bhatthars/nbme_qna huggingface dataset:
Patient Note: HPI - 20 y/o F c/o headache
- Patient reports dull, constant, ache, 8/10 headache that began yesterday morning. Patient notes that headache is worsening.
- Patient was woken from sleep due to headache.
- Aggravating factors include light, bending over, along with walking
- Patient notes no relieving factors after using tyelenol, ibuprofen and sleeping
- Affirms fever, vomiting and feeling sick
- Denies nausea, chest pain, shortness of breath, bowel or urinary complaints, visual field changes, hearing changes, gait imbalance
- LMP 2 weeks ago, regular 28-30 day cycles, not related to headache
ROS - as per HPI. 
ALLERGIES - NKDA
MEDs - OCPs for birth control
PMHx - Noncontributory
PSH - Noncontributory
FM - Mother has h/o migraines. Father has high cholesterol 
SH - Drinks 2-3x on the weekend, denies tobacco usage, affirms marijuana usage 3-4 times per week

Keywords and phrases relevant to diagnosis:
no relieving tyelenol, no relieving ibuprofen
20 y/o
yesterday
vomiting
FM migraines, Mother has h/o migraines
F
Aggravating factors include light
fever
Patient Note: 20-year-old female, has come to the doctor's office complaining of a headache of one day hx. Pian on all head, 8/10 pain scale, dull type, pegressive , constand, and no past episodes. Aggravating by walk and bending over, only minimal relieve with Ibuprofen an tylenol. Also present nauseas, vomiting, nasal discharge, general malayse, and ST. LMP 2 weeks ago. G0P0A0. no trauma. Use a OCP for birht control. 
ROS: negative exept as above
PMH: none
Allergies: NKDA
FH; father hight cholestreol mother migrane
SH: marihuana occationally

Keywords and phrases relevant to diagnosis:
20-year-old
one day
headache all head
vomiting
nauseas
nasal discharge, ST
mother migrane, FH migrane
female
Patient Note: Stephanie Madden is a 20 year old female who presents with a severe headache. She awoke yesterday morning with the headache, and it has been constant since then. It is now an 8/10 in pain, and feels dull. She has thrown up three times since then, and it has not improved with over the counter medications. She says that the headache is worse with bright lights, and denies any changes in vision. She denies any recent trauma, liquid running out of her nose with leaning forward, and denies sick contacts. She is unsure of whether she has had a meningitis shot. She has had headaches in the past, but never any of this severity.

Medications - Daily oral contraceptive pill use
PMH - None
Surgical history - None
FHx - Mother has migraine disorder, dad has hyperlipidemia
Social - Smokes 3-4 joints weekly, no tobacco, 2-3 beers or wine on weekends, uses condoms consistently with boyfriend

Keywords and phrases relevant to diagnosis:
not improved with over the counter medications
20 year old
yesterday
thrown up
unsure of meningitis shot
Mother migraine, FHx migraine
female
worse with bright lights
denies sick contacts
Patient Note: 20 Y OLD F C/O HEADACHE X 2 DAYS 
- STARTED SUDDENLY , CONSTANT , ALL OVER THE HEAD , SHE STATED IT AS VERY SEVER , PREGRASSIVE , NOT ALLEVOIATED BY ANYTHING , EXACERBATED BY MOVING , BENDING FORWARD 
- ASSOCIATED BY VOMITING 3 TIMES , FOOD CONTENT , NAUSEA , AND FEELING WARM 
- SHE FEELS SCRACHY THROAT AS WELL WITH RUNNY NOSE 
- NO TRAUMA , NO LOC, NO WEAKNESS ,
- NO AURA BEFOREE THE HEADACHE 
- NO EYE TEARING , 
ROS : NORMAL EXCEPT AAS ABOVE 
PMH  PSH  : NON
MEDS : OCP FOR 2 Y , TYLNOL 
ALLRGEY : NKDA  
FH : MOTHER HAS MAGRAINE 
SH : NOT SMOKER , COUPLE OF BEERS IN THE WEEKENDS , AND MARIOGGNA USE

