bhatthars/nbme_qna huggingface dataset:
Patient Note: 67-year-old female, has come to the physician's office because of trouble sleeping. Started 3 weeks ago for the first time after his son died and since it sarted it is getting worst. Describe as problems to fall to sleep and wake up early in the morning tht don't improves even when she took a ambien for the last 5 days. Also she reports feel tire during the day but can't take a nap because can't fall to slee. Refers feel sad, drained,  loss in interest, eating more and feel safe at home. Denied plan to harm herself or otherm headaches, weakness, nubness, adominal pain, chest pain, joint pain, changes in bowel or urinary habits, convulsions,changes in weight, fever o SOB. 
ROS: none except above
PMH: HBP
MED: HCTZ, beta blocker
ALL: NKDA
PS: none, no trauma
OBG: LMP at 52 y/o

SH: retired marriage with children, no smoke, 2-3 glass wine at weeks, no ilicit drugs, sexually active with husband, no STDs


Keywords and phrases relevant to diagnosis:
eating more
3 weeks ago son died
female
67-year-old
problems to fall to sleep
Started 3 weeks ago
"cant take a nap because cant fall to slee"
"dont improves even when she took a ambien"
tire during the day, feel drained
loss in interest
wake up early
Denied plan to harm herself
trouble sleeping
Patient Note: Mrs. Wicks is a 67 year old female who presents with 3 weeks of trouble sleeping. She has been sleeping 4-5 hours per night since the death of her son Leonard on July 5. She reports that she has had trouble falling asleep, she tosses and turns, and is tired and has low energy during the day. She has been taking Ambien for the past 5 nights but has not seen an improvement. She has lost interest and has diffculty concentrating on her hobbies but is still able to complete her ADLs. She does not feel guilt. Her appetite has increased, but she denies weight gain. She denies suicidal and homicidal ideation and says her husband has been supportive. Denies cold intolerance, changes in skin or bowel habits.
PMH: HTN, breast cancer in remission for 10 yrs
Meds: HCTZ 25mg once daily, lisinopril 20mg once daily
SH: never smoked, occasional wine, none for past 3 weeks, no recreational drugs
FH: father died of stroke age 75, mother h/o depression

Keywords and phrases relevant to diagnosis:
appetite has increased
death of her son Leonard on July 5
Mrs, female
tosses and turns
67 year old
trouble falling asleep
with 3 weeks
taking Ambien has not seen an improvement
tired, low energy
lost interest
mother h/o depression
denies suicidal ideation
trouble sleeping, sleeping 4-5 hours per night
Patient Note: 67 y/o female with 3 weeks of insomina. She has trouble falling asleep; it takes up to one hour to fall asleep. She wakes up often in the middle of the night tossing and turning without need to go to the bathroom. She also wakes up earlier than usual. Her sleep time is from 11pm till 4-5 am at this point. She often feels very tired in the morning and throughout the day. This has occurred every day for the past 3 weeks. She lost her son 3 weeks ago, and is dealing with that. She has a strong support system at home. She has not consumed more alcohol than usual. She has low interest in her activities, low energy, increased appetite, no suicidal ideation or homicidal ideation. She has auditory halcuinations thinking the neighbors are having a party. She has visual hallucination of seeing her son even though he is not there.
PMHx: HTN, breast cancer 10 years ago
PSHx: lumpectomy, appendectomy
Social: Lives w/ husband. 2-3 drinks per week.

