bhatthars/nbme_qna huggingface dataset:
Patient Note: Mrs. Wicks is a 67 year old woman with history of HTN who presents for difficulty sleeping for 3 weeks. 3 weeks ago her only son Leonnard died. She thought she saw him once in the kitchen after he died and she has also heard a party at her neighbor's that wasn't there. These false perceptions do not bother her. Her primary issue is diffuclty sleeping. She goes to bed at 11 PM, falls asleep at midnight, and has poor sleep. Awkaens at 4 or 5 AM. Also has very low energy throughout day but performs daily tasks like cooking. Has a good support system of family and friends. Tried ambien for 5 nights which did not help. She has no thoughts of suicidality or self harm. No nightmares. No nausea, no chest pain, no difficutly breathing. 
family history of HTN and CVA in father, depression in mother
Allergies: none
Meds: HCTZ, lisinopril, ambien (for last 5 days)
Surg Hx: lumpectomy, laparotomy
Soc: no smoking, occasional etoh, no drugs

Keywords and phrases relevant to diagnosis:
3 weeks ago her only son Leonnard died
Mrs., woman
"heard a party at her neighbors that wasnt there"
67 year old
goes to bed at 11 PM, falls asleep at midnight
for 3 weeks
Tried ambien which did not help
low energy
aw him once in the kitchen after he died
depression in mother
Awkaens at 4 or 5 AM
no thoughts of suicidality
difficulty sleeping, diffuclty sleeping, has poor sleep
Patient Note: 67yo F c/o trouble sleeping x3weeks. Pt states her son passed away 3 weeks prior when her insomnia started. She states she has trouble falling asleep, and trouble staying asleep. States she feels "tired and groggy" in the morning upon waking. States feelings of sadness and devastation since losing her son, states loss of interest in hobbies, low energy, increased appetite. +ve Visual hallucinations of son x1. +ve auditory hallucinations (hypnogogic) prior to falling asleep x1. Denies weight changes, feelings of guilt, lack of concentration, psychomotor retardation. Denies skin/hair changes. No change in caffeine intake.
PMH: HTN, Breast CA remission
Allergies and Meds: NKDA, HCTZ, Ambien for sleep
FH: Dad-Stroke, deceased. Mother-Depression.
SH: retired, married. Denies smoking, drugs. Drinks socially on weekends.

Keywords and phrases relevant to diagnosis:
increased appetite
son passed away 3 weeks prior
F
auditory hallucinations x1
67yo
trouble falling asleep
x3weeks, 3 weeks prior insomnia started
feels "tired, low energy
loss of interest
Visual hallucinations of son x1
Mother-Depression
trouble sleeping, trouble staying asleep
Patient Note: Ms. Wicks is a 67yo who presents for difficulty sleeping. She reports that for the past 3 weeks, she has been experiencing difficulty falling asleep and staying asleep. October 13, her only son Leonard passed away. Since then, she has been experiencing increased appetite and difficulty sleeping. She has tried taking ambien. Endorses feeling down. Denies any feelings of guilt. Denies any thoughts of hurting herself or others. Endorses audio and visual hallucinations. Thought she saw her son sitting at the table, and thought she heard voices like her neighbor was having a party when she was not. Denies that hallucinations have told her to hurt herself or others. 

PMH: high blood pressure
PSH: laparotomy for appendicitis, mastectomy for breast cancer (14 years in remission)
FH: none
Social: lives with husband, strong support network, feels safe at home
Substance Use: no smoking, drinks 1-2 drinks per week
Work: retired

Keywords and phrases relevant to diagnosis:
increased appetite
October 13, her only son passed away
Ms
audio hallucinations, heard voices like her neighbor was having a party when she was not
67yo
difficulty falling asleep
past 3 weeks
visual hallucinations, saw her son sitting at the table
Denies any thoughts of hurting herself
difficulty sleeping, difficulty staying asleep, difficulty sleeping
Patient Note: 67yo F presents with difficulty sleeping for 3 weeks after loosing her son. she has difficulty falling asleep, staying asleep and has early morning awakening. she gets about 4/5 hours of sleep a night and feels drained throughout the day. she also reports hearing muffled voices (like a lot of people having a party) that was not actually happening, she also reports seeing her dead son for a few seconds. she also has increased appetite, loss of  interest in things she liked to do and anhedonia. shes in menopause and has had a mammogram last year and apapsmear 2 years ago. she had 1 child by normal vaginal delivery

