bhatthars/nbme_qna huggingface dataset:
Patient Note: Ms. Whelan is a 26 yo F who presents with a history of palpitations. The palpitations started 5 years ago but worsened in the past 3 weeks. 2 weeks ago she visited the ER where her labs were normal. The episodes consist of shortness of breath, tight throat, nausea, feeling hot, palpitations, and they come out of no where. Also has numbness of her fingers. No alleviating or aggravating factors. Episodes go away on their own in 15-30 minutes. Does not consume caffeine. Has experienced lots of stress recently with losing her job and buying a condo.
PMHx: None
PSHx: None
NKDA
Meds: None
ROS: negative except as above.
FH: None
OB hx: G0P0. LMP 1 week ago. 1 male sexual partner. No hx of STDs. Condom use.
Social hx: Nonsmoker, no EtOH use. Denies illicit drug use. Feels safe at home. Support system includes her boyfriend.

Keywords and phrases relevant to diagnosis:
started 5 years ago
Ms, F
Does not consume caffeine
episodes consist of shortness of breath
palpitations, palpitations, palpitations
2 weeks ago she visited the ER where her labs were normal
Denies illicit drug use
episodes consist of nausea
worsened in the past 3 weeks
go away in 15-30 minutes
episodes consist of tight throat
feeling hot
numbness of her fingers
experienced lots of stress, losing her job and buying a condo
26 yo
Patient Note: Ms. Whelan is a 26F who presents with palpitations. Started 5 years ago during a stressful period in college, occured twice in 1 month. Afterwards occured 1 a year until 3 weeks ago when they reoccurred twice in one day. Then 2 weeks ago they occured with numbness in her hands, she went to ED with normal workup. She is now here for follow-up on this. She denies any history of cardiac or neurologica abnormalities
MedHx: none
SurgHx: none
Medications: none
Family History: none
Social: lives alone, no smoking, drinking, or drugs

Keywords and phrases relevant to diagnosis:
Started 5 years ago
F
palpitations
2 weeks ago she went to ED with normal workup
no drugs
occured 1 a year until 3 weeks ago when they reoccurred twice in one day
occured with numbness in her hands
26
Patient Note: Edie Whelan is a 26 year old AAF who presents to the clinic today for CC "I'm having heart pounding". She states that she was previously seen in the emergency room 2 weeks ago for heart palpitations and a sensation that she "was going to die". She was told to follow up in the clinic today. She states that for the past 5 years she has been dealing with heart palpitations which she describes as a feeling that "my heart is going to beat out of my chest". These occurences have become more frequent over the past 3 weeks. During the episodes she states she has nausea, SOB, throat tightness, hot flashes and clammy hands. She denies vomiting, weight loss, syncope, change in appetite or bowel habits. She states that these episodes occur randomly and occur once every 2-3 days. She has many life stressors at this time. 
PMH: none
FMH: none
SHx: denies tobacco, alcohol and illicit drug use.
Meds: none
Allergies: none
Surgeries: none 


Keywords and phrases relevant to diagnosis:
for the past 5 years
F
has SOB
feeling that "my heart is going to beat out of my chest, palpitations, palpitations
denies illicit drug use
has nausea
more frequent over the past 3 weeks
sensation that she "was going to die
has throat tightness
hot flashes, clammy hands
stressors
26 year old
Patient Note: Patient is a 26yo F who presents for foloow-up of palpitations.  Was seen in the ED 2 weeks ago for increasing occurance of palpitations; with heart racing, SOB, throat tightening, nausea, finger numbness, and diaphoresis.  Patient states she has felt like this for the past 5 years, with episodes occuring 1-2x/month, but that it has acutely gotten worse, with episodes occuring 1-2x/day in the past 3 weeks.  Patient denies any chest pain, exacerbating or relieing factors, wheezing, diarrhea, constipation, urinary symptoms, blurry vision, headache, or other systemic complaints. Is concerned by these episodes, stating she "feels my heart is going to stop", and is motivated to get to the bottom of them. 
ROS: negative unless stated above
PMH: none
Medications: none
Allergies: nkda
FHx: none
Social history: denies alcohol, tobacco, drug use. Unemployed. Eats balanced diet, no change in appetite. Sleeping well.

