bhatthars/nbme_qna huggingface dataset:
Patient Note: 20 yo f present with vomiting that while she was a sleep yesterday morning.it has progressive gotten worse and it a constant headache.the pain is a dull 8/10 and iit is associated with vomiting and the vomit dosesnt have blood in or foul smell.he tried taking ibrubrofen which produced minimal relive . she also dscribe photophobia
ROS
PMH none 
PSH none 
ALLERGIES 
MED ibuprofen for headcahe 
SH she has been taking OCP for the past 2 years 
FH mother had migrane headche

Keywords and phrases relevant to diagnosis:
20 yo
vomiting, vomiting
FH migrane, mother had migrane
f
photophobia
Patient Note: Mrs. Madden Is a 20 y/o  patient who c/o of headache since yesterday morning which started yesterday morning at 2/10 and has progressed to 8/10. Pain is exacerabted by bending forward, and lights. It was not alleviated with tylenol, ibuprofen or sleeping. She reports photophobia and 3 episodes of vomiting and generalized myalgias but denies auras. Patient also reports runny nose and sore throat and generalized fatigue for the past few days. She deniess episodes of diarrhea, recent travel or sick contcts.
Past Med Hx: None
Gyn: LMP 2 weeks ago, regular cycles, last 4-5 days without pain
Allergies: NKDA
Medications: oral contraceptives.
Sugeries: None
Family History: mother has migraines, father as hyperlipidemia
Social: salesperson, lives in apartment with roommate, sexually active with boyfriend only-they use condoms regularly, no tobacco, 2-3 glasses wine on weekend CAGE 0/4, 3-2 joints marihuana throughout the week

Keywords and phrases relevant to diagnosis:
not alleviated with tylenol, not alleviated with ibuprofen
20 y/o
yesterday, yesterday
myalgias
vomiting
runny nose, sore throat
lives in apartment with roommate
Family History migraines, mother has migraines
exacerabted by lights, photophobia
deniess sick contcts
Patient Note: 20 yo female c/o headache since yesterday morning. She states that it started when she awoke in the morning, did not wake her from sleep. She states tht it is a dull constant ache throughout her head, 8/10 in severity. She describes it as "the worst headache of my life." She denies head trauma. She endorses nausea and emesis since teh headache began. She denies blurred vision or visual changes, she denies pressure behind her eyes. She endorses photophobia, and states that walking or bending over makes her headache worse. She does endorse subjective fever, denies chills. She denies any past episodes similar to this. She took ibuprofen and tylenol with no relief.
PMH: none
PSH: none
Meds: OCP, ibuprofen, tylenol; allergies: NKDA
FH: mom: migaraines
SH: 2-3 drinkes on weekends, nonsmoker, smokes 3-4 joints of marijuana per week, works at sporting goods store

Keywords and phrases relevant to diagnosis:
ibuprofen no relief, tylenol with no relief
20 yo
yesterday
headache throughout her head
emesis
nausea
mom: migaraines, FH migaraines
female
photophobia
subjective fever
Patient Note: 20 yo F complaing of severe headache x1 day. Previously would have 2-3 mild headaches per year. Pain is dull and constant, and felt throughout her head. No associated aura. Endorses photophobia, nausea, and vomiting. NSAIDS are not improving pain. PAin was worse when patient woke up this AM, and does not worsen with sitting up. Was able to get full night's sleep last night , no issues with falling asleep. Endorses rhinorrhea and sore throat x1day. Endorses subjective fever. Denies nightsweats. No increased lacrimation.
PMH: none; no surgicl hx; Family hx: mother with migraines, father with hyperlipidemia; Meds: OCPs;
NKDA; Social: lives with roomate, drinks 2-3 ETOH drinks per week, denies tobacco use, smokes 2-3 marijuana cigarettes per week


