bhatthars/nbme_qna huggingface dataset:
Patient Note: Mrs. Moore 45 y/o F c/o nervousness. This symptoms started cople weeks ago. This symptos are constanst and are affecting her daily activities. Nothing makes this symptoms better or worst. Patient refers truble falling asleep also cince couple weeks ago. 
ROS: patient denies palpitation, SOB, fever, Abdominal pai, changes in bowel movements. Recently change to another job, under a lot of stress. 
llergies: NKDA
Medictaion: Tylenol occasionally for headaches.
FH: father had a heart attack.
Social H: EtOC occasionally. Patient is a english profesor . Exercises 3 times per week. Caffeine ingestion throughout the day.

Keywords and phrases relevant to diagnosis:
denies palpitation, denies changes in bowel movements
nervousness
Caffeine ingestion throughout the day
truble falling asleep
F
45 y/o
Patient Note: 45 yo F presents with nervousness for the past few weeks. Constantly feels this way. SHe is an english professor and it started after changing positions in work from doing resarch to teaching in a classroom. She feels it the most on Sunday nights and monday mornings when preparingfor work. It is affecting her personal and her work life. Feels overwhelmed with the change and has a decreased appetite. Difficulty falling asleep, it takes her an hour to fall asleep when it used to be 10 minutes. Denies sweating, palpitations, or chest pain 
PMH: none  Meds: tylenol   Allergies: NKDA
FH: father died of heart attack at 65
SH: Denies smoking, drinking, alcohol; walks 1 mile 3x per week. Healthy and balanced diet.
Sexual: active with husband 
OBGYN: LMP 1 wk ago, regular, lasting 4 days. PAP smear every year, no abnormal; G2P2

Keywords and phrases relevant to diagnosis:
Denies sweating, Denies palpitations
nervousness, Feels overwhelmed
Difficulty falling asleep, takes her an hour to fall asleep
F
decreased appetite
45 yo
Patient Note: 45 f c/o nervous from 4 months ago started gradually she swithced her job on that time  and problem w/ falling asleep, noo fever nausea heaart racing, has lot s problem in home has to manage, drink 6 cup of caffe each day, enjoy from life, has hobby for her slef, decrease appetitte, no hot falshes, or vaginal dry ness
FH: father died MI,
SH: proffesor , no cig/ etoh occasional? no rec drug, lives w/ family
OB&GY: LMP 1 WK AGO  the same as past no spotting, pap smear normal,

Keywords and phrases relevant to diagnosis:
no heaart racing, no hot falshes
nervous
drink 6 cup of caffe
problem w/ falling asleep
f
decrease appetitte
45
Patient Note: Ms. Moore is a 45 y/o WF who presents w/ nervousness. This started out of the blue 2 weeks ago with no inciting event. She just noticed a general sense of constant nervousness that is showing no signs of abatement. This has never happened to her in the past. Stated that "I feel like I'm losing my mind a bit." Endorses no recent traumatic events of any regard.

ROS: endorses occasional HAs, denies dizziness, denies anxiety, denies depression, denies chest pain, denies SOB
PMH: none
PSH: none
Social Hx: never used tobacco, has 1-2 drinks once a month, no illicit drug usage, good diet, exercises regularly; is an english professor and endorses being quite overwhelmed
PSexualHx: monogomous w/ husband, but this current constant nervousness is negatively affecting their sex life - husband is understanding
Meds: Tylenol on occasion
Allergies: none

