bhatthars/nbme_qna huggingface dataset:
Patient Note: 17-year-old male, has come to the outpatient clinic with chest pain. it started yesterday morning. the pain is located in the right chest , intensity is 5/10, the pain is aggravated by physical activity and relieved by nothing. he had nasal stuffiness and body aches the day before. pain increased on breathing. pt had  subjective fever. not relieved with tylenol
the pt denies cough, phlegm, sob, nausea, vomiting, bowel changes and sleep disturbances, no recent weight changes.no trauma and recent travel
ros: negative except as above
pmh: has exercise induced asthma psh: none
meds: tylenol and albuterol
allergy: nka no hospitalisations
ssh: sexually active with partner x 6 months and uses protection. denies smoking/EToH/illicit drug use

Keywords and phrases relevant to diagnosis:
subjective fever
male
17-year-old
nasal stuffiness
exercise induced asthma
chest pain
started yesterday
denies sob
Patient Note: Patient is a 17 yo Male with PMHx of exercise induced asthma presenting in the ED for chest pain since yesterday morning. Mother gave permision to exam son over phone. Patient reports baseline sharp generalized chest pain since yesterday morning rating 5/10 in severity at rest and worsening to 8-9/10 in severity with exertion or changing position. Patient reports trying albuterol inhaler yesterday and 2 tablets of tylenol every 4 hours yesterday with minor relief in chest pain. Patient reports congested nose with rhinorrhea starting 3-4 days ago productive of white-yellow mucus without blood. Patient reports muscle aches and subjective fevers with onset of rhinorrhea but those symtpoms are improving. Pateint denies sick contacts. No surgical hx.
Med: Albuterol last used yesterday and 6 mo prior 
Allergies: NKDA
Social: 1 beer per month, denies tobacco or other drug use. feels safe at home 
Family: Dad- HLD, asthma, GF- MI

Keywords and phrases relevant to diagnosis:
subjective fevers
Male
17 yo
congested nose with rhinorrhea starting 3-4 days ago
exercise induced asthma
chest pain, chest pain, chest pain
since yesterday, since yesterday
albuterol inhaler with minor relief
sharp, 8-9/10
Patient Note: 17 Y O MALE PRESENTED WITH COMPLAIN OF LEFT SIDED CHEST PAIN FOR LAST 1 DAY, CONSTANT, NON RADIATING, SHARP TYPE AGGRAVATED BY DEEP BREATHING AND MOVEMENT, RELIEVED BY LYING STILL. HE COMPALINS OF FEELING WARM FOR LAST FEW DAYS. HE ALSO REPORTS OF RUUNY NOSE AND MUSCLE ACHE FEW DAYS BACK. HE TOOK TYLENOL FOR HIS PAIN YESTERDAY BUT IT DIDNT RELIEVED THE PAIN. HE DENIES ANY SOB, DIZZINESS, COUGH,  SWELLING OF LIMBS, SWEATING, RACING OF HEART, RECENT ILL CONTACT.
ROS: NONE EXCEPT ABOVE
PMH: DIAGNOSED AS EXERCISE INDUCED ASTHMA UNDER INHALATION ALBUTEROL AS REQUIRED
MEDICATION: INHALTION ALBUTEROL AS REQUIRED
FH: FATHER HAS ASTHMA, HYPERLIPIDEMIA, GRADFATHER DIED OF HEARTATTACK
SH: SEXUALLY ACTIVE 1PARTNER, USES CONTACEPTION.
      USES MARIJUWANA LAST USED 1 WEEK BACK, NON SMOKER, NO ETOH USE
PSH: NONE
ALLERGIES: NKA