Keywords and phrases relevant to diagnosis:
increased appetite
lost her son 3 weeks ago
female
auditory halcuinations
tossing and turning
67 y/o
trouble falling asleep, takes up to one hour to fall asleep
with 3 weeks, for the past 3 weeks
feels very tired, low energy
low interest
visual hallucination
wakes up earlier than usual
no suicidal ideation
insomina, wakes up often in the middle of the night
Patient Note: 67 year old F presening with a history of difficulty sleeping for the past few weeks. She states that it takes her longer to fall asleep, she tosses and turns throughout the night and she gets up earlier than usual. Her son recently passed away on September 30 which she associates with the onset of her trouble sleeping. Currently sleeping about 4-5 hours a night. Tried ambien, did not help. Has had visual hallucination of her deceased son. Increase in appetite over the past few weeks, has no energy, no longer takes evening walks, and has lost interest in her hobbies. Denies feeling guilt, She states she has a strong support system. Denies suicidal ideation. Denies, blurred vision, chest pain, SOB. 
PMHx: HTN, breast cancer; Meds: HCTZ, lisinopril; NKDA; Surg: lumpectomy, laparotomy for appendix; Gyn: G1P1, vaginal birth no complications; menopause age 52
FHx: father deceased age 75 stroke, HTN, hypercholest; mother depression

Keywords and phrases relevant to diagnosis:
Increase in appetite
son recently passed away
F
tosses and turns
67 year old
longer to fall asleep
past few weeks
ambien, did not help
no energy
lost interest
visual hallucination of her deceased son
mother depression
gets up earlier than usual
Denies suicidal ideation
trouble sleeping, sleeping about 4-5 hours a night, difficulty sleeping
Patient Note: 67 Y/O F C/O SLEEPING PROBLEMX 1 MONTH AGO AFTER HER SON PASSED AWAY. SHE HAD DIFFICULLTY FALLING ASLEEP, GETTING UP EARLY IN MORNING. REPORTS FEELING SAD ,SEEING HER SON 3 DAYS AGO AND HEARING SOME PARTY VOICES LAST NIGHT THAT NOONE ELSE CAN HEAR. SHE HAS POOR ENERGY, LACK OF CONSENTRATION, ANHEDONIA, BUT SHE CAN TAKE CARE OF HERSELF, AND HAS A GOOD SUPPORT FAMILY AND FRIENDS. ALSO REPORTS THAT SHE EATING MORE THAN USUAL. DENIES FEELING GUILTY, WEIGHT LOSS, CONTROLED BY SOMEONE ELSE, SUICIDAL THOUGHTS, 
ROS:NEGATIVE EXCEPT AS ABOVE/PMH: HTN/PSH:NONE/MEDICATIONS: HTCZ. LISINOPRIL/FH: MOHTER HAD DEPRESSION/ SH: NOT SMOKER. 2BEERS/ WEEK. USES APN FOR LASTFEW  DAYS

Keywords and phrases relevant to diagnosis:
EATING MORE THAN USUAL
1 MONTH AGO SON PASSED AWAY
HEARING SOME PARTY VOICES LAST NIGHT THAT NOONE ELSE CAN HEAR
67 Y/O
DIFFICULLTY FALLING ASLEEP
X 1 MONTH
POOR ENERGY
ANHEDONIA
SEEING HER SON 3 DAYS AGO
MOHTER HAD DEPRESSION
GETTING UP EARLY IN MORNING
DENIES SUICIDAL THOUGHTS
SLEEPING PROBLEM
Patient Note: HPI:67 Y F c/o trouble sleeping since last 3 weeks, son died in a motor vehicle accident 3 weeks ago when the symptoms started,takes AMPIEN for problem but not relieved completely. no compla complains of eating more since then, no complaints of,no weight gain, constipation.

PMH:kc/o high blood pressure takes HCTZ since last 15 years and LIsinopril since last 5 years, h/o breast cancer- lumpectomy 10 years ago
 h/o laparotomy for appendicitis at 20 years of age, no history of travel
FH: not significant

SH: retired receptionist, lives with husband,
      no smokig, drinks occasionally,  no recreational drugs
      sexually active with husband

Keywords and phrases relevant to diagnosis:
eating more
son died 3 weeks ago
F
67 Y
last 3 weeks
takes AMPIEN not relieved completely
trouble sleeping
Patient Note: 67 year old woman with hypertension and history of breast cancer in remission here with difficulty sleeping for past 3 weeks since son passed away in MVA. 
-  prior to 3 weeks ago, slept 8 hours per night. 
- since son passed away, has taken1 hr to fall asleep, tossed and turned through the night, and wakes at 4-5 am. 
- no changes to sleep hygeine - no screen time, though decreasd exercise. 
- Denies feelings of guilt for son's loss, denies SI or thoughts of self-harm, has good social support network. 
- has had hallucination of son but knew it was just a hallucination. also 1 hypnogogic hallucination.
- no snoring, or morning headache, weight loss, or other systemic symptom
- took ambien for past 5 nights, without improvement. 