Keywords and phrases relevant to diagnosis:
nervousness, nervousness, "I feel like Im losing my mind a bit", nervousness
denies depression
F
45 y/o
Patient Note: CC: Nervous all the time
HPI: Mrs. Moore is a 45 year old WF that comes to clinic with constant nervousness about her personal and work life. She has recently sqwitched jobs and is lecturing infront of students on Mondays. She gets most nervous on sunday evenings and monday mornings but the nervousnes continues throughout the week. She also gets headaches when she gets stressed and takes a tylenol which resolves the issues. She also has a decrease in appetite during Sunday/Monday. c/o insomnia. She denies racing thoughs, CP, palpitations, nail changes, hair changes, abdominal pain, and quivering voice during presentations.
ROS: See HPI
PMHx: Hospitalized for the birth of her 2 kids. Takes tylenol. Denies surgeries, allergies,traveling, and sick contacts. Up to date on vaccinations
FHx: Father heart attack at 65
Shx: Denies tobacco, drug use. Drinks socially 1-2 wine glasses. Monogamous with husband, no condoms. English professor

Keywords and phrases relevant to diagnosis:
denies palpitations, denies nail changes, denies hair changes
Nervous, nervousness, nervous, nervousnes
insomnia
F
decrease in appetite
45 year
Patient Note: Ms. Moore si a 45 yo woman with chief complaint of nervousness over the las 3-4 weeks. States that she is less hungry, but denies CP,SOB,palpitations,nausea,vomiting,diarrhea,abdominal pain/sweating/hot or cold intolerance/HA/hair loss. States that she has had difficulty falling asleep but that once she gets to sleep she has no issue with staying asleep. She has no daytime naps and works as an English professor with new lectures that began 2 weeks ago. She states that the nervousness is about anything and everything, and that she thinks about her kids, and her work and taking care of her mother. she states that it starts in the morning and is constant. She has no past medical/sugical history. 2 hospitalizations for the birth of her two children. Father had sudden MI at 65 and she takes tylenol occasionally for headaches. NKDA. drinks socially 1-2 drinks, no tobacco or drug use. Denies psychiatric history, depression or anxiety.

Keywords and phrases relevant to diagnosis:
denies hair loss, denies hot or cold intolerance, denies sweating, denies palpitations, denies diarrhea, denies nausea,vomiting
nervousness, nervousness
thinks about taking care of her mother
Denies depression, Denies psychiatric history
difficulty falling asleep
woman
she is less hungry
45 yo
Patient Note: 45 yo female presents with several week history of increased anxiety about multiple issues including family and work. it has effected her work as an english professor. She notes an associated difficulty with falling asleep at night and denies any associated decreased mood, anahdonia, Suicidal ideation, homicidal ideation, Audiohallucinations, visial hallucinations or delusions. She notes increased life stressors with caring for her family and in laws. She denies any alleviating factors for her anxiety and any assocaited sweating or plapations. 
PMH: none, Surgires: none, Allergies: NKA, Meds: occasional tylenol for frontal headache, last headach a while ago. ROS - for skin changes, sweating , wieght changes. fx: father  MI, sexually active 1 partner i past year. no condums no STI hx. Social: occasional etoh use (a few time/ month) no tabacco or ilecit drug use feels safe at home.
Obstertic: G2P2002, last menses last week, last pap Nl.

Keywords and phrases relevant to diagnosis:
denies sweating, denies plapations, - for skin changes, - sweating
increased anxiety
increased life stressors with caring for her in laws
denies any associated decreased mood, denies anahdonia, denies Suicidal ideation
- wieght changes
difficulty with falling asleep
female
45 yo
Patient Note: Ms. Moore is a 45 year old female who presents complaining of nervousness that has been occurring for a few weeks since her job changed from primarily research to now lecturing at univerisy. She finds that her nervousness is worst on Sunday and Monday leading up to her Monday lecture. However, the nervousness is constant. She also has had reduced appetite and trouble falling asleep. This has never happened before. She notes other stressors including her elderly mother lives with her and the majority of the burden of care falls to the patient. She feels that she is becoming overwhelmed with responsibility. ROS negative except as noted above.
PMH: None, no surgeries FH: Father had MI, Mom healthy SH: No tobacco, occasional alcohol use, no drug use, is a professor, current stressors include job change and being a caretaker. MEDications: Tylenol for headaches. Allergies: NKDA, NKA

Keywords and phrases relevant to diagnosis:
nervousness, nervousness, nervousness
stressors including her elderly mother lives with her
trouble falling asleep
female
reduced appetite
45 year old
Patient Note: Karin Moore is a 45 year old female with an episode of nervousness. It has been for hte past few weeks. Nothing has made it better, and it is worse on sunday mornings and mondays before lectures. The lecturres have made her nervous and stressful, she changed her job about a month and a half ago. She also states a loss of appietite,difficulty falling asleep. She says that she is happy and enjoys her hobbies and has no thoughts of harming herself.