Keywords and phrases relevant to diagnosis:
felt like this for the past 5 years
F
with SOB
palpitations, palpitations, heart racing
denies chest pain
denies drug use
with nausea
for the past 5 years, episodes occuring 1-2x/month episodes occuring 1-2x/day in the past 3 weeks
feels my heart is going to stop
with throat tightening
finger numbness
Unemployed
26yo
Patient Note: Ms. Edie Whelan is a 26 year old female with no PMHx presenting today with a three week history of heart palpitations.  She reported to the emergency department two weeks ago with similar symptoms.  At that time, she had a normal EKG, CBC, CMP and cardiac enzymes.  Since then, she has been experiencing these palpitations multiple times throughout the day.  These palpitations are associated with feelings of 'clamminess', throat tightness, shortness of breath and nausea.  Patient recently lost her job, 1 month after closing for a condominium here in Atlanta.  She reports increased stress during the past few weeks.

Patient denies any chest pain, joint pain, fever or edema.  She reports similar palpitations 5 years ago, although she does not recall any triggers for these events.  Patient has no history of physical, emotional or sexual trauma.  Patient denies any anhedonia, feeligns of guilt, change in appetite or energy levels.

Keywords and phrases relevant to diagnosis:
palpitations 5 years ago
Ms, female
associated shortness of breath
palpitations, palpitations, palpitations, palpitations
emergency department two weeks ago had a normal EKG, CBC, CMP and cardiac enzymes
denies chest pain
associated nausea
associated throat tightness
clamminess
lost her job, after closing for a condominium, increased stress
26 year old
Patient Note: Ms. Whalen is a 26 yo F without sig past medical history presenting for palpitations. She reports that she has experienced increased plapitations in the last 3 weeks. These episodes are described as "heart pounding, feeling clammy" which lasts for 15 minutes at a time. 2 weeks ago she presented to the ED because she also experienced "fingers going numb" that accompanies palpitations. ED work up included EKG, CBC, CMP were normal. Episodes goes away on its own. She has not tried anything for this. Last episode was yesterday. There were no reported changes in symptoms since being seen by the ED.  Denies chest pain. Endorses shortness of breath. Denies syncopal episodes. Endorses nausea, but no vomiting or abdominal pain. Denies caffeine intake. No hx of strokes or blood clots.  
ROS - neg. No meds, No PMHX or fam Hx
Social - denies smoking tobacco, alcohol use or drug use. Recent job loss and apartment. Reports good support. 


Keywords and phrases relevant to diagnosis:
F
Denies caffeine
Endorses shortness of breath
palpitations, plapitations
2 weeks ago ED work up included EKG, CBC, CMP were normal
Denies chest pain
denies drug use
Endorses nausea
increased in the last 3 weeks
lasts for 15 minutes
feeling clammy
fingers going numb
Recent job loss and apartment
26 yo
Patient Note: Ms Whelan is a 26 year old female who came in for a follow up visit from the Emergency room for palpitations. The patient started to notice "heart pounding" about 5 years ago, but the palpitations became more frequent about 3 weeks ago. Around that time, the patient lost her job and just bought a  new condo. 1 week ago, the patient stated that her fingers went numb and she went to the ED. At the ED, her CBC, BPM, EKG came back normal. She states that when she has these episodes she feels SOB, feels that her throat is closing in on her, and goes from hot to cold and clammy. The only things that make it better are rest and waiting for it to pass. She also states that she becomes fatigued after the episodes. 
ROS: denies HA, visual changes, constipation, diarrhea, hair falling out or becoming brittle, urinary changes, mood changes
PMHx: none
Meds: None, Surgeries: none, NKDA
Fam Hx: None
Socal: Denies smoking, alcohol, and drugs

