bhatthars/nbme_qna huggingface dataset:
Patient Note: Mr. Hamilton is a 35 yo M who presents today due stomach pain. He states that the pain has been occuring for the past 2 months and comes and goes randomly. Endorses nausea, rates the pain at a 5/10, it is nonradiating. Endorses feeling bloated after meals, diet consists of mostly fast food. Previously noted pain was worse with food. Recent Bowel Movements have been darker than usual. Previously had relief with TUMS, now pain does not go away. Patient takes motrin PRN for aches/pains he experiences while working construction. 
Allergies: NKDA
Meds: Motrin PRN. 
PMH: None
PSH: None 
Fam: Paternal uncle had bleeding ulcer 
Social: drinks few beers per week, smoked since age of 15, 0.5 to 1 PPD, not interested in quitting. No Drug use, not sexually active, no history of STIs.

Keywords and phrases relevant to diagnosis:
Paternal uncle had bleeding ulcer
Bowel Movements have been darker
motrin, Motrin
bloated after meals
few beers per week
Mr, M
past 2 months
comes and goes
Previously had relief with TUMS, now pain does not go away
nausea
35 yo
Patient Note: CC: 35 y/o male patient that comes to clinic due to stomach pain.
HPI: Patient mentions pain began 2 months ago. The pain was described as a 5/10 gnawing, and burning in the epigastric area. It does not radiate or move anywhere else. Mentions having nausea , pain waking him from sleep, bloating, and dark stools since 2 weeks ago. Denies fever , vomiting, diarrhea or weight loss. Not alleviated by antacids anymore.
PMH: Recurrent back aches due to construction work. Takes Motrin
Allergies: None
PSH: Non contributory
FH: Fathers side of family has alcohol problem and bleeding ulcer in stomach.
SH: Patient works in construction. Lives alone. Mentions smoking cigarettes 1 PKD for 15 years. Mentions consuming 2-3 beers a week but having to cut down recently due to bloating.

Keywords and phrases relevant to diagnosis:
Fathers side bleeding ulcer in stomach
pain in the epigastric area
dark stools
Takes Motrin
gnawing, and burning
bloating, bloating
2-3 beers a week
male
began 2 months ago
pain waking him from sleep
Not alleviated by antacids anymore
nausea
35 y/o
Patient Note: Mrs. Moore is a 45 year old female presenting with "nervousness". She reports the nervousness started a few weeks ago and has become constant. She's stressed at work as a English Professor and endorses the nervousness had happened while she is lecturing. She denies a history of panic attacks, anxiety or any alleviating factors. She also reports having trouble going to sleep but getting enough sleep. She complaints of a headache that resolves with tylenol use. She denies any depression, palpitations, sweatness, panic attacks, weight loss or tremors.
PMH: none
PSH: none
Meds: tylenol for headache
NKDA
SH: english professor, 1-2 wine or beer per month, denies smoking or IVDU, monogamous with husband who had vasectomy
FM: father died of MI



Keywords and phrases relevant to diagnosis:
denies palpitations, denies tremors, denies sweatness
nervousness, nervousness, nervousness
denies any depression
denies weight loss
trouble going to sleep
female
45 year old
Patient Note: Karin Moore is a 45 year old F who presents with nervousness. It has occured every day over the last few weeks. It is constant, but is worst on Sundays and Mondays before lecturing on Mondays. She also reports decreased appetite and difficulty falling asleep. She reports no early morning awakenings and sleep is restful. She identifies many triggers in her life. She recently resumed lecturing (she is an English Professor), and is currently taking care of her elderly mother and in-laws. She denies palpitations, diaphoresis, weight loss, weight gain, heat and cold intolerance, palpitations, chest pain, shortness of breath, and diarrhea/constipation.

ROS: Per HPI, otherwise negative.
PMHx: None
PSHx: None
Meds: tylenol
FHx: Father died from MI, mother elderly but healthy. 1 child, healthy.
Allergies: NKDA
Social: english professor. Occasionally drinks alcohol at social occasions, denies tobacco, MJ, illicit drug use.

