bhatthars/nbme_qna huggingface dataset:
Patient Note: 17 yo M who complains of sharp, L sided pleuritic chest pain over the anterior chest since yesterday morning when he woke up. THe pain is worse with changes in position and walking and Tylenol q2-4 hrs and albuterol inhaler have not helped with the pain. He reports that the pain may be slightly improved with leaning forward. He reports 3-4 days of congestion, rhinorrhea, muscle aches and subjective fevers. He denies cough, congestion, abdominal pain, SOB, chest pain with exertion N/V/D. He denies sick contacts. He is most worried about being able to get back to rock climbing. 
PMHx: exercise-induced asthma, takes albuterol inhaler (last needed 6 months ago) 
no allergies, PSHx or other meds
FMHx: father has asthma and and HLD. grandfather survived MI few yrs ago 
Social: lives at home with mom and dad. senior in high school, likes to rock climb. Drinks 1-2 beers with friends once/month, denies tobacco, drugs

Keywords and phrases relevant to diagnosis:
subjective fevers
M
17 yo
congestion, rhinorrhea
pleuritic
exercise-induced asthma
chest pain
since yesterday
denies SOB
rock climbing, rock climb
albuterol inhaler have not helped
sharp
Patient Note: Kane Smith is a 17 year old male who presents with chest pain that began yesterday morning when he woke up. Consent from mother. It is a left sided, sharp stabbing pain worse with deep inspiration and movement. Unrelieved with tylenol q 4 hours as per bottle. Reports subjective fever, congestion, myalgias. Denies history of trauma, SOB, angina, numbness, nausea, vomiting, diarrhea, dysuria, abd pain, chest pressure, sick contacts. Senior in high school. Works as carpenter's assistant. Enjoys rock climbing. Participated in both in the last 2-3 days, lots of heavy lifting. PMH of exercise induced asthma controlled with albuterol prn, last used 6 months ago. NKDA. No surgeries. Lives at home with parents. Reports occasional beer and marijuana at parties. No drug use otherwise. Concerned about missing school and what the pain could be. Permission to speak with mother.

Keywords and phrases relevant to diagnosis:
subjective fever
male
17 year old
congestion
worse with deep inspiration
exercise induced asthma
chest pain
began yesterday
Denies SOB
last 2-3 days heavy lifting
sharp, stabbing
Patient Note: Mr. Kane Smith is a 17-year-old male presenting with chest pain since yesterday. He does not recall any precipitating events, including trauma. The pain is primarily located on the left parasternal border and does not radiate anywhere. He describes the pain as sharp and stabby. It is worse when he takes a deep breath and when he moves around. Better with rest. He has tried tylenol and his albuterol inhaler with no relief. Of note, he states that he recently had a stuffy nose and some muscle aches, about 4 days ago. He has been feeling warm for the past several days.
ROS: Denies exertional dypnea, nausea/vomiting, and diaphoresis. Denies changes in bowel habits.
PMH:  Exercise induced asthma
Meds: Albuterol inhaler
NKDA
FH: HA in grandfather at age 70.
SH: Non-smoker. Drinks 1-2 beers occasionally at parties. Has tried marijuana, but no other illicits. SEnior in high school. Works in woodworking. Rock-climbs.

Keywords and phrases relevant to diagnosis:
feeling warm
male
17-year-old
stuffy nose
worse when he takes a deep breath
Exercise induced asthma
chest pain
since yesterday
Denies exertional dypnea
Rock-climbs
albuterol inhaler with no relief
sharp, stabby
Patient Note: 17 yo Male with sharp L sided chest pain for 1 day. worse with deep inspiration. Took tylenol and albuterol inhaler and did not help. Located broadly around the L chest area. 
PMH includes excersize induced asthma. medications are albuterol inhalor for asthma. no allergies, no hospitilizations, no GI symptoms, no Urinary symptoms, no surgeries. 
Endorses a stuffy nose and muscle aches 3-4 days ago. 
Denies tobacco use, some EtOH use socially, denies any drug use. Senior high school student also works as carpenter assistant, lives at home with parents. Will need doctors note for school today. Has been feeling warm/feverish, no weightloss or gain, no night sweats.