Meds - hctz, lisinopril, ambien (past 5 nights)
pmhx - breast cancer in remission, HTN. 
fam med - dad with CVA. 
Social - 1-2 glass wine/week, no tobacco or drugs. 
no allergies

Keywords and phrases relevant to diagnosis:
3 weeks since son passed away, 3 weeks ago son passed away
woman
1 hypnogogic hallucination
tossed and turned
67 year old
1 hr to fall asleep
past 3 weeks, prior to 3 weeks ago
ambien without improvement
hallucination of son
wakes at 4-5 am
denies SI, denies thoughts of self-harm
difficulty sleeping
Patient Note: Ms. Wicks is a 61F w/ insomnia. Difficulty falling asleep, with frequent awakenings, only getting 4 hours total/night and feeling fatigued. Does not look at screens before bed or spend time in bedroom when not trying to sleep. She does not snore. Her son passed away on August 9th of this year, and she has been grieving. Reports sad mood, anhedonia, decreased energy, increased appetite. Denies psychomotor agitation/retardation, guiltyness, difficulty concentrating, and suicidal ideation. No history of mania. Also reports she "saw her son" in the living room, although she knew he was not there. Denies prior hallucinations, paranoid thinkings, ideas of reference, or thought broadcasting. No sensitivity to temperature, skin/hair changes, or cahnges in bowel movements. PMH: HTN, breast cancer, PSH: lumpetomy, laparotmy. Meds HCTZ, lisinopril, ambien. NKDA. SH: 2/3 ETOh/wk. No drugs or tobacco. FH: Mother depressed. Father: HTN. Sexual




Keywords and phrases relevant to diagnosis:
increased appetite
son passed away on August 9th
Ms., F
61
Difficulty falling asleep
feeling fatigued, decreased energy
anhedonia
"saw her son" in the living room, although she knew he was not there
Denies suicidal ideation
insomnia, frequent awakenings, only getting 4 hours total/night
Patient Note: Loraine Wicks is a 67 year old female with past history of hypertension breast cancer (in remission) presenting for evaluation of difficulty sleeping. She explains that she has difficulty both falling asleep and staying asleep that began 3 weeks ago. At this time, she explained that her son died unexpectedly. She has used ambien to help her sleep for the lat 5 nights, but it has not helped. She gets 4-5 hours of sleep. She indicates an increased appetite, but denies thoughts of hurting self/others, guilt or difficulty concentrating, fevers, chills, night sweats, changes in weight, chest pain, SOB, nausea, vomiting, changes in her hair. Social Hx: follows no particular diet, exercise - walks every day, but has not recently due to her son's death, caffeine - 1 coffee/day. Medical Hx: HTN, breast cancer (in remission). Allergies: none. Surg Hx: lumpectomy, appendectomy, Family Hx: mother - depression, Meds: hydrochlorothiazide, lisinopril

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks ago son died
female
67 year old
difficulty falling asleep
began 3 weeks ago
ambien has not helped
mother - depression
denies thoughts of hurting self
difficulty sleeping, difficulty staying asleep, 4-5 hours of sleep
Patient Note: 67 yo female presents with 3 weeks of insomnia with recent death of son. describes difficulty falling asleep and maintaining sleeps. wakes up multiple times during the night. thinks about son at night. no nocturia. no snoring. reports depressed mood, anhedonia, increase appettite, inability to enjoy activitie, fatigues. reports hearing a party that did not happen and seeing son in kitchen . denies fever, chills, night sweats, weight changes, palpitations, cold symptoms, changes in hair skin or nails, cold/heat intolerance, headaches, dizziness, numbness, weakness, tingling, nausea, vomiting, diarrhea, constipation or other chnages in urianry habits or bowel movements. PMhx: hypertension, breast cancer 10 y ago. PSHx: lumpectomy, laparotomy for appendix. FMHx: hypertension. high cholesterol, stroke in father. depression in mother. NKA. Takes HCTZ, lisniopril, and ambien from friend. No drugs or smoking. drinks 2-3 wine/wk. 0/4 cage. sex