Keywords and phrases relevant to diagnosis:
20 Y OLD
HEADACHE ALL OVER THE HEAD
VOMITING
NAUSEA
SCRACHY THROAT, RUNNY NOS
MOTHER HAS MAGRAINE, FH MAGRAINE
F
FEELING WARM
Patient Note: 20y/o F c/o headaches
started when she woke yesterday and is dull and constant, described as the worst headache she has felt and diffuse throughout the head
ibuprofen and tylenol does not make it better, worse with bending and walking
+ve neck pain, fever, nausea and vomiting of food contents and greenish substance, 
+ve hx of photophobia
no hx of visual changes, nasal or ear discharge, cough, chest pain or weight changes, no weakness, tingling or numbness in body parts
no past hx of similar complaints, no HTN, DM or high cholesterol
NKA, no medication use besides ibuprofen and tylenol
mother had migraines and father has high cholesterol
LMP was 2wks ago, regular at 28 days and lasts 5-6days, no dysmenorrhea
no tobacco use, 2-3 beers on weekends and marijuana 3/4 times a week
works at a sporting goods store

Keywords and phrases relevant to diagnosis:
tylenol does not make it better, ibuprofen does not make it better
20y/o
yesterday
headaches diffuse
neck pain
vomiting
nausea
mother migraines
F
photophobia
Patient Note: CC: "ive been having a headache since yesterday"

HPI: Patient is a 20 yo female presenting to the office with fever, aches, and headache since yesterday. She endorses sever neck/head pain when moving her neck from side to side. She also endorses nausea and vomiting. She also admits feeling warm. The pain is severe but she is unable to rate it on a 1-10 scale. She does not have any sick contacts. She endorses photophobia but does not have any worsening with sound. She beleives her vaccines are up to date. 

ROS: see above HPI
Allergies: NKDA
MedS:  OCP for 2 years
PMHx: none
FMHX: dad has HLD, mother has migraines
SHX: lives with room mate, blanced diet, runs 3x /wk, 2-3 drinks on weekend, no smoking, marijuana 3x/wl, sexually active with oone partner condoms 


Keywords and phrases relevant to diagnosis:
20 yo
yesterday, yesterday
aches
neck pain
vomiting
nausea
lives with room mate
FMHX migraines, mother migraines
female
photophobia
does not sick contacts
fever, feeling warm
Patient Note: 20yo F with no PMH who presents with headache starting yesterday morning.  Pt had flu-like symptoms of muscle/joint aches, subjective fever, runny nose, throat soreness.  Developed a gradually worsening to 10/10 holocephalic headache associated with neck stiffness.  Sleep, NSAIDs, and tylenol have not helped.  In the past 24hr patient has vomited gastric contents 3 times.  She denies recent travel or sick contacts.  Pt reports living in an apartment with a roommate.
ROS: No weakness, numbness.  Otherwise negative.

PMH: none
PSH: no surgeries
Rx: Patient takes OCPs.  OTC analgesics as above.  No other meds.
Allergies: none
Social: living in apartment.  no sick contacts
Family: Mother with migraines, father with HLD


Keywords and phrases relevant to diagnosis:
NSAIDs have not helped, tylenol have not helped
20yo
yesterday
muscle/joint aches
holocephalic headache
neck stiffness
vomited
flu-like symptoms, runny nose, throat soreness
living in an apartment with a roommate
Family migraines, Mother with migraines
F
denies sick contacts, no sick contacts
subjective fever
Patient Note: HPI: Ms. Madden, a 20 yo F, presents to the office with c/o headade:
-started yesterday morning and progressively worse
-never had this headache before
-generalized 8/10 headache without improvement when taking tylenol or ibuprofen
-pain increased with walking, bending forward
-no relieving factor, dull, constant pain, no radiation, bright light can elicit pain, nause and vomiting nonbloody emesis X2 yesterday
ROS: negative except the above
PMHx: none
PSHx: none
FHx: mom with migraine, dad with hypercholesterolemia
Meds: OCPs for 2 years
Allergies: none
SHx: sale peronnel at local store, lives with a roomate in an apartment, drinkes 2-3 beers/ wine over the weekend, no tobacco use, 3-4 marijuana uses/ week, last use was few days ago


