with no past medical history who presents with headache 
- Reports global headache described as dull and constant rated a 8/10 in severity 
- Assocaited photophobia vomiting, with an episode of bilious emesis 
- Assocaited neck and shoulder stiffness
- Reports Subjective fever 
- LMP 2 weeks ago 

-ROS: headache, vomiting, photophobia. Denies phonophobia, changes in vision, weakness, numbness or tingling sensation. 

Medical History: None 
Family History: Mother-migraines, father-hyperlipidemia 
Social History: Seuxally active with boyfriend uses contraception, smokes marijuana 2-3 times per week, denies tobacco use, 2-3 drinks of alochol on the weekends 
Surgical History: None 
Medications: Birth Control

Keywords and phrases relevant to diagnosis:
20 year olf
global headache
neck stiffness
vomiting, vomiting, emesis
Mother-migraines, Family History migraines
female
photophobia, photophobia
Subjective fever
Patient Note: Stephanie Madden is a 20 year old F with a 2 day history of dull, aching headache. It was present on waking yesterday morning and has been constant, progressively worsenign. She reports feeling feverish, photophobia, and exacerbation with walking, bending over. +n/v with 3 episodes of greenish vomitus. No relief with ibuprofen or tylenol. PMH of headaches which last minutes and are much less severe. PSH none. 2-3 beers on weekends. non-smoker. 3-4 joints marijuana  weekly. monogaous with boyfriend and uses condoms and OCPs.

Keywords and phrases relevant to diagnosis:
No relief with ibuprofen, No relief with tylenol
20 year old
yesterday
v
n
F
photophobia
feverish
Patient Note: Ms. Madden is a previously healthy 20 y/o female presenting for headache. Pt says this is the worst headache she has ever had, and describes pain as dull and constant. Pain started yesterday morning, and has progressively worsened to an 8/10. She has had associated nausea and vomiting (3x yesterday). Pain is worse with bending forward and walking, and ibuprofen and sleep have not helped with improving pain. She has been achy all over, with neck pain and runny nose as well. She endorses photophobia, but denies phonophobia. She has not taken her temperature, but says she has felt warm. She denies any head trauma.
ROS: negative except as stated above
PMhx: none, PShx: none
Meds: birth control, ibuprofen as needed
Allergies: NKDA
Fam hx: mom migraines, dad HLD
Social: lives with roomate, works at sporting goods store, no smoking, drinks 2-3 beers every weekend, smokes 3-4 joints per week, sexually active with boyfriend, uses condoms

Keywords and phrases relevant to diagnosis:
ibuprofen have not helped
20 y/o
yesterday
achy
neck pain
vomiting
nausea
runny nose
lives with roomate
mom migraines, Fam hx migraines
female
photophobia
felt warm
Patient Note: CC: headache
HPI: Mrs Madden is a 20 yo F presenting with 1 day hx of headache and states "I have never felt this bad". Headache is diffuse, dull ache in quality, and constant for past 24 hrs. No provoking factors/settings noted. She endorses photophobia, feeling "warm" this morning, nausea, and 3 episodes of vomittus without blood. She denies loss of consciousness. Tylenol, Ibuprofen, and sleep have not alleviated the pain.
ROS: negative except as stated above
Meds: Ibuprofen and Tylenol as needed, regular OCP
Allergies: NKDA, no other allergies
PMH: none
PSH: none
Social: lives with roomate who is not sick, no tobaccuse use, 2-3 glasses of wine per weekend, 3-4 marjuana joints per week (counseled on cessatino)
OBGYN: LMP 2 wks ago, regrular periods, staes she is not pregnante
Sex: sexually active with 1 male partner

Keywords and phrases relevant to diagnosis:
Tylenol not alleviated the pain, Ibuprofen not alleviated the pain
20 yo
1 day
Headache is diffuse, headache diffuse
vomittus
nausea
lives with roomate
F
photophobia
roomate who is not sick
feeling "warm"
Patient Note: Sephanie madden is a 20 yo female presenting with headache. Pain began 1d ago. Pain is diffuse over head. Has been worsening since onset. Described as a dull ache. Pain is not relieved with ibuprofen or sleep. Worsend with walking, bending over. Eye pain is reported with bright light. Patient endorses subjective fever and fatigue. 3x vomiting and nausea since onset of headache.  Denies weight changes, numbness, tinghling, vision changes, hoarsenenss.  muscle weakness, abdonminal pain, chest pain. no head trauma
PMH: none
Allergy; None
medications: taking Oral contraceptive pill daily Surgery: None
No recentillness or hospitalizztion. No recent travel
Family: Mother sufferes from migraines. Father hypercholesteroemia
Social;Alcohol 2-3 drinks on weekends. Smokes 3-4 joints of marajuana weekly. No tobacco use. Lives with roomate works at sport store. Sexually active with men, uses condoms. No sexual transmitted infec tions in past.

Keywords and phrases relevant to diagnosis:
not relieved with ibuprofen
20 yo
1d
headache diffuse
vomiting
nausea
Mother migraines, Family migraines
female
Eye pain bright light
fever
Patient Note: Mrs. Madden is a 20 y/o F complaining of Headaches.

HPI: She woke up yesterday morning with a headache 8/10 in severity. She reports it hurting all over. She has tried tylenol, ibuprofen, and sleep but no relief. It seems to be worse when she is ambulating, or bending forward. She preferred the room light to be turned off in the exam room. She had nausea/vomiting yesterday which was non-bloody.

ROS: WNL except as above
PMH: None
PSH: none
FH: Migraine headache in mother, high cholesterol in father
SH: No Tobacco use, Drinks 2-3 cups of wine on the weekends, smokes 3-4 joints of marijuana per week. Is sexually active with a male partner. She takes birth control and he uses condoms every time. She has never been pregnant.
Medications: Ibuprofen, Tylenol
Allergies: NKDA

Keywords and phrases relevant to diagnosis:
ibuprofen no relief, tylenol no relief
20 y/o
yesterday, yesterday
Headaches all over
vomiting
nausea
Migraine mother, FH: Migraine
Mrs, F
preferred the room light to be turned off