ROS: Denies sweating, consptiation, diarrhea, N/V, no weight changes, no axiety, no thoughts of harming herself. 

PMH: None
PSH: None
Meds: Tylenol occasionally
Allergies: NKDA
SH: No smoking, occasional social alcohol, no illecit drugs
Occupation: English Professor
Travel: No Receny
Exercises: Walks
Sexual: Sex with husband

Keywords and phrases relevant to diagnosis:
Denies sweating, Denies consptiation, diarrhea, Denies N/V, Denies diarrhea, no weight changes, Denies consptiation
nervousness, nervous
no thoughts of harming herself, she is happy and enjoys her hobbies, she is happy, enjoys hobbies, no thoughts of harming herself
no weight changes
difficulty falling asleep
female
loss of appietite
45 year, 45 year old
Patient Note: 45 y/o female who reports to the office experiencing a few week of increased nervousness. The patient reports that she experiences consistent nervousness but it increases on Sunday evening and monday morning. The patient reports experiencing increased nervousness but with no identifying relieving factors. She has not tried any treatments for the symptoms. She has never experienced these symptoms before. The patient has recently switched jobs from being a researcher to an English professor a few weeks ago. 
Endorses: trouble falling asleep, and decreased appetitie, drinking coffee
Denies: Blurry vision, dizziness, Dry mouth, SOB, Cough, fever, chills, palpitations, chest pain, abdominal pain, change in urinary or bowel habits, swelling of the legs and the inability to concentrate.
PMH: none
Medications: Tyenolol PRN
PSH: none
Family history: father passed from heart attack at 65
Alcohol denies, tabacco denies, illicit denies

Keywords and phrases relevant to diagnosis:
Denies palpitations, Denies change in bowel habits
nervousness, nervousness, nervousness
drinking coffee
Denies inability to concentrate
trouble falling asleep
female
decreased appetitie
45 y/o
Patient Note: 45 yo f  g2p2 c/o nervousness since a few weeks ago. It is present constantly every day but worsens every sundays and mondays. she worked at reasearch and recently started teaching class on mondays, she feels very anxious at the moment, and nothing makes it better. she denied any recent stressor other than her new job and taking care of many sick family members. she expresses having difficulty falling asleep but once she falls asleep she feels refreshed next morning and wakes up with alarmshe also experiences headache while reading which is relieved by tylenol. she denied any recent trauma, fever, chills or nightsweats. no recent change in weight or appetite, urinary or bowel habits. 
ros: -
all: nka
meds: tylenol prn headache
pmh/pshx: none
fh: father died at 65 of mi
sh: english profesor, drinks 5-6 cups of caffeine daily, no illicit drugs, drinks socially, no smoking, exercises 3miles per week, monogamous with husband

Keywords and phrases relevant to diagnosis:
no recent change in bowel habits
nervousness, anxious
stressor aking care of many sick family members
drinks 5-6 cups of caffeine daily
no recent change in weight
difficulty falling asleep
f
45 yo
Patient Note: Ms. Moore is a 45 yo female with 1 month history of nervousness. Patient reports that one month ago, she changed from doing research to giving lectures in front of many people. Patient reports that her nervousness is worst on Sunday nights and Monday mornings, when thinking about these lectures. Patient reports that this nervousness is non-stop. She reports that this nervousness has caused difficulty with sleeping and affects every aspect of her life. She says that nothing helps relieve the nervousness. No similar previous episodes.
ROS: Slight decrease in appetite, but no weight loss. No hot/cold intolerance, N/V, headaches, palpitations
VS: HR 96, BP 130/85; otherwise WNL
PMHx: none
SH: lives with supportive husband and youngest son; social alcohol, no tobacco, no illicit drugs
Meds: None - at times tylenol for infrequent headaches
FH: Father passed from heart attack at 65, mom healthy