Keywords and phrases relevant to diagnosis:
denies palpitations, denies diaphoresis, denies heat and cold intolerance, denies palpitations, denies diarrhea/constipation
nervousness
taking care of her elderly mother and in-laws
denies weight loss, denies weight gain
difficulty falling asleep
F
decreased appetite
45 year
Patient Note: Karin Moore, a 45-year-old female, has come to the outpatient clinic with episodes of nervousness. 
- PATIENT REPORTS A FEW WEEKS OF FEELING ANXIOUS. IT WAS PRECIPITATED BY CHANGES IN THER FUNCTION AT WORK.  SHE ALSO TAKES CARE OF SICK MOTHER AND OF HER CHILDREN
- IT'S GETTING WORSE AND IT'S CONSTANT. IT'S ASSOCIATED WITH DIFFICULTY TO SLEEP, NO APPETITE
ROS: NO PALPITATION, CHEST PAIN, CHANGES IN HAIR OR SKIN, SOB, DIZZINESS, LOSS OF INTEREST, CHANGES IN CONCENTRATION
PMH/PSH: NO
ALLERIGIES: NO
MEDICATION: TYLENOL
FH: FATHER - MI
SH: NO SMOKING, ILLICIT DRUGS. DRINKS ALCOHOL OCCASIONALLY. EATS A HEALTHY DIET.
SEXUAL: SEXUALLY ACTIVE WITH HER HUSBAND, LOSS OF DESIRE

Keywords and phrases relevant to diagnosis:
NO PALPITATION, NO CHANGES IN HAIR OR SKIN
nervousness, ANXIOUS
TAKES CARE OF SICK MOTHER
NO LOSS OF INTEREST, NO CHANGES IN CONCENTRATION
DIFFICULTY TO SLEEP
female
NO APPETITE
45-year
Patient Note: CC/HPI: 45yo F c/o nervousness starting few weeks back. she recently had change in work nature from researcher to lecturer. anxiety is most pronounced sunday nights/ monday mornings, when she has to give the lectures. she also reports difficulty falling asleep, esp sunday night. no difficulty staying asleep. she has decreased appetite but hasn't lost any weight recently. ROS normal otherwise.
PMH and PSH: none; allergies NKDA; meds: tylenol for occasional headaches from reading
FHx: father died from heart attack. mother alive and well
OBGYN: LMP 1wk ago, regular, no menorrhagia. 
Sexual Hx: monogomous with husband who got vasectomy; pt concerened about decreased sexual activity w/ husband since onset of nervousness. 
Social: lives at home with mom, husband; drinks alcohol on social occasions only, nonsmoker, exercises 3x/ week, eats balanced diet.

Keywords and phrases relevant to diagnosis:
nervousness, anxiety, nervousness
"hasnt lost any weight"
difficulty falling asleep
F
decreased appetite
45yo
Patient Note: 45 yo f pt come to the outpatient clinic due to nervousness since few weeks ago. Two weeks ago patient switched role in her work as a teacher and has multiple tasks at home that includes nursing. She states that for the past two Sundays and Mondays she has been feeling like these, and reports lose of her appetite. Patient reports this nervousness as been constant and denies previous episodes. Patietn has been having trouble sleeping since she got to bed at 9:30 and does not get sleep after hours. Denies changes in weight, bowel movements, hot intolerance, diaphoresis, palpitations, dyspnea and urinary changes.
ROS: neg except as above
All: NKDA
Meds: Tylenol
PMH: healthy
PShx: none  Trauma: none
Hospitalization: when her children born
Social history: Balanced diet and exercise. Denies toxic habits, except for caffeine use 5-6 times a day. Sexually active with husband. No STD.

Keywords and phrases relevant to diagnosis:
Denies bowel movements, Denies hot intolerance, Denies diaphoresis, Denies palpitations
nervousness, nervousness
caffeine use 5-6 times a day
Denies changes in weight
trouble sleeping
f
lose of her appetite
45 yo
Patient Note: 45 yr old f came to clinic with c/o nervousenss for few weeks. She is nervous all the time, getting worse, nothing helps with the nervousness. The pt is in teaching profession and just switched jobs few weeks ago in her teaching profession. On sunday evening and on monday she is more worried. She had decreased sleep from before. On sundays she had decreased appetite. Pt drinks 5-6 cups of caffeine every day. No h/o sadness, loss of interest, memory changes, or loss of concentration, heart racing. ROS as above; ALLERGIES NKA NKDA; MEDS none; PMH none; PSH none; FH father died of stroke, Mother is doing well; SH monogamous with husband, 2 kids, drinks wine ocassionally on the weekend.

