bhatthars/nbme_qna huggingface dataset:
Patient Note: - 35 yo M with worsening mid epigastric pain for the past 2 months
- Never had this before
- Describes as a gnawing, burning sensation
- Had it once a week, but not 2-3 times a week, with episodes lasting 1-2 hours
- Associated with bloating
- Partially relieved by Tums before
PMH: Back paind and spasms
PSH: None
Meds: Motrin once a week
Allergies: none
FH: Uncle has a bleeding PUD
SH:  Filed for divorce in the last year. Works in contstruction. 1/2-1 PPD for 20 year smoker. Drinks beer occasionally but stopped more recently.


Keywords and phrases relevant to diagnosis:
Uncle has a bleeding PUD
epigastric pain
Motrin
gnawing, burning
bloating
worsening, Had it once a week, but not 2-3 times a week
Drinks beer occasionally
M
past 2 months
Partially relieved by Tums before
35 yo
Patient Note: Mr Hamilton a 35 yo male, presenting with burning non radiating midepigastric pain three days ago of 5/10 intensity .He tried some antacids which used to help but no longer efective.His pain was associated with hiccup for last months together with nausea bloating ,and  his stool getting darker .No vomitting , diarrhea, chest pain , SOB , cough, fever or other constitutional symptoms.
ROS: normal except for above
PMH: low back pains treated with motrins for a year.
PSH : none
SH:construction worker, smoker since was 15 , 0.5-1 , Etoh: quitted recently beacuase of bloating , not sexually active ,no hx of STDs
FH: Uncle with bleeding stomach ulcer.

Keywords and phrases relevant to diagnosis:
Uncle with bleeding stomach ulcer
midepigastric pain
stool getting darker
motrins
burning
bloating, bloating
Etoh: quitted recently
Mr, male
antacids no longer efective
nausea
35 yo
Patient Note: 35M w/ no PMHx/PSHx now p/w 2 months of episodic epigastric pain associated with nausea
- Denies vomiting
- Episodes increasing in frequency lately and epigastric pain now 5/10
- Episodes wake patient up at night and last 1-2 hours
- Previously sx improved with food and TUMS, but not recently
- Episodes are sporadic with no obvious triggers or palliating factors
- Noticed stools are darker in past 2 weeks
ROS: Denies vision changes, numbness/tinginling, chest pain, SOB, urinary or bowel changes, denies recent travel or sick contacts. Negative except as per HPI
FHx: Uncle with bleeding ulcer
Occupation: Construction worker for high-rise buildings
Current smoker since age 15, 0.5-1 pk/day. Denies rec drug use. Not sexually active.


Keywords and phrases relevant to diagnosis:
Uncle with bleeding ulcer
epigastric pain, epigastric pain
stools are darker
increasing in frequency
M
w 2 months
Episodes wake patient up at night
episodic, last 1-2 hours, sporadic
Previously sx improved with TUMS
nausea
35
Patient Note: Mr. Hamilton is a 35 yo male who presents with 2 months of upper abd pain that has been worsening. The pain is burning and nawing, does not radiate , and is a 5/10 severity. The pain comes and goes with no specific associations. Initially tums made the pain a little better but doesn't work any more, nothing makes the pain worse. He also complains of bloating, nausea, no vomiting, and darkening of his stools without diarrhea. No urinary symptoms, no fever/chills.
ROS negative except as above
PMHx backaches
Medications motrin 400mg per week.
FHx: paternal uncle with "bleeding ulcer"
NKDA
patient usually has a few alcoholic beverages a week but has recently stopped due to the abd pain and bloating
smokes 1 PPD for past 20 years
no other drug use
not sexually active