Keywords and phrases relevant to diagnosis:
started to notice 5 years ago
Ms, female
when she has these episodes she feels SOB
palpitations, palpitations
1 week ago went to the ED CBC, BPM, EKG came back normal, 1 week ago At the ED CBC, BPM, EKG came back normal
Denies drugs
more frequent 3 weeks ago
when she has these episodes she feels that her throat is closing
feels hot, clammy
fingers went numb
fatigued
lost her job and just bought a  new condo
26 year old
Patient Note: Edie Whelan, a 26-year-old female, has come to the outpatient clinic for a follow-up visit for palpitations.  Report from visit to the emergency department 2 weeks ago: Complete blood count - within normal limits; Metabolic panel - within normal limits; Cardiac enzymes - within normal limits; ECG - within normal limits.
She has had palpitations for 5 years.  2 weeks ago they were also associated w/ finger numbness, since resolved.  She admits to SOB, N, throat tightness, and going from "hot to cold and clammy" during the episodes.  She denies CP, V, bowel changes, urinary symptoms, HA.  She denies triggers and alleviating factors.
ROS: as above
PMHx: neg
PSHx: neg
Meds: none
FMHx: neg
NKDA
SH: denies toxic habits X3, sexually active w/ male partner, uses condoms
LMP 2 weeks ago, G0P0

Keywords and phrases relevant to diagnosis:
for 5 years
female
SOB during the episodes
palpitations, palpitations
visit to the emergency department 2 weeks ago: Complete blood count - within normal limits; Metabolic panel - within normal limits; Cardiac enzymes - within normal limits; ECG - within normal limits
denies CP
denies toxic habits
N during the episodes
throat tightness during the episodes
clammy, going from "hot
finger numbness
26-year-old
Patient Note: 26Y/O F C/O POUNDING OF THE HEART FOR 2 WEEKS 3 TIMES . LAST TIME SHE VISITED ER . SHE HAS THIS PALPITATION FOR 5 YR 3 ATTACKS IN 5 YR . LAST FOR 20 MINS  EVERY TIME. ASSOCAITED WITH NAUSEA, SOB, AND SWEATY AND COLD SKIN. SHE HAS LAID OFF FROM JOB FEW M AGO AND STRESSED OUT ABOUT IT. NOTHING MAKES IT BETTER OR WORSE . DENIES ANY WT LOSS, FEVER , HEAT INTOLERANCE, CHANGE IN BOWEL HABIT . CAHANGES IN URINATION AND TREMOR , CHEST PAIN , WHEEZING. DENIES ANY CAFFEINE INTAKE
MENS HX:  MENARCHE 13Y/O, REGULAR PERIOD 4DAYS /28DAYS . WITH NORNAL FLOW
ROS: -VE EXCPT ABOVE
PMH; NONE
PSH:NONE
MEDS: NONE
ALLERGIES: NKDA
FH:NONE
SH:DENIES ANY ETOH , SMOKING TOBACCO AND CAFFEINE AND SEXUALLY ACTIVE WITH BF WITH CONDOMS. SALES WORKER

Keywords and phrases relevant to diagnosis:
SHE HAS THIS FOR 5 YR
F
DENIES ANY CAFFEINE, SH:DENIES CAFFEINE
ASSOCAITED WITH SOB
PALPITATION
ASSOCAITED WITH NAUSEA
LAST FOR 20 MINS
LAID OFF FROM JOB FEW M AGO, STRESSED OUT
26Y
Patient Note: 29 yo F retail worker c/o episodes of paliptations x 2 wk, assoc w/ feeling of sense of doom, feeling of dying, numbness of the fingers, SOB, throat tightness, nausea, feeling of warmth during episodes and cold and clammy after. No triggering events, last 15-30min, one episode every few days
-previous similar episodes x 3wk, 1-2/d, episodes x 5y 2-3/month during college
-denies assoc w/stress, currently under increased stress
-no thoughts of anxiety/LOC, dizziness/bladder/bowel complaints/bodyaches/skin changes/difficulty adjusting to temperatures (except in episodes)
-no changes in diet/appetite/weight.balanced diet, eating and drinking well
ROS: as above
PMH: ER visit for similar complaints 2 wk ago
PSH: none
Allergies: NKA medications: None
SH: no smoke/alcohol/illicit drugs. sexually active with boyfriend, regularly uses condoms
OBGYN: LMP 1 wk ago, regular cycles, last PAP smear normal
FH: noncontributory