Keywords and phrases relevant to diagnosis:
NSAIDS are not improving pain
20 yo
1 day, 1day
headache throughout her head
vomiting
nausea
rhinorrhea, sore throat
lives with roomate
mother migraines, Family hx migraines
F
photophobia
subjective fever
Patient Note: 20yo F,C/O SUDDEN BILATERAL HEADACHE, PROGRESIVELY WORSENING,X1DAY,DULL,AND CONSTANT ,USED TYLENOL BUT NO RELIEVE. ASS NECK PAIN AND FEVER, RUNNING NOSE ,PHOTOPHOBIA,,SCRATHY THROAT 
PT VOMITTED -3 EPISODES ,INITALLY CONTAINED RECENTLY INGESTED MEAL BUT NOW GREENISH
ROS= NEGATIBVE EXCEPTA AS ABOVE
MEDS ==OCP
ALLEG=
PMH
NONE
FH=MOTHER MIGRAINE ,FATHER HIGH CHOLESTEROL
SH=2-3 WINE ON WEEKEMDS,NO SMOKING

Keywords and phrases relevant to diagnosis:
TYLENOL BUT NO RELIEVE
20yo
NECK PAIN
VOMITTED
RUNNING NOSE, SCRATHY THROAT
MOTHER MIGRAINE, FH MIGRAINE
F
PHOTOPHOBIA
FEVER
Patient Note: stephanie madden is a 20 year old female presents today with sever headache of 2 days duration. Never had this pain before and has nausea and vomitting, vomitting 3 times yesterday. Pain is 8/10, constant dull ache that is all over and is worse with bending over, walking and lights. tried taking ibuprofen and sleeping but did not help. She says she felt feverish but did not check her tempertare. 

ROS: none except above
PMH: none
allergies: none
meds: ibuprofen and OCPS
FH: father has high chol and mother has hx of migraines
SH: sexually active with 1 partner, drinks 2-3 alcoholic drinks on the weekend, smokes marijuana 3-4 times a week

Keywords and phrases relevant to diagnosis:
ibuprofen but did not help
20 year old
2 days duration
headache all over
vomitting
nausea
mother migraines
female
worse lights
feverish
Patient Note: Ms. Madden is a 20 year old female who presents with headache x 1 day. She states that it is a dull constant pain that involves the whole head, associated with fever, neck stiffness, photosensitivity and vomiting x 3 episodes. 
ROS: Positive for generalized muscle aches, but no blurry vision, red eyes, strange smelling sensations or generalized body weakness, coughing, SOB, chest pain
PMH: non-contributory
Meds: Oral contraceptive pills
Allergies: None known
FH: Mother has migraine headaches, father has hypercholesterolemia
SH: She doesn't smoke and uses EtOH occasionally. In a monogamous relationship with her boyfriend and uses condoms

Keywords and phrases relevant to diagnosis:
20 year old
muscle aches
headache whole head
neck stiffness
vomiting
Mother has migraine, FH migraine
female
photosensitivity
fever
Patient Note: A 20 year old female patient presented complaining of a headache, that started yesterday morning, sudden in onset, continuous, and getting worse. It is localized to the entire of head, with 8-9/10 intensity, dull in quality, not radiated or shifted. Not relieved by ibuprofen, aggravated when walking around or with bright light. She also felt warm yesterday, and had 3 episodes of vomiting, the vomitus was food, and green in color, with no blood. She has runny nose since yesterday. Her headache is not related to menses. No similar pain episodes in the past. No history of weakness, or numbness
ROS: negative except as above
Allergy: NKDFA
Medications: OCPs, and ibuprofen
PMH and PSH: none
Family hx: her mother has migraine headaches
Ob/GYN: LMP was 2 weeks ago, regular cycles every 30 days with 4-5 days of bleeding
SH: does not smoke, drinks 2-3 glasses of alcohol on weekends, smokes week 3-4 times/week, working at a store