PMH Hypertension, 10 years in remission from breast cancer
PSH: lumpectomy 10 years ago, laparotomy for appendicitis
SHX she doesbt smoke or use illicit drugs but she drinks a few glasses of wine 2-3 times a week
mother had depression, father died of stroke



Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks after loosing her son
F
hearing muffled voices that was not actually happening
67yo
difficulty falling asleep
for 3 weeks
feels drained
loss of  interest, anhedonia
reports seeing her dead son
mother had depression
early morning awakening
difficulty sleeping, difficulty staying asleep, 4/5 hours of sleep a night
Patient Note: HPI: A 67 YO F COMPLAINS OF TROUBLE SLEEPING SINCE 3 WEEKS AGO. SHE RELATE THE ONSET OF SYMPTOMS WITH THE LOSS OF HER SON THIS PAST NOVEMBER. SHE REFERS ANHEDONIA, DEPRESSED MOOD, FEELING DRAINED AND HAVING EXPERIENCED INCREASED APPETITE. SHE DENIES SUICIDE THOUGHTS, NO PSYCHOMOTOR RETARDATION OR AGITATION, RASHES OR COLD INTOLERANCE. SHE USUALLY TAKES A RELAXING BATH BEFORE GOING TO SLEEP AND USED TO SLEEP FOR 7-8 HRS PER NIGHT, BUT NOW IS ONLY GETTING 4-5 HRS. SHE HAS TRIED AMBIENS FOR THE PAST 5 NIGHTS BUT THEY ARE NOT OF MUCH HELP. SHE DENIES HAVING ANY OTHER STRESSES AT HOME AND REPORTS THAT HER HUSBAND IS VERY SUPPORTIVE.
ROS: SAME AS ABOVE
PMH: ARTERIAL HYPERTENSION.
NKDA
MEDICATIONS: AMBIEN, HCTZ AND LISINOPRIL
PSH: C-SECTION FOR PREGNANCY.
FH: FATHER HAD ARTERIAL HYPERTENSION AND HYPERCHOLESTEROLEMIA PASSED AWAY OF STROKE. MOTHER SUFFERS FROM DEPRESSION
SH: RETIRED. LIVES WITH HUSBAND. ETOH 2-3CUPS OF WINEX3 PER WEEK.

Keywords and phrases relevant to diagnosis:
INCREASED APPETITE
LOSS OF HER SON THIS PAST NOVEMBER
F
67 YO
SINCE 3 WEEKS AGO
AMBIENS NOT OF MUCH HELP
FEELING DRAINED
ANHEDONIA
MOTHER SUFFERS FROM DEPRESSION
DENIES SUICIDE THOUGHTS
TROUBLE SLEEPING, SLEEP ONLY GETTING 4-5 HRS
Patient Note: 67 y/o F comes to the clinic c/o trouble sleeping. Started 3 weeks ago, for the first time, since it started is getting worst. Refers that she only sleep 4-5 hours, awake at 3- 4 am and is no able to fall asleep agian. Refers not feeling rested during the day and can not takes nap.  Refers her son died a months ago, and she feels devasted about this. Refers increased appetite, refers an episodes that she saw her dead son in the kitchen and loss of interest in her daily activities. No suicidadal ideation and refers that her husband and friends are very supportive. Denies fever,  nausea, vomiting,  problem with concentration,  recent infections, weakness, nuimbness, changes in GI/GU or pain in chest, abdomen, or joints.
ROS: none, except as above. PM: HTN for 15 years; All: NKDA; Med: HCTZ, lisinopril; FM: father died of a stroke and mother has MDD. OB: Menopause 53 y/o. SH: retired, drinks 3-4 cup of wines per week, no recreational drug