Keywords and phrases relevant to diagnosis:
feeling warm, feverish
Male, sharp
17 yo
Endorses a stuffy nose 3-4 days ago
worse with deep inspiration
excersize induced asthma
chest pain
for 1 day
albuterol inhaler did not help
Patient Note: Patient is a 17-year-old man presenting with sharp chest pain that began yesterday morning. He describes the pain as sharp like a knife and occurs every time he takes a depp breath. The pain is located in his left anterior chest and does not radiate. He has tried Tylenol and using his albuterol inhaler without relief. The only aggravating factor is taking a deep breath - he denies the pain being worse or better when leaning foward. Notably, he has had 3-4 days of feeling warm, stuffy nose, and muscle aches. He denies any shortness of breath, racing heart, weight loss/gain, change in bowel movements or urinary frequency/urgency. 
Past medical history: exercise-induced asthma, uses inhaler every 6 months
Past surgical history: none
NKDA
Family history: dad - asthma, paternal grandfather - MI, mom - healthy, older brother - allergies
Social history: no tobacco use, alcohol 1x/month, no illicit drug use, lives with Mom and Dad

Keywords and phrases relevant to diagnosis:
man
17-year-old
3-4 days stuffy nose
aggravating factor taking a deep breath
exercise-induced asthma
chest pain, pain chest
began yesterday
denies shortness of breath
albuterol inhaler without relief
sharp, sharp, like a knife
Patient Note: Kane smith, 17 yo M presents with Left chest pain, sharp, 5/10 at rest, 9/10 during deep inspiration that started yesterday morning. Pain does not radiate. Deep breaths makes pain worse. Nothing makes it better. Rhinnorhea muscle aches and feeling warm for past 3-4 days with possible URI. Used tylenol and albuterol yesterday for pain but did not help; -cough; -headache; -sore throat; -racing heart
ROS: all other ros neg
allergies: nkda
PMH: exercise induced allergies
Meds: Albuterol prn; tylenol prn
PSH: None
SH: 1-2 etoh drinks per month; occasional weed use, used last week; no tobacco use; lives at home with mother, father and 21 yo brother; senior is high school; works part time at carpenter; sexually active with GF; 1 partner in past year; uses condoms; never screened for sti;
FH: Father - asthma and hypercholesterimia; Mother healthy; brother healthy


Keywords and phrases relevant to diagnosis:
feeling warm
M
17 yo
Rhinnorhea, URI
Deep breaths makes pain worse
chest pain
started yesterday
albuterol did not help
sharp
Patient Note: Mr. Smith is a 17 yo male presentign with chest pain. Pain started acutely yesterday, described as sharp chest pain that worsens with breath and movement. No radiation. He has tried tylenol (2 pills every 4 hours) and albuterol inhaler with no relief. Does not know if pain improves with leaning forward. He has had muscle aches, stuffy nose and subjective fever for the past 3-4 days. Denies any N/V, palpitations, abdominal pain, wheezes, headaches. 
ROS negative except for above
PMH: exercise induced asthma, Allergies: NKDA, Medications: Albuterol inhaler, PSH: none
Fam Hx: dad has asthma, high cholesterol, mom is healthy, grandpa had heart attack 
Sexual Hx: Is sexually active with girlfriend, uses condoms, no hx of STIs
Social Hx: Does not smoke or use illicit drugs, drinks beer 1 a month at social occassions

Keywords and phrases relevant to diagnosis:
subjective fever
male
17 yo
stuffy nose
worsens with breath
exercise induced asthma
chest pain
yesterday
albuterol inhaler with no relief
sharp
Patient Note: 17 y/o M with left sided chest pain
patient complaining of left sided chest pain that he woke up with yesterday morning. At rest it is 5/10 intensity, with movement or palpation 7/10. Tried tylenol, no relief. Deep breath causes intense pain too. No trauma to area, no travel, no sick contacts , no cough, no fever but patient feels warm, no nausea vomiting or diarrhea, no weight loss, no dizziness, no sore throat or oltagia. Pain stays localized in same spot. never happened. rock climber 4 days ago. 
PMHx: History of excercize induced asthma, but has not needed inhaler for 6 months. Uses albuterol PRN and tylenol OTC. No allergies. No surgeries. FHx of paternal asthma and HTN, and grandfather had MI at age 70. Does not smoke, occasional beer, uses marajuana (last one week ago). Denies cocaine use. Lives w/ parents and brother, works as carpenter assistent lifting heavy items. + sex, monogamous, w/ women, uses protection.