Keywords and phrases relevant to diagnosis:
FEELING WARM
MALE
17 Y O
RUUNY NOSE FEW DAYS BACK
AGGRAVATED BY DEEP BREATHING
EXERCISE INDUCED ASTHMA
CHEST PAIN
FOR LAST 1 DAY
DENIES SOB
SHARP
Patient Note: Kane Smith is a 17 yo M who presents with sharp, pleuritic L sided chest pain that is not position dependent that began yesterday morning. Notes that he has been sick with a stuffy nose and muscle aches for the past 3-4 days. States albuterol and Tylenol have not helped. Worse with deep breathing and movement. Denies trauma to chest. Notes he feels warm but denies chills, night sweats, SOB, orthopnea, abd pain, nausea, vomiting, blood in stool, constipation, diarrhea, or numbness or tingling. PMH: exercise-induced asthma PSH: none Allergies: none Meds: Albuterol, Tylenol FH: Dad - asthma, high cholesterol, Grandpa - MI Denies tobacco or cocaine usage, EtOH: occasionally Sex: with girlfriend, uses condoms Healthy diet Exercise: rock climbing Occupation: Senior in high school, carpenter assistant

Keywords and phrases relevant to diagnosis:
feels warm
M
17 yo
stuffy nose
pleuritic, Worse with deep breathing
exercise-induced asthma
chest pain
began yesterday
denies SOB
sharp
Patient Note: CC: Chest pain
HPI: Patient has had a 1 day history of chest pain. The pain is localized to one location on his L chest, and is tender to touch. The pain is also worse when he takes in a deep breath. The pain is not associated with food intake. The pain is non-radiating and constant throughout the day, and is described as soreness. He also describes a 3-4 day history of stuffy nose, muscle aches, and feeling "warm." He is also a regular rock climber, and goes often (2-3x/week). He has no SOB outside of difficulty with deep inspiration, and denies any other symptoms.
ROS: Otherwise negative
PMH: Exercise induced asthma
PSH: None
Meds: Inhaler, Tylenol
Allergies: None
SHx: Alcohol 1x/month, non-smoker, no illicit drug use. Sexually active with girlfriend. Senior in HS, works as a carpenter assistant, goes rock climbing at least 2-3x/week.
FHx: Grandpa survived HA.


Keywords and phrases relevant to diagnosis:
feeling "warm
history of stuffy nose
worse when he takes in a deep breath
Exercise induced asthma
Chest pain, chest pain
1 day history
no SOB
rock climber, rock climbing
Patient Note: 17yo M presents with 1 day of sharp L sided CP worse on inspiration and movement. Tylenol and albuterol did not relieve the pain. He reports a recent viral URI for the past 3-4 days accompanied by subjective fever. He denies SOB, N/V, cough, changes with food intake, odynophagia, stomach pain, rashes, joint pains, bowel or urinary changes. He has a history of exercise-induced asthma for which he uses an albuterol inhaler as needed, but states that this pain feels completely different. The patient requests a school excuse note. 

ROS: (-) except as above
PHx: exercise induced asthma
FHx: dad- asthma and hypercholesterolemia; grandpa- MI
Surgical HX: none
Meds: albuterol inhaler PRN
Allergies: none
SoHx: EtOH: 1-2 beers 1x mo; tobacco (-); illicit drugs: THC <1x/mo. The patient is sexually active with his girlfriend and uses condoms for protection.

Keywords and phrases relevant to diagnosis:
subjective fever
M
17yo
recent viral URI
worse on inspiration
exercise-induced asthma, exercise induced asthma
CP
1 day of
denies SOB
albuterol did not relieve the pain
sharp
Patient Note: HPI: 17 yo M, c/o left parasternal chest pain, that started suddenly yeasterday morning,the pain is sharp in quality it is always there, not progressive, aggravated by deep breathing and movement, alleviated by rest, the pain is not radiating. he denies any cough or SOB, used pain relief but it didnt help. he usually do climbing in his free time but he doesn't recall any stress on his muscles or History of trauma, patient also had Common cold and stuffy nose 3 days ago an it is getting better. 
he denies any swelling or tenderness at his calf, no palpitation, neck swelling, hurtburn, no nausea, vomiting, bowel or urinary habits change, no change in weight or appetite, sweating more than usual. 
ROS: - except as above 
PMH: exercise induced asthma but he is off inhalers now as it is improved 
FH: father has asthma, grandfather had MI 
SSH: no smoking. social EtOH, smoking weed occasionally last time last weekend