Keywords and phrases relevant to diagnosis:
No hot/cold intolerance, No palpitations
nervousness, nervousness, nervousness, nervousness, nervousness
no weight loss
difficulty with sleeping
female
decrease in appetite
45 yo
Patient Note: Karin Moore, 45 yo f comes in complaining of nervousness throughout the day but especially on sundays and mondays when she has to give a presentation for her english lit classes. She has difficulty falling asleep and stressed from her responsibilities of work and taking care of her family. She consumes caffeinge throughout the day but denies mood changes, depression, tremors, palpitations or sweating.
ROS: WNL
PMH: none 
Allergies: NKDA
Medications: none
FH: father died of heart attack
SH: decreased sexual activity, no cigarettes or alcohol, good relationships at home

Keywords and phrases relevant to diagnosis:
denies tremors, denies palpitations, denies sweating
nervousness
stressed from taking care of her family
caffeinge throughout the day
denies mood changes, denies depression
difficulty falling asleep
f
45 yo
Patient Note: Ms. Moore is a 45 year old, previously healthy woman, who presents with 2-3 weeks of worsing nervousness. During this time, she reports constant, increasing nervousness, restless sleep, loss of appetite and feeling overwhelmed. She denies any episodes of panic attacks. She is a professor and has been conducting research for the last few years; she returned to lecturing students 3 weeks ago. This has reportedly been the only recent change in her life. She denies any history of anxiety. She denies headaches, changes in gastrointestinal patterns, weight loss, palpitations, or recent illnesses. She reports that her anxiety has significantly impacted her personal and professional life. 

Denies any significant past medical history. 
Denies any allergies.
Denies prior surgeries. 
Family history: Father died of heart attack, mother alive and healthy 
Denies any smoking or drug use.
Endorses occasional alcohol use.

Keywords and phrases relevant to diagnosis:
denies palpitations, denies changes in gastrointestinal patterns
nervousness, her anxiety, nervousness, feeling overwhelmed, anxiety
denies weight loss
restless sleep
woman
loss of appetite
45 year, 45 year old
Patient Note: Ms. Whelan is a 26 yo F with a 6 mo hx of heart palpitations that have been increasing in freq in the past 2 weeks. She was seen 2 weeks ago for similar symptoms with a w/u WNL. 
-The events last 12-30 min, are not assoc with anything particular, no alleviating or aggrevating factors. 
-She has assoc SOB, hot and then cold and clamy skin
-Recently had numbness of fingertips on both hands during palpitation event 
ROS: No dyspne, CP, skin, hair or wt changes. 
PMH: none
PSH: None 
Meds: none 
Allergies: NKD
FH: non contributory 
SH: 2 months unemployed, recently purchased a condo but is optomistic about her financial and occupational situation. Lives alone, sexual active with one partner, uses condoms. No alcohol, tobacco or drug use.

Keywords and phrases relevant to diagnosis:
F
assoc SOB
palpitations, palpitation event
was seen 2 weeks ago for similar symptoms with a w/u WNL
No CP
No drug use
increasing in freq in the past 2 weeks
last 12-30 min
clamy
numbness of fingertips, numbness of hands
2 months unemployed, recently purchased a condo
26 yo
Patient Note: Ms. Whelan is a 26y/o F presenting to f/u from the ED with heart palpitations.  She staes she has felt her heart "pounding" and "racing", she feels a sense of doom, "like somehting bad is going to happen" and also gets hot, then very cold and clammy.  She also becomes nauseous and can become very fatigued afterwards. Her fingers also went numb with the attack 2 weeks ago.  Pt does state she's under a lot of stress, as she recently bought a condo and just lost her job 2 mos. ago.  She has been noticing these attacks for about 5 years.
ROS + for SOB, chest tightness, sense of doom, stress, anxiety, nausea, flushing, poor concentration
denies sweating, diarrhea, vomiting, dizziness, headache, or weight loss or gain, or brittle skin/hair
No allergies, meds, PMHx, SHx, FMHx, or OB Hx.
Lives alone in a condo, is a non-smoker, non-drinker, and no illicit drug use.