Keywords and phrases relevant to diagnosis:
feels warm
M
17 y/o
Deep breath causes intense pain
excercize induced asthma
chest pain, chest pain
woke up with yesterday
rock climber 4 days ago, carpenter assistent lifting heavy items
7/10
Patient Note: HPI:  17 YO M C/O LT SIDE CHEST PAIN SINCE YESTERDAY.
- STARTED SUDDENLY, STAY THE SAME, SHARP, NOT RADIATING, INCRSEAE BY MOVEMENTS AND DEEP BRATHING, ALLEVIATED BY TYLENOL
- ASSOCIATED WITH FEVER 100 F, 
- HAS STUFFINESS OF NOSE AND MUSCLE ACHES 4 DAYS AGO
- DENIES COUGH, SOB, PALPITATIONS, DIZZINESS, URINE/WEIGHT/BOWEL HABITS CHANGES, SIMILAR PAIN BEFORE
-ROS: AS IN HPI
PMH: EXERCISE INDUCED ASTHMA X 4 Y
ALLERGY: NKDA
MEDS: INHALOR, TYLENOL
FH: FATHER ASTHMA AND HIGH CHLOESTEROL
SH: HIGH SCHOLL STUDENT, WORK AS CARPENTER ASSISTANT. DRINKS ONCE IN  AWHILE. MONOGAMUS .

Keywords and phrases relevant to diagnosis:
ASSOCIATED WITH FEVER
M
17 YO
STUFFINESS OF NOSE
INCRSEAE BY DEEP BRATHING
EXERCISE INDUCED ASTHMA
CHEST PAIN
SINCE YESTERDAY
DENIES SOB
SHARP
Patient Note: 17 yo male seen with verbal parental consent. He states that he has been having chest pain with deep breathing for the past 2 days. Pain is accompanied by muscle aches, nasal congestions, and subjective fevers. Pain was not relieved by tylenol or albuterol inhaler. Denies cough, weight loss, chest pain, falls, recent trauma, or drug use (e.g. cocaine). Denies sick contacts or recent travel.  
PMH: Exerxcise induced asthma
Medications: albuterol PRN for asthma, last use 6 months ago.
NKDA
Family hx: father with asthma and hyperlipidemia, grandpa with MI at 70 yo, denies hx of sickle cell, marfans, or ehler danlos
Social hx: Senior in high school applying to college, works as carpenter assistant, rock climbs 2-3 times per week and stays active (denies falls), sexually active with one female partner uses condoms, drinks 1-2 beers & smoke 1-2 joints monthly at parties, denies tobacco or other drugs (e.g. cocaine, methamphetamine, MDMA)

Keywords and phrases relevant to diagnosis:
subjective fevers
male
17 yo
nasal congestions
pain with deep breathing
Exerxcise induced asthma
chest pain
rock climbs
not relieved by albuterol inhaler
Patient Note: Kane Smith, a 17-year-old male, has come to the outpatient clinic with chest pain. Mr. Smith's mother has given verbal consent for a history, physical examination, and treatment.
New onset of sharp chest pain , first 5-6 /10 but now is getting worse 7-9/10 in severity 
He is a Carpenter assistant and lifting heavy materials
The pain is worse with movements and deep breathing 
No Nausea , Vomiting , SOB, Bowel or urinary troubles   
PMHx Exercise induce Asthma
Meeds Albuterol As needed 
Alergies none
Pshx : none 
Fhx DAd Asthma , mother healthy , grandfather MI 
Sexually active  use condoms always 
No Drugs , Alchol ocassional ,  tobacco