Keywords and phrases relevant to diagnosis:
without improvement when taking tylenol, without improvement when taking ibuprofen
20 yo
yesterday, yesterday
generalized headache
vomiting, emesis
nause
lives with a roomate in an apartment
mom migraine, FHx migraine
Ms, F
bright light can elicit pain
Patient Note: HPI: 20 YO F COMPLINS OF SEVERE HEADACHE SINCE YESTERDAY WITH SEVERITY 8/10. IT IS ASSOCIATED WITH NAUSEA AND VOMITING FOIR THE SAME TIME. SHE USE TO GET SAME HEADACHE 2 TIMES A YEAR SINCE MANY YEARS BUT NOT SEVERE AS THAT TIME. NO INFECTION, JAW PAIN, EAR PAIN. MILD FEVER SINCE YESTERDAY. NO HISTORY OF EYE AND EAR DISCHARGE. 
MEDICATION: OCP
ALL. NKDA
FH: MOTHER HAS MIGRANE. FATHER HAS HYPERCHOLESTEROLEMIA.
SH: SEXUALLY VACTIVE WITH BOYFRIEND.NO SMOKING, 2 GLASS OF WINE AT WEEKEND, EXERCISE REGULARLY, HEALTHY DIET
PMH: NONCONTRIBUTORY
PSH: NONE.

Keywords and phrases relevant to diagnosis:
20 YO
YESTERDAY
VOMITING
NAUSEA
MOTHER HAS MIGRANE, FH MIGRANE
F
FEVER
Patient Note: Pt is a 20 yo F with c/o "worst headache ever" since she woke up yesterday morning. The pain has been a constant 8/10, dull, constant ache in her entire head. She also reports neck stiffness. The pain has not responded to tylenol, ibuprofen, or sleep, and is worse with walking, bending forward. Pt also reports some photophobia but denies phonophobia. She denies any history of headaches, but reports her mother gets migraines. Denies sick contacts. Pt works in sales at a sports store. Pt reports feeling warm and achy but denies fevers. Denies PMhx, Surgical history. Reports OCP use x 2years. Denies tobacco use. EtOH: 2-3 drinks on weekends. Marijunana use: 3-4 joints/day x few years.  ROS otherwise negative. Denies any recent trauma. LMP 2 weeks ago.

Keywords and phrases relevant to diagnosis:
has not responded to tylenol, has not responded to ibuprofen
20 yo
yesterday
achy
headache entire head
neck stiffness
mother migraines
F
photophobia
Denies sick contacts
feeling warm
Patient Note: 20 yr old f c/o headache since yesterday morning.It started suddenly,is continous and progressively worsening,dull/aching pain,8/10,radiate to neck,exacerbated by light,leaning and bending  forward,associated with nausea and 3 episodes of non bloody vomiting.She has been fever since yesterday morning,had runny nose and scratchy throat.She has been using oral conntraceptives pills for birth control.
She denies sick contacts,rash,trauma,change in sleep/weight
ROS:Negative except as hpi
fh:mother had migraine and father had HLD
SSH:Denies smoking,drinks alcohol 2 -3 glasses on weekends cage 1/4,smoke weed,sexually active,protected intercourse.
PMH/PSH/MEDS:oral contraceptives pills for birth control

Keywords and phrases relevant to diagnosis:
20 yr old
yesterday, yesterday
vomiting
denies rash
nausea
runny nose, scratchy throat
mother migraine, fh migraine
f
exacerbated by light
denies sick contacts
Patient Note: Pt is a 20 yo F presenting with 1 day of headache as well as upper respiratory symtpoms including sore thraot, body aches, and rhinorrhea. This started yesterday and is bilateral. She rates it an 8/10 and describes a dull and constant ache. She also reports having nausea, vomiting, and sensitivity to light and sound. Sleeping and NSAIDs has not helped the pain. She denies any fevers, SOB, CP, diarrhea, blurry vision, weakness, or numbness. She has never had this before
ROS: negative except as in HPI
PMH: none
PSH: none
NKA
Meds: OCPs, NSAIDs
FH: Dad with HLD, mom with migraines
SH: Does not smoke, drinks 2/3 beers on weekends. smokes 2/3 marijuana cigarrettes per week. Sexually active with boyfriend and use condoms consistently
OBGYN: LMP 2 weeks ago, nml menstrual periods no irregularities


