bhatthars/nbme_qna huggingface dataset:
Patient Note: 44 yo F has C/O irregular periods. Her periods have been irregular for the last 3 years. She states that the periods last anywhere from 2-6 days, can be either heavy or light. and has no timeframe for when they appear. She says she has hot flashes 1-2 times a month and night sweats last week. She denies any blurry vision, fatigue, feelings of cold,  chest pain, abdominal pain, changes in bowels and weight gain. Patient denies any feelings of sadness or depression.  

ROS: Negative except those stated in HPI
PMH: HTN
Allergies: None
Medications: HZTZ
Hospitalizations: Vaginal delievey. 
Fhx: Mother has osteoarthritis, brother has high blood pressure. 
OBGYN: Mechanice at age 14. Periods were regular till 3 years ago, used 2-3 pads. No vaginal discharge
SH: no smoking, no etoh, no history of stds. Sexual active with husband, monogomous


Keywords and phrases relevant to diagnosis:
Periods were regular
Sexual active, monogomous
irregular periods, periods have been irregular
F
hot flashes
last from 2-6 days, can be heavy or light., has no timeframe for when they appear
for 3 years, till 3 years ago
night sweats
44 yo
Patient Note: 44 yr old f w/ 3 yrs irregular menstrual bleeding
-notes no pattern to her perioeds
-notes it feeling crampy
-nothing makes it better or worse
-Notes hot flashes, sweating, nausea, vomit, early morning waking
No previous episodes. No allergies. Takes HCTZ for hypertension. No trauma, or surgeries. ROS neg except for above.
OBGYN: LMP 2 months ago, menarchy at age 14, period used to last 6 days but now unpredictable, uses 6 tampons a day, notes vaginal dryness, G2P2. Sex hx: active w/ husband, uses IUD, no hx of STDS. Soc hx: lives w/ family, she is a manager at a company, no unusual stress. Occasional wine, denies tobacco, and recreational drugs.

Keywords and phrases relevant to diagnosis:
period used to last 6 days
IUD
Sex hx: active
vaginal dryness
irregular menstrual bleeding, no pattern to her perioeds, period now unpredictable
f
LMP 2 months ago
hot flashes
w/ 3 yrs
sweating
early morning waking
44 yr old
Patient Note: Patient is a 44 year old G2P2 female with irregular menses for 3 years. Menarche age 14, regular menses 28 days for 5 days with moderate flow (3-4 pads a day) and premenstrual sx breast tenderness, lower back pain, mild menstrual cramps. Periods became unpredictible over last 3 years, duration 2-6 days ranging light (1-2 pads/day) to heavy (6 pads/day) with frequency ranging 3 weeks to 3 months. LMP 2 months ago for 4 days, moderate flow (prior was 3 weeks), accompanied with premenstrual sx (that ceased for 3 years prior). Random hot flashes, diaphoresis (1 episode night sweats), vaginal dryness over past year. Vaginal discomfort with intercourse, improved with lubrication. ONe week ago 2 days of stomach flu with nausea/vomiting, self-resolved in 2 days. PMH: HTN treated with CHTZ, no surgeries, 2 vaginal births, normal pap smears

Keywords and phrases relevant to diagnosis:
regular menses for 5 days, regular menses with moderate flow, regular menses 3-4 pads a day
with intercourse
Vaginal discomfort improved with lubrication
irregular menses, Periods became unpredictible
ONe week ago flu, ONe week ago nausea/vomiting
premenstrual sx ceased
female
LMP 2 months ago
duration 2-6 days, ranging light to heavy, ranging 1-2 pads/day to 6 pads/day, frequency ranging 3 weeks to 3 months
over last 3 years, for 3 years
44 year old
Patient Note: 44 yo F with a h/o HTN who complains of irregular menses. started 3 years ago, no pattern to when menses occurs, periods may range from light to heavy (6 pads/ day), lasting from 2-6 days. Has hot flashes and night sweats not accompanied with menses. Menses was previously regular. No h/o surgeries, denies h/o fibroids, thyroid abnormalities. Reports 1 episode of breast tenerness, cramping, and back pain. Denies painful menses, fever chills, nausea, vomitting, consitpation, diarrhea. 