Keywords and phrases relevant to diagnosis:
Not relieved by ibuprofen
20 year old
yesterday
headache entire of head
vomiting, vomitus
runny nose
Family hx migraine, mother has migraine
female
aggravated with bright light
felt warm
Patient Note: Stephanie Madden 20 y/o F with CC of headache
HPI: work up yesterday morning with HA. 2/10 onset, progressed to 8/10. Constant. Describes as dull/aching, b/l and diffuse. Also endorses radiation to neck. No relief from ibuprofen, Tylenol or sleeping. Exacerbated by walking, bright lights. Denies halos. Has vomitted 3x, bilious, no blood. Endorses cough, sore throat, diffuse achiness. No influenza vaccine this year. Denies sick contacts.
ROS: as above, also "feels warm." No changes in appetite, no changes in vision/hearing, no changes in memory/speech, denies palpitations, chest pain, denies SOB, abdominal pain, changes in bowel habits, changes in urinary frequency.
PMH: none. PSH: none. Meds: OCP. Allerg: none. FH: dad has high cholesterol, mom migraines. SH: takes online classes and works at sporting goods store, denies cigs, 4-5 marijuana joints/week, 2-3 drinks every weekend, sexually active with boyfriend, always uses condoms.

Keywords and phrases relevant to diagnosis:
No relief from ibuprofen, No relief from Tylenol
20 y/o
yesterday
diffuse achiness
HA diffuse, headache diffuse
radiation to neck
vomitted
cough, sore throat
mom migraines, FH migraines
F
Exacerbated by bright lights
Denies sick contacts
feels warm
Patient Note: 20 yo female who presents with headache. Pain is reported to be "all over". Pt awoke with it yesterday morning and it has progressively worsened since that time. Pain desribed as dull ache. Associated with n/v and URI symptoms which began at same time. Walking around or bending forward worsen the discomfort. Pt tried ibuprofen and tylenol which did not relieve the pain. No known recent sick contacts. No history of similar symptoms. Pain 8/10 at this time.

PMH: negative
Medications: oral contraception used for past 2 years. ibuprofen and tylenol for headache occassionally.
No drug allergies.
FH significant for mother with headache migrains. 
Social history: neg for tobacco use. Pt does report smoking 3-4 joints during the week. Pt was advised to discontinue. Drinks 2-3 glasses of wine on weekends.

Keywords and phrases relevant to diagnosis:
tylenol did not relieve, ibuprofen did not relieve
20 yo
yesterday
headache all over
v
n
URI symptoms
mother migrains, FH migrains
female
No sick contacts
Patient Note: Ms. Madden is a 20 year old female who presents today with sudden onset holocranial headache that started yesterday morning. She states that she was awoken with intense pain. She states that the pain is dull and constant. There is not a specific area of the head that hurts the most. She does state she has some neck stiffness and pain. She has photophonia, nausea, decreased appetite, 3 episoes of vomiting. Denies phonophobia, diarrhea, constipation. States that she has had body aches since yesterday as well. She has not experienced anything like this before. She does get about 2 headaches a year, but are different than the one she is experiencing now. She does not recall any sick contacts. She has been taking birth control pills for 2 years. NKDA. No significant medical history. Mom has a history of migraine headaches that are well controlled with medications. Does use marijuana occasionally, but denis injection drug use.

Keywords and phrases relevant to diagnosis:
20 year old
yesterday
body aches
holocranial headache
neck stiffness, neck pain
vomiting
nausea
Mom migraine
female
photophonia
does not recall any sick contacts
Patient Note: Patient is a 20yo F presents for evaluation for HA. HA has been present for 1 day in duration. Unable to define to to single lobe, notes it is present in front, back, and on sides of head. It has been worseing since onset, and has been constant. Has tried ibuprofen and tylenol to abate discomfort but to no avail. Sleep did not abort HA. Pain is worsened with walking and bending over to tie shoes. Denies photophobia, sensitivity to sound, and aura. She notes nausea with nonbloody vomiting. She has been unable to work due to the pain.
ROS: no D, CP, SOB, Abd pain, weight changes, night sweats
PH: none
Meds: OCP (2years)
FH: F - HLD. M - Migraines
SurgH: none
SocH: works as sporting goods store. ETOH 2-3x week. Tob - none. Majijuana - 3-4x week.
Allergies: none