Keywords and phrases relevant to diagnosis:
episodes x 5y
F
assoc w/ SOB
paliptations
illicit drugs no
assoc w/ nausea
assoc w/ feeling of sense of doom, assoc w/ feeling of dying
assoc w/ throat tightness
assoc w/ feeling of warmth
assoc w/ numbness of the fingers
currently under increased stress
29
Patient Note: 26 yo woman with a 3 week history of heart pounding most recent happened about 2 weeks ago and associated with nausea, coldness, clammyness and throat tightness. During the most recent episode her hands went numb. She said she wasn't doing anyhting specific at the times and that the episodes come and go at randome times. Not associated wiht activity. has had these attacks some for 5 years but only got worse 3 weeks ago. They last 15 to 30 min. No diareah, no weight changes or apetitie changes. No dizzyness with the episodes. No changes in hand color with numbness. No signs of depression. 
ROS: negative except as above
PMH-negative
PSH: none
Medications: none
Allergies: NKDA
FH: noncontributory 
SH: healthy diet no Etoh, no smoking illicit drugs, walks once a day

Keywords and phrases relevant to diagnosis:
has had for 5 years
woman
no illicit drugs
associated nausea
got worse 3 weeks ago
last 15 to 30 min
associated throat tightness
clammyness
hands went numb
26 yo
Patient Note: 26 yo female with 5 year history of palpitations that has gotten worse in past three weeks
HPC- 5 years ago they started, infrequently. 2 months ago she lost her job. 3 weeks ago panic attacks became more frequent, usually 1-2 times/day. Last 15-30 minutes. Happen at random times. Nothing to exacerbate or alleviate. Must wait out the episode, nothing she does makes it goes away.
Describes each episode as "heart racing, throat tightens, shortness of breath, feeling very hot then very cold, and feeling nauseous. Feels like I'm going to die" Feels very tired after and has difficulty concentrating. No chest pain.
Since visit to ER, episodes are once every few days.
Med HX- nil. Surg Hx- Nil. Medications- Nil. NKDA. Social: nil smoking, nil drinking, nil recreational drug use. Lives alone. Used to work as sales consultant, lost job 2 months ago. Has another interview soon which she is looking forward to.
ROS negative except as above.

Keywords and phrases relevant to diagnosis:
5 year history of, 5 years ago they started
female
episode shortness of breath
palpitations, heart racing
No chest pain
nil recreational drug use
feeling nauseous
worse in past three weeks, 3 weeks ago more frequent
"Feels like Im going to die"
Last 15-30 minutes
episode throat tightens
feeling hot
tired, difficulty concentrating
lost her job, lost job
26 yo
Patient Note: HPI: A 26 y/o female patient comes to the clinic to follow up after an ER visit due to symptoms of palpitations. 5 years ago she began to experience as she describes a "Heart Pounding" sensation that would come and go. It has gotten worse in the past 3 weeks. This would be followed with symptoms of shortness of breath, nausea, numbness of the fingers, tighting of the thoat and feeling clamy. Nothing would alleviate the symptoms, patient states that by waiting it reassures her that the symptoms will subside. Denies Headache, Sweating, radiating of chest pain to the left arm, diarrhea and loss of weight.
PMHx: No medical condition, does not take any medication, denies allergies, last menstruation was 1 week ago, regular, no cramps, no pregnancy.
PSHx: Denies smoking, Is unemployed - looking for a job, prior was a sale associate, well-balnced diet, no illicit drugs, no alcohol, no travel, Sexually active with boyfriend, uses protection