Keywords and phrases relevant to diagnosis:
NSAIDs has not helped
20 yo
1 day, yesterday
body aches
vomiting
nausea
upper respiratory symtpoms, sore thraot, rhinorrhea
FH migraines, mom migraines
F
sensitivity to light
Patient Note: This is a 20 year old woman that presents with new onset HA 1 day ago that is dull and constant in nature. It is an 8/10 on severity that worsens with light, walking, and bending over. She did not experience any aura prior to her headace. She states that she has associated nausea and vomiting, and she is unable to keep down any food. She denies back pain, change of bowel symptoms, or urinary symptmos. She has not had any viual changes or changes to her hearing. She states that she's had headaches before but never this bad. Worse with movement and bending. Denies: chest pain, chortness of breath, endorses congestion and sore throat.  no changes to urinary or bowel symptoms. no lightheadedness or weakness. Mild fever.
Med History: noncontributory
Family history: mother has migrains, father has HLD
Soc: lives in an apartment with roomate. no tobacco. Drinks 2-3 times per week. Regular marijuana user. 
No surgical history.

Keywords and phrases relevant to diagnosis:
20 year old
1 day
vomiting
nausea
congestion, sore throat
lives in an apartment with roomate
migrains Family history, mother has migrains
woman
worsens with light
fever
Patient Note: HPI: patient is a 20 y/o FM who complains of bilateral dull, constant headache which woke her up in the morning yesterday. She denies any past history of headaches and also denies stress in her life. She furthermore denies preceeding ssx consistant with an aura. She reports neck stiffness with her headache and cannot rate the pain; stating that she "feels really bad". She reports feeling "warm" recently. She denies any recent travel or sick contacts and is sexually active with protection during intercourse. 
ROS: denies abdominal pain, weakness, numbness, blood in her stools. 
PMH: denies
PSH:denies
Allergies:NKDA
Meds OCP history for 2 years 
FH: mother had migraines, father has high cholesterol

Keywords and phrases relevant to diagnosis:
20 y/o
yesterday
neck stiffness
mother migraines, FH migraines
F
denies sick contacts
feeling "warm
Patient Note: Ms. MAdden is a 20yo previously healthy female presenting with headache for 1 day. The headache started yesterday and she states she has never felt this bad before. She has also been experiencing nause, vomiting, rhinorrhea, and full-body aches. Has had subjective fevers but not taken her temp. Also reports neck stiffness and pain. She tried tylenol and ibuprofen but neither helped. Nothing makes it better. Bending over, walking, and bright light makes it worse. Vomit is nonbloody, but she reports it has been green. Unable to keep down food. Denies diarrhea or constipation, no visual disturbances, no phonophobia. Denies sick contacts.
ROS: negative except otherwise stated in HPI
PMH: none
Medications: combined oral contraceptive pill
FHx: mother with migraines

Keywords and phrases relevant to diagnosis:
ibuprofen neither helped, tylenol neither helped
20yo
1 day, yesterday
body aches
neck stiffness, neck pain
vomiting, Vomit, Unable to keep down food
nause
rhinorrhea
mother migraines, FHx migraines
Ms, female
bright light makes it worse
Denies sick contacts
subjective fevers
Patient Note: 20 yo F complains of HA that started yesterday morning. This is the first time she has ever experienced this. She describes the pain as all her whole head, dull in nature, 8/10 in severity and constant since yesterday. There were no precipitating factors, and nothing makes it better despite trying ibuprofen. Patients reports HA is worse when waking up and bending over to tie her shoes. She says shes felt warm yesterday, and experienced nausea and vomiting with onset of the HA. She denies any chills, sweating, SOB, dizziness, or ill contacts. 
ROS: negative except for above. 
PmHX: none
Allergies: NKDA, NKFA
Meds: Birth controll pills for the last two years 
FMhx: mom - migraines; Dad -high cholesterol 
SoHx: patient is sexually active with boyfriend of 1 year and tested negative for STDs; + EtOH - 2-3 beers or wine on weekends;  - smoking tobacco product; + marijuana - smokes 3 to 4 joints weekly, but hasn't since onset of HA