Keywords and phrases relevant to diagnosis:
increased appetite
son died a months ago
F
67 y/o
Started 3 weeks ago
can not takes nap
not feeling rested during the day
loss of interest
saw her dead son in the kitchen
mother has MDD
awake at 3- 4 am
No suicidadal ideation
trouble sleeping, sleep 4-5 hours
Patient Note: The patient is a 67 yo woman with trouble sleeping. Her son was killed in an MVA 3 weeks ago, and since that time she has had difficulty falling and staying asleep and early morning awakening. No schedule change and normal healthy sleep hygeine. She has tried ambien the past few nights but did not feel that it helped. Since her son's death, she has had decreased energy, loss of sleep, increased food intake, and sadness. She denies psychomotor agitation or retardation, worthlessness or guilt, and suicidal ideation. Normal concentration.  She denies being hot or cold, weight loss or weight gain, changes in timing, consistency, or color of bowel movements, hair or skin changes.]
ROS PMH: HTN, breast cancer in remission for 10 years
PSH: laparotomy for appendectomy, mastectomy
Meds: HCTZ, lisinopril, ambien
Allergies: none
Family: Father stroke age 75, HTN, HLD, Mother depression
No smoking, EtOH 2x/wk., no drugs, sex with husband

Keywords and phrases relevant to diagnosis:
increased food intake
son was killed 3 weeks ago, "sons death"
woman
67 yo
difficulty falling asleep
3 weeks ago, and since that time
tried ambien did not feel that it helped
decreased energy
Mother depression
early morning awakening
denies suicidal ideation
trouble sleeping, difficulty staying asleep, loss of sleep
Patient Note: Pt. is a 67 y/o causcaisun female coming in for 3 week hx. of trouble sleeping. She states she has also had hallucinations for the past 4 days. Her son recently passed away 3 weeks ago in a MVA and ever since then she has had trouble going to sleep, waking up early, feeling tired all the time, eating more. She states usually she is a happy person but has been down recently. She sleeps about 4-5 hrs a night now. She has good sleep hygeiene. She has tried ambien but doesnt help. Hallucinations she states she saw her son 4 days ago, and last night she heard music and partying when there wasnt any. She has lost interest in her hobbies as well. Denies suicidality. No psych hx. Good support systems.

PMH: High blood pressure, breast cancer in remission
PSH: Lumpectomy, laparotomy for appendix
FH: mom- depression
SH: retired receptionist. Normal diet and exercise. No smoking, alcohol some CAGE neg.
Meds: HCTZ, lisinopril
Allergies: None

Keywords and phrases relevant to diagnosis:
eating more
son recently passed away 3 weeks ago
female
heard music and partying when there wasnt any
67 y/o
trouble going to sleep
3 week hx
tried ambien but doesnt help
feeling tired all the time
lost interest
Hallucinations she states she saw her son 4 days ago
mom- depression
waking up early
Denies suicidality
trouble sleeping, sleeps about 4-5 hrs
Patient Note: 67 yo F presents to the clinic with the c/o decreased sleep for the last 3 weeks which happened after her son died on June the 6th. 
PREVIOUSLY SHE MANAGED TO SLEEP FOR A GOOD 8 HOURS, SLEEPING AT 11PM AND WAKING UP AT 7AM. CURRENTLY SHE gpes to bed at 11pm and falls asleep at midnight afte much tossing and turning, wakes up at 4am, sometimes will wake up in between, no snoring, restless sleep. activities before sleeping are dinner and conversation with husband. coffee intake is 1 in the morning. interest has gone down, crying spelLs, no feeling ofguilt, decreased energy and fatigued, decreased ability to concentrate, apetite has gone up, no weight changes, no  suicidal ideations. denies any skin /hair chnages no constipation. 
PMH HTN, Regression for Breats cancer 
PSH lumpectomy, laparatomy for appendix removal
FH father died of stroke mum had depression
SH unremarkable, good relationsip with husband
DRUGS,HCTZ,AMBIAN,LISINOPR


