bhatthars/nbme_qna huggingface dataset:
Patient Note: 26 yo F in the clinic for follow up after episode of palpitation with impending doom x 3 weeks ago and numbness in fingers.  This complaint started 5 years; it comes/goes; starts out of nowhere; a/w fear of dying; throat toghtness; shortness of breath and cold and clummy fingers. Increases in frequency. 
Denies HA; vission and hearing changes; sore throat; DOE; cough; heartburn; abd pain; bowel and urinary changes; muscle weakness/tingling/numbness (exc as stated above); nausea; vomiting; fever; night sweats; appetite changes; sleep disturbances.
ROS neg exc as above
PMH none; Meds: none; All none
PSH none; travel/trauma none
SH: lives alone; lost job looking for new one; no toxic habits; sex active w/ boyfriend and uses condoms consistently; no STD hx; LMP 2 weeks ago; regular; menarche 13 years.

Keywords and phrases relevant to diagnosis:
started 5 years
F
a/w shortness of breath
episode of palpitation
no toxic habits
3 weeks ago Increases in frequency
impending doom, a/w fear of dying
a/w throat toghtness
clummy fingers
numbness in fingers
lost job
26 yo
Patient Note: Ms. Whelan is a 26 yo woman with history of palpitations. First noticed 5 years ago, when they occured 2-3x/month. 3 weeks ago they occured multiple times per day, 2 weeks ago went to the emergency department. At that time CBC, metabolic panel, cardiac enzymes and ECG were within normal limits. Now episodes occcuring every few days. Associated with shortness of breath, tightness in the throat, nausea, feeling heat/claminess. Episodes last 15-30 minutes and are followed by fatigue. endorses stress associated with recent job loss 2 months ago, and buying a condo 3 months ago. denies changes in skin, hair loss, changes in weight, difficulty sleeping, or depressed mood. No muscle tension. No fevers, chills, night sweats.

No allergies, medications, past medical history, surgical history or family history.
Social history: No cigarrete, alcohol or illicit substance use. Sexually active with boyfriend (regular condom use). Feels safe.

Keywords and phrases relevant to diagnosis:
noticed 5 years ago
woman
Associated with shortness of breath
palpitations
2 weeks ago went to the emergency department. At that time CBC, metabolic panel, cardiac enzymes and ECG were within normal limits
No illicit substance use
Associated with nausea
last 15-30 minutes
Associated with tightness in the throat
claminess, feeling heat
fatigue
endorses stress, recent job loss, buying a condo 3 months ago
26
Patient Note: Patient is a 26 yo female who presents to clinic for palpitations.  Patient states heart palpitations first started 5 yrs ago but have become more frequent in the last 3 weeks.  2 weeks ago she went to the ER because she had numbness in her fingers with the palpitations. She gets episodes 1-2x/day but sometimes only few times/week. They come on randomly without trigger, she never thinks about them, but she feels like she will die when she gets them, heart races, feels hot, clammy, throat tighness, has shortness of breath, nausea, and they can happen anywhere. No weight loss, no fever, no headaches, no diarrhea/constipation, no confusion or loss of sensation/weakness, no lumps in throat, no cold/heat intolerance, no chest pain. They interfere with her life and cannot focus after attack. No PMH, PSH, meds, FH, or substance use. Currently employed has interview soon. Has boyfriend, sexually active, uses condom. LMP 3 days ago normal flow.

Keywords and phrases relevant to diagnosis:
first started 5 yrs
female
when she gets them has shortness of breath
palpitations
no chest pain
No substance use
when she gets them nausea
have become more frequent in the last 3 weeks
feels like she will die when she gets them
when she gets them throat tighness
when she gets them clammy, when she gets them feels hot
26
Patient Note: elie welan 26 year female having palpitaion for last 5 year but now for last 3 week increase heart PONDING OR PALPITATION .LAST VISIT FOR 2 WEEK BACK DID ALL BLOOD INVESTIGATION CBC ,METABOLIC, ECG WNL. NOW SHE WORRIED ABOUT TIRNESS FOR LAST 2 WEEK . SHE WANT TO CAUSE OF PALPITATION. SHE DENY WT LOSS,VOMITING ,ABDOMINAL PAIN, SWEATING FLASH. DURING PALPITAION SHE FEEL SHORTEN OF BREATH. NO ASSOCIATION OF INCREASE AND DECREASE PALPITAION, FOOD IS NOT ASSOICITE PROBLEM
NO ALLERGEY 
PAST MEDI NOTING SIGNIFICANT
PAST SURGICAL NOTING SIG
NO SMOKING
NO DRINKING
NO ILLUCIT MEDIC
SEX ACTIVE WITH BOY FERIEND WITH CONDOM
CURRENT MEDI NOTHING