Keywords and phrases relevant to diagnosis:
nothing makes it better ibuprofen
20 yo
yesterday, yesterday, yesterday
HA whole head
vomiting
nausea
mom migraines, FMhx migraines
F
denies ill contacts
felt warm
Patient Note: Stephanie Madden is a 20 year old female with a two day history of a headache.
- Headache since yesterday morning upon waking.
- Nausea and vomited three times with greenish vomitus.
- Photophobia.
- Feels hungover.
- Minimal improvement with tylenol and ibuprofen.
- Pain is worse with bending over.
- No dizziness, vision problems, or problems with balance.
- Subjective fever no chills. No diarrhea/constipation. 

ROS: negative except for as stated above. 
PMH: none.OBGYN: G0, sexually active with one partner, always uses condoms.
Medications: oral contraception pills.PSH: none.Allergies: none.Sochx: no tobacco, drugs, alcohol 2-3 times on weekends. lives with roomate feels safe at home.FamHx: father hypercholesterolemia, mother with migrains.

Keywords and phrases relevant to diagnosis:
20 year old
two day, yesterday
vomited, vomitus
Nausea
lives with roomate
mother migrains, FamHx migrains
female
Photophobia
Subjective fever
Patient Note: 20yo F presents with 1 day history of headache. Patient describes headache as "really severe," all around her head and into her neck, with accompanying nausea, 3x emesis, and photophobia. Patient has never had a similar headache. Patient has tried sleeping/ibuprofen/tylenol with no relief. Pain increases with bending over or flexing neck Headache is getting worse. Patient states she was febrile yesterday, but did not record her temperature. Patient has a dry cough that she attributes to a perfume in the waiting room, as well as a scratchy throat and post nasal drainage. Patient's only med is combination OCP. Family history positive for maternal migraines and paternal hyperlipidemia. Patient is otherwise healthy, and has had no surgeries or allergies. No exacerbation with teethbrushing, no tearing. No sick contacts. ROS otherwise negative. Marijuana use 3x wek

Keywords and phrases relevant to diagnosis:
ibuprofen with no relief, tylenol with no relief
20yo
1 day
headache all around her head
Pain neck
emesis
nausea
scratchy throat, nasal drainage
maternal migraines, Family history migraines
F
photophobia
No sick contacts
febrile
Patient Note: 20yoF with no significant PMHx presents with headache. Dull achy quality all over head. Started yesterday in the AM and has been constant since. Pain level is 8/10, no alleviated by OTC pain meds. Better when in a dark room resting. Sleep has not helped. Worse when walking or leaning forward. No radiation of pain. Other symptoms include nausea, vomiting (3x since yesterday, food and then bilious). Did not get meningococcal vaccinations, has felt subjective fevers at home. Reports neck pain/stiffness. First headache. No association with new foods, meds, or menstrual cycle.

PMHx - none, no surgeries
Meds - OCPs, no allergies
FHx - mother with migraine headaches
Social - taking online classes, no tobacco, ETOH or other drug use.

Keywords and phrases relevant to diagnosis:
no alleviated by OTC pain meds
20yo
yesterday
headache all over head
neck pain
vomiting
nausea
Did not get meningococcal vaccinations
FHx migraine, mother with migraine
F
subjective fevers
Patient Note: 20 Yo F c/o Bl headache . Onset > yesterday morning after waking up . Feels like the worst hang over. constant . 8/10. no radiation. aggravated by walking around , bending down . Tried ibuprofen sleep and tylenol , not getting better. ROS : POS :  feeling of tiredness PHOTOPHOBIA , n/ vomittng x 3 . food and green voit.. rhinorrhea , 
no hematuria sensitivity to sound, aura, loss of consiousness , eye pain , NO  PMH , ALLERGIES , using OCP x 2 years. no hospitalizations, trauma . FH ; MIGRAINES 
 lmp : 2 weeks ago , menarche 13 . period 4-5days Q month . works as sporting goods. no smoking , drinks alchohol 2-3 drinks / week .Cage . does not need it as eye opener . marijauna . 2-4 / week . 1 sexual partner

Keywords and phrases relevant to diagnosis:
ibuprofen not better, tylenol , not better
20 Yo
yesterday
vomittng
n
rhinorrhea
FH ; MIGRAINES
F
PHOTOPHOBIA
Patient Note: This is a 20 Female with a headache that started yesterday when she woke up.  She describes the headache as severe, 8/10 in severity.  It isa dull, constant ache that is all over her head, but it does not radiate anywhere else.  Walking and bending over and bright lights make it worse. She has some nausea and vomiting.  She vomited 3 times since yesterday.  There is no bllod in the vomit.  