Keywords and phrases relevant to diagnosis:
male
17-year-old
worse with deep breathing
Exercise induce Asthma
chest pain, chest pain
No SOB
lifting heavy materials
sharp, 7-9/10
Patient Note: Mr SMith is 17yo male who presents with 1 day of acute onset left-sided chest pain. Described as constant sharp stabbing pain that is worsened with deep breathing and movement. Not alleviated by tylenol or albuterol inhaler. He states that he woke up yesterday morning with this pain. At rest this pain is 5/10 but with breathing is 8-9/10 in severity. He also endorses recent fever, muscle aches, and stuffy nose 3-4 days ago. Denies dyspnea, heartburn, change in weight or appetite, cough.
ROS; negative except as above
PMH: exercise induced asthma diagnosed 4y ago
PSH: none
Meds: albuterol inhaler last needed 6mo ago
Allergies: NKDA
FH: Father has asthma and hyperlipidemia, grandfather had MI 2y ago
SH: Senior in high school, carpenter's apprentice. Denies smoking. Drinks beer once a month. Has tried marijuana, but denies other drugs. Sexually active with girlfriend, uses condoms. Active with good diet.

Keywords and phrases relevant to diagnosis:
fever
male
17yo
stuffy nose 3-4 days ago
worsened with deep breathing, pain with breathing
exercise induced asthma
chest pain
1 day of, woke up yesterday with this pain
Not alleviated by albuterol inhaler
sharp, stabbing, 8-9/10
Patient Note: Case of 17 y/o M comes to the clinic because chest pain. Patient report he wake up this morning with pain in his Left chest pain. Pain is sharp, constant, worse with movements, improve if sit still, does not radiates. Patient also report fever, runny nose with with/yelllow mucous, no odor and some muscle pain since 2 days ago. Denies N/V, dizziness, cough, changhe in bowel movements, change in urinary habits, loss of weight, headache.
ROS: negative except as above
PMH: asthma. Meds: albuterol PRN, tylenol. NKDA
PSH/ hospitalization/surgeries: none
FMH: noncontributory
SH: senior student, work as a carpenter assistant and do rock climbings. EtOH social, Weed social last time last week, no smoke. Sexually active with girlfriend use condoms.

Keywords and phrases relevant to diagnosis:
fever
M
17 y/o
runny nose since 2 days ago.
asthma
chest pain, chest pain
report this morning with pain
rock climbings
sharp
Patient Note: Kane Smith, a 17-year-old male, has come to the outpatient clinic with chest pain. Patient describes sharp CP, onset yesterday morning, that is worse with deep inspiration. Tyelonol has not helped the pain. Associated subjective warmth, no chills. Has never had pain like this before. Denies recent trauma, headaches, cough, SOB, sore throat, abdominal pain. Patient has had recent /associated "stuffy nose"/congestion and muscle aches last 3-4 days. Denies sick contacts. 
ROS: per HPI
PMHx: Asthma (exercise-associated). No hospitalizations. Unsure immunizations hx. No trauma, surgeries. 
Allergies: NKDA
Meds: Albuterol prn. Tyelonol prn.
FHx: Father with asthma and HLD, mother healthy. Grandfather had MI, currently better. 
Social: nonsmokers, rare etoh use, does use marijuana occasionally. No IVDU. Sexually active with female partner, uses condoms. Enjoys rockclimbing.

Keywords and phrases relevant to diagnosis:
subjective warmth
male
17-year-old
stuffy nose, congestion
worse with deep inspiration
Asthma exercise-associated
chest pain
Denies SOB
rockclimbing
sharp
Patient Note: Mr. Smith is a 17 year old male here for a chief complaint of "very sharp chest pain every time I breathe." The pain is located in the upper left chest wall and does not radiate. The patient's pain began yesterday upon waking up, and was rated 5/10, but can become a 8-9/10 with breathing. The pain is constant, exacerbated by movement and deep breathing. The patient attempted to alleviate his pain with tylenol and albuterol however this did not alleviate his pain. The patient is a senior in high school, and is unsure of his vaccination history. 