Keywords and phrases relevant to diagnosis:
uncle with "bleeding ulcer"
upper abd pain
darkening of his stools
motrin
burning and nawing
bloating, bloating
worsening
few alcoholic beverages a week
Mr., male
with 2 months
comes and goes
"tums doesnt work any more"
nausea
35 yo
Patient Note: HPI 35 YO M IN OFFICE C/O  BURNING EPIGASTRIC PAIN  IN THE MIDDEL OF HIS CHEST THAT STARTED 2 MONTHS AGO. THE PAIN WAS ONCE A WEEK IN THE BEGINNING BUT NOW IT IS TWICE A DAY. IT IS 5/10 IN SEVERITY.NOTHING AGRRAV/ALLEV THE PAIN. HE NOTICED HIS STOOL IS DARKER THAN USUALL RECENTLY . NO BLOOD IN IT.  HE HAS NAUSEA WHEN HE FEELS THE PAIN BUT NO VOMITING.AT FIRST TUMS HELPED HIM  BUT NO IT ISN'T. THERE IS NO RELATION  OF PAIN TO  FOOD.  DENIES ANY CHANGE IN URINARY OR BOWEL HABIT, NO FEVER , NO COUGH.
ROS NONE EXCEPT AS ABOVE
PMH BACK PAIN MANAGED CONSERVATIVLY, MEDS MORTIN AND TUMS. 
PSH/HOSP/TRAUMA NONE
FH UNCLE HAD BLEDDING PUD 
SH CONSTRUCTORE WORKER, DRINKS OCC, SMOKES 0.5-1 PPD FOR SEVEERAL YEARS

Keywords and phrases relevant to diagnosis:
UNCLE HAD BLEDDING PUD
EPIGASTRIC PAIN
STOOL IS DARKER
MORTIN
BURNING
NOW IT IS TWICE A DAY
DRINKS OCC
M
STARTED 2 MONTHS AGO
NO BLOOD IN IT
"AT FIRST TUMS HELPED HIM  BUT NO IT ISNT"
NAUSEA
35 YO
Patient Note: 35 yo M c/o 2 month history of epigastric pain with a background history of smoking. Pain is burning, does not radiate, nausea, intermittent, severity of 5/10, but no vomiting or diarrhea. Toms helped relieve pain at beginning, but no longer helps. Pain occasionally wakes patient up from sleep. Pain onset unrelated to food consumption.No change to bowel movements or urination, except stool is darker than usual with no blood. Bloating present, but no appetite changes or weight loss. Pain no exacerbated by postural changes.
ROS: negative except as above.
PMH/PSH: back pain (construction worker)
Medications: Toms, Motrin.
Allergies: NKDA.
FH: paternal uncle had bleeding ulcer.
SH: smokes 1/2-1 PPD for 20 years. No illicit drugs. Drinks few beers a week, but not for past couple of weeks. Lives alone, not sexually active. Works as construction worker. Eats fast food or food from food truck. Regular exercise except past couple of weeks.

Keywords and phrases relevant to diagnosis:
paternal uncle had bleeding ulcer
epigastric pain
stool is darker
Motrin
burning
Bloating
few beers a week
M
2 month history
wakes patient up from sleep
intermittent
Toms helped relieve pain at beginning, but no longer helps
nausea
35 yo
Patient Note: 35 yo M c/o pain in the middle of the stomach for a few months. It comes and goes, lasts for 1-2 hours, burning pain, no radiation PS 5/10, alleviated with Tums at first, but nor anymore, no aggravating factors, not related to meals. He sometimes feel nauseated, but not vomitted. No fever, no nightsweats, no change in his bowel movement, appetite, weight, urination. However, he reports black stool without blood sometimes. He also feels fatigue and tired. 
ROS: normal except above
PMH: back pain with muscle aches
Allergies: NKDA
Meds: Motrin for back pain once a week
FH: Uncle has bleeding ulcer
SH: smoking for 20 years 1/2-1 PPD, no EtOH, illicit drug use. He is not sexually active.