PMH: none
PSH: none
Meds: birth control
Allergies NKDA
Family history: migranes mother
ETOH minimal, no smoking marijuana 3-4 times per 


Keywords and phrases relevant to diagnosis:
20
yesterday
headache all over her head
vomiting, vomited
nausea
migranes mother, Family history migranes
Female
lights make it worse
Patient Note: Ms. Stephanie Madden is a 20 yo F with a CC of heacahe. It started yesterday AM, waking her up. Worse headache of her life. Pain is located all over her head. It is dull, constant, achy. Progressed from 2-3/10 to 8/10. She has photophobia, nausea, vomitting (three times yesterday). Nothing improves the pain. Walking and bending over make the pain worse. Also has neck stiffness, and aches in her neck and shoulders. No recent travel or sick contacts. Has felt warm. Also reports runny nose and scratchy throat. No current life stressors.

ROS: denies chills, night sweats, vision changes, sound sensitivity, lacrimation, chest pain, shortness of breath, numbness, tingling.
PMH: none
PSH: none
Meds: OCP (alesse generic)
ALL: NKDA
FH: Mom - migraines
Dad - Hypercholesterolemia
SoH: sales in sporting goods, has BF, sexually active, uses condoms, 2-3 drinks per week. Denies Tob. Smokes 3-4 MMJ joins per week.

Keywords and phrases relevant to diagnosis:
20 yo
yesterday
heacahe over her head
neck stiffness, aches in her neck
vomitting
nausea
runny nose, scratchy throat
FH migraines, Mom migraines
F, Ms
photophobia
No sick contacts
Has felt warm
Patient Note: 20 yo F presents with "head hurting" all over. Pain began yesterday morning suddenly and has progressively worsened. The pain is dull and constant and bending over exacerbates the pain. The pt has tried ibuprofen and sleeping with no alleviation. She has also experienced subjective fevers, Nausea and vomiting yesterday, but the vomiting has ceased. She also has had scant rhinorrhea that began with the headache. She denies any headache like this before, stress at work, and trauma. Not associated with menstruation.
ROS: denies ear pain, sore throat, weakness, LOC. 
Pmhx: none
Med: OCP for 2 y
Allergies: none
SH: none
OBgyn: LMP 2 weeks ago, no issues
SH: never smoked, 2-3 beers on weekend, no drug use. sexually active with bf of 1 year.


Keywords and phrases relevant to diagnosis:
ibuprofen no alleviation
20 yo
yesterday
"head hurting" all over
vomiting
Nausea
rhinorrhea
F
subjective fevers
Patient Note: HPI: 20 y/o F complaines of progressive headache that started yesterday morning and is getting worse.  She describes the pain as all over her head and dull constant ache in nature.  Rated 8/10 w/ no radiation.  Walking, bending over and lights make the headache worse.  She has tried Ibuprofen, tylenol and sleeping by they have not improved the pain.  She also reports being achy all over since yesterday.  She reports significant nausea with her headaches.  She reports a subjective feeling of warmth and an achy neck.

ROS: Denies travel, recent illnesses, previous episodes, cough, sick contacts, rashes, urinary or bowel changes
Meds: Birth control pill
FH: Mother with migraines, dad w/ high cholesterol
Social: 2-3 beers on weekend, 3-4 joints per week, sexually active w/ boyriend and use condoms
GyN: LMP 2 weeks ago with 28 day regular cycles

Keywords and phrases relevant to diagnosis:
Ibuprofen not improved the pain, tylenol not improved the pain
20 y/o
yesterday
achy
headache all over her head
achy neck
Denies rashes
nausea
FH migraines, Mother with migraines
F
lights make the headache worse
Denies sick contacts
subjective feeling of warmth