Keywords and phrases relevant to diagnosis:
M
17 yo
Common cold and stuffy nose
aggravated by deep breathing
exercise induced asthma
chest pain
yeasterday
denies SOB
sharp
Patient Note: CC: "I've had this very sharp pain in my chest and it hurts when I take a deep breath."
HPI: Patient is a 17yo who presents with sharp, pleuritic, non-radiating left sided chest pain since yesterday morning. The pain is a 5-6/10 at rest and worsened with movement and deep breaths to a 7-9/10. Denies any precipitating factors. He recently had a runny nose and muscle aches. Has been feeling warm. Has taken Tylenol w/ no relief. Denies shortness of breath, palpitations, nausea, vomiting, abdominal pain, cough, weakness, wheezing, sick contact, headache. No history of blood clots and no recent travel. No leg pain.
ROS: negative except as in HPI
PMH: exercise-induced asthma
PSH: denies
FH: Dad w/ asthma and HLD; Paternal grandfather w/ MI years ago
All: denies
Med: Tylenol; albuterol inhaler
SH: denies tobacco use; drinks a couple of beers at parties; denies drug use; sexually active w/ girlfriend; uses condoms; no history of STD

Keywords and phrases relevant to diagnosis:
feeling warm
17yo
recently had a runny nose
hurts when I take a deep breath, pleuritic, worsened with deep breaths
exercise-induced asthma
pain in my chest, chest pain
since yesterday
Denies shortness of breath
sharp, sharp, 7-9/10
Patient Note: patient is a 17 year old man presenting with 2 days of chest pain. The pain began yesterday morning when the patient woke. It is located to the left of the patients sternum. The pain is made worse with deep breathing, and has not been relived with tylenol or albuterol. He also reports that for the 3-4 days prior, he had nasal congestion, subjective fevers, and muscle aches. 
ROS: denies headaches, shortness of breath, abdominal pain, back or joint pain, changes in urinary or bowel habits
PMH: exercise induced asthma  Meds: albuterol, tylenol
Allergies: none PSH: none
FH: father with ashtma and hyperlipidemia, grandfather with a recent MI
Soc: no tobacco, alcohol one drink per month, no drug use. Participates in rock climbing. Sexually monogamous with girlfriend, uses condoms. Works part time as carpenter.

Keywords and phrases relevant to diagnosis:
subjective fevers
man
17 year old
nasal congestion
worse with deep breathing
exercise induced asthma
chest pain
began yesterday
denies shortness of breath
rock climbing
not been relived with albuterol
Patient Note: HPI: 17 yo M c/o RUQ chest pain when he woke up yesterday morning. pain is worse with deep breaths, sharp , 5-6/10 when sitting, 7-9/10 when deep breathing. no radiation of pain . pt used tylenol and albuterol which did not help, while moving and deep breathing makes it worse. he has also had a runny nose and muscle aches 3-4 days ago. no associated N/V, weight loss, or recent travel. he has had a mild fever but no chills.
ROS: negative except as above
PMH: evercised induced asthma
allergy: NKDA
meds: tylenol OTC for pain
FH: Dad- asthma , hypercholesterolemia ; Grandad- heart attack
SH: non smoker, 2 beers/ month, no recreational drug use, sexuially active with gf only, condom use , 1 partner over the past 1 yr

Keywords and phrases relevant to diagnosis:
fever
M
17 yo
runny nose 3-4 days ago
pain is worse with deep breaths, 7-9/10 when deep breathing, deep breathing makes it worse
evercised induced asthma
chest pain
when he woke up yesterday
albuterol did not help
sharp
Patient Note: HPI: This is a 17 y.o M who presents with sharp chest pain that started suddenly yesterday and has been constant since then. The pain is worse with movememnt and is pleuritic in nature, improving with leaning forward adn worse with deep breaths. nothing makes the pain better, treid tylanol and albuterol inhaler that did not help. No radiation of pain. Pt admits for feeling a little warm but denies SOB, palpitations, shoulder pain, N/V, sweating, heat intolerance, increased anxiety, or abnormal skin or hair changes, or any LE edema, or recent travel. pt had recent URI recently for 4 days with stuffy nose
ROS- otehrwise WNL
PMH - exercise-induced asthma
PSH - none
Meds; albuterol, tylanol as needed. 
NKDA
FH - asthma and hyperlipidemia in father. and MI in GF at 70
SH - eats regular diet, exercises by climbinng often., no EToh, tobacco, street drug use. Sex active with GF - uses condoms. no recent travel