Keywords and phrases relevant to diagnosis:
Uncle has bleeding ulcer
pain in the middle of the stomach
black stool
Motrin
burning
M
for a few months
stool without blood
comes and goes, lasts for 1-2 hours
alleviated with Tums at first, but nor anymore
nauseated
35 yo
Patient Note: Mr Hailton, a 35 year old male comes for evaluatiuon of an epigastric tenderness. Patientr had had this pain for 2 months now, its intermittent, ocuring 2 times daily and last about 2 hours when it happens. Pain resolves spontaneously. Pain is rated 5/ 10 in severity, non-radiating  and progressively getting worse. Patient has had darlk stools recently. patient uses motrin very often for body pains.
ROS: no fever, chills, vomiting, urinary symptoms, no receent travels
Pmhx: None
Allergies: NKA
Meds:, Motrin PRN for pain, TUMS
FHX: Pternal uncle with Bleeding gastric ulcer
Social HX: lIVES ALONE, CONSTRUCTION WORKER, drinks ocasionally, smokes 1/2 to 1 PPD. No illicit drug use

Keywords and phrases relevant to diagnosis:
uncle with Bleeding gastric ulcer
epigastric tenderness
darlk stools
uses motrin, Motrin
ocuring 2 times daily, progressively getting worse
drinks ocasionally
Mr, male
for 2 months
intermittent
35 year old
Patient Note: 35 M who presents with 2 months of progressive epigastric abdominal pain. Pain initially occurred a few times per week but has progressed to occurring 2x/day. Pain is not associated with eating or hunger. Initally better with Tums but now nothing makes the pain better. No aggrevating factors. Burning and gnawing in quality. 5/10 in severity. No radiation. Has associated nausea and bloating after meals. For the past week, patient has noticed stool is darker in color. No recent illness

ROS: + nausea; denies: difficulty swallowing, heartburn, sour taste, vomiting, diarrhea, constipation, weightloss, fevers, chills, rashes
PMH: none
PSH: none
FH: uncle with bleeding ulcer
Med: motrin 400mg 1x/wk, Tums
All: none
Social: EtOH 1-2 beer/wk - stopped 3 wks ago due to lack of appetite, Tob: 1/2-1ppd x 20 yrs, not ready to quit, Drugs: none, Work: construction, not sexually active

Keywords and phrases relevant to diagnosis:
uncle with bleeding ulcer
epigastric abdominal pain
stool is darker
motrin
Burning and gnawing
bloating after meals
progressive, progressed to occurring 2x/day
1-2 beer/wk
M
with 2 months
Initally better with Tums but now nothing makes the pain better
nausea, nausea
35
Patient Note: Mr. Hamilton is a 35yo M who presents to the clinic complaining of stomach problems. He states that he has had a burning pain in his upper mid epigastric area that transiently began 2 months ago but is now recurring daily. He initially was using TUMS for relief but now states that it is no longer effective. The pain does not radiate and has occasionally awoken him from sleep. He endorses nausea and some darkening of his stools. 
ROS: negative for vomitting, diarrhea, constipation, cough, or SOB
Meds: TUMS and motrin
FH: uncle diagnosed w/ bleeding ulcer
Social hx: eats mostly from food trucks (e.g. burritos), smokes 1/2-1 ppd of cigarettes since age 15 no interest in quitting today, used to drink a few beers/wk. but that made his pain worse, works in construction
no prior surgeries or hospitalizations

Keywords and phrases relevant to diagnosis:
uncle diagnosed w/ bleeding ulcer
pain in his upper mid epigastric area
darkening of his stools
motrin
burning
now recurring daily
few beers/wk
Mr., M
began 2 months ago
pain has occasionally awoken him from sleep
TUMS is no longer effective
nausea
35yo
Patient Note: A 35 yo M presented with abdominal pain for 2 months
- began 2 months, getting worse, intermittent (2-3/day), sometimes at night, no previous episode
- burning pain, no radiation, 5/10, no trauma
- alleviated by tums; no aggravative factor
- has nausea, dark brown stool (no blood/melena)
- no fever, vomiting
ROS negative except above
MEds Motrin, Tums; Allergies NKDA
PMH/PSH none
SH smoking 20 py, EtOH occasionally, no illicit drugs; work as high elevator constructor; no sexually active
FH Ulcer had bleeding peptic ulcer

