bhatthars/nbme_qna huggingface dataset:
Patient Note: The patient is a 26 year old female presnting for follow-up from the ED for palpitations. ED workup of Complete blood count, Metabolic panel, Cardiac enzymes and ECG were within normal limits. She reports feeling "like my heart is pounding out of my chest" intermittently for the last 5 years with a significant worsening of her symptoms over the last 3 weeks. She was laid off of work 2 months ago and has been more stressed. She also reports associated nausea, throat tightness, hot flashes alternating with feeling cold and clammy as well as one episode of her fingertips tingling. She reports a sense of impending doom and all the prior symptoms occuring at the same time and resolving spontaneously. She denies chest pain but she has also been short of breath during these episodes. ROS otherwise negative. She has no past medical history, no allergies and takes no meds. No family history of illness. No drinking, smoking or illicit drugs. 


Keywords and phrases relevant to diagnosis:
for the last 5 years, for 5 years
female
also short of breath
palpitations, heart is pounding out of my chest
ED workup of Complete blood count, Metabolic panel, Cardiac enzymes and ECG were within normal limits, follow-up from the ED workup within normal limits, follow-up from the ED Complete blood count, Metabolic panel, Cardiac enzymes and ECG were within normal limits
denies chest pain
No illicit drugs
associated nausea
worsening over the last 3 weeks
sense of impending doom
associated throat tightness
feeling clammy
fingertips tingling
laid off of work, more stressed
26 year old
Patient Note: 26yo F with no significant PMH presents with 3 weeks of heart palpitations.  She states she first had them 5 years ago and from then to 3 weeks ago has had maybe 4 occurances.  
3 weeks ago started happening 1-2x a day.  Accompanied by nausea, SOB, throat tightness, cold/clamy skin, but denies dizziness or syncope
went to ED 2 weeks ago when she developed hand numbness in conjunction with one of these episodes: CBC,CMP, Cardiac enzymes and EKG were all WNL at this time
These episodes last 15-30minutes and resolve on their own.  She takes no medications and has  no known allergies
No consistent timing, do not happen at night
She bought a condo 3 months ago and lost her job 2 months ago.  She has an upcoming job interview in 2 weeks.
Denies TOB, EToH or recreational drug use

Keywords and phrases relevant to diagnosis:
first had 5 years ago
F
Accompanied by SOB
palpitations
went to ED 2 weeks ago CBC,CMP, Cardiac enzymes and EKG were all WNL
Denies recreational drug use
Accompanied by nausea
5 years ago to 3 weeks ago had 4 occurances 3 weeks ago started happening 1-2x a day
last 15-30minutes
Accompanied by throat tightness
clamy skin
bought a condo and lost her job
26yo
Patient Note: 26 year old female with no significant medical history presents for multiple episodes of palpitations for three weeks. Episodes come on without provocation, described as heart racing, feeling like something bad might happen including death, shortness of breath, throat tightness, nausea, hot/clammy feeling. Episodes come and go at random, lasting 15-30 mintues at a time. 5 years ago she had 2-3 episodes in a month. 3 weeks ago she had an episode every day for a week. She went to the ED at which time CBC, BMP, EKG, cardiac enzymes were negative. She continues to have an episode every few days since discharge. No recent changes in weight, energy or bowel movements. Mood is okay. No symptoms of anxiety including excessive worrying, preoccupation. No surgical history. No tobacco or illicit drug use. No relevant family history. No psychiatric history. During one episode she noted her hands went numb; has since resolved.

Keywords and phrases relevant to diagnosis:
5 years ago
female
Episodes including shortness of breath
palpitations, heart racing
3 weeks ago went to the ED at which time CBC, BMP, EKG, cardiac enzymes were negative
No illicit drug use
Episodes including nausea
5 years ago she had 2-3 episodes in a month. 3 weeks ago she had an episode every day for a week
feeling like something bad might happen
lasting 15-30 mintues
Episodes including throat tightness
feeling hot, clammy
hands went numb
26 year old
Patient Note: Patient is a 26 year old female presenting in clinic today for evaluation of intermittent palpitations. Patient presented to the ED 2 weeks ago with same symptoms. Workup in ED with CBC, metabolic panel, troponins, ECG within normal limits. Patient has been experiencing these  palpitations for the last 5 years but they have worsened in the last 3 weeks. She describes them as a feeling of her heart "pounding" with associated nausea, shortness of breath, and subjective feelings of alternating hot and cold. She has also recently noticed the subjective feeling of hand numbeness, impending doom during these episodes. They occur every 2-3 days and last 15-20 minutes before resolving spontaneously. They happen at rest and with activity and do not occur in a specific setting. Patient does not drink or smoke, no other recreational drug use. No PMHx. She does note some increased social stressors with recent unemployment and financial burden.