FH: brother - HTN, mom - osteoarthritis, obesity
SH: lifetime nonsmoker, uses alcohol socially, denies IV drug use, denies any increased stress


Keywords and phrases relevant to diagnosis:
Menses was previously regular
irregular menses
F
hot flashes
no pattern to when menses occurs, range from light to heavy, lasting from 2-6 days
started 3 years ago
night sweats
44 yo
Patient Note: Ms Montgomery is a 44yo female with chief complaint of irregular meses x 3 years. Her periods last from 2-6 days and alternate between light spotting and heavy bleeding requiring 5-6 pads per day. LMP was 2 months ago. Prior to 3y ago she had regular 28 days cycles. She is a G2P2 with normal vaginal deliveries 10y ago and 14y ago. She is utd on her pap smears, last was 1 year ago, nl. UTD on mammograms, last 1y ago nl. 
ROS: denies heat/cold intolerance, denies hirsutism, denies voice changes. No changes in bladder or bowel habits. 
PMH HTN, treated with HCTZ
denies allergies
No family history of irregular menses
lives with husband and children, everyone feels safe
No smoking or illicit drugs, drinks socially

Keywords and phrases relevant to diagnosis:
had regular 28 days cycles
pap smears, last was 1 year
irregular meses
female
LMP was 2 months ago
alternate between light spotting and heavy bleeding, last from 2-6 days
x 3 years
44yo
Patient Note: 44 yo female c/o irregular periods
- started 3 years ago, is getting worse, has never had this before
- irregular periods that las for 2-6 days and may have a light or a heavy flow, LMP was 2 months ago
- has hot flashes
- denies dysmenorrhea, weight changes, stool changes, fatigue, urine changes, vaginal discharge,  hair changes, visual changes, skin changes, fever or mood changes.
- PMH: HTN treated with HCTZ,  had 2 vaginal deliveries (the last was 10 years ago); Allergies: none, PSH: none, FH: mother has osteoarthritis and brother has HTN
- SH: no smoking, is a office manager, has a diet with low salt and fat, no drugs, drinks etoh on rare ocasions (1 glass of wine), exercises 3x a week, feels safe at home, is sexually active with husband only

Keywords and phrases relevant to diagnosis:
sexually active
irregular periods, irregular periods
female
LMP was 2 months ago
hot flashes
las for 2-6 days, may have a light or a heavy flow
started 3 years ago
44
Patient Note: Mrs Montgomery 44 year old F Presented wth Irregular Mesntruation. For Past 3 years has noted abnormal/irregular mestrual cycle length -time between cycles varying between 3 weeks and 4 months -  and volume of menstrual blleding - sometimes very heavy cycles, sometimes very light. Periods last between 2 and 6 days. No spotting or abnormal vaginal discharge or itch. Has noted vaginal dryness and occasional hot flashes. 1x episode of night sweats last week. No weight change, fatigue, skin or hair changes or abdominal pain. Bowel and bladder habit normalObs/Gyn Hx: Previously periods were every 28-29 days and lasted 5 days with 2/3 pads or tampons used per day. 2 uncomplicated pregnancies with vaginal deliveries. No miscarriages or abortions. PMH: Htn PSH: Nil Meds HCTZ NKDA Family Hx: Mother osteoarthritis and htn Social: Office Manager, Alcohol on special occaions only. non smler, no illicit drug use, sexually active with husband only