Keywords and phrases relevant to diagnosis:
ibuprofen to no avail, tylenol to no avail
20yo
1 day in duration
HA front, back, and on sides of head
vomiting
nausea
M - Migraines, FH Migraines
F
Patient Note: HPI: 20 yo F c/o headache since yesterday. it is severe throbbing in nature, not localized, associated w/ 3 episodes of vomiting and nausea. no relation to menstrual cycle. it is aggravated w/ bright light. and relieved in a dark room. no relief from tylenol ibuprofen or sleep. there is also associated runny nose and itchy throat. denies any ear pain. ROS: negative except as above PMH&PSH: none FH: mother has migranes. SH: no tobacco use. drinks 2-3 beers on weekend, uses marijuana 2-3 times a week. sexually active w/ boyfriend. uses condoms and is on OCP's since 2 years.

Keywords and phrases relevant to diagnosis:
no relief from tylenol, no relief from ibuprofen
20 yo
yesterday
vomiting
nausea
runny nose, itchy throat
mother migranes, FH migranes
F
aggravated bright light
Patient Note: 20 y/o F with headache by 2 days in the context of rhinorrhea and "scratchy throat" as well as generalized malaise, HA began yesterday morning, no head trauma or LOC, not worsened by laying down but also not relieved, began at a 2/10, pain all throughout head, has been a constant dull ache which has worsened to an 8/10 today, worsened by movement, photophobia present, n/v present, not experiencing much relief with tyenol or ibuprofen, slept but this did not relieve the headache 
ROS: as above, endorses subjective fever today, no abdominal pain, no headaches brought on by sneezing, coughing or bm, no focal neuro symptoms
PMHx: none
Medications: as above, OCP
NKDA
PSHX: none
FHx: mom with migraine dad with HLD
SHx: smokes 3-4 joints of marijuana/day, no other recreational drug use, no smoking tobacco, 2-3 wine/beer drinks on weekends, sexually active with 1 partner, uses protection, LMP 2 weeks ago

Keywords and phrases relevant to diagnosis:
not experiencing much relief with tyenol, not experiencing much relief with ibuprofen
20 y/o
yesterday
v
n
rhinorrhea, scratchy throat
FHx migraine, mom with migraine
F
photophobia
subjective fever
Patient Note: Stephanie Madden is a 20 yo female with no significant PNH reporting to clinic with a headache. The headache began yesterday morning a few minutes after she woke up (but was not the cause of her awakening). Since then the pain has increased from a 3 to a 10/10, currently feeling like the "worst pain in my life". She has never had anything like this before. She has tried ibuprofen and tylenol and bed rest without improvement; pain is worsed by lights, bending over and walking around. She has intense nausea/vomiting (3x) but denies visual problems like blurriness or double vision. She has no concerns about incontinence of urine or stool. Denies recent changes in weight. Patient reports feeling mildly warm recently. vaccines up to date
FH: father high cholesterol, mother migraines
Medical: no other history
Social: alcohol 3 drinks weekly, no smoking, occasional marijuana, sexually active with men on BC and condoms, no hx of STIs

Keywords and phrases relevant to diagnosis:
ibuprofen without improvement, tylenol without improvement
20 yo
yesterday
vomiting
nausea
mother migraines, migraines FH
female
pain is worsed by lights
feeling mildly warm
Patient Note: Ms. Madden is a 20 yof female with a 2 day history of worst headache of her life. Her headache began 2 days ago when she woke up. She reports that it has worsened in intensity to the point where is feels like an 8/10. The pain is global throughout her head and is  described as dull, throbbing, and constant. She endorses photophobia, nausea, vomiting with 3 episodes yesterday. She denies any hematemesis, weakness, numbness, tingling, or diarrhea. She denies any chils, or night sweat. She does endorse rhinorrea, sore throat. Denies LOC or falls.