Keywords and phrases relevant to diagnosis:
for 5 years
female
associated shortness of breath
palpitations, palpitations
presented to the ED 2 weeks ago Workup normal, presented to the ED 2 weeks ago CBC, metabolic panel, troponins, ECG normal
no recreational drug use
associated nausea
worsened in the last 3 weeks
impending doom
last 15-20 minutes
feelings hot
hand numbeness
stressors, recent unemployment
26 year old
Patient Note: 26 yo female patinet presents to the office for evaluation of heart palpitation since 5 years ago. Palpitations have been occuring more recently. she refers an episode of hand numbness BL after the palpitation occured. She also refered feeling hot, cold and clammy in the extremity, SOB and nausea. Denies any chest pain during the eipisoed. She worries that somwthing terrible is about to happend. Lab work done last visit was - for any abnormalities. 
ROS: Denies headache, fever, chills, abdominal pain, chest pain, weakeness or loss of sensation in any part of her body with exception of her hands.
PMH: None
PSH: None
Social: Unemployed at the moment. Denies alcohol, smoking and drug use. She walks 3-4 times a week for 30-60 min. Denies any consumption of Cofee or energy drinks. She is in a lot of stress atthe moment, she bought a condo and lost her job. Sexually active with Boyfriend use condoms and - for STD.
FH: Unremarkable

Keywords and phrases relevant to diagnosis:
since 5 years ago
female
Denies any consumption of Cofee or energy drinks
heart palpitation
Denies chest pain, Denies chest pain
Denies drug use
Palpitations have been occuring more recently
feeling hot, clammy
hand numbness after the palpitation occured
bought a condo and lost her job, a lot of stress
26
Patient Note: Pt is a 26 yo f who presents for f/u after being seen 2 weeks ago in ED for palpitations. Prior to ED visit, palpitation would occur at least once throughout the day, multiple days a week. Since being seen in the ED, she has had 1 episode, 3 days ago while watching TV. She describes the events as heart pounding with associated SOB, throat tightness, nausea and feeling hot then cold with clamminess. They last 15-30 min. Frequency has improved since ED but quality of event has remained the same. No FH with these symptoms. No alleviating or aggravating symptoms. No attempted treatment. Of note, Unemployed for past 2 mo., reports as stressful. All workup in ED was WNL. ROS negative for lightheadeness, dizziness, HA, chest pain, abdominal pain, recent illness and edema. No PMH, SH, Allergies, Meds, or FH. Sexually active with boyfriend. No tobacco, illicit drug or alcohol use. Balanced diet with regular exercise.

Keywords and phrases relevant to diagnosis:
f
associated SOB
palpitations, palpitation
seen 2 weeks ago in ED workup in ED was WNL
negative chest pain
No illicit drug use
associated nausea
last 15-30 min
associated throat tightness
feeling hot, feeling clamminess
Unemployed, stressful
26 yo
Patient Note: The Pt is a 26 Asian female presenting with frequent episodes of palpiations for 2 weeks. They are usually 15-30 minutes in time and is usually asosciated with SOB, tighting of throat, feelings of Hot and Cold, Clamy, nausea. She has had one episode of numbs fingers. About 3 weeks ago it go worse but has tappered down since her last ER visit. She lost her job 2 months ago and bought a condo 3 months ago. She currently denies any anxiety, fevers, chills, abdominal pain, joint pain.
PMH negative, denies lupus, HTN, Diabetes
PSH negative
FH Negative all healthy
Social. She is interview for jobs in a couple of weeks, No ETOH/Drugs/Smoking. Single, sexually active with boyfriend only uses condoms. Regular diet. Excerices a few times out of the week
Meds negative
All NKDA

Keywords and phrases relevant to diagnosis:
female
asosciated with SOB
episodes of palpiations
No Drugs
asosciated nausea
3 weeks ago it go worse
15-30 minutes in time
asosciated tighting of throat
feelings of Hot and Cold, Clamy
episode of numbs fingers
lost her job and bought a condo
26
Patient Note: Ms. Whelan is our 26 year old lady coming in due to palpitations.  She said these episodes have been going on for 5 years but have acutely worsened during the last 3 weeks.  She describes them as a pounding and racing sensation of her heart.  She also develops shortness of breath, nausea, a throat tightness and a cold clamminess when they happen, this last episode was also associated with numbness in her fingers. They last approximately 15-30 minutes per episode.  They are followed by a period of tiredness and difficulty concentrating. She has not lost consciousness.  She has had increased stress over the last 3 months buying a condo 3 months ago and losing her job as a sales consultant 2 months ago.  She has never felt overwhelmed
ROS otherwise negative
NO PMH 
No PSH
No FH
NKDA
Social - no Tobacco, alcohol or drug use, lives alone in a condo.  Close with boyfriend. Was a sales consultant, currently looking for work