Keywords and phrases relevant to diagnosis:
apetite has gone up
son died on June the 6th
F
tossing and turning
67 yo
gpes to bed at 11pm and falls asleep at midnight
for the last 3 weeks
decreased energy and fatigued
interest has gone down
mum had depression
wakes up at 4am
no  suicidal ideations
decreased sleep, sometimes will wake up in between, restless sleep
Patient Note: Mrs. Wicks is a 67 year old female who presents to the clinic due to difficulty sleeping. This has been occurring for 3 weeks in which she has difficulty falling asleep and staying asleep. She recently lost her son unexpectedly in a MVA and has been grieving. Since his death, she has been having trouble sleeping. She used to get 8 hours now she gets 4-5 hours and is not able to take naps. She tried taking Ambien which she got from a friend which has not helped her sleep. She has also had visual hallucinations of her son and auditory hallucinations of others. 
Depression screening: no suicidal ideation. Has had anhedonia, increased appetite, trouble sleeping
ROS: neg
Allergies: NKDA
Meds: HCTZ, Lisinopril, Ambien
MH: Hypertension, Remission of Breast Cancer 10 years ago
SH: Lumpectomy, Laparotomy (appendix)
Social: Retired Receptionist, lives with husband Rober, sexually active, never smoked, EtOH: 0/4 CAGE , no recreational drugs

Keywords and phrases relevant to diagnosis:
increased appetite
recently lost her son
Mrs., female
auditory hallucinations of others
67 year old
difficulty falling asleep
occurring for 3 weeks
not able to take naps
Ambien has not helped
anhedonia
visual hallucinations of her son
no suicidal ideation
difficulty sleeping, difficulty staying asleep, trouble sleeping, used to get 8 hours now she gets 4-5 hours, trouble sleeping
Patient Note: 67 y female presents to the clinic  compaling of trouble sleeping.  she states that her son passsed away 3 weeks ago on april 16 and she is devastated. she states that she has a strong support system and  is still able to spend time withy friends and husband whi sis very supportive at the moment. denies inabillity to concentrate, eight gain, cold intolerance. admits to fatigue and being emotionally drain. states that she is sad but not depress. denies suicidal ideation.  denies nausea, vomiting. states that she is still able to cook and clean. 
pMH: HBP contoilled, remission for breat cancer 10 years ago. 
allergies: none
meds: ATCZ, linopril, ambien for sleep.
PH: father died at 75 of stroke, had HBP, and dyslipedemia. mother is healthy. 
social history: no ciggarretes, drinks wine 2-3 times a week 0/4 cage. no drugs
sexual history: sexually active with husband

Keywords and phrases relevant to diagnosis:
son passsed away 3 weeks ago
female
67 y
fatigue, emotionally drain
denies suicidal ideation
trouble sleeping
Patient Note: 67 yo female presenting with 3 wk history of difficulty falling asleep/staying asleep coinciding with passing of her son Leonard 3 wks ago. She has not had issues with sleeping in the past, has tried Ambien without success during this episode, and is unclear why it is happening. ROS -: headache, chest pain, cough, wheeze, abdominal pain, numbness/tingling. She describes her sleep hygiene as unchanged: consisting of dinner at 6.30, spending time with husband until 10.30, then washing and sleeping without TV or exposure to electronics. Recently, she is eating more food, not exercising as much with her walks, and had 2 episodes of seeing "visions" of her son and hearing a neighbor's party. PMH: HTN, breast cancer in remission Meds: HCTZ, lisinopril. No allergy. Surgery: lumpectomy and laparotomy for appendicitis in past. Social: retired 2 yrs ago, healthy diet, no smoking/drugs, 2-3 red wine cups/wk. Not sucidal/diminished will to live.