Keywords and phrases relevant to diagnosis:
5 years ago, 5 years ago she began to experience Heart Pounding
female, y/o female
with shortness of breath, would be followed with symptoms of shortness of breath
palpitations, comes to the clinic to follow up after an ER visit due to symptoms of palpitations
Denies chest pain
no illicit drugs
with nausea
gotten worse in the past 3 weeks, has gotten worse in the past 3 weeks
with tighting of the thoat
This would be followed with symptoms of feeling clamy, feeling clamy
numbness of the fingers, This would be followed with symptoms of numbness of the fingers
unemployed
26 y/o, 26
Patient Note: Ms. Whelan is 26 y/o F with palpitations that started 5 years ago and worsening 3 weeks ago to 1-2 x day (before it was 2-3 episodes/month). last 15-30 min. went to ED 2 weeks ago due to palpitations with numbness in fingers. palpitations stop by themselves, no preciptiating events. Endorses feeling hot and then cold and clammy afterwards and shortness of breath. Denies fever, hives, rashes, tremors, weight changes, headache, loss of conciousness, jerking moements. 
PMH: none. PSH: none. FH: health, no cardiac history or thyroid history. OBGyn hx: sex with boyfriend, uses contraception. menarche at 12, regular periods, uses condoms. Recently lost job, anxious over this. No tobacco, etoh, or drug use. no meds, no allergies, no caffeiene use.

Keywords and phrases relevant to diagnosis:
started 5 years ago
Ms, F
no caffeiene use
palpitations, palpitations, palpitations
No drug use
worsening 3 weeks ago, 3 weeks ago to 1-2 x day (before it was 2-3 episodes/month
last 15-30 min.
feeling hot, clammy
numbness in fingers
lost job
26 y/o
Patient Note: Edie Whelan, a 26-year-old female, has come to the outpatient clinic for a follow-up visit for palpitations. 
- began 5 years ago, got worse 3 weeks ago, happens1-2 times/day, lasts 15-30 mins; 
- has numbness in her fingers, sweats, SOB, nausea
- after the events she has difficulty concentrating and fells tired
- Denies vomits, fever, changes in mood, weight changes, dizzness, changes in vision or hearing, seizures, LOC
- nothing makes it better or worse
- impares daily lives activities

OB/GYN: LMP 9 days ago, periods are regular
PMH: none          PSH: none
FH: none
SH: no smoking, no EtOH, no illicit drug; sexually active with boyfriend, uses condoms, no previous STIs;  unemployed for 2 months

Keywords and phrases relevant to diagnosis:
began 5 years ago, got worse 3 weeks ago
female
has SOB
palpitations happens1-2 times/day
no illicit drug
has nausea
lasts 15-30 mins
sweats
numbness in her fingers
difficulty concentrating, fells tired
unemployed
26-year-old
Patient Note: Ms. Whelan is a 26F presenting with 3 weeks of intermittent episodes of heart pounding and SOB
- The palpitations first began 5 years ago, but increased in frequency in the past 3 weeks. They now happen every 2 days or so, and last 15-30 minutes.
- Feels pounding of heart in chest; associated with SOB, feelings of impending doom
- Nothing relieves the episodes, patient just sits and waits it out
- No identified triggers

ROS: Denies any chest pain, lightheadedness during episodes. Denies any symptoms in between episodes, including nausea, vomiting, diarrhea, constipation, headaches
PMHx/PSHx: None
Meds: None
Allergies: None
Fam hx: None
Social history: No alcohol, tobacco, substance use. Only sexualyl active with boyfriend. 4 months ago, bought a condo, and 3 months ago, lost her job. Has been a stressful period of her life.

Keywords and phrases relevant to diagnosis:
first began 5 years ago
Ms, F
associated SOB
palpitations
Denies chest pain
No substance use
increased in frequency in the past 3 weeks
feelings of impending doom
last 15-30 minutes
lost her job bought a condo, and, stressful period
26
Patient Note: A case of 26 year old female patient comes in due to palpitations. Started 2 weeks ago. It has been better and occuring less. Intermittent. Lasting for 15-30 minutes. Used to be 1-2 last 3 weeks but now it is once every other day. Associated with clammy fingers, throat tightening, SOB, and nausea. Negative history for fluttering of chest, dizziness, Loc, chest pain, weight change, appetite change, hot intolerance, diarrhea, sweaty palms, fever, chills, vomiting, visual changes, headaches, abdominal pain