Keywords and phrases relevant to diagnosis:
Previously periods were every 28-29 days, Previously periods lasted 5 days, Previously periods with 2/3 pads or tampons used per day
sexually active
vaginal dryness
Irregular Mesntruation, abnormal mestrual cycle, irregular mestrual cycle
F, Mrs
hot flashes
time between cycles varying between 3 weeks and 4 months, sometimes heavy sometimes light, last between 2 and 6 days
For Past 3 years, For 3 years
night sweats
44 year old
Patient Note: Ms. Montgomery is 44year old female with cheif coplaint of irregular periods. For the past three years she has had unpredictable periods both in time and heaviness. Prior to this periods were every 28-29 days with moderate flow and some pms.  last period was 2 months ago and moderate flow. SHe endores one episode of drenching sweats last weak and occaisonal hot flashes. Also complains of stomach flu last week with n/v. She endorses vaginal dryness but no pruritis or discharge. 
OB/GYN history: 2 children via uncomplicated vaginal birth. Used IUD for contraception x20yrs, most recently changed 4 yrs ago. 
ROS: Denies HA, dizziness, weakness, tremors, CP, SOB, constipation, diarrhea, weight change
PMH: HTN
PSH: none
meds: HCTZ
allergies: NKDA
Family: mother has OA, brother has HTN
Social: works as office manager, lives with husband and 2 children. Safe in marriage, sex only with husband, uses lubricant. Rare EtOH, no tobacco

Keywords and phrases relevant to diagnosis:
Prior to this periods were every 28-29 days
IUD
sex only with husband
vaginal dryness
irregular periods
complains of stomach flu last week with n/v
female
last period was 2 months ago
hot flashes
unpredictable heaviness, unpredictable in time
For the past three years
drenching sweats
44year
Patient Note: Ms. Montgomery is a 44yoF who presents with 3 years of irregular periods. These periods can last for 2-6d with variable amounts of flow and are not associated with pain, crmaps, breast tenderness, or back pain which are her usual PMS symptoms. Her last period was 2 months ago which she did have pain but says it was a normal period for her.  She had recent history of flu-like gastric distress last week.  She denies any bleeding anywhere else but does admit to night sweats recently without fever. She has 2 children who were born vaginally with uncomplicated pregancies. She uses IUD for contraception which was placed 4 years ago. Pt had PAP last year and has no history of abnormal paps.  She has HTN for which she takes HCTZ and NKDA.  Mother has obesity and osteoarthritis, brother has HTN. She does not smoke, has EtOH rarely, no drugs, is married for 20years, and works as an office manager.

Keywords and phrases relevant to diagnosis:
had PAP last year
IUD
irregular periods
recent history of flu -like gastric distress, flu-like distress last week
not associated with PMS symptoms, not associated with crmaps, breast tenderness, or back pain
Ms, F
last period was 2 months ago
can last for 2-6d, with variable amounts of flow
with 3 years of
night sweats
44yo
Patient Note: 44 y F c/o irregular periods. Menarche was 14 yrs. Cycles were 28-29 days. 3/4 pads a day. No spotting or bleeding in between cycles. Vagina is dry, uses lubricant. Having hot flashes and woke up one day with sweat. No STDS/hiv test. Has vomited couple of days ago, no blood. No abortions/miscarriages. No numbness or tingling. Denies vision changes, chest pain, SOB. Appetite is good. Excerises 3-4 a week. Works as an office manager. 

ROS-negative
PMH- high BP
A-none
medications-HCTZ
Sh-none
Sexual- with husband, IUD, no std in past, no hiv test
Social- drinks on rare occasions, does not smoke/use illicit drugs
Fh-Brother high BP, mother- osteoarthritits
Diet- low fat/salt

Keywords and phrases relevant to diagnosis:
Cycles were 28-29 days
IUD
Sexual- with husband
Vagina is dry
irregular periods
vomited couple of days ago
F
hot flashes
woke up one day with sweat
44
Patient Note: CC: Irregular peroids

HPI: 44 year olf F c/o irregular peroids for the last 3 years. Patient says she sometimes goes months without a menstrual period. Patient endorses night sweats with subjective fevers for the last year. Denies vaginal puritus, pain-ful sexual intercourese, discharge and intermenstrual bleeding. 

ROS: Per hpi
OB/GYN: G2P0: both vaginal. LMP; 2 months ago. Peroid frequncy ranges from weeks to months and last 2-6 days. Last pap smear was 1 year ago; it was normal. No history of abnormal pap smears. No history of STDs.
 