Keywords and phrases relevant to diagnosis:
increase appettite
recent death of son
female
reports hearing a party that did not happen
67 yo
difficulty falling asleep
with 3 weeks
fatigues
anhedonia, inability to enjoy activitie
seeing son in kitchen
depression in mother
insomnia, difficulty maintaining sleeps, wakes up multiple times during the night
Patient Note: Ms. Wicks is a 76 yo F who presents with "trouble sleeping," difficulty falling asleep, and early morning awakening. This started 3 weeks ago. Roughly 3 weeks ago her son passed away. In addition to sleeping difficulties, she has had decreased interest level, decreased energy, increased appetite, no suicidal thoughts, no guilty feelings. Has had visual hallucinations of her son, and has heard voices recently: she has never had previous episodes like this before. No skin/hair changes. She has tried ambien to help with sleep, but it has not helped. No other relieving or exacerbating factors. No increased anxiety or fluctations in mood, no intrusive thoughts. 
ROS: negative except for HPI
Medications: HCTZ for HTN, lisinopril
Allergies: NKDA
PMHx: breast cancer survivor (remission 10 years)
PSurghx: R. breast lumpectomy, laparotomy appendix as a teenager
Socialhx: ret. receptionist, 2-3 drinks/week, no illicit drugs,lives w/husband

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks ago her son passed away
Ms, F
has heard voices recently
difficulty falling asleep
started 3 weeks ago
ambien has not helped
decreased energy
decreased interest level
visual hallucinations
early morning awakening
no suicidal thoughts
trouble sleeping, sleeping difficulties
Patient Note: Pt is 67F who presents with trouble sleeping since 3 weeks ago. Patient states 3 weeks ago her son died suddenly in a MVA and since then she has had trouble sleeping as well as waking up multiple times throughout the night. She has tried taking Ambien but it has not helped. 4 days ago patient states she saw her son in her kitchen, admits she knows it is impossible he could be there. Additionally she heard sounds of party from neighbor previous night, though neightbor states there was no party. 
Patient has lost interest in her favorite activities since events of her son's passing, does not feel guilt, notes decreased energy levels, and increased appetite. Denies decrease in concentration, psychomotor retardation or thoughts of suicide. 1 cup coffee in morning.

ROS: Neg except as stated above
PMH: HTN, Remission Breast Cancer, NKDA
Meds: HCTZ, Lisinopril
EtoH - 2-3 glass wine/week (0/4 CAGE), denies smoking, drugs.

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks ago her son died
F
heard sounds of party from neighbor previous night, though neightbor states there was no party
67
since 3 weeks
tried taking Ambien but it has not helped
decreased energy levels
lost interest
saw her son in her kitchen
Denies thoughts of suicide
trouble sleeping, trouble sleeping, waking up multiple times throughout the night
Patient Note: Mrs. Wicks, 67 yo F presents with 3 week history of difficulty falling asleep, early awakenings, and tossing and turning. She gets 4-5 hours of sleep throughout the night, does not feel refreshed upon awakening, and is tired throughout the day. She tried taking Ambien for the last 5 days but it does not help. Her son passed away 3 weeks ago and she has been feeling sad. She has been seeing her son and hearing late-night parties, which she knows are not real. She also reports loss of interest, low energy, increased appetite. She has a good support system. She has a mild cough which she says is due to someone's perfume. Denies constipation, cold intolerance, hair/skin/nail 
ROS: negative except as above
PMH: HTN
PSH: none
Meds: hydrochlorothiazide, lisinopril
Allergies: NKDA
SH: lives with husband, no tobacco or drugs, couple glasses of wine 2-3 times per week, CAGE 0/4
FH: dad- HTN, high cholesterol, died of stroke; mom-depression