Keywords and phrases relevant to diagnosis:
No heart racing
nervousenss, nervous, nervousness
5-6 cups of caffeine
No h/o sadness, No loss of interest, No loss of concentration
decreased sleep
f
decreased appetite
45 yr
Patient Note: Karin Moor is a 45 yo F with no significant PMH now presenting with 2-3 weeks of constantly feeling anxious, associated with decreased appetite, and difficulty falling asleep. During the last three weeks she has been switched from research to the lecture circut for her work as a professor.  Other life stressors include taking care of her elderly mother and in-laws, having a 17 yo son at home, and having a busy self-employed husband.  She denies palpitations, SOB, nighttime awakenings, chest pain, weakness, abd pain
PMH: none
FH: denies family history of thyroid disease, denies family hx of heart disease, HTN, DM
Medications: occasional Ibuprophen
Allergies: NKA
Social: as stated above
Surgical: none

Keywords and phrases relevant to diagnosis:
denies palpitations
anxious
stressors include taking care of her elderly mother and in-laws
difficulty falling asleep
F
decreased appetite
45 yo
Patient Note: Ms. Moore is a 45yoF with 2-3 week history of "nervousness". She works as a college professor and has recently begun giving lectures; preparing for these lectures increases her anxiety. She also cares for her elderly mother and teenage son who live at home, as well as her elderly in-laws who live nearby. She says she does not get much help from her husband taking care of her mother.

CC: "unbearable, constant nervousness all of the time"
ROS: Some trouble falling asleep, gets around 7 hours of sleep per night. Occasional loss of appetite while nervous. Rarely has headaches which improve with tylenol use. Denies fever, weight loss, palpitations, pain.
Medications: Tylenol as needed for headache.
SocHx: lives with husband, mother, and teenage son.
Smoking history: None
Alcohol: rarely/socially
Drugs: none
FamHx: father died of MI at age 65

Keywords and phrases relevant to diagnosis:
Denies palpitations
nervousness, nervousness, nervous
cares for her elderly mother, cares for her elderly in-laws
Denies weight loss
trouble falling asleep
F
loss of appetite
45yo
Patient Note: mrs Moore 45 yo f present c\o nervousness and anxiety started couple weeks after she started a new job, that where sudden , constant, same severity since started, no allev, aggrev sunday evning and monday morning, no previous episodes. she also reported diffuclty falling asleep, go to bed at 10pm , sleeps 11pm , and decrease appetite. she exersize regularly 3 times \wk , during the day 
she denies depression, suicidal ideation, wt changes, loss of interest, palpitation, heat intolerance, headache, SOB, fever, dizziness, weakness
ROS neg excpet as above 
PMH\meds none.  NKDA
PSH\hosp\trauma\travel none
SH english professor, live with family, sexually active w husband, dont smoke or take illicit drugs, drink ETOH occ

Keywords and phrases relevant to diagnosis:
denies palpitation, denies heat intolerance
nervousness, anxiety
denies depression, denies suicidal ideation, denies loss of interest
denies wt changes
diffuclty falling asleep
f
decrease appetite
45 yo
Patient Note: HPI: 45 yo anxious f comes in clinic with c/o nervousness x few weeks (3) that is constant, progressive and aggravates before delievering a lecture and has no alleviating factor. 
Pt states that she feels nervous especially a night before she has to give a lecture and have problems sociallizing.
PT is also stressed out because she has to take care of her children and ill in laws and has been having difficulty sleeping because of it.
Pt also changed her role in her job from researcher to lecturer recently.
Pt denies any SOB, chest pain, numbness, inc fear of having these attacks in future, hand tremors, sweating, change in bowel/urinary habits, travel/trauma recently.
ROS: neg except above
PM/MED HX: neg    ALL: nka   FHX: father died of IHD    OB?GYNAE: no active compalints.
SHX: no smoking.et