Keywords and phrases relevant to diagnosis:
Ulcer had bleeding peptic ulcer
dark brown stool
Motrin
burning
getting worse, 2-3/day
EtOH occasionally
M
for 2 months, began 2 months
sometimes at night
no blood/melena
intermittent
nausea
35 yo
Patient Note: Mr. Chad Hamilton is a 25 yo gentleman presenting with two months of epigastric pain.  Pain is intermittent, rated at 5/10 occurring 2 times daily and lasting 1-2 hours.  Patient reports that originally it was occurring once a week and relieved with Tums, he reports that antacids are no longer helping.  Patient reports nothing that alleviates or worsens his pain.  There is no radiation of the pain, although he generally has some back pain, he treats with motrin. Nausea, no vomiting, no fevers or chills. He has had decreased appetite.  He has had some darker brown stools, no gross blood, no change in consistency. No change in urination. No CP and no SOB.
ROS: otherwise -, PMH/ PSH: back pain  Meds: Motrin and Tums PRN, NKDA
SH: Works in construction,not sexually active,15py smoking pre-contemplation stage of change,was drinking a couple beers weekly,none for 2 weeks, no drugs.
FH: Uncle bleeding pep ulcer.

Keywords and phrases relevant to diagnosis:
Uncle bleeding pep ulcer
epigastric pain
darker brown stools
motrin, Motrin
2 times daily
couple beers weekly
Mr., gentleman
with two months
no gross blood
intermittent
antacids are no longer helping, originally relieved with Tums
Nausea
Patient Note: A 35 YO M C/O EPIGASRIC PAIN X 1 MO , GRADUAL , GETTING WORSE , OCCUR 2 TIMES /DAY AND WAKES HIM UP FROM SLEEP 3 TIMES / WK , AFFECTING HIS DAILY ACTIVITIES. GNOWING IN NATURE , LOCALIZED , 5/10 IN SEVERITY , NOT RELATED TO FOOD ,, AND TUMS ARE NOT WORKING FOR IT ANYMORE. HE FEELS NAUSEATED BUT NEVER VOMIT , HE HAS BLOATING AND AVOIDS FOOD BECAUE OF THAT BLOATING BUT DENIES WEIGHT CHANGES . HE ALSO DENIES CHANGES IN HIS BOWL HABITS .HE HAS NO FEVER  OR JANDICE . HE IS RECENTLY STRESSED BECAUSE HE RECENTLY DIVORCED WITH HIS WIFE.HE DENIES DYSPHAGEA, ODYNOPHAGEA OR BAD TASTE IN HIS MOUTH 
ROS:NO DIZZINESS, NO PALPITATIONS 
PMH : BACK ACHES AS HE'S A CONSTRUCTIOM WORKER 
PSH : NONE    ALLERGIES : NONE
MEDS : MOTLIN ONCE / WK , TUMS ( STOPPED WORKING)
FH : UNCLE HAS BLEEDING PEPTIC ULCER 
SH : SMOKER 1/2- 1 PPD/ 20 YRS , QUIT DRINKING (USED TO DRINK 3 BEERS/WK ) , NO ILLICIT DRUGS , NO SPECIAL DIET , NOT SEXUALLY ACTIVE AS HE'S DIVORC