Keywords and phrases relevant to diagnosis:
increased appetite
son passed away 3 weeks ago
Mrs., F
hearing late-night parties, which she knows are not real
tossing and turning
67 yo
difficulty falling asleep
3 week history
Ambien does not help
low energy, tired throughout the day
loss of interest
seeing her son nows are not real
mom-depression
early awakenings
gets 4-5 hours of sleep
Patient Note: HPI: Loaraine Wicks is a 67 y/o female who presents with trouble sleeping for the last 3 weeks. She said this trouble sleeping started around the time of the the death of her son. She used to get 8 hrs a sleep a night, but now she wakes up around 4AM or 5AM with about 3 hours of sleep completed. She has been more fatigued lately, and has had a lost of interest in activities. She had 1 episode of seeing a vision of her son that passed away. She has also had 1 episode of hearing voices outside her door, thinking that it was her neighbor. Ambien has not provided any relief. 
ROS: negative except above. 
Allergies: none 
Meds: hydroclorthiazide, lisinopril 
PMH: HTN
PSH: lumbectomy, appendix removal 
SH: retired, lives with husbadn, no smoking, drinks red wine about 2-3 times per week, no recreational drug usage. 
FH: father had HTN and high cholesterol, mother is 98 with hx of depression 


Keywords and phrases relevant to diagnosis:
3 weeks death of her son
female
1 episode of hearing voices outside her door
67 y/o
last 3 weeks
Ambien has not provided any relief
fatigued
lost of interest
1 episode of seeing a vision of her son
mother hx of depression
wakes up around 4AM or 5AM
trouble sleeping, trouble sleeping, 3 hours of sleep
Patient Note: Mrs. Wicks is a 67 yo woman who presents to clinic with trouble sleeping for the past 3 weeks. She started having trouble sleeping after her son died in an accident. She reports that she has trouble both falling asleep and staying asleep and has been waking up early. She is getting about 4-5 hours of sleep a night. She also reports that she has been sad, had an increased appetite, lost interest in her acitivites, and had a low energy level. She reports that she has seen her son James at the breakfast table and heard a party she knows was not real. She denies any headaches, dizziness, SOB, CP, fevers, chills, nausea, vomiting, weight loss or gain. 
ROS: see above
PMSH: HTn for 15 years
Meds: HCTZ, lisinopril, ambien for the past week
PSH: None
FH: Father had HTN and HLD died of stroke, mother 90 and healthy with depression
SocHx: No tobacco or illicit drugs, 2-3 glasses wine/week, sexually active with husband, retired receptionist

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks after her son died
Mrs., woman
heard a party she knows was not real
67 yo
trouble falling asleep
for the past 3 weeks
low energy
lost interest
has seen her son James at the breakfast table
mother with depression
waking up early
trouble sleeping, trouble sleeping, trouble staying asleep, getting about 4-5 hours of sleep a night
Patient Note: 67 yo F, presents w/ 3 weeks of sleep disturbances.  takes an hour to fall asleep. multiple nightly awakenings, sleeps ~ 4-5 hr each night. no naps during the day. does not snore. 
reports that her son died 3 weeks ago in an MVA. has good support system (husband and close friends). reports this limits her daily activity.
tried sleeping pills but didn't help.
No intolerence to heat/cold. no nighttime sweats.
Meds: HCTZ, lisinopril.
Allergies: none
PMH: High BP, Breast cancer survivor (10 years)
PSH: rt. Lumpectomy 10 ya. Laparotomy and appendectoy in her 20s.
SH: no smoking or drug history. drinks wine 2-3 glasses a week.