Keywords and phrases relevant to diagnosis:
noticing these attacks for about 5 years
F
palpitations, heart racing
no illicit drug use
felt her heart "pounding" and "racing", she feels a sense of doom
gets hot, clammy
fingers also went numb
fatigued, poor concentration
recently bought a condo, lost her job 2 mos. ago, under a lot of stress
26y
Patient Note: Edie Whelan is a 26 year old female who presents as follow up from the ED for palpitations. She has been having episodes where she will notice her heart pounding and feel hot/cold and have clammy hands. She was seen in the ED 2 weeks ago with normal CBC, metabolic panel, troponins, and ECG. This happened 5 years ago and stopped and recently started again 3 weeks ago. She has been under a lot of stress as she just bought a condo and lost her job 2 months ago. This last episode she did notice tingling in her fingers. This will come on sporatically. She will also get nauseous during the episodes. 
ROS: negative execpt for above
PMH/ past surgeries: none
Medications: none
Allergies: none
Family history: non contributory.
Social history: lives alone in a condo. Denies alcohol, tobacco, durg use and travel. Is sexually active with boyfriend and they use condoms. She walks a couple times a week for exercise and does not drink coffee.

Keywords and phrases relevant to diagnosis:
happened 5 years ago
female
does not drink coffee
palpitations
in the ED 2 weeks ago with normal CBC, metabolic panel, troponins, and ECG
Denies durg use
nauseous during episodes
feel hot, clammy
tingling in her fingers
under stress, bought a condo and lost her job 2 months ago
26 year old
Patient Note: HPI:  26 YO F C/O EPISODES OF PALPITATIONS THAT STARTED 5 Y AGO BUT HAS BEEN MORE FREQUENT OVER THE LAST 2 WEEKS. THE EPISODES LAST FOR 15-30 MINUTES EACH AND RESOLVE SPONTANEOUSLY. NO SPECIFIC TRIGGERS OR ALLEVIATING FACTORS. SHE REPORTED SOB, NAUSEA AND CHEST TIGHTNESS AND NUMBNESS OF HER FINGERS DURING THESE EPISODES. SHE DENIED SLEEP DISTURBANCES, VOMITING, WEIGHT LOSS, DIARRHEA, ABDOMINAL PAIN, DIZZINESS, LOC OR OTHER NEUROLOGICAL SYMPTOMS.
SHE REPORTED RECENT LOSS OF HER JOB 3 MONTHS AGO WHICH IS A STRESSFUL EXPERIENCE FOR HER. SHE DENIED BEING AFRAID OR SAD. ROS IS OTHERWISE NEG
PMH, PSH: NEG, NKA
FH: NON CONTRIBUTABLE
SOCIAL: NON SMOKER, NO ALCOHOLS, SEXUALLY ACTIVE WITH BOY FRIEND, CONSISTENT USE OF CONDOMS
MENSTRUAL: LMP 2 WEEKS AGO, REGULAR, NO MENORRHAGIA