Keywords and phrases relevant to diagnosis:
UNCLE HAS BLEEDING PEPTIC ULCER
EPIGASRIC PAIN
MOTLIN
GNOWING
BLOATING, BLOATING
GETTING WORSE, 2 TIMES /DAY
3 BEERS/WK
M
WAKES HIM UP FROM SLEEP
TUMS ARE NOT WORKING, TUMS ( STOPPED WORKING
NAUSEATED
35 YO
Patient Note: 35 yo M c/o stomach pain for 2 months.
HPI: The pain gradually started 2 months ago and it is getting worse. It is located in the epigastric area and does not radiate to anywhere. It is a dull and intermittent pain. It last 1-2 hours every time and Tums relieved the pain before. However, Tums did not improve his symptom right now. Nothing makes the pain worse. The severity is 5/10. He also noticed intermittent dark stools in last few weeks and he denies any change in the shape of the stool. He feels tired but denies any change in body weight and appetite. He denies nausea, vomiting or diarreha. 
ROS: negative except as above
PMH: has back and musle pain which was treated wiht OTC NSAIDs
Medications: Tums and NSAIDs, and NKDA
FH: father and uncle had history of bleeding ulcer
SH: construction worker, 0.5 PPD tobacco since 15 years old, EtOH occasionally, no sexually active, eats fast food usually

Keywords and phrases relevant to diagnosis:
father and uncle had history of bleeding ulcer
pain in the epigastric area
dark stools
NSAIDs, NSAIDs
getting worse
EtOH occasionally
M
for 2 months, started 2 months ago
intermittent
Tums did not improve his symptom
35 yo
Patient Note: HPI: 35 YO M CO EPIGASTRIC ABD PAIN, STARTED 2 MO AGO, INTERMITTENT, INCREASED  IN FREQUENCY RECENTLY, 5/10 INTENSITY, USED TUMS TO HELP IT BUT STOPPED AS IT DOES NO LONGER HELP, PAIN IS ASSOCIATED WITH NAUSEA BUT NO VOMITING, ALSO ASSOCIATED WITH BLOATING.  NO RELATION TO FOOD, NO ABNORMAL TASTE IN THE MOUTH, NO COUGH AT NIGHT, NO CHANGE IN BOWEL HABITS, BUT HE NOTICED THAT THE STOOL IS DRAKER THAN USUAL STARTED 3 WKS AGO, ON AND OFF. NO CHESTPAIN, FEVER, WEIGHT CHANGES, BUT HE EATS LESS THAN USUAL BECAUSE OF THE PAIN. HE ALSO DESCRIBES BACK PAIN AND RELATES THE PAIN TO HIS WORK IN CONSTRUCTIONS. 
ROS: - EXCEPT AS ABOVE.
MEDS: USED TO USE TUMS BUT HE DOES NO LONGER USE IT. NKDA.
PMH: BACK PAIN.
PSH: NONE.
FH: UNCLE HAD BLEEDING PEPTIC ULCER.
SH: SMOKES 1/2 TO 1 PPD SINCE AGE 15. DRINKS ETOH BUT CUT DOWN HIS BEERS LATELY. NO ILLICIT DRUGS.

Keywords and phrases relevant to diagnosis:
UNCLE HAD BLEEDING PEPTIC ULCER
EPIGASTRIC ABD PAIN
STOOL IS DRAKER
BLOATING
INCREASED  IN FREQUENCY
M
STARTED 2 MO AGO
INTERMITTENT
USED TUMS TO HELP IT BUT STOPPED AS IT DOES NO LONGER HELP, USED TO USE TUMS BUT HE DOES NO LONGER USE IT
NAUSEA
35 YO
Patient Note: Chad hailton is a 35M with 2 months of epigastric pain. Pain is burning, non-radiating intermittent lasting for 1-2 hour, rated 5/10 severity. Accompanied by nausea, no vomitting. He has noted bloating sensation after every meal and now eatss maller portions. Has noted darker stool. No hematochezia, vomiting, diarrhea, or change in appetite. Feel tired as pain is waking him up in night No fver, chest pain, or palpitatons. mhx: chronic low back pain. surgeries: none. Med: motrin 2 200 tables once/week. Allergies none; family hx: n/a shx: work as construction worker, No recent travel, 20 pack-year smoking history, 2 alcoholic beverage/week (but stopped drinking 2 weeks ago), not sexually active, no hx of sexually transmitted infection. Diet: eats from food trucks