Keywords and phrases relevant to diagnosis:
going on for 5 years
Ms, lady
develops shortness of breath when they happen
palpitations, racing of her heart
no drug use
develops nausea when they happen
worsened during the last 3 weeks
last 15-30 minutes
develops throat tightness when they happen
clamminess
numbness in fingers
tiredness, difficulty concentrating
increased stress, buying a condo and losing her job
26 year old
Patient Note: 26 yo female presents for palpitations. Palpitations started 5 years ago and worsened in past 3 weeks, now occuring every few days. 2 weeks ago she had episode with associated numbess in fingers. Episodes also include SOB, throat tightening, nausea, and feeling clammy. Also states that she has feelings of impending doom during episodes. Episodes start suddenly and can occur at any time of day with no aggrevating or alleviating factors or triggers. Went to ED 2 weeks ago with CBC, CMP, cardiac enzymes, and EKG normal. She did not experience an episode in ED. ROS otherwise negative. 
PMH- none
PSH - none
Meds- none
All - none
FH - none
SH - no tobacco, drug, or alcohol use. She lives alone. Recent life changes include buying a condo and losing job 3 months ago.

Keywords and phrases relevant to diagnosis:
Palpitations started 5 years ago
female
Episodes also include SOB
palpitations
Went to ED 2 weeks ago with CBC, CMP, cardiac enzymes, and EKG normal
no drug
Episodes also include nausea
worsened in past 3 weeks
has feelings of impending doom during episodes
Episodes also include throat tightening
Episodes also include feeling clammy
associated numbess in fingers
losing job 3 months ago
26
Patient Note: 26 yo female with palpitations 
-Patient's palpitations began 5 years ago, with recent worsening starting about 3 weeks ago 
-Recently these episodes have worsened and occur 1-2x per day, episodes last 15-30 minutes 
-Desribes epsiodes as pounding feeling in chest with increased heart rate and a "feeling like I am about to die"
-Episodes are assoc with SOB, nausea, tightness in throat, hot, cold clamy feeling
-She fears have another episode
-Endorses have many stressors in her life currently 
-Denies cold or heat intolerance, change in bowel movements, change in sleep patterns, worrying about other aspects of life, weakness or nubmness currently, also denies being sad or depressed 
past medical history: none
all: none
meds: none
fam hx: none
occupation: retail and currently looking for a job, currently living alone, denies smoking, alcohol drugs 
surg hx: none obgyn hx: last pd 1 week ago, normal periods no pregnancy

Keywords and phrases relevant to diagnosis:
began 5 years ago
female
assoc with SOB
epsiodes as pounding feeling in chest, palpitations
denies drugs
assoc nausea
worsening 3 weeks ago, recent worsening, Recently episodes have worsened
feeling like I am about to die
last 15-30 minutes
assoc tightness in throat
clamy feeling, hot feeling
stressors
26 yo
Patient Note: Ms Edie Whelan is a 26 year old female who presented for a follow up appointment after going to the ED for heart palpitations.  She states that she has been experiencing palpitations for the past 5 years, but they have increased in frequency over the past 3 weeks.  She describes the episodes as her "heart pounding and racing" for 15-30 mins.  She states that she also feels shortness of breath, nausea, and hot during the episodes, and afterwards she feels cold and clammy.  The episodes are not related to any particular stressors or events, but she states that she has recently purchased a condo and lost her job, so she feels more stress than usual.  
PMH- unremarkable, no medications, NKDA, no surgeries
Social- denies smoking, alcohol use, or illicit drug use
ROS- denies headache, vomiting, diarrhea, muscle cramps