ROS:The patient denies any fever, sob, cough, nausea or vomiting. 
Allergies: none
medications: albuterol PRN, tylenol 
past medical history: exercise induced asthma 
past surgical history: none 
Social history: denies tobacco or ilicit drug usage, drinks 1-2 beers per month, works as carpenter assistant 
Family history: Paternal (asthma, hyperlipidemia), grandfather (MI)

Keywords and phrases relevant to diagnosis:
male
17 year old
pain every time I breathe, exacerbated by deep breathing
exercise induced asthma
chest pain
yesterday
denies sob
albuterol did not alleviate his pain
sharp, 8-9/10 with breathing
Patient Note: 17yr m with mother's consent,  c/o sharp chest pain since yeterday. The pain started gradually, constant, non radiating, exacrebated with deep breaths, movement, walking, relieved with rest however he tries tylenol and albuterol but did not help. 
He also c/o fever, nasal stuffiness and malaise since 3days. 
He exercises regularly at an indoor rockclimbing arena, last time was 3 days ago.
He denies any cough, dyspnea, palpitaions, change in weight or appetie, change in urinary or bowel habits. 
ROS - neg except as above
PMH - Exercise induced asthma for 4yrs, takes Albuterol
PSH - none
Meds - as above
SSH - senior in school, works as carpenter assistant, Occasional EtOH , weed, no smoking. Sexually active with girl friend , uses condoms.



Keywords and phrases relevant to diagnosis:
c/o fever
m
17yr
nasal stuffiness
exacrebated with deep breaths
Exercise induced asthma
chest pain
since yeterday
denies dyspnea
rockclimbing 3 days ago
albuterol did not help
sharp
Patient Note: Mr. Smith is a 17 year male with a past medical history of exercise induceed asthma who presents today for evaluation of chest pain. He says that the pain began yesterday with a sharp stabbing pain that worsens with inspiration. He rates it aboust 5/6 at rest but can increase to a 7, 8, or 9 with deep inspriation. He tried some Tylenol 1-2 over 4 hours but it did not improve. He also used his inhaler without relief. He previously had runnose and muscle aches. He says he felt warm but denies fever, chills, nights sweates, SOB, or palpiations. 

ROS: Negative unless otherwise stated in HPI
PMH: exercised induced asthma
PSH: none
Meds: 1-2 tablets of tylenol but stopped, Albuterol inhaler stopped taking 6mo ago until now
Allergies: none
Socal Hx: senior in hight school, denies tobacco, drinks somes (CAGE:0/4), deneis illicits substnace use
Fam: Father alive asthma HLD, mom healthy, grandfather MI a few years ago

Keywords and phrases relevant to diagnosis:
felt warm
male
17 year
worsens with inspiration
exercise induceed asthma, exercised induced asthma
chest pain
yesterday
denies SOB
used his inhaler without relief
sharp, stabbing
Patient Note: Kane is a 17 yo male here today complaining of chest pain that began yesterday morning. He reports the pain is sharp and isolated to the left side and does not radiate. No Trauma. Reports it is ok when he is sitting but worsens when takes a deep breath and with exercise. Endorses recent fever, stuffy nose, and muscle aches that began 3-4 days ago. Denies joint pain and cough. Reports the pain is constatnt and does not improve with tylenol or albuterol. Pt has a a history of exercise induced asthma and last used his inhaler 6 mos ago for this. His current medications are albuterol and motrin. Denies hospitalizations or surgeries in past, denies urinary frequency, urgency, burning, denies abdominal pain, changes in frequency/'color of bowel movements. Does enjoy rock climbing, lives at home with mom, is senior in High school. Does not use tobacco but does have beer 1x per month. Denies anxiety, useweed occasionally, sex with gf, condoms.