Keywords and phrases relevant to diagnosis:
epigastric pain
darker stool
motrin
burning
bloating sensation after every meal
2 alcoholic beverage/week
M
with 2 months
pain is waking him up in night
No hematochezia
intermittent
nausea
35
Patient Note: 35-year-old male presents with 2 months of epigastric pain which has worsened. Pain is 5/10 in severity, dull knawing pain which strarted gradually. He reports increased frequency of the pain; 2 times per day and each episode lasts about 1 hour. Admits to nausea, no vomiting. Patient reports food avoidance because it makes the pain worse though appetite is otherwise normal. Denies constipation or diarhea or pain any where else in the abdomen. He reports having dark stools for 2 weeks. and admits to feeling fatigued. 
ROS - denied chest pain, SOB, headache, feverm, chills or weight loss. 
PMH: aches and pains
PSH: none
Meds: motrin and tums 
FH: bleedign ulcer in uncle
Social history: 0.5 to 1 ppd for 20 years, few beers per week (now none because makes pain worse), high elevation contruction worker, going through divorce which makes his stressed. Provided counselling on smoking cessation , NKDA, no illicit drug use,

Keywords and phrases relevant to diagnosis:
bleedign ulcer in uncle
epigastric pain
dark stools
motrin
knawing pain
has worsened, increased frequency, 2 times per day
few beers per week
male
with 2 months
nausea
35-year-old
Patient Note: 35-year-old male, has come to the physician's office today because of abdominal pain
- occurred 2 mo ago, intermittnetly, twice a day, in upper middle ABD, intensity 5/10, burning and iching
- feel bloated after eating, neaseated, stool is darker, reduced appetite
- deny vomiting, heart burn, urine changes, fever, constation and diarrhea, weight changes, sleep and mood changes, fresh blood in stool
ROS: neg except as above
PMH/PSH: none
All: NKDA
Med: Methotrix
FH: NONE
SH: 1/2-1ppd for 20 yr, ETOH 1-2 beers a day, reduced recently, no recreatinal drugs, regular GYM exercise, not active sexually

Keywords and phrases relevant to diagnosis:
in upper middle ABD
stool is darker
burning
bloated after eating
twice a day
1-2 beers a day
male
occurred 2 mo ago
deny fresh blood in stool
intermittnetly
neaseated
35-year-old
Patient Note: patient is a 35yo male with intermittant buring stomach pains for the last 2 months assicted with nausa but no vomtting. pain is non radating in the epigartric region. not made worse by food inatke or positon change or time of day. has noticed some darknmesing of stool but do change to bowel habits
med: tums/ motrin chronic
allergies: none
pmh: back pain
fmh: unlce bleeding ulcer
smh: smokes 1/2ppd, occaional etoh, -drugs
ros: no dizzyness, palpitation, sob, chest pain, brusing, hetaturia, hemochezia

Keywords and phrases relevant to diagnosis:
unlce bleeding ulcer
pain in the epigartric region
darknmesing of stool
motrin
buring
occaional etoh
male
the last 2 months
no hemochezia
intermittant
nausa
35yo
Patient Note: HPI: Mr. Hamilton is a 35 year old male who presents with "stomach problems". This has now been going on approximatley 2 months. The pain is described as gnawing/burning, and comes and goes. The pain does not radiate. He has experienced nausea, but no vomiting or diarrhea. He has noticed dark stools. He has never had this pain before. He has not noticed an association with foods. Tums helped at first, but now don't help. He denies headache, vision changes, cough, shortness of breath, or chest pain.
PMH: back pain/spasms
PSH: none
Rx: Motrin
FH: Uncle with "bleeding ulcer"
SH: smoked 0.5-1 ppd for 20 years, occasional EtOH until 3 weeks ago, no other drug use, not sexually active, works constuction