Keywords and phrases relevant to diagnosis:
eating more food
passing of her son 3 wks ago
female
"episodes of hearing a neighbors party"
67 yo
difficulty falling asleep
3 wk history
tried Ambien without success
episodes of seeing "visions" of her son
Not sucidal
difficulty staying asleep
Patient Note: Loraine Wicks 67yo F with PMH HTN on HCTZ and lisinopril presents with 3 weeks history of difficulty sleeping. She has difficulty falling asleep and remaining asleep. She tosses and turns at night. She takes 1 hr to fall asleep and gets about 4-5hrs of sleep a night. She has tried ambien for 5 days; it does not help. She is a retired community college receptionist and spends her days doing house chores. She recently picked up scrapbooking and reading, but has been less interested in doing so lately. She admits to increased appetite, though with no weight changes, and decreased energy levels. Her son recently died and she admits to seeing/hearing things that she knows are not real. Her concentration is normal and she does not feel guilty. She had a lumpectomy 10years ago for breast cancer and is in remission, laparotomy for appendicitis many years ago. FHx: father- HTN/HLD, died of stroke. mother-healthy, depression in the past.

Keywords and phrases relevant to diagnosis:
increased appetite
son recently died
F
hearing things that she knows are not real
tosses and turns
67yo
difficulty falling asleep, takes 1 hr to fall asleep
3 weeks history
tried ambien for 5 days; it does not help
decreased energy
less interested
seeing things that she knows are not real
mother depression in the past
difficulty sleeping, difficulty remaining asleep, gets about 4-5hrs of sleep a night
Patient Note: HOI: 67 y/o F c/o difficulty falling asleep and staying asleep for the last 3 wks. She is also c/o hearing voices and visual hallucinations. She sleeps an average of 4 hrs, is fatigued, and has no energy to do her daily activities. Pts son recently died in a car accident and she is depressed since then. No suicidal thoughts or ideation, feelings of guilt, appetite problems, diarrhea, tremors, heat intolerance or excessive caffiene intake. Pt started taking Ambien from a friend recently and symptoms excaerbated since then. ROS: Negative except as above. PMH: CA Breast, Hypertensive for the last 15 yrs. Menopause 20 years ago. PSH: B/L mastectomy. Medications: HCTZ, Lisinopril, AMBIEN
Allergies: NKDA. SH: Pt is  aretired receptionist and vdoes not use any alcohol, illicit drugs or tobacco. FH: Mother has depression amd father had stroke, HTN.

Keywords and phrases relevant to diagnosis:
son recently died
F
hearing voices
67 y/o
difficulty falling asleep
started taking Ambien from a friend recently and symptoms excaerbated since then
for the last 3 wks
fatigued, has no energy
visual hallucinations
Mother has depression
No suicidal thoughts or ideation
difficulty staying asleep, sleeps an average of 4 hrs
Patient Note: Ms. Wicks is a 65 y.o. F with a history of 3 wks of insomnia after suffering the loss of her only child 3 weeks ago in an MVA.  trouble falling sleep, taking approx 1 hour and waking up in the early morning not being able to go to bed. Getting about 4-5 hrs as opposed to regular 8 hours. No excessive worries or intrusive thoughts overnight. NO changes in sleep habits. Good sleep hygeine--1 cup of coffee per day. Has tried ambien a few nights and does not notice a changeShe does feel sad and have loss of interest in regular acitviites, decreased energy, increased appetite. No suicidal ideation. No fevers, weight changes. No cold or heat intolerance, skin changes, hair changes. 
PMH: r Breat ca-10 yrs remiss, s/p surg, chem, rad. HTN
PSH: ex lap for append, R lumpect
Meds: HCTZ, lisinopril. Recent ambien
FH: Mom depression- unsure of tx
SH: good support sys, lives w/ husb. No tobacco, 2-3 wine/wk, less since incident. Retired.

Keywords and phrases relevant to diagnosis:
increased appetite
loss of her only child 3 weeks ago
Ms., F
65 y.o.
trouble falling sleep
history of 3 wks
tried ambien and does not notice a change
decreased energy
loss of interest
Mom depression
waking up in the early morning
No suicidal ideation
insomnia, Getting about 4-5 hrs as opposed to regular 8 hours
Patient Note: HPI: 67,f,c/o trouble sleeping for the past 3 weeks since his only son passed away due to car accident. She goes to bed at 10PM and have difficulty of maintaining sleep. She reports early morning awakening and felt tired during the day. She talks with his husband before sleeping. She also noted seeing his son and hearing noises at night but which apparently are not present at that time. She also noted increased in appetite but no weight changes.  Patient has a good support system. No snoring, no SOB, no orthropnea, no paroxysmal nocturnal dyspnea. 
ROS: No weight changes, no loss of interest, no urinary or bowel problems
Allergies: NKDA
Medications: HCTZ, Lisinopril, NBN
PMHx: HTN, Breast CA on remission x20yrs
PSHx: Bilateral Mastectomy 20 years ago
SHx: Lives with husband, retired for 2 years, 2-3glasses of redwine/wk, no tobacco, no illicit drugs
FHx: Father died at 75 due to stroke and with HTN; Mother 90 with Depression