PMH: Hypertension
PSH: None
Meds: Hydrochlorothiazide 
Allergies: None
SH: Works in office management. Lives with husband and two kids. Sexually monogamous with husband. Denies tobacco and recreational drug use. Occasional alcohol; a few drinks a month

Keywords and phrases relevant to diagnosis:
Last pap smear was 1 year ago
Sexually monogamous
Irregular peroids, irregular peroids
F
LMP; 2 months ago
for the last 3 years
night sweats
44 year olf
Patient Note: 44yo woman c/o 3yrs of "unpredictable" periods last 2-6d, with flow light to heavy, q3wks to 4mo. No spotting between periods. Endorses hot flashes and sweating and vaginal dryness- lubricant with husband during intercourse. Some abdominal pain with last  menses but not usually. Last week, one episode of drenching night sweats with nausea and flu-like sx's, went away. Before, pt had regular periods ~q28d, lasting 4days with moderate flow and PMS symptoms- breast tenderness, back pain, cramps. Today, denies wt changes, voice changes, nipple d/c, vision changes, cold/heat intolerance, facial hair. Pt has 2kids, born vaginally, pregnancies uncomplicated- last born 10yrs ago. Has copper IUD- 4yrs old
ROS: neg cough, cold-like sx's, chest palpitations/pain, SOB, vomiting, changes in bowel habits, dysuria, blood in stool/urine.
PMH: HTN
Meds: HCTZ
Aller: none
FH: noncontributory
SH: manager, rare Etoh, no tobacco/drugs

Keywords and phrases relevant to diagnosis:
Before had regular periods, Before periods ~q28d, Before periods lasting 4days, Before periods with moderate flow
IUD
during intercourse
vaginal dryness-
unpredictable" periods
Last week, nausea, "Last week flu-like sxs"
woman
hot flashes
last 2-6d, flow light to heavy, q3wks to 4mo
3yrs of
sweating, night sweats, drenching sweats
44yo
Patient Note: 44 yo G2P2A0 female presents to the clinic with irregular menstrual period for three years. The patient states that her menstrual period is unpredictable. The interval ranges from 3 weeks to 4 months. The duration ranges from 2-6 days. The flow ranges from very light amount to 5-6pads when heavy. She denies any spotting between menstruation, or cramps. The pateient denies vaginal discharge. Before that, patient had regular period of 28days and her menstruation lasted for 5 days with daily use of 2-3pads. She is sexually active with her husband and they use copper IUD for contraception. Patient noticed night sweat a week ago. Her last pap smear was normal a year ago. The patient denies headache, dizziness, skin change or change in hair. Patient denies intolerance to heat and cold.

ROS: negative except the above.
PMH: high blood pressure, MEDS: HCT
FH: noncontributory
SH: drinks alcohol 1-2glass/ month, tobacco(-), illicit drug (-)

Keywords and phrases relevant to diagnosis:
Before had regular period, Before had period of 28days and her menstruation lasted for 5 days with daily use of 2-3pads
pap smear a year ago
IUD
sexually active
irregular menstrual period, period is unpredictable
female
interval ranges from 3 weeks to 4 months, duration ranges from 2-6 days, flow ranges from light to 5-6pads, flow ranges from light to heavy
for three years
night sweat
44 yo
Patient Note: HPI: 44 year old female presenting with irregular periods. Periods have been "unpredictable" for the last three years, occurring every 3-6 months w/ bleeding lasting 2-6 days and varying in amount from heavy to light flow. She also complains of vaginal dryness for the last year alleviated by lubrication. She woke up from sleep last week "drenched in sweat". She describes having "hot flashes" for the last two years lasting approx 1-2 minutes. Denies change in weight, change in bowel habits, fatigue, hirsutism, hair loss and mood change. LMP 2 months ago, had two negative home pregnancy tests last week.
ROS: per HPI
Allergies: NKDA
Meds: HCTZ, IUD (x4yrs)
PMH: Hypertension
FHx: No thyroid disease or premature ovarian failure
Obstetric: G2P2, uncomplicated pregnancies (children 10 and 14yrs)
Social: No cigarette or illicit drug use. <1 drink EtOH/month. Sexually active w/ husband, uses protection. No Hx of STD