Keywords and phrases relevant to diagnosis:
fever
male
17 yo
recent stuffy nose
worsens when takes a deep breath
exercise induced asthma
chest pain
began yesterday
rock climbing
does not improve with albuterol
sharp
Patient Note: Mr. Smith is a 17 y/o male who presents with a 1 day history of chest pain. The pain began yesterday morning awakening the pt from sleep. Movement and breathing makes the pain worse, nothing makes it better though he tried tylenol and albuterol. Pain is 5/10-9/10 sharp constant pain with no radiation. Located on left sided chest. No previous episodes of chest pain. Pt reports fever but no night sweats or chills. stuffy nose and muscle aches since 3-4 days ago. No ill contacts. Denies headache and cough.
PMH: exercise-induced asthma
PSH: none
MEDS: tylenol 2x every 4 hours yesterday, albuterol as needed (last took yesterday morning)
ALL: NKDA
Social: social drinking, no tobacco, infrequent marijuana use (last took last weekend). Sexually active with girlfriend, consistent condom use. No prior STDs. Exercises by rock climbing , last exercised 3 days ago.

Keywords and phrases relevant to diagnosis:
fever
male
17 y/o
stuffy nose 3-4 days ago
breathing makes the pain worse
exercise-induced asthma
chest pain.
1 day history, began yesterday
rock climbing 3 days ago
nothing makes it better tried albuterol
sharp
Patient Note: Patient is a 17 year old male with a PMHx of asthma complaining of chest pain onset yesterday morning. He describes the chest pain as sharp, non-radiating, and exacerbated by deep inspiration and movement. He notes that the pain has worsened since the onset. He denies SOB, palpitations, nausea and vomiting. Pt confirms a recent illness with myalgias and nasal congestion for three days.
ROS: negative except stated as above
PMHx: exercise-induced asthma
Medication: albuterol as needed
Allergies: none
PSHx: none
FHx: asthma (father), HLD (father), CAD (grandfather)
Social: non-smoker; occasional alcohol; no illicit drug use

Keywords and phrases relevant to diagnosis:
male
17 year old
nasal congestion for three days.
exacerbated by deep inspiration
asthma, exercise-induced asthma
chest pain, chest pain
onset yesterday
denies SOB
sharp
Patient Note: Kane is 17yoM who presents with 1 day of chest pain assocaited with breething and reproducible on palpation. He says that he woke up yeswterday with pain in left center chest and has tried tylenol and his inhaler to no avail. The pain is 5/10 at rest but 9/10 with movement or deep inspiration. He denies a positional quality to the pain and it does not radiate. He denies SOIB, palpiations or worsening of pain with exertion. He mentioned that he has been having runny nose, muscle aches, fevers/chills/night sweats over the past few days.

PMH: exercis induced asthma
PSH: none
Meds: albuterol PRN
All: None
FamHx: HLD and asthma (dad), Mi (grandpa)
SHx: Senior in HS, carpenter assistant, No tobacco or drugs, occacsional alcohol, sexually active with GF with condoms

ROS: As per HPI, otherwise negative 


Keywords and phrases relevant to diagnosis:
M
17yo
runny nose over the past few days
assocaited with breething, 9/10 with deep inspiration
exercis induced asthma
chest pain, pain chest
1 day of, woke up yeswterday with pain
denies SOIB
inhaler to no avail
Patient Note: Kane is a 17yo male with a history of exercise-induced asthma who presents with one day history of chest pain. He describes the pain as deep that is worse with deep breaths. He does not notice a difference in symptoms with change in position such as leaning forward. He also notes 3-4 days of stuffy, runny nose, muscle aches, and subjective fever. No recent travel history.
ROS: as per HPI; no wheeze, SOB, abdominal pain, heartburn, N/V, cough
PMH: exercise-induced asthma
Meds: Tylenol every 4 hours PRN for chest pain; albuterol
Allergies: none
Surgical history: none
SH: student; EtOH 1 beer 1 time per month; no smoking, no drug use; rock climbs
FH: HLD, asthma (dad); MI in 70s (grandfather)

Keywords and phrases relevant to diagnosis:
subjective fever
male
17yo
stuffy, runny nose
worse with deep breaths
exercise-induced asthma, exercise-induced asthma
chest pain
one day history
no SOB
rock climbs