Keywords and phrases relevant to diagnosis:
Uncle with "bleeding ulcer"
dark stools
Motrin
gnawing/burning
occasional EtOH
Mr., male
approximatley 2 months
comes and goes
Tums helped at first, "Tums now dont help"
nausea
35 year old
Patient Note: 35 y.o M with 2 month history of abdominal pain in epigastric area. Burning knawing pain that comes and goes. Pain the same over last 2 months. Can occur at any time of day. Used to be relieved by tums but no longer effective. Associated with nausea but no vomiting. Nothing makes it better or worse. Eating makes him feel more bloated. 
PMH: back pain attributed to heavy lifting
FH: uncle has bleeding ulcer
SH: construction worker, divorced, tobacco for last 15 years 1/2-1 ppd, occasional alcohol, no recreational drugs
Meds: motrin 1/wk for back pain
ROS: nausea, darker stools

Keywords and phrases relevant to diagnosis:
uncle has bleeding ulcer
pain in epigastric area
darker stools
motrin
Burning knawing
Eating makes him feel more bloated
occasional alcohol
M
2 month history, last 2 months
comes and goes
tums no longer effective
nausea, nausea
35 y.o
Patient Note: Patient is a 35 yo M who presents with c/o stomach problems. Patient reports onset 2 months ago that have been worsening. Patient reports non-radiating epigastric pain that occurs 2x a day, 3x per week that last 1-2 hours and has burning and gnawing qualities. Patient reports previous relief with tums, but is no longer working. Patient denies association with food. Patient rates pain 5/10. Patient reports associated bloating and early satiety for 2 months, nausea, and melena. Denies vomiting, hematoschezia, heartburn, cough. Patient PMH notable for lower back pain related to construction work. denies PSHx. Medications include motron (2 tablets of 200mg 1x/week) and tums. NKDA. Patient FH notable for uncle with PUD. Works in construction. Drinks 2-3 drinks/week, reports absinence for 2 weeks due to abd sxs. Smoking 0.5-1PPD since 15. Not interesting in quitting. Denies drug use. Not currently sexually active.

Keywords and phrases relevant to diagnosis:
uncle with PUD
epigastric pain
melena
motron
burning and gnawing
bloating
worsening, occurs 2x a day
2-3 drinks/week
M
onset 2 months ago
Denies hematoschezia
tums no longer working
nausea
35 yo
Patient Note: 35 yo M presents with epigastric pain accompanied by nausea for 2 months. Has progressed and occurs twice a day and 3 nights a week. Pain is waking him up from sleep. Intermittent, burning pain with 5/10 in intensity. No relationship of food to pain. Noticed darker stool the past 2 weeks, on and off. Feeling bloated after eating which is making him eat less. Has a good apetite, no changes in weight. Significant stress, divorce and work related. Pain was alleviated with tums previously not anymore. Denies diarrhea or constipation, fresh blood. No fever or chills. 
ROS:negative except as above
Allergies: nkda
Medications: tums, motrin
PMH: back ache, spasms
SH: construction worker, lives alone, One sexual partner and regular use of condoms. EtOH use of a few beers a week since age 21, cut down since symptoms of bloating. Tobacco use of 1/2-1PPD since age 15. No use of illicit drugs
FH: uncle with a bleeding ulcer.

Keywords and phrases relevant to diagnosis:
uncle with a bleeding ulcer
epigastric pain
darker stool
motrin
burning
bloated after eating, bloating
Has progressed, occurs twice a day
few beers a week
M
for 2 months
Pain is waking him up from sleep
Denies fresh blood
Intermittent
Pain was alleviated with tums previously not anymore
nausea
35 yo