Keywords and phrases relevant to diagnosis:
feeling a little warm
M
17 y.o
recent URI, stuffy nose
pleuritic, worse with deep breaths
exercise-induced asthma
chest pain
started yesterday
denies SOB
albuterol inhaler did not help
sharp
Patient Note: 17 yo m c/o L upper chest pain for 1 day that started suddenly. It is  sharp, constant, nonradiating,exacerbated by movements and taking deep breath, alleviated by nothing. 3-4 days ago he had flu like symptoms.Associated with fever but did not measure. He has been doing exercises and at last he did 3 days ago. He denies SOB, weakness, cough, previous episode, any trauma, sore throat. 
ROS:Negative except as above
Allergies:NKDA
Medication:tylenol but did not relieve pain
PMH:exercise induced asthma
PSH:None
SH:sexually active with girlfriend, uses condom regularly, no smoking, once in a while uses ETOH, uses weed sometimes
FH:F:HLD, asthma


Keywords and phrases relevant to diagnosis:
Associated with fever
m
17 yo
flu like symptoms
exacerbated by taking deep breath
exercise induced asthma
chest pain
1 day
denies SOB
sharp
Patient Note: Patient with a history of L chest pain for 24 hours, worse with inspiration. Patient woke up with severe pain in L chest, describes difficulty with movement and worse on inspiration. Patient works as a carpenter and does a lot of lifting. Did not work yesterday. Avid rock climber, went rock climbing the day before onset of pain but denies trauma or fall. Describes some rhinorrhea and congestion, muscle aches, subjective warmth though did not take temperature at home. No sick contacts. History of exercise induced asthma, however rarely uses inhaler, albuterol did not help symptoms. - smoking, alcohol, drugs.

Keywords and phrases relevant to diagnosis:
subjective warmth
rhinorrhea and congestion
worse with inspiration, worse on inspiration
exercise induced asthma
chest pain, pain in chest
for 24 hours
works as a carpenter and does a lot of lifting, rock climbing
albuterol did not help
Patient Note: CC: Chest Pain
HPI: Mr. Smith is a 17 year old male with a one day history of chest pain. Localizes t the left side of chest. Says that it is a sharp pain that is worse with breathing. Tried tylenol and albuterol inhaler which did not help. Deep breathing makes it worse. Slightly better with leaning forward. No specific time of the day. Very severe. Also reports a URTI over the past 3-4 days with nasal congestion 
ROS: Has had fever, and chest pain. No shortness of breath, no nausea, vomitting, consipation, diarrhea.
PMH: Exercise induced asthma, no surgeries, no allergies, takes tylenol and albuterol inhaler as needed.
PSH: No smoking, alcohol occasionally, no drug use, is sexually active with GF. Uses condoms consistenly. No STD. Exercises regularly. Normal balanced diet.
FH: Mom healhy, Dad asthma and HLD, GPA MI

Keywords and phrases relevant to diagnosis:
fever
male
17 year old
URTI over the past 3-4 days
worse with breathing, Deep breathing makes it worse
Exercise induced asthma
Chest Pain, chest pain, chest pain, chest pain
one day history
No shortness of breath
albuterol inhaler which did not help
sharp
Patient Note: Mr. Smith is a 17 yo M w/PMH of asthma who presents with 1 day of deep chest pain in the left upper quadrant that began when he awoke yesterday. The pain is 6/10 at rest and 7-9/10 with breathing. He denies cough or sputum or recent trauma. He has tried tylenol for the pain which has provided little relief. He has never had symptoms liks this. He has also felt warm and had a runny nose for 3-4 days. Pt denies N/V, chills, night sweats, abdominal pain, radiating pain down arms or into jaw, illegal drug use, or changes in bowel or uniary habits. 

ROS: negative except as noted above 

PMH: Exercise induced Asthma diagnosed 4 years ago 
PSH: none 

FH: Father - asthma, HLD, Grandfather - MI 
SH: Drinks EtOH occasionally, non smoker, does not use illegal drugs, sexually active w/girlfriend of 6 months. 