Keywords and phrases relevant to diagnosis:
denies hand tremors, denies sweating, denies change in bowel habits
anxious, nervousness, nervous
stressed has to take care ill in laws
has been having difficulty sleeping
f
45 yo
Patient Note: 45 yo F. CC: nervousness x 3 weeks. Increased stress at work. Change in role from researcher to lecturer. Also many responsibilities at home, caring for elderly mother and in-laws, and 17 and 19 yo sons. Noticed decreased appetite, but forces herself to eat 3 meals a day. Associated with difficulty falling asleep (duration 30 to 60 min), but attaining full 7 hours with no interruptions, no early morning awakenings. Also decreased libido for 2 weeks. Nervousness worsened on Sunday and Monday when preparing for lectures for the week. 
ROS: no recent illness, no headache, dizziness, palpitations, tremors, chest pain, SOB, n/v/d/c, pain
PMH: none, no pasMeds: none, Past hosp/surgeries: 2 vaginal births no complications, FHx: no pysch hx, father passed from acute MI at age 65 yo, no thyroid disease
LMP: 1 week ago 
SHx: English literature professor, no smoking, occasional EtOH, no ilicit drug use, sexually active.

Keywords and phrases relevant to diagnosis:
no palpitations, no tremors, no d, no c
nervousness, Nervousness
responsibilities at home, caring for elderly mother, responsibilities at home, caring for in-laws
difficulty falling asleep
F
decreased appetite
45 yo
Patient Note: 45 yo female presents with complaints of anxiousness for 2-3 weeks. Reports that she is overwhelmed and "has a lot on her plate" with work, taking care of mother, and other responsibilities. Reports decrease in appeitite and difficulty falling asleep. Denies anhedonia, fatigue, decrease in concentration, psychomotor retardation or suicidal ideation. No past suicide attempts. Denies weight gain, cold intolerance, constipation, brittle nails, or hair loss. 
OB/GYN: G2P2, no miscarriages. LMP 1 week ago. regular every 4 weeks. No dysmenorrhea. Sexually active with husband only, husband had vasectomy 18 years ago. 
ROS: negative except for above 
PMH: none 
PSH: none 
Meds: tylenol 
allergiesL none 
FH: dad passed at 65 yo due to MI 
SH: lives with husband, mother, and youngest son. Works as english professor. Occasional EtOH, never smoker or drug use.

Keywords and phrases relevant to diagnosis:
Denies cold intolerance, Denies constipation, Denies hair loss, Denies brittle nails
anxiousness
overwhelmed taking care of mother
Denies anhedonia, Denies decrease in concentration, Denies suicidal ideation
Denies weight gain
ifficulty falling asleep
female
decrease in appeitite
45 yo
Patient Note: HPI: 45 yo F presents with a few weeks of increased nervousness. She has a constant feeling of nervousness in the setting of a new job change and home stresses. She recently swited from a research focused to teaching focused job at the university. She has decreased appetite on Sun evening and Mon morning. She also has had difficultly falling asleep. She feel "overwhelmed". Denies SI or HI. Still enjoys reading at home. Denies SOB, CP, palpitations, diaphoresis, lightheadedness, numbness, tingling, fever, chills, or abdominal comlaints. No change in attention or energy.
PMH: none. Takes occaisional tylenol
FMH: Father had an MI
SH: works as an English teacher. She recently started teaching more instead of research which is stressfull. She aslo takes care of numerous people at home including cousins which is added stress in her life. She feels safe at home and with her husband. Infrequent EtOH use. No tabacco or drugs.
ROS: as per HPI

Keywords and phrases relevant to diagnosis:
Denies palpitations
nervousness, nervousness
people at home added stress takes care of
Denies SI, No change in attention, No change in energy
difficultly falling asleep
F
decreased appetite
45 yo
Patient Note: 45 y/o F with complaints of nervousness since the last few weeks. She has been feeling this way since she changed jobs from a researcher to a professor in school. She says she feels overwhelmed, especially on sundays and mondays. She also has a lot of work load at home as a caregiver to her in-laws, mother, and youngest child. The nervousness is constant but there are no palpitations or feeling of chest tightness. She has not increased her caffeine intake and says she has lost her apetite but still manages to eat healthy. She exercises 3 times a week and has not had any weight loss. Her husband is supportive and helps with taking care of his parents. She has been having difficulty falling asleep. Her work environment is friendly.
ROS: Negative except as above
Allergies: none
Medications: Tylenol occasionally
PSH and PMH: Nothing
SH: Teacher, non smoker, occasional alcohol use
FH: Father died of heart attach, mother alive healthy