Keywords and phrases relevant to diagnosis:
for 5 year
female
DURING FEEL SHORTEN OF BREATH
palpitaion, PALPITATION, PALPITATION, PALPITAION, PALPITAION
NO ILLUCIT MEDIC
for last 3 week increase
26 year
Patient Note: CC: chest palpitations
HPI: 26 yo females presenting with episodic chest palpitations for the past 3 weeks. States that multiple times throughout the day, with no identifiable trigger, she will feel chest palpatations with associated SOB, nausea, throat swelling and feeling "something bad is going to happen." The episodes last 15-30min then she feels back normal again with no intervention. Episodes have been happening for 5 years but since 3 weeks ago got more frequent. She presented to the ED 2 weeks ago where they did an ECG, troponins, CBC and metabolic panel which were wnl. Denies weight loss, changes to skin or hair.
ROS: negative except as above, PMHx: healthy
Meds: none  Allegeries: NKDA
FHX noncontributory,  SurgHx: none
Social: no ETOH, no tobacco use, no illicit drug use, lives alone in an apartment in midtown, currently unemployed, sexually active with monogamus boyfriend with consistent condom use

Keywords and phrases relevant to diagnosis:
have been happening for 5 years
females
associated SOB
chest palpitations, palpitations, palpatations
presented to the ED 2 weeks ago where they did an ECG, troponins, CBC and metabolic panel which were wnl
no illicit drug use
associated nausea
3 weeks ago got more frequent
associated feeling "something bad is going to happen."
episodes last 15-30min
26
Patient Note: Ms. Whelan is a 26 yo female who presents to clinic for follow-up from ED for palpitations.  Work-up (CBC, Metabolic panel, Cardiac enzymes, EKG all WNL) in ED all WNL.  First started experiencing palpitations 5 years ago at that time occurred 2-3x/month, increased in frequency 3 weeks ago -- began occuring 1-2x/day for first week, and every few days for the last 2 weeks. Describes the palpitations as "heart pounding" rather than fluttering. Denies exacerbating sx, episodes occur randomly.
ROS: + nausea, warm sesnations, + throat tightness, + SOB during palpitation episodes, + sense of impending doom; denies dizzines, loss of consciousness, incontience
PMH: none; PSH: none; FH: non-contributory; Social: currently unemployed, increased life stress in context of financial stressors (condo purchase) & recent unemployment; denies smoking, drug & EtOH use

Keywords and phrases relevant to diagnosis:
5 years ago
female
+ SOB during palpitation episodes
palpitations, palpitations
Work-up (CBC, Metabolic panel, Cardiac enzymes, EKG all WNL) in ED all WNL
denies drug
+ nausea during palpitation episodes
increased in frequency 3 weeks ago
during palpitation episodes + sense of impending doom
+ throat tightness during palpitation episodes
warm sesnations
increased life stress, financial stressors, recent unemployment, condo purchase
26
Patient Note: 26 yo female with 5-year history of palpitations presenting for f/u after an ED visit for palpitations. Last ED visit was two weeks ago for "heart pounding," where CBC, CMP, cardiac enzymes, and EKG were all within normal limits. She states these episodes began five years ago occuring once every 2-3 months, but has now become worse in frequency occuring "every few days for the last two weeks." Episodes are described as "racing heart, feeling as if [she] might die," and are associated with dyspnea as if "[she] can't catch breath," "throat tightness," nausea (no vomiting), and feeling "hot, then cold." No associated diaphoresis. No chest tightness, no abdominal pain, no dizziness, no LOC during these episodes. Describes significant life stressor recently - she bought a condo and then lost her job, but is able to sustain herself through her savings. Is able to sleep ok. 