ROS;  negative except as above OB/GYN; LMP 1 week ago, 5/30 days, uses tampons, menorchea at 12 years with no discharge, itchness, redness PMH; none  PSH; none  FH; none SH;  no smoking, no alcohol, no illicit drugs, sexually active but uses protection, no STDs  MEDS; none  ALL; nkda

Keywords and phrases relevant to diagnosis:
female
Associated SOB
palpitations
Negative history for chest pain
no illicit drugs
Associated nausea
Lasting for 15-30 minutes
Associated throat tightening
clammy
26 year old
Patient Note: 28-year old female presents for a follow-up after 3 week history of palpitations. She describes sudden episodes of heart pounding, shortness of breath, nausea and feeling hot and clammy.No clear trigger. The episodes started from nothing 3 weeks ago, the episodes occured daily back then, currently they occur every other day. She visited the ER, the ECG, heart enzymes, metabolic panel and CBC weree all normal back then.
ROS: weight constant, no fever, no night sweats, no headaches, no cold or heat intolerance, no episodes of sickness recently, no chest pain, no vomiting, constipation or diarrhea, no urinary symptoms
OBGYN: G0P0, constant menstruation of 30days with 4 day bleeding, no contraception, sexually active with boyfriend only
Med: none
Nox, Allergies: none
FH: none
SH: looking for work currently

Keywords and phrases relevant to diagnosis:
female
episodes of heart pounding, shortness of breath
palpitations
3 weeks ago visited the ER, the ECG, heart enzymes, metabolic panel and CBC weree all normal
no chest pain
episodes of heart pounding nausea
feeling hot, clammy
Patient Note: Pt is a 26 y/o female who presents with palpitations. Pt was recently seen in ED 2 weeks ago and was found to name normal CBC, chem panel, cardiac enzymes, and EKG. Pt states palpitations started 5 years ago and was infrequent. sypmtoms worsened 3 weeks ago and become more frequent. Pt c/o episodes of palpitations with SOB, nausea, sensation of throat closing, trouble concenrating and diaphoresis that are now occuring 1 or 2 times per day. Pt also had an episode where her fingers went numb. Episodes resolve on their own and pt denies any inciting events. Pt denies sypmtoms of depression but notes she recently bought a condo and lost her job and is dealing with the stress associated with that. Denies CP, diarrhea, vomiting, abd pain, weight or appetite changes. No alleivating or exacerbating factors to these episodes.
PMH: none
PSH: none
Meds: none
FH: non contributory
SH: denies smoking, drinking, and drugs
NKDA

Keywords and phrases relevant to diagnosis:
started 5 years ago
female
episodes with SOB
palpitations, palpitations, palpitations
in ED 2 weeks ago normal CBC, chem panel, cardiac enzymes, and EKG
Denies CP
denies drugs
episodes with nausea
5 years ago was infrequent 3 weeks ago become frequent, sypmtoms worsened 3 weeks ago, 3 weeks ago become more frequent, now occuring 1 or 2 times per day
episodes with sensation of throat closing
fingers went numb
trouble concenrating
recently bought a condo and lost her job, stress
26 y/o
Patient Note: 26 y f presented with palpitations since 3 weeks, associated with nausea, tingling sensation in upper limbs, nausea and cold extremities. frequency of these episodes are increased since then with 1-2 episodes per day at present. Had similar complaints 5 years back, was asypmtomatic after that. Has feeling of impending doom and fear of death during these episodes.
- no excess caffeine use / no reacreational drugs . no intolerance to heat or cold. No changes in the weigth/ appetite/ skin or hair changes.
-Lost a job 2 months ago and worried about it. No temporal relation with palpitations.
-No low mood/ decreased energy. no suicidal tendencies.
SH - Non smoker / non alcoholic.
FH- insignificant
PMH/PSH- insignificant
Had pap smear done - normal.

Keywords and phrases relevant to diagnosis:
similar complaints 5 years back
f
no excess caffeine, no caffeine use
palpitations, palpitations
no reacreational drugs
associated nausea, associated nausea
since 3 weeks frequency of these episodes are increased
feeling of impending doom, fear of death
tingling in upper limbs
Lost a job
26 y