Meds: Tylenol, Albuterol
Allergies: NKDA

Keywords and phrases relevant to diagnosis:
felt warm
M
17 yo
runny nose
Exercise induced Asthma
chest pain
1 day
Patient Note: Kane smith, 17 yo old male presented with chest pain of one day history, there is no previous episodes. The pain is in his left chest and does not radiate. Patient mentioned he woke up yeterday and suddening starting having the pain. Patient could not quantify the amount of pain but admits its sharp in nature, associated with stuffy nose, muscleache and worsened by deep breath. Patient tried taking tylenol but does not alleviate the pain. 
ROS all negative except for the ones listed above.
PMH: exercise induced asthma no surgical or hospitalizations
Meds: tylenol for the pain since yesterday, asthma inhaler
FH: ashsma, hypercholestle in father. Grandfather w/ previous history of MI
SH: works as carpentor assistant. sexually active with one girlfriend, use of condoms. Does not smoke, social ethanol use no illict drug use.

Keywords and phrases relevant to diagnosis:
male
17 yo old
stuffy nose
worsened by deep breath
exercise induced asthma
chest pain, pain is in his chest
one day history, yeterday
sharp
Patient Note: Kane Smith is a 17 y/o male who presents with constant, left sided chest pain since yesterday morning that worsens with deep inspiration associated with a subjective fever. He has tried Tylenol and Albuterol inhaler with no relief. He denies the pain radiating anywhere. He can't think of any inciting events and has no prior hx of such pain. Of note, he states that he has 3-4 days of stuffy nose and muscle aches. He denies sick contacts, recent travel, or trauma to chest. No family hx of sudden cardiac death and denies drug use apart from marijuana every "blue moon."

ROS: Neg except as stated above
PMH: Exercise induced asthma
FH: Dad-asthma
Surgeries: None
Meds: As stated above
Allergies: None
Beer: 1x/month. Rarely smokes marijuana. Denies other drug use. No tobacco use
Senior in high school with good grades. Lives with mother, father and older brother

Keywords and phrases relevant to diagnosis:
subjective fever
male
17 y/o
3-4 days of stuffy nose
worsens with deep inspiration
Exercise induced asthma
chest pain
yesterday
Albuterol inhaler with no relief
Patient Note: 17yo m presents with 1 day h/o sharp chest pain.  Intensity 7-8/10 with deep breath or movement, pain localized to left upper chest does not radiate, began when pt woke up yesterday and has not changed since onset.   No recent h/o trauma or injury.  Recent URI 3-4 days ago with congestion and myalgias. 
ROS: negative for sore throat, chills, N/V, diarrhea, constipation, lymphadenopathy 
PMH: exercise induced asthma, well controlled
Medications: Tylenol yesterday for pain, Albuterol for asthma (not needed in 6 months)
FH: Father HTN and asthma, grandfather MI
SHx: Pt is avid rock climber, no tobacco use, occasional EtOH use at parties, tried marijuana a few times consumed via smoke inhalation.

Keywords and phrases relevant to diagnosis:
m
17yo
URI 3-4 days ago with congestion
7-8/10 with deep breath
exercise induced asthma
chest pain, pain chest
1 day h/o, began yesterday
rock climber
sharp, 7-8/10
Patient Note: Mr. Smith is a 17 year old male presenting to clinic with sharp left sided chest pain since yesterday morning that has been constant. Pain does not radiate and and is worse with deep breathing and movement. He has never felt this before. He denies SOB, N/V, diarrhea, palpitations, or a sore throat. Denies difficulty urinating. Tried albuterol and tylenol without any relief.
PMHx: Exercise induced asthma controlled with albuterol
FHx: Dad has asthma and hyperlipidemia. Grandfather had MI and is alive
No meds other than albuterol
No surgeries or allergies
Denies smoking tobacco. Drinks once per month socially. Smokes marijuana rarely. Lives with parents and works as a carpentry assistant for a few months.