Keywords and phrases relevant to diagnosis:
son died 3 weeks ago
F
67 yo
takes an hour to fall asleep
w/ 3 weeks
"tried sleeping pills but didnt help"
limits her daily activity
sleep disturbances, multiple nightly awakenings, sleeps ~ 4-5 hr each night
Patient Note: HPI:67 YO F C/O DIFFICULTY IN SLEEPING X 3WKS, STARTED AFTER SHE LOST HER SON, DIFFICUTY IN FALLING ASLEEP, STAYING ASLEEP AND EARLY MORNING AWAKING, ASSOCIATED WITH FATIGUE, LOSS OF INTERST, FLASHBACKS OF HER SON SITTING IN FRONT OF HER, FEELING SAD INCREASE APPETITE. SHE DENIES COLD INTOERANCE ,CHANGE IN APPETITE, WEIGHT CHANGE, DECREASE CONCENTRATION, FEELING GUILTY, SUICIDAL THOUGHTS. SHE REPORTS THAT SHE HAD A GOOD SUPPORT FROM HER HUSBAND AND FRIENDS.
ROS:NO CHEST PAIN ,CHANGE IN BOWEL OR URINARY HABITS.
PMH:HTN X15 Y, COMPLIANT WITH TX.
MEDS:HCTZ.
SH:NO SMOKES, OCCASIONAL ETOH, NO ILLICIT DRUGS. SEXUALLY ACTIVE WITH HUSBAND.
OB/GY:LMP AT AGE 52.

Keywords and phrases relevant to diagnosis:
INCREASE APPETITE
3WKS, STARTED AFTER SHE LOST HER SON
F
67 YO
DIFFICUTY IN FALLING ASLEEP
X 3WKS
FATIGUE
LOSS OF INTERST
FLASHBACKS OF HER SON SITTING IN FRONT OF HER
EARLY MORNING AWAKING
DENIES SUICIDAL THOUGHTS
DIFFICULTY IN SLEEPING, DIFFICUTY STAYING ASLEEP
Patient Note: 67yo woman presents with 3 weeks of difficulty falling asleep.  3 weeks ago her son was killed in an auto accident.  Pt says that it takes her a long time to fall asleep as shes thinking about her son, and she tosses and turns.  Pt has tried to take naps during the day, but has been unable to fall asleep.  Pt endorses a good support network including a loving and understanding husband.  Pt endorses increased appetite lately.  No change in weight.  Pt describes herself as sad, but not depressed.  She has diminished interest in hobbies, but is socializing.  Pt tried ambien to sleep but it didn't help.  Pt denies chest pain, SOB, fever, chills, nausea, vomiting, abdominal pain.  PMH sig for HTN treated with lisinopril and HCTZ, and pt is a 10yr breast CA survivor s/p lumpectomy.  Pt doesn't smoke, occassional EtOH use, no illicit drugs. Home BPs measurements have been good.

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks ago her son was killed
woman
tosses and turns
67yo
difficulty falling asleep, takes her a long time to fall asleep
with 3 weeks
tried to take naps during the day, but has been unable to fall asleep
"tried ambien to sleep but it didnt help"
diminished interest
Patient Note: 67-year-old female, has come to the physician's office because of trouble sleeping. Patient said her only son died 3 weeks ago unexpectedly in an MVA. Since then she's been feeling sad, eating more, has lost interest in hobbies. Patient describes difficulty falling asleep, tossing and turning and waking up early. Patient also says she saw her son at the kitchen table 4 days ago, but knows he wasn't there. She also states she heard loud "party like noises" from neighbor's house 2 nights ago, but neighbor did not have a party. Patient tried ambien for last 5 days but hasn't helped. No fever, chills, nausea, vomiting, chest pain.

ROS negative except as noted above
PMH - HTN, breast cnacer
PSH - lumpectomy, lap appendectomy
Meds - hctz, lisonpril, ambien
FH - Father - HTN, HLD, Mother - dperession
Social - never smoker, drinks a couple glasses of wine 2-3 nightsper week, no drugs, lives at home with husband.

Keywords and phrases relevant to diagnosis:
eating more
son died 3 weeks ago
female
heard loud "party like noises" from neighbor\s house 2 nights ago, but neighbor did not have a party
tossing and turning
67-year-old
difficulty falling asleep
"ambien hasnt helped"
has lost interest
"saw her son at the kitchen table 4 days ago, but knows he wasnt there"
Mother - dperession
waking up early
trouble sleeping