Keywords and phrases relevant to diagnosis:
for the past 5 years
female
shortness of breath, during the episodes
palpitations, palpitations
denies illicit drug use
nausea during the episodes
increased in frequency over the past 3 weeks
episodes for 15-30 mins
feels hot, clammy
recently purchased a condo, recently lost her job, feels more stress
26
Patient Note: 26/f comes to the clinic with co racing of heart for the past 5 years,getting worse, initially 2-3 episodes/month , now 1-2 episodes/day over the past 3 weeks lasting for a minute  its associated with SOB, chest tightness,cold clamy ,feeling hot during the episode,and lack of concentration following,but denies any triggers and resolves on its own.Reports she is feeling stressed over losing her job and buying a new condo.Denies sleeping difficulties, sadness, guilt,worthlessness, suicidal thoughts, denies appetite,bowel,weight,urinary changes,cold/hot intolerance,loc,headache, dizziness
Ros negative as above
PMH none. meds none, nkda
psh none, hosp none, trauma none
fh not significant
OBgyn lmp 1 week ago, regular, not associated with cramps, pap 6months ago normal.
social lives alone, no alochol,no illlicit drug, no smoking use
sexually active with boyfriend, uses protection, no ho sti

Keywords and phrases relevant to diagnosis:
for 5 years
f
associated SOB
racing of heart
no illlicit drug
worse over the past 3 weeks, initially 2-3 episodes/month , now 1-2 episodes/day over the past 3 weeks
clamy, feeling hot
lack of concentration following
stressed, losing her job and buying a new condo
26
Patient Note: CC: f/u palpitations
Ms. Whelan is a 26yo AAF here for f/u of ED visit 2 wks ago for palpitations with numbness of fingers. Has 5yr hx of palpitation episodes lasting 15-30mins, 3 wks ago began happening more frequently once/2-3days. During episodes she has SOB, nausea, throat tightening, and gets hot. Afterwards she feels cold/clammy and has trouble concentrating. No LOC. Denies symps when not having palpitations. No prev seizures. Mood good, no anxiety. No recent travel or illness. 
ROS neg except as above
PMH: none
PSH: none
Fam HX: none
Meds: none
NKDA
Social Hx: no tobac/EtOH/drugs, lives alone, sexually active w/ boyfriend using condoms. Laid off 3 months ago has been stressful.


Keywords and phrases relevant to diagnosis:
Has 5yr hx of palpitation
26yo AAF
she has SOB
here for palpitations
ED visit 2 wks ago
no tobac/EtOH/drugs
3 wks ago began happening more frequently
she has throat tightening
and gets hot, she feels cold/clammy
with numbness of fingers
has trouble concentrating
Laid off 3 months ago has been stressful
26yo
Patient Note: HPI: 26 year old female presented for a follow up of heart palpitations. 5 year history of palpitations, increased in the last 2 weeks, occuring almost every day. they are associated with finger numbing, nausea, shortness of breath, feeling cold and clammy, and a fear of impending doom. they are not triggered by anything specific. she denies chest pain, loss of conciousness, weight or appetite changes, skin and hair changes., change in bowel habit, abnormal mood or sleep changes. the patient reports increased stress after buying a condo and then losing her job.
ROS: nil except as above
PMH: nil
PSH: nil
meds: nil
allergies: NKDA
FH: non contributary
SH: currently unemplyed, lives alone, no alcohol, smoking or drugs use, walks 3-4 times per week, balanced diet, sexually active with BF, uses condoms

Keywords and phrases relevant to diagnosis:
5 year history
female
associated with shortness of breath
palpitations, palpitations
denies chest pain
no drugs use
associated with nausea
increased in the last 2 weeks
associated with fear of impending doom
feeling clammy
finger numbing
increased stress
26
Patient Note: Ms. Whelan is a 26 yeo female who presents for a followup for heart palpitations. She has been having intermittent "heart pounding" for the past 5 years 2-3 times/month but starting 3 weeks ago it occurs 1-2 times per day. 2 weeks ago, it decreased in frequency to 1 time every 2 days. 2 weeks ago, she went to ED for palpitations where all labs WNL. When these palpitations do occur, she feels like her throat feels tight, she has trouble catching her breath, and feels hot and nauseous. Afterwards she feels cold and clammy. She says these palpitations occur randomly and are not associated with exercise or caffeine intake. She does acknowledge that she's been stressed in the past 2 months after losing her job. 
ROS: No chest painheadache, dizziness, blurry vision, lightheadedness, cough, unsteadiness
PMH: none
PSH: none
LMP: last week, 4-5 days, 5 pads/day - normal for her
Meds: None
NKDA
FH: none
SH: no tobacco, EtOH, or drug use