Keywords and phrases relevant to diagnosis:
Sexually active
vaginal dryness
irregular periods, Periods have been "unpredictable
female
LMP 2 months ago
hot flashes
occurring every 3-6 months, lasting 2-6 days, from heavy to light flow
for the last three years
drenched in sweat
woke up
44 year old
Patient Note: 44 yo african american lady with irregular periods of 3 years, lasting each between 2 to 6 days with light to heavy flow as described, with no pelvic main or nausea or weight loss. she has intermittent hot flashes, sweating and vaginal dryness but no dyspareunia or vaginal infections , no dysuria or urinary frequency, no constipation, no bleeding disorder, no fatigue.  menarche at 14 years.married with 2 kids, sexually active with her husband, has an IUD placed 4 years ago, no past surgeries. she has HTN on hctz.no allergies. nonsmoker nonalcoholic, walks daily, well balanced diet, no eleict drug use, 1 ocffee cup daily, happy with her husband, works as an office manager with no increasing stress levels. LMP was 2 months ago.last pap smear and mammography were normal last year.fam hx: mom has osteoarthritis and obese, brother has htn, no cancers in family

Keywords and phrases relevant to diagnosis:
IUD
sexually active
vaginal dryness
irregular periods
lady
LMP was 2 months
hot flashes
lasting each between 2 to 6 days, with light to heavy flow
of 3 years
sweating
44
Patient Note: 44 yo F G2P2 with 3 year history of irregular periods
- regular periods before (5 days of periods with 20-29 days in between); used about 3-4 pads
- now "unpredictable": 1 or more elements (bleeding, duration) change with each period, light to heavy bleeding, 2-6 days of period)
- biggest concern: nocturnal heavy sweating 
- endorses: daytime hot flashes and sweating, nausea & vomitting x 2 days
- denies: mood changes, weight changes, diet changes, new excercize regimen, no family history of early menopause
Ob/Gyn: G2P2002, no gynecological issues, most recent pap smear 1 yr ago was normal, pregnancies and deliveries normal
PMH: HTN
PSHx: none
Med/Allergies: HCTZ, no allergies
FHx: no gynecological issues
Soc: lives with hsuband and two sons, uses copper IUD; no past or present tobacco or recreational drug use; "rare" use of alcohol (champagne, weine)
ROS: none except as stated above

Keywords and phrases relevant to diagnosis:
regular periods before
most recent pap smear 1 yr ago
IUD
irregular periods, now "unpredictable"
F
hot flashes
1 or more elements (bleeding, duration) change with each period, 2-6 days of period, light to heavy bleeding
3 year history of
sweating, sweating
44
Patient Note: CC: Stomach pain 

HPI: Patient is a 35 year old male presenting with stomach pain that is getting worse. States that his pain is located in the epigastric region and it comes and goes. Describes it as a burning/gnawing pain and rates it as a 5/10. States that he has been feeling nauseous but denies vomiting. States that Tums helped at first with the pain but has not been helping recently. States that nothing makes the pain worse and there is no association between the pain and meals. States that his stools have appeared darker occasionally. States that he has been stressed out after splitting with his wife one year ago. Admits to feeling tired the past few weeks. Denies headache, chest pain, diarrhea/constipation. 
ROS: Negative unless stated above 
Meds: Motrin once/week
Allergies: Denies
PMH: Denies
Surgical: Denies 
FH: Uncle with bleeding ulcer 
SH: Smoked 1/2 pack per day since 15. Occasional alcohol use.

Keywords and phrases relevant to diagnosis:
Uncle with bleeding ulcer
pain is located in the epigastric region
stools have appeared darker
Motrin
burning/gnawing
getting worse
Occasional alcohol use
male
comes and goes
Tums has not been helping
nauseous
35 year old
Patient Note: Chad Hamilton is a 35yo male with no significant PMH who is here for evaluation of stomach pain. For the last two months he has been experiencing 1 to 2 hr episodes of epigastric stomach pain twice a day. He experiences nausea along with the pain. There is no associations with mealtime or with type of food eaten. The pain is burning/gnawing in nature and is a severity of 5/10. It sometimes wakes him up at night. He is also experiencing bloating with meals and has noted darker than normal stool. He has tried taking Tums but not found it to be very helpful.
Denies travel or sick contacts. He reports considerable stress as he is undergoing a divorce.