Keywords and phrases relevant to diagnosis:
STARTED 5 Y AGO
F
SOB DURING THESE EPISODES
PALPITATIONS
NAUSEA DURING THESE EPISODES
MORE FREQUENT OVER THE LAST 2 WEEKS
EPISODES LAST FOR 15-30 MINUTES
NUMBNESS OF HER FINGERS
LOSS OF HER JOB 3 MONTHS AGO WHICH IS A STRESSFUL
26
Patient Note: Pt is 26 yo F presenting w/ c/o palpitations and racing heart. Symptoms have been present since 5 years ago, but have been fairly absent until 3 weeks ago. Patient describes feeling like heart is racing, about to jump out of chest, with assoc. chest tightness, dyspnea and nausea. Patient was seen in ED 2 weeks ago for same complaint and bloodwork (CBC, CMP, cardiac enzymes, and ECG) were all unremarkable. Patient is having some acute life stressors with recent loss of job and moving to new condo. Denies any caffeine use or illicit drugs. No hx of panic attacks or COPD. Endorses numbness/tingling in fingers, remits. Denies perioral tingling or spasms. Denies Headache, changes in vision, chest pain retrosternally with pressure, wheezing, abd. pain., dysuria, or muscle weakness.
PMH, Meds, Allergies all absent. Psurg.Hx, and Smoking, ETOH use and Illicit drugs all unremarkable.
ROS: negative except as above

Keywords and phrases relevant to diagnosis:
since 5 years ago
F
Denies caffeine use
assoc dyspnea
palpitations, racing heart, heart is racing, heart is about to jump out of chest
in ED 2 weeks ago bloodwork and ECG) were all unremarkable, in ED 2 weeks ago CBC, CMP, cardiac enzymes and ECG) were all unremarkable
Denies chest pain
Denies illicit drugs, Hx, Illicit drugs unremarkable
assoc nausea
numbness in fingers, tingling in fingers
stressors, loss of job and moving to new condo
26 yo
Patient Note: 26 y/o female w/o pertinent PMH who presents to clinic following presentation to emergency room with palpitations and bilateral numbness in the fingers. She reports that palpations have been occuring for the past 5 years inconsitently but began again 3 weeks ago. The poudning is a racing he her chest that is now occuring 1 to 2 times a day, during these episodes she is afraid that she is going to die. Not associated with LOC, dizziness, N/V, abdominal pain or visual changes. 2 weeks ago she presented to the ED due to new associated numbness in bilateral fingers. Evaluation in Emergency room was unrevelaing w/ CBC, metabolic panel, cardiac enzymes and EKG in normal limits. Patient reports no inciting factors. 

She has had increased life stressors recently with job loss, new condo and new prospect for a job on the horizon. 

ROS: dnegative except as above
PMH: None
PSH: none
meds: none
FH: not pertinent
SH: no drinking, smoking

Keywords and phrases relevant to diagnosis:
for 5 years
female
palpitations, palpations, poudning is a racing
2 weeks ago Evaluation in Emergency room was unrevelaing, 2 weeks ago in Emergency room CBC, metabolic panel, cardiac enzymes and EKG in normal limits, 2 weeks ago presented to the ED Evaluation was unrevelaing
occuring 5 years inconsitently 3 weeks ago occuring 1 to 2 times a day
during these episodes she is afraid that she is going to die
numbness in the fingers, numbness in fingers
stressors, job loss, new condo
26 y/o
Patient Note: 26 YO F COMING FOR A FOLLOW UP due to cardiac palpitations. the patient went to the ED 2 weeks ago when her heart started racing and felt numbness for the 1st time in her finger tips. The patient has been having these palpitations for 5 years that comes and goes, last 15-30 mins. patient denies sweating, loss of consciousness, weakness .however only numbness on finger tips. Patient denies recent fall, any cold sensation. pt denies cough, fever, vomiting however feels nauseated before the symptoms.

ros: negative except as HPI
PMH: NONE
PSH: NONE
FH: BOTH parents healthy
allergies: none
SH: no smoking, no alcohol, no drugs, no coffee or energy drinks
Sexually active

Keywords and phrases relevant to diagnosis:
for 5 years
F
no coffee
palpitations
no drugs
eart started racing and felt numbness for the 1st time in her finger tips
26