Keywords and phrases relevant to diagnosis:
20 yo
2 day, 2 days
headache globa, headache throughout her head
vomiting
nausea
rhinorrea, sore throat
f
photophobia
Patient Note: 20 yo F complaining of severe headache starting yesterday morning when she awoke from sleep. It is progressive, dull, and constant. Worse with bending forward and walking. No relief with ibuprofen, tylenol, sleep changes. Assoicated with nausea and vomiting, achiness especially in neck and shoulders, photophobia, runny nose, scratchy throat. Feels slightly warm but has not measured temperature. Denies visual changes, aura, numbness, weakness. No stresNo sick contacts. Last menstrual period 2 weeks ago and has regular periods. Never been pregnant
PMHx: none
Med: OCP, ibuprofen, tylenol
PSHx: none
NKDA
FHx: Mom- migraine
SHx: 2-3 beers on weekends. Never smoker. Smoke 3-4 joints of marijuana a week. Sexually active with boyfriend and they use condoms. Works at sporting good store.

Keywords and phrases relevant to diagnosis:
No relief with ibuprofen, No relief with tylenol
20 yo
yesterday
achiness neck
vomiting
nausea
runny nose, scratchy throat
Mom- migraine, FHx migraine
F
photophobia
No sick contacts
Feels warm
Patient Note: 22 yo F with sudden onset severe persistent headache since yesterday morning, woke her up. Worse with leaning forward, achy, diffuse covering whole head. Reports 3 episodes of nonbloody nonbilious vomiting and nausea, photophobia, myalgias. No sick contacts, no rash, no arm weakness or sensory changes. Does have scratchy throat and rhinorrhea, no nasal congestion. Ibuprofen, Tylenol, sleeping has not helped. Felt warm at home, no temp taken. On OCPs. Gets tension type headaches occasionally but this is unlike those. No hx of migraines although mother has migraines. No scik contacts, no recent travel.
ROS: no chest pain, SOB, cough, abd pain, diarrhea, constipation, leg swelling, urinary symptoms
PMH: none
Meds: OCPs; no allergies
FH: mom migraine, dad HLD
Surg; None
Soc: no smoking, occasional alcohol, smokes marijuna 3x week; sexually active with 1 male partner, uses condoms consistently
OB: LMP 2 weeks ago, 4-5 days flow

Keywords and phrases relevant to diagnosis:
Ibuprofen has not helped, Tylenol has not helped
22 yo
yesterday
myalgias
headache whole head
vomiting
no rash
nausea
scratchy throat, rhinorrhea
mother has migraines, FH migraine, mom migraine
F
photophobia
No sick contacts, No scik contacts
Felt warm
Patient Note: Ms. Madden is a 20y/o F who presents with headache. Reports that dull, constant aching headache all over that began yesterday morning. She has never had pain like this before. Rated as 8/10. Has tried ibuprofen, tylenol and sleep with no relief. Pain is worst with walking and bending over. Associated with nasuea and vomiting, had green emesis x 3 yesterday. Eyes are sensitive to bright lights, but not vision changes or blurred vision. Reports body aches, but no rashes. Recently had running nose, congestion and scratchy throat. No recent falls. No warning of headache, no eye pain or tearing. Denies fever, chills, weight loss. Reports decreased appeitite since yesterday. Denies numbess, tingling, weakness, changes in bowels, changing in urination.  
PMH: none
PSH: none
FH: dad - high cholesterol, Mom - migrained
SH: non smoker, drinks on weekends, smokes 3-4 joints, wokrs at sporting goods, sexually active with 1 partner, on pill

Keywords and phrases relevant to diagnosis:
ibuprofen no relief, tylenol no relief
20y/o
yesterday
body aches
headache all over
vomiting, emesis
no rashes
nasuea
running nose, scratchy throat
Mom - migrained, FH migrained
F
sensitive to bright lights
Patient Note: Stephanie Madden, a 20-year-old female presenting with headache.
-started yesterday morning
-all over, constant, dull ache
-hast trried ibuprofen,k tylenol, and sleep without improvment
-walking and bending over worsen the apin
the pain wwas worse this mroning
she has a history of mild headaches 1-2 times per year, but nothing htis bad
says this si the worse headache of her life
ROS: Nausea and vomiting, light hurts eyes, sick to stomach, overall body aches
no chest pain, shortness of breath, congestion, constipation or diarrhea, weakness, or irine changes
PMHx: healthy, only takes oral contraceptive pill
PSHx: none
FHx: Mom- migraines
Social Hx: drinks 2-3 beers on weekends, smokes marijuana 3-4 times per week, lives with roommate