Review of systems: Negative except as in HPI
Allergies: NKDA
Meds: Motrin 400mg once a week
PMH: None
PSH: None
Family History: Uncle with "Bleeding ulcer"
SH: Smokes cigarettes 1 ppd for 20 years
  ETOH: 1-2 beers a week. Quit recently

Keywords and phrases relevant to diagnosis:
Uncle with "Bleeding ulcer
epigastric stomach pain
darker than normal stool
Motrin
burning/gnawing
bloating with meals
twice a day
1-2 beers a week
male
last two months
wakes him up at night
tried taking Tums but not found it to be very helpful
nausea
35yo
Patient Note: Patient is a 35 year old M who presents c/o episodes of 5/10 gnawing epigastric pain since 2 months ago. Patient states he also feels nauseous when the pain occurs but has no vomited. Patient states he initially had 1 episode of this pain per week, but now it occurs twice per day. He states tums helped the pain but it no longer helps. The pain is unrelated to food intake. He also sometimes wakes up with this pain during the night. The pain comes on gradually, lasts for 1-2 hours. Patient notes his stools have been darker lately. He also has less appetite. Develops gastric bloating with food. 

ROS: negative except as above
allergies: NKDA
Medications: motrin (400 mg as needed for "aches") and tums as needed
PMH: "Aches and pains" from construction work
PSH: None
SH: Patient drank 1-2 beers/week up until 2 weeks ago. He does not smoke cigarettes or use illicit drugs. He has not had sex for 1 year.
FH: bleeding ulcer in uncle

Keywords and phrases relevant to diagnosis:
bleeding ulcer in uncle
epigastric pain
stools have been darker
motrin
gnawing
bloating with food
initially had 1 episode of this pain per week, but now it occurs twice per day
1-2 beers/week
M
since 2 months ago
wakes up with this pain during the night
tums helped the pain but it no longer helps
nauseous
35 year old
Patient Note: 35 yo M with CC of "my stomach is bothering me".
- Stomach pain that started 2 months ago 1X per week is not occuring multiple times a day and at night
- Pain lasts 1-2 hours and is described as burning and knawing, rated 5/10
- Pain is above his umbilicus and does not radiate
- Two weeks of intermittent black stools
- No aversion to food
- Tums no longer alleviate pain and he takes ibuprofen for back pain and spasms
ROS has nausea but no vomitting, fever, chills, night sweats, wt loss, no aversion to food, he does complain of back spasms
PMH None
PSH None
Alleriges NKDA
Family history fathers brother had a stomach ulcer
SH construction worker for 10 years and has 1/2-1 pack of cigarettes a day for 20 years, few beers a week but stopped since stomach pain, no illiciut drug use

Keywords and phrases relevant to diagnosis:
fathers brother had a stomach ulcer
Pain is above his umbilicus
black stools
takes ibuprofen
burning and knawing
few beers a week
M
started 2 months ago
Tums no longer alleviate pain
nausea
35 yo
Patient Note: HPI: 35 yo M c/o epigastric pain for 2 months burning, has become constant and rates it 5/10. Tums helped earlier but no relief now, Food has no relationship to pain.He has nausea, dark colored stools, stress of getting a divorce, belching and feeling of bloating. Denies chest pain, vomiting, headache , dizziness, LOC, SOB+.
ROS: none except above
PMH: has had back ache for some time
PSH: none
FH: Father has  a bleeding ulcer
SH: construction worker, not sexually active,smokes 1/2 to 1 ppd since the age of 15 yrs, stopped taking alcohol, no illicit drugs
NKDA
Medicines: tums, Motrin
Diet: junk food low fiber diet

Keywords and phrases relevant to diagnosis:
Father has  a bleeding ulcer
epigastric pain
dark colored stools
Motrin
burning
feeling of bloating
has become constant
M
for 2 month, for 2 months
Tums helped earlier but no relief now
nausea
35 yo