Remainder of HPI is negative.

Keywords and phrases relevant to diagnosis:
5-year history of, began five years ago
female
associated with dyspnea, "associated with she cant catch breath"
palpitations, palpitations, racing heart
ED visit two weeks ago CBC, CMP, cardiac enzymes, and EKG were normal
No chest tightness
associated with nausea
five years ago occuring once every 2-3 months occuring "every few days for the last two weeks, worse in frequency for the last two weeks
feeling as if she might die
associated with throat tightness
feeling "hot
stressor, bought a condo and then lost her job
26 yo
Patient Note: Pt is a 26 y/o female w/ no significant PMHx who presents for multiple occasions of heart palpitations. The patient reported that the first episode of her heart beating fastly/strongly occured five years ago and gradually has been increasing in frequency and number. Since about 3 weeks ago, she's noticed more and more episodes. 2 weeks ago, she was seen by the 
ED and they performed a complete cardiac work-up with CBC, Metabolic panel, ECG, and Cardiac enzymes, which were all normal. The patient reports that she also becomes nauseated and Short of Breath during these episodes. She reports that they occur spontaneously and resolve on their own. She denies recent fevers, chills, ns, vomiting, diarrhea, and any recent weight changes. She is fearful for another episode. She does not drink any caffeinated beverages, does not smoke, does not use recreational drugs, and is sexually active with her boyfriend. Recently laid off and stressed.

Keywords and phrases relevant to diagnosis:
first episode occured five years ago
female
does not drink caffeinated beverages
also becomes Short of Breath, Short of Breath during these episodes
palpitations, heart beating fastly, heart beating strongly
2 weeks ago seen by the ED work-up normal
also becomes nauseated, nauseated during these episodes
increasing in frequency 3 weeks ago, 3 weeks ago noticed more episodes
does not use recreational drugs, Recently laid off, stressed
26 y/o
Patient Note: Patient is a 26 yo F who presents with episodes of palpitations since 5 years ago. These have occurred rarely since onset, until 3 weeks ago when they occured 1-2X/day. For past two weeks have occured every couple of days. Accompanied by nausea but no vomiting, feeling hot and cold/clammy, sensation that she is going to die, and dyspnea. 2 weeks ago, had an episode with finger numbness as well, presented to ED and work-up including cardiac enzymes, ECG was normal. Nothing alleviates. Denies changes in sleep, appetite, urination/BM, dizziness, chest pain, fever, headache. Mood is good, no anxiety, no SI. Stressor is loss of job 2 months ago. No temperature intolerance, no skin/hair changes
ROS: neg except as per HPI
PMH: none
Allergies: NKDA
Meds: none
Fam hx: helathy
PSH: none
SocHx: no smoking/EtOH/drugs. Sexually active with boyfriend, uses condoms
Ob/gyn: LMP 2 weeks ago, normal Pap 6mo ago, periods regular, nulliparous

Keywords and phrases relevant to diagnosis:
since 5 years ago
F
Accompanied by dyspnea
palpitations
2 weeks ago presented to ED work-up was normal, 2 weeks ago presented to ED cardiac enzymes, ECG was normal
Denies chest pain
no drugs
Accompanied by nausea
occurred rarely since onset, until 3 weeks ago when they occured 1-2X/day
sensation that she is going to die
feeling hot, clammy
finger numbness
Stressor, loss of job 2 months ago
26 yo
Patient Note: Ms whelan is a 26 yo femalwe that presets for a follow up for palpitations. 2 weeks ago she went to the emergency room during one of these episodes where she felt numbness in her hands. She has had these for the past 5 years and the frequency has increased in the past 3 weeks. During these episodes her heart races, but there is no chest pain. She aslo has shortness of breath , nauseu, tight throat, and feelings of hot and cold with these episdoes. She has a terrible feeling about these episodes adn worries about them. Nothing makes them better or worse. NO inciting events. She is under stress because she boiught a condo and then lost her job. Denies any fever or chills, weight or diet changes.