Keywords and phrases relevant to diagnosis:
increased in appetite
3 weeks since his only son passed away
f
hearing noises at night but which apparently are not present
67
past 3 weeks
felt tired
noted seeing his son
Mother 90 with Depression
early morning awakening
trouble sleeping, difficulty of maintaining sleep
Patient Note: HPI - 67 yo F c/o insomnia for 3 weeks. It started after death of her son. Is costant and   feels tired, Has drowsiness during a day. has increased apetite. Has difficulty to fall asleep, awakes during night and also earlier at morning.No change of body weight, headache, nause/vomiting, change of vision. No cold intolerance. No chest pain, palpitations, shortness of breath.
ROS - Negative except as above
Allergy - NKDA
Meds - Hydrocholothiazide, Licenopril
PMH- Breast cancer 11 years ago. Hypertension. Lapratomy in the past.
FH - High BP and died from stroke. Mother had depression.
SH - Retired college receptionist. Drinks 1-2 glass vine 3 times per week. No smoking or illicit drug use.

Keywords and phrases relevant to diagnosis:
increased apetite
for 3 weeks started after death of her son
F
67 yo
difficulty to fall asleep
for 3 weeks
feels tired, drowsiness during a day
Mother had depression
awakes earlier at morning
insomnia, awakes during night
Patient Note: 67 yo F comes to the clinic with a complaint of difficulty to sleep. She recalls it starting 3 weeks ago. At that date, she lost her sudden unexpectedly after a car accident. She isn't doing any strenuous activity or having heavy meals before bedtime. She has trouble starting sleeping and takes about 1 hour to fall asleep. She also wakes up many times a night. She recalls no snoreing or shortness of breath in the middle of the night. No nightmares. She feels sad, has low energy and has lost interest in most of the activities she used to take pleasure on. She tried to use Ambien with no help. She didn't contemplate suicide. No guilty feelings. She has no change in skin or hair, no changes in her bowel movements, no intolerance for extreme weather.
ROS: None except above
PMH: Hypertension treated. Breast cancer 10 y ago.. Takes HCTZ and enalapril. Ambien.  NKDA.  PSH lumpec. and apendect. 
FH: Mom had Depression.

Keywords and phrases relevant to diagnosis:
F
67 yo
trouble starting sleeping, takes about 1 hour to fall asleep
starting 3 weeks ago
tried to use Ambien with no help
low energy
lost interest
Mom had Depression
difficulty to sleep, wakes up many times a night
Patient Note: Loraine Wicks is a 67 y/o AAF who presents with trouble sleeping for the last 3 weeks after the recent dead of her only son who past in a MVC. She reports 4/5 h of sleep per night, difficulty falling asleep and not feeling rested upon waking. She feels devastated and drained and had increased appetite for a couple weeks with no changes in weight. She also reports decreased intrest in reading which she used to enjoy very much. Denies feelings of guilt, headaches, changes in vision. Positive for visual and auditory hallucinations.

PMHx: HTN for 15 years, controlled with HCTz and lisinopril
PFHx: Father - HTN, high cholesterol; stroke (deceased); Mother - depression
Social: no smoking or illegal drugs; couple glasses of wine 1-2/wk; lives with husband and receives support from him and friends
No allergies
No surgical history

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks after the recent dead of her only son
AAF
auditory hallucinations
67 y/o
difficulty falling asleep
last 3 weeks
not feeling rested upon waking, feels drained
decreased intrest
visual hallucinations
Mother - depression
trouble sleeping, 4/5 h of sleep per night