Keywords and phrases relevant to diagnosis:
male
17 year old
worse with deep breathing
Exercise induced asthma
chest pain
since yesterday
denies SOB
Tried albuterol without any relief
sharp
Patient Note: THE PATIENT IS A 17 YEAR OLD MALE THAT COMPLAINS OF CHEST PAIN. THE PAIN STARTED A DAY AGO AND THE PAIN IS OVER THE LEFT CHEST WALL AND CAUSES DECREASED RANGE OF MOTION IN THE LEFT ARM. THE PAIN INCREASED WITH DEEP BREATHS AND DECREASED WITH REST THE PATIENT HAD AN UPPER RESPIRATORY INFECTION 4 DAYS AGO THAT WAS UNTREATED
ROS: SAME AS HPI
PMH: EXERCISE INDUCED ASTHMA TREATED WITH ALBUTEROL
MEDS: ALBUTEROL, TYLENOL
FH: HIS DAD HAS ASTHMA AND HIS GRANDFATHER HAD A HEART ATTACK

Keywords and phrases relevant to diagnosis:
MALE
17 YEAR OLD
HAD AN UPPER RESPIRATORY INFECTION 4 DAYS AGO
INCREASED WITH DEEP BREATHS
EXERCISE INDUCED ASTHMA
CHEST PAIN, PAIN CHEST
STARTED A DAY AGO
Patient Note: 17 year old male presenting with sharp stabbing chest pain on left side that started yesterday morning. It's a constant pain but doesn't radiate. It's worse with taking a deep breath or moving, and he tried taking Tylenol and using his inhaler but it didn't help. No previous similar pain. Associated symptoms include stuffy nose and muscle aches for past 3-4 days, feels warm but hasn't checked temperature. Denies nausea, vomiting, dyspnea, changes in urine or bowel function, night sweats, chills. Past medical history: exercise induced asthma diagnosed 4 years ago, uses inhaler as needed, last use 6 months ago. No surgeries, no medications daily, no allergies. Family history: father has asthma and HTN, grandpa had MI. Drinks beer at parties 1x/month, never smoked cigarettes, smokes weed at parties. Sexually active with girlfriend, uses condoms, never tested for STIs.

Keywords and phrases relevant to diagnosis:
feels warm
male
17 year old
stuffy nose for past 3-4 days
worse with taking a deep breath
exercise induced asthma
chest pain
started yesterday
"inhaler didnt help."
sharp, stabbing
Patient Note: 17 yo male complains of chest pain that started yesterday accompanied by stuffy nose and muscle ache, no runny nose or throat pain
descibes a sharp pain, constant, mid sternal pain, worsened after deep breathing , was not relieved by tynelol or albuterol
no similar pain in the past
mentions rock climbing 3 days ago
denies palpitations, sweating, cough, shortness of breath
no recent long flight or travel
ROS - felt warm, no chills, no nausea or vomiting, no abdominal pain, no change in bowel habits or urinary habits
PMH - exercised induced asthma diagnosed 4 yers ago
medication - albuterol as needed
allergies - none
SH - senior class student, brother and sisters, parents are married, no h/o smoking or drugs, drinks beers occasionally at parties, sexually active with girlfriend uses condoms
FH - father with asthma and cholesterol, mother healthy

Keywords and phrases relevant to diagnosis:
felt warm
male
17 yo
stuffy nose
worsened after deep breathing
exercised induced asthma
chest pain
started yesterday
denies shortness of breath
rock climbing
not relieved by albuterol
sharp
Patient Note: 17 y.o patient presents w/ c/o chest pain started yesterday morning on awakening. Pain is localized to Left chest wall (T2-T4) and is sharp and non radiating. IT is worse with deep breathing and movement and the pain has been constant. He tried telenol and his inhaler which did not help and change in position does not affect pain (eg leaning forward). The pain is the same as when it started and he did not experience any trauma but does heavy lifting at work. He has had a stuffy nose and body aches for the past 3-4 days which is better today. ROS (-)
PMH: exercise induced asthma
Allergies: NKDA
MEds: albuterol inhaler and tylenol q 4 hours yesterday 
PSH: none
FH: father asthma and HLD, grandfather had MI
SH: drinks beer on occasion, nonsmoker, uses marijuana at parties last used last week, sexually active with Girlfriend and uses contraception, no STI screens.

Keywords and phrases relevant to diagnosis:
17 y.o
stuffy nose
worse with deep breathing
exercise induced asthma
chest pain
started yesterday
heavy lifting at work
tried inhaler which did not help
sharp