PMH: negative
SH: does not smoke, drink or use other drugs, Her menstraul history is regualr
FH: none

Keywords and phrases relevant to diagnosis:
had these for the past 5 years
femalwe
shortness of breath with these episdoes
palpitations
no chest pain
does not use other drugs
nauseu with these episdoes
has increased in the past 3 weeks
tight throat with these episdoes
feelings of hot
felt numbness in her hands
under stress
26
Patient Note: 26 yo female with 5 year history of heart palpitations that intensified 3 weeks ago and promted a visit to the ER 2 weeks ago. At that time the patient experienced numbness in her hands. CBC, Metabolic panel, ECG and cardiac enzymes wnl at that time. Palpitations occur at random time points. No precipitating event, no alleviating or aggravating factors known to the patient. ROS: after the palpitations the patient feels slightly fatigued and tired for the rest of the day, associated with shortness of breath, Nausea and vomiting. No agina, no heat intolerance, no changes in bowel movements. Currently the patient presents for followup to the clinic, no current symptoms. Numbness never occured again after the one incident.
PMH: noncontributory: no surgeries, no hospitalizations, Allerigies: NKDA; Meds: none; fhx: none; shx: patient unemployed recently lost her job screening for depression negative, no etoh,tabacco or drugs

Keywords and phrases relevant to diagnosis:
5 year history of
female
associated shortness of breath
palpitations, Palpitations, palpitations
visit to the ER 2 weeks ago CBC, Metabolic panel, ECG and cardiac enzymes wnl
No agina
no drugs
associated Nausea
intensified 3 weeks ago
numbness in her hands
fatigued, feels tired
unemployed, lost her job
26 yo
Patient Note: 26 YO F WITH PALPITATION ,  THER IS NOO THING THAT MADE THIS PALPITATION AND NO EXACERBATING OR ALLEVIATING FACTORS FOR PALPITATION,NO DIZZINESS , NO FAINT OR SYNCOPE, NO CHANG E OF LIFRE STYLE RECENTLY EXCEPT BOUGHT A CONDO AND NOW SHE LOST THE JOB FOR 2 MONTHS , SHE LIVES ALONE , NO KIDS , NO PREGNANCY BEFORE , SOCIALIZED WITH PEAPOLE NORMALY, NO HEAT OR COLD INTOLERANCE, SHE HAS NOT HX OF ANXIETY OR PSCHIATRY PROBLEMS, SHE HAS HOBIES WITH FAMILY AND FRENDS, NO HX OF SLEEP DISORDER OR HX OF UNHEDONIA OR DEPRESSION, JUST ONE STRESSOR AS MENTIONED ABOVE, NO HX OF GAIT DISTERBANCES

PMH  NEG
FH   NEG
SH   NO SMOKING , NO DRUG , NO ETOH
NO ALLERGY

Keywords and phrases relevant to diagnosis:
F
PALPITATION, PALPITATION, PALPITATION
NO DRUG
BOUGHT A CONDO AND NOW SHE LOST THE JOB FOR 2 MONTHS, STRESSOR
26 YO
Patient Note: Edie Whelan is a 26yo F who presents with history of palpitations for the past 5 years. She reports they have gotten worse in the past 3 weeks. She reports the palpitations as a heart pounding associated with SOB, nausea, diaphoresis, and impending doom. She reports that they happen from 1-2x day to every few days. The episodes last for 15-30min. She reports they are not associated with caffeine intake or exercise. She reports she feels tired after the episodes and finds it difficult to concentrate. She was seen in the ED two weeks ago with these same symptoms and she reported her fingers were numb. Workup in ED was negative. LMP was a week ago. No history of heart murmur. 
ROS: negative for diarrhea, weight loss, anxiety, headaches, lightheadedness, chest pain
PMH: none
Meds: none
Allergies: none
PSxHx: none
FH: mom and dad healthy
SH: no ETOH, no smoking, no drug use, sexually active with condom use every time, no contraception

Keywords and phrases relevant to diagnosis:
for the past 5 years, for 5 years
F
not associated with caffeine
associated SOB
palpitations, palpitations
in the ED two weeks ago Workup in ED was negative
negative for chest pain
no drug use
associated nausea
worse in the past 3 weeks
impending doom
episodes last for 15-30min
fingers were numb
feels tired, difficult to concentrate
26yo
Patient Note: Patient is a 26 y/o F p/w cc of palpitations. Patient seen in ER 2 wks ago for same sx, VS, EKG, cardiac markers, CBC, BMP all WNL at ED 2 wks ago. Patient has had sx intermittently for 5 yrs, increase in frequency 3 weeks ago, most recent episode yesterday. Patient describes palpitations, numbness, fear of something bad happening, nausea, throat tightness, and coldness/hot flashes. Episodes last 15-30 minutes. Nothing aggravtes or relieves sxs. Sxs infrequently a/w exercise or strenuous activity. Patient denies headache, fever, changes in vision chest pain, abdominal pain, vomiting, changes in weight, and changes in appetite. 