Keywords and phrases relevant to diagnosis:
no palpitations, no feeling of chest tightness
nervousness, nervousness
a lot of work load caregiver to her in-laws, mother
difficulty falling asleep
F
lost her apetite
45 y/o
Patient Note: Karin Moore, a 45-year-old female, has come to the outpatient clinic with episodes of nervousness. 
- the symptoms started 2 months ago, suddenlly, it is getting worse, constant no  alleviated or aggavated factors.
- she also c/o increase of symptoms in the Sunday evening when she has a apresentation in he school, she has loss of energy, difficulty to started sleep, occasional headache. 
- she denies, SOB, diarrhea, cold intolencace, constipation, tremors, chest pain, no suicidal toughts.
ROS: none except as above
PNH: none
All: none, Meds: OTC tylenol
Fhx: fther died at age 65 of MI.
Obgyn: LMP 1 week ago, regular periods.
Social: no tobacco use,  occasional alcohol use, no illicit drugs. she works a Englisgh Profession, with stressful at job

Keywords and phrases relevant to diagnosis:
denies diarrhea, denies cold intolencace, denies constipation, denies tremors
nervousness
no suicidal toughts
difficulty to started sleep
female
45-year-old
Patient Note: Karin Moore, a 45-year-old female, is here becuasue of nervousnous for a few weeks. She feels nervous and "overwehlmed" by her life, especially when thinking about her english lectures. Nothing seems to make it better She does not report any hisrtory of anxiety. Denies feeling of being on edge, muscle tension, anhedonia, suicidal thougths. Does endorse loss of apetite, but no weight lost. denies fevers and night sweats, athritis. Does report trouble sleeping (takes 30 to 1 hr to fall asleep). Does not report illicit drug use or smoking.  No significant PMH or PSH or SH.

Keywords and phrases relevant to diagnosis:
nervousnous, feels nervous
Denies suicidal thougths, Denies anhedonia
no weight lost
trouble sleeping
female
loss of apetite
45-year-old
Patient Note: Patient is a 45 year old female presenting with few weeks of neurvousness at all times especially on sunday nights and monday mornings. SHe describes unbearable anxiety that started when she was transitioned at work to more of a lecturing role after 15 years doing research, She has never had this before and nothing makes it better. She has has decreased appetite, but no weight changes, no fatigue, no headaces, no issues with her mood, concentration or energy level. She has severeal stressors including moter living with her, inlaws with health issues and her son living at home. She denies changes in skin or hair, cold/heat intolerance.
ROS: negative except as above
PMH, surgeries, meds: none
Social: no smoking, social drinker, caffiene 5-6 cups/days, no illicit drug use, sexually active with husband, healthy diet, walks 3x/week for exercise
Fam Hx: MI

Keywords and phrases relevant to diagnosis:
no fatigue, denies changes in skin or hair, denies cold/heat intolerance
neurvousness, anxiety
stressors moter living with her, stressors inlaws with health issues
caffiene 5-6 cups/days
no issues with mood, no issues with concentration, no issues with energy level
no weight changes
female
decreased appetite
45 year
Patient Note: 45 yo f c/o nervousness for 1 month. c/o difficulty fallling asleep. takes 1hours to fall asleep. no trouble maintaining sleep or early awakenings. stressors at home and at work. taking care of sick mom and children. works as a english liturature professor. just started to give lectures. drinks 5-6 coffee during the day. no SOB, chest pain, recent headache, fever, chills, changes of hair and skin, hand shaking, heat intolerance, changes to bowel movements. loss of interests, suicidal thoughts. do not feel sad. feel safe at home.
PMH: none. nkda, no rx drug. used tylenol for occational headache. 2 vaginal deliveries.
SH: lmp last week. no smoking. drinks occasionally. no rec drugs. walks 3 times a day.