Keywords and phrases relevant to diagnosis:
for the past 5 years
Ms, female
not associated with caffeine intake
When palpitations occur she has trouble catching her breath
palpitations, palpitations, palpitations
2 weeks ago went to ED all labs WNL
No chest pain
no drug use
When palpitations occur she feels nauseous
for the past 5 years 2-3 times/month starting 3 weeks ago it occurs 1-2 times per day
When palpitations occur throat feels tight
feels hot, clammy
stressed, losing her job
26 yeo
Patient Note: 26 yo f presents w/ cc of palpitations that began 5 years ago but have worsened over the last three weeks. 2 weeks ago, she had an episode in which finger nymbess accompanied the palpitations. She went to the ED and CBC, ECG, Metabolic Panel were normal. She states that these episodes have gotten somewhat better since her ED visit. She States that the episodes occur 1-2 times/ day. they last 15-30 minutes and she feels hot, someimes cold, and clammy. and has associated dyspnea. She reports feelings that something bad may happen to her during one of these episodes, but has no overall impairment of function. She denies weight loss, fever, chills, heat or cold intolerance when she isn't having an episode and changes in bowel or bladder function. 
Meds: No medications
All: NKDA
PMHx: None. no surgeries.
FHx: None
SHx: Live in Atlanta. Worked as sales consultant but recently lost her job and can't pay for it. No tobacco, etoh, or drugs.

Keywords and phrases relevant to diagnosis:
began 5 years ago
f
associated dyspnea
palpitations
2 weeks ago went to the ED and CBC, ECG, Metabolic Panel were normal
No drugs
worsened over the last three weeks
feelings that something bad may happen during one of these episodes
last 15-30 minutes
feels hot, clammy
finger nymbess
recently lost her job
26
Patient Note: CC: 26 yo F with palpitations, comes for follow up
HPI: started 5 y ago, got worse 3 weeks ago with episodes every day and 2 weeks ago had an episode with numbness in fingers on both sides. Gets clammy, hot and cold, has a tight throat feeling and SOB during those episodes. Episodes last 15- 30 min, nothing makes them better or worse. Has not had this before. No chest pain, no other pains, no fever, chills, weight loss.
PMH: No hospitalisation, no trauma, no surgeries, no illnesses, no meds, NKDA
FH: noncontributory
SH: lost job and is still looking and stressed, lives alone, no drugs, alcohol or smoking
Sx/OB: LMP 2 weeks ago, regular, sexually active w boyfriend, uses condoms,

Keywords and phrases relevant to diagnosis:
started 5 y ago
F
SOB during those episodes
palpitations
No chest pain
no drugs
got worse 3 weeks ago
last 15- 30 min
tight throat during those episodes
clammy, Gets hot
numbness in fingers
lost job, stressed
26 yo
Patient Note: Edie Whelan is a 26 year odl female who presents to the clinic for follow up after being seeng at the ED for palpatations and finger numbness
- 5 year history of "heart pounding" that has recently increased in frequency over the past 3 weeks
- In past 3 weeks, occuring 1-2 times per day
- No other episodes of finger numbness
- Patient endorses shortness of breath, throat tightening, nausea, episodes of hot flushing followed by cold clammy feeling
- Patient denies menstrual changes, prior episodes of hypoglycemia
PMH - denies
PSH - denis
FH- denies
SH- recently unemployed 2 mo ago, purchased a condo and is stressed she cannot afford to keep it
Denies tobacco, alcohol, drugs. In a monogamous relationship with boyfriend, uses condoms

Keywords and phrases relevant to diagnosis:
5 year history of
female
Denies drugs
recently increased in frequency over the past 3 weeks
hot flushing, clammy
finger numbness, finger numbness
recently unemployed 2 mo ago, 2 mo ago, purchased a condo, is stressed
26
Patient Note: HPI: 26 yo F c/o palpitations X5 years, with increased  frequency recently. Last week she had 2 episodes aday. palpitation episodes are associated with SOB, numbness in the fingers, nausa and feeling hot. She reports having stress in life due to unemployment. patient denies weight , skin,hair or appetite changes. She also denies weakness and menstural abnormalities.
ROS: - except as above.
Meds: none.
All: NKDA.
PMH: - except for similar episodes in the past.
PSH: none.
SH: No tobacco, alcohol, illicit drugs or caffee. sexually active with boyfriend only and use condoms regularly. no hx of STIs, unemployed.
FH: noncontributory.


Keywords and phrases relevant to diagnosis:
X5 years, c/o palpitations X5 years
F, yo F
No caffee
associated with SOB, associated with SOB
palpitation episodes, c/o palpitations, palpitations 2 episodes aday
No illicit drugs
associated with nausa
increased  frequency recently, c/o palpitations with increased  frequency recently
feeling hot, palpitation episodes are associated with feeling hot
numbness in the fingers, palpitation episodes are associated with numbness in the fingers
having stress, unemployment, She reports having stress
26 yo