ROS: Negative except as mentioned above
PMH: None
PSH/Hospitalizations: None
FHx: None
SHx: Bought condo 3 months ago, lost job 2 months ago, looking for work, currently stressed, no EtOH, tobacco, or illicit drug use, sexually active w/ boyfriend using condoms
Diet: Normal
Exercise: Walks few times/week

Keywords and phrases relevant to diagnosis:
for 5 yrs
F
palpitations, palpitations
in ER 2 wks ago VS, EKG, cardiac markers, CBC, BMP all WNL, VS, EKG, cardiac markers, CBC, BMP all WNL at ED 2 wks ago
denies chest pain
no illicit drug use
describes nausea
increase in frequency 3 weeks ago
fear of something bad happening
Episodes last 15-30 minutes
describes throat tightness
describes coldness/hot
Bought condo 3 months ago, lost job 2 months ago, stressed
26 y/o
Patient Note: HPI: 26 YO F C/O SUDDEN ONSET OF POUNDING HEART WITH SHORTNESS OF BREATH AND THROAT TIGHTNESS AND TINGLING SENSATION OVER PALMS AND NAUSEOUS.SHE HAS BEEN EXPERIENCING THESE SYMPTOMS SINCE 5 YEARS WITH INCREASE IN SEVERITY SINCE PAST 3 WEEKS.AFTER THE EPISODE SHE IS FEELING COLD AND CLAMMY EXTREMETIES.NO ASSOSCIATED HEADACHES,VOMITING,LEG SWELLING.PATIENT IS FEELING INCRREASE IN STRESS SINCE PAST 3 WEEKS SINCE SHE LOOSE HER JOB.
OBG: MENSES REGULAR
PMH: NONE
PSH: NONE
ALLERGIES: NONE
MEDS: NONE
ROS: NEGATIVE EXCEPT AS ABOVE
SH: NON ALCOHOLIC AND NON SMOKER,NOT USING ANY ILICIT DRUGS,NONEMPLOYEED AT PRESENT

Keywords and phrases relevant to diagnosis:
SHE HAS BEEN EXPERIENCING THESE SYMPTOMS SINCE 5 YEARS
YO F
C/O SUDDEN ONSET OF POUNDING HEART WITH SHORTNESS OF BREATH
C/O SUDDEN ONSET OF POUNDING HEART
NOT USING ANY ILICIT DRUGS
INCREASE IN SEVERITY SINCE PAST 3 WEEKS
SHE IS FEELING CLAMMY
WITH TINGLING SENSATION OVER PALMS
PATIENT IS FEELING INCRREASE IN STRESS
26 YO
Patient Note: HPI: 26 year old female c/o palpitations for 3 weeks. Started around 5 years ago but past 3 weeks have gotten progressively worse. Episodes are accompanied by dyspnea, throat tightening, hot/cold sensation last about 15- 30 minutes. Three weeks ago used to come on 1-2x day but now are more frequent.  2 weeks ago had an episdoe that resulted in hand numbnes bilaterally. After episodes occur also feels fatigue and confrused. Nothing makes them better or worse. 3 month ago had recent stressor of buying a new condo. Positive h/o palpitations, dyspnea, confusion, fatigue. Negative h/o vision changes, headaches, weight changes, diarrhea, heat intolerance, h/o heart problems, loss of consciousness, post ictal urination, tongue biting, excessive, bruising, heavy menses. ROS: Negative except as above. Ob/gyn: Uses 3-4 tampons/day. 
Allergies: NKDA. Medications: None. PMH: None. PSH: None. FH: Parents are both alive and healthy.