Keywords and phrases relevant to diagnosis:
no changes of hair, no changes skin, no hand shaking, no heat intolerance, no changes to bowel movements
nervousness
stressors at home taking care of sick mom
drinks 5-6 coffee
no loss of interests, no suicidal thoughts, do not feel sad
difficulty fallling asleep
f
45 yo
Patient Note: 45 y/o F who presents with a several week hx of episodes of nervousness
other symptoms include headaches
occur predictably with regard to work, family, and daily tasks
has affected every aspect of her life
Describes life as very stressful working, taking care of 2 kids, mother and in-laws
Describes husband as supportive, but very busy
Worse Sunday nights and Monday mornings preparing for class
Not alleviated by anything
All: NKDA
Mdx: Tylenol 
PMH: headaches
FHx: Heart attack at 65 (paternal)


Keywords and phrases relevant to diagnosis:
nervousness
stressful taking care of mother and in-laws
F
45 y/o
Patient Note: 45 yo F presents c/o nervousness
- few weeks duration, constantly "feeling nervous", progressively worsening over time
- significant social stressors of being carer for elderly mother who lives with her; also has recently started new job as lecturer
- nervous feeling is worst on Sunday nights / Monday morning prior to work
- no panic attacks, no mood changes, just "feels overwhelmed"
- los of appetite, nausea with no loss of weight
- loss of libido related to nervousness
- no palpitations, no hair / skin changes, no neck lumps, no heat / cold intolerance
ROS: unremarkable
PMH / PSH: nil
DH: tylenol occasionally for headache, nil allergies
FH: father had heart attack, elderly mother is well
SH: non smoker, drinks alcohol occasionally, nil illicit drug use, excessive caffine intake 5 - 6 cups per day, works as lecturer, lives with elderly mother, husband, and teenage son, good social supports, sexually active with husband only

Keywords and phrases relevant to diagnosis:
no palpitations, no hair / skin changes, no heat / cold intolerance
feeling nervous, nervous, nervousness, nervousness
stressors carer for elderly mother, lives with elderly mother
excessive caffine intake 5 - 6 cups
no mood changes
no loss of weight
F
los of appetite
45 yo
Patient Note: 45 Y/O F CAME TO THE CLINIC C/O NERVOUSNESS. SHE HAS THIS SYMPTOM FOR A FEW WEEKS. SHE IS A ENGLISH PROFESSOR. AFTER SHE GAVE LECTURES THE SYMPTOMS STARTED. IT IS WORSE SUNDAY NIGHTS, MONDAY MORNING. SHE HAS NO PREV EPISODES. SHE IS HAVING DIFFICULTY FALLING ASLEEP, SLEEPS 7 H A DAY, WAKES UP REFRESHED. SHE FEELS OVERWHELMED. HER ENERGY LEVEL IS GOOD. HER APPETITE IS NOT LIKE BEFORE, THERE IS SOME DECREASING.
DENIES FEELING SAD, LOSS OF INTEREST, FEELING GUILTY, DIFFICULTY CONCENTRATING., WEIGHT CHANGES, SKIN CHANGES, HAIR CHANGES, TREMOR.
ROS NEG EXCEPT AS ABOVE.
PMH NONE. MEDS TYLENOL OCCASIONALLY. NKDA.
PSH NONE. HOSP TWICE WHEN SHE GAVE BIRTH. TRAVEL/ TRAUMA NONE.
FH FATHER DIED W MI.
SH SEX ACTIVE W HUSBAND, DECREASED SEXUAL DESIRE. NO STDS. SMOKE/ DRUG NONE. ETOH OCCASIONALLY.


Keywords and phrases relevant to diagnosis:
DENIES SKIN CHANGES, DENIES TREMOR, DENIES HAIR CHANGES
NERVOUSNESS
ENERGY LEVEL IS GOOD, DENIES FEELING SAD, DENIES LOSS OF INTEREST, DENIES DIFFICULTY CONCENTRATING, DENIES FEELING GUILTY
DENIES WEIGHT CHANGES
DIFFICULTY FALLING ASLEEP
F
APPETITE IS NOT LIKE BEFORE DECREASING
45 Y/O