Keywords and phrases relevant to diagnosis:
ibuprofen without improvment, tylenol without improvment
20-year-old
yesterday
body aches
vomiting
Nausea
lives with roommate
FHx migraines, Mom- migraines
female
light hurts eyes
Patient Note: Pt is a 20 yo female with chief complaint of headaches. She reports it began yesterday morning with a dull, constant , achy pain that progresses since then. She reports neck and shoulder pain, sensitivity to light, and hurts when she bends or walks. She also endorses vomiting and feeling warm. She denies abdominal pain, weakness or numbness of extremities. She denies any sick contacts however reports having a runny nose and scratchy throat that started yesterday morning. 

pmh: none, states she is healthy
psh: none
pfh: mother with history of migraines and father with hypercholesteremia 
Obgyn: she reports her menstrual cycles is regular and normal flow 
soc: works at sporting good store, lives at an appartment with her roommate. 
Meds: ocp use
Allergies: nka

Keywords and phrases relevant to diagnosis:
20 yo
yesterday
neck pain
vomiting
runny nose, scratchy throat
lives at an appartment with her roommate
pfh migraines, mother migraines
female
sensitivity to light
denies any sick contacts
feeling warm
Patient Note: Female patient of 20 yo, that comes to the office c/o headache since yesterday. Patient refers that the headache is still the same episode and that is getting worse. Also refers that is present all the time, and is the 1st time that have an episode like this. No alleviates w/AINES and sleep. Get worse when patient bends her head foward and when walks. Also refers nausea and vomiting in 3 ocasions, of food content at first an that now is a greenish sluid. Patient also refers that does not have appetite, decrease in elergy level, and that takes OCP's for the past 2 years. ROS: dneied except as above mentioned. no PMHx, no surgeries, no hospitalizations. Meds: OCP's for the past 2y. FH: mother has migraine and dad high cholesterol levels. Shx: takes alcohol 2-3 beers on weekends, no tabacco use and use marihuana for the past years, being the last time 4 days ago. LMP: 2 weeks ago, and work in a sport store.

Keywords and phrases relevant to diagnosis:
20 yo
yesterday
vomiting
nausea
mother migraine, FH migraine
Female
Patient Note: 20 y female here in the clinic with c/o headache since yesterday , she states pain stated in the morning when she woke up , pain is getting progreesively worse , took tylenol and ibuprofen which didn't help with the pain , pain she describes aas all over the head and never had thia type of pain before , she also vomited x 3 , denies any blood in the vomit , she has no appetite , walking and bending over making the pain worse, photophobia + ,  
ros ; NEG except mentioned in HPI 
PMH : None   PSH : None 
All : Nka     Meds : OCP
SH : works at sporting goods , no smoking , occasional beer use , uses joints 3-4 times a week ,

Keywords and phrases relevant to diagnosis:
"ibuprofen didnt help", "tylenol didnt help"
20 y
yesterday, stated in the morning when she woke up
headache all over the head
vomited, vomit
female
photophobia
Patient Note: 20 year old female. Complains of headache today, worst she has ever experienced. Described as dull and constant, worsened by walking around and bright light. Also has nausea and vomiting 3 episodes- food at first, now bilious. She also has fever today with myalgia. Previous episodes of headache but never this severe. No weaknes or numbness. No decrease in visual acuity or double vision noted. 
ROS- negative except above
Allergies- NKDA
Medications- Oral contraceptive pills for 2 years. Took ibuprofen, tylenol but no improvement
PMH/PSH- non contributory
FH: father has hyperlipidemia. Mother has history of migraines
SH: non smoker. Drinks alcohol 2-3 times a week. Lives with room mate.Works in sporting goods store.
Sexually active and uses condoms
OG: regular menstrual cycles.


Keywords and phrases relevant to diagnosis:
ibuprofen no improvement, tylenol but no improvement
20 year old
myalgia
vomiting
nausea
Lives with room mate
Mother migraines
female
worsened by light
fever