Keywords and phrases relevant to diagnosis:
Started 5 years ago
female
accompanied by dyspnea
palpitations, palpitations
Three weeks ago more frequent, past 3 weeks have gotten worse
last 15- 30 minutes
accompanied by throat tightening
hot sensation
hand numbnes
feels fatigue, fatigue
stressor
26 year old
Patient Note: Ms Whelan is a 26 year old previously healthy woman who presents with 3 weeks of intermittent episodes of "chest pounding". They happened multiple times daily 3 weeks ago for one week, then every other day the last two weeks. They last 15-30 minutes and get better when she sits down and calms herself. She feels clammy and her throat feels tight. There doesnt seem to be an obvious trigger. She was seen in the ER for these problems 2 weeks ago and had normal CBC, CMP, cardiac enzymes, and electrocardiogram findings, She recently bought a new condo, then lost her job 2 weeks ago. SIGECAPS screening mostly negative for depression. No thought of harming self or others.

Denies urinary problems, constipation, diarrhea, hair loss, weight change, problems with vision, problems with balance, sleep changes,

Medhx: benign
Famhx: benign
Surghx: none
Socialhx: no alcohol, cigarettes, illicit drug use. has a boyfriend
No medications

Keywords and phrases relevant to diagnosis:
Ms, woman
in the ER 2 weeks ago had normal CBC, CMP, cardiac enzymes, and electrocardiogram
no illicit drug use
happened multiple times daily 3 weeks ago
last 15-30 minutes
clammy
recently bought a new condo, then lost her job 2 weeks ago
26 year old
Patient Note: Ms. Whelan is a 26 year old female with no past medical history who presents for a follow up visit of palpitations. These palpitations have been occurring intermittently for 5 years and worsened 3 weeks ago. Her most recent episode was associated with bilateral finger numbness. She notes that SOB, throat tightness, nausea, and hot/cold intolerance can be associated with each of these episodes. Each episode lasts 15-30 minutes and it feels like her heart is racing. Over the past 3 weeks this has been occuring at least once a day. She has had a negative cardiac workup 3 weeks ago. Patient denies caffeine use.
ROS: no chest pain, no weight change, no diarrhea/constipation.
No notable PMHx or PSHx.
No medications or allergies
Social History: Recently lost her job. No alcohol, tobacco or illicit drug use. Sexually active with boyfriend, uses condoms. No STI history.

Keywords and phrases relevant to diagnosis:
for 5 years
female
denies caffeine use
SOB associated
palpitations, palpitations, feels like her heart is racing
negative cardiac workup 3 weeks ago
no chest pain
No illicit drug use
nausea associated
worsened 3 weeks ago, Over the past 3 weeks occuring at least once a day
lasts 15-30 minutes
throat tightness associated
finger numbness
lost her job
26 year old
Patient Note: 26yo asian female here for palpitations. Has been having heart pounding sensation for 5 yrs. 3 wks ago became more frequent 1-2x/day but is now 1x/every few days. She went to the ED 2 wks ago when she had heart pounding and numbness in her fingers. She gets nausea, throat tightening, short of breath, hot, cold ,clammy, feels like she's going to die with the heart pounding episodes. She does not have any previous medical or surgical history, does not take medications, G0P0, Does not use ETOH/tobacco/recreational drugs. Sexually active with  boyfriend, feels safe in relationship, uses condoms. Lives alone. Just lost her job 2 mths ago and bought a new condo 3 mths ago. Will have a job interview in a few weeks. LMP was 1.5 wk ago, occurs monthly, lasts 5 days, moderate flow. No family hx. Diet is healthy, walks every day. Denies heat/cold intolerance, weight changes, appetite changes, hair chang.
ED visit shows CBC, BMP, tropinin, ecg wnl

Keywords and phrases relevant to diagnosis:
for 5 yrs
female
gets short of breath
palpitations
CBC, BMP, tropinin, ecg wnl went to the ED 2 wks ago, ED visit shows CBC, BMP, tropinin, ecg wnl 2 wks ago
Does not use recreational drugs
gets nausea
3 wks ago became more frequent
"feels like shes going to die"
gets throat tightening
clammy
numbness in her fingers
lost her job 2 mths ago and bought a new condo 3 mths ago
26yo