bhatthars/nbme_qna huggingface dataset:
Patient Note: Mrs Moore is a 45 year old female presenting with feelings of nervousness. 
-started a few weeks ago
-feels nervous all the time, nothing improves this feeling but it is noticably worse on sunday evenings and monday mornings.
-changed job responsibilites about 1 month ago to include more lecturing and less research. 
-additional symptoms include decreased appetite and difficulty falling asleep at night. Denies lying in bed worrying about things.
-denies chest pain, palipations, nausea, vomiting, abdominal pain, diarrhea, tremors, unintentional weight loss.

PMHs: insignificant
Meds: occasioanl tylenol
Past surgical history: none
FHx: father died of MI
SHx: non-smoker, occasional EtOH, no drugs. drinks 5-6 cups of coffee per day as late as 5pm. lives at home with husband, 2 children, and her mother who is h. works as a professor, recently changed jobs from research to more lecturing. sexually active with husband only

Keywords and phrases relevant to diagnosis:
denies palipations, denies tremors, denies nausea, vomiting, denies diarrhea
nervousness, nervous
5-6 cups of coffee per day
denies weight loss
difficulty falling asleep
female
decreased appetite
45 year old
Patient Note: Patient is a 45 yo female who presents with episodes or nerviousness. Onset has been few weeks ago and she feels as though she is "losing her mind". She says that it was worse on Sunday night and monday morning. However, she states that the nervousness is constant. There is no particular onset to when she feels nervous.  She used to be a researcher but recently has been teachiing in a classroom. She states that she has had difficulty falling asleep. She lives with husband, sons and mom and says that she feels safe and has a good relationship with the,. She denies loss of interest, decreased energy, suididial ideation,  or harming of others. Additionally, she denies headache, tremor, palpitations and GI symptoms 
PMH: none
FH: father had HA
SH: no smoking , drugs or alcohol. sexually active with husband. 
Meds: none
Allergies: one

Keywords and phrases relevant to diagnosis:
denies tremor, denies palpitations, denies GI symptoms
nerviousness, losing her mind, nervousness, nervous
denies loss of interest, denies decreased energy, denies suididial ideation
difficulty falling asleep
female
45 yo
Patient Note: This patient is a 45 yo female who presents to the clinic due to a new onset of nervousness. She says that it started a few weeks ago and has been constant ever since it started. She states that nothing really helps her symptoms during this time. She has recently changed her position at her job from being a researcher to be a lecturer and feels as though it may be related to her change in jobs. Sunday and Monday appear to be the worse days for her as she tends to spend the days thinking about teaching. She also has had a decrease in appetite and difficulty sleeping during this time. She denies excessive sweating or tremors.

ROS: Negative except as mentioned above
Allergies: NKDA
Medication: None
PMH: None
PSH: None
Family history: Father died of heart attack
Social: Denies tobacco use, social drinker. No illicit drug usage. Only sexually active with husband.

Keywords and phrases relevant to diagnosis:
denies excessive sweating, denies tremors
nervousness
difficulty sleeping
female
decrease in appetite
45 yo
Patient Note: HPI: 45 y/o f c/o worsening nervousness for 3-4 wks. The symptom is intermittent.
A/w giving lectures, decrease appetite for 1 wks, increasing work load and caffeine intake ( coffee 4-5 cups/d * 12 y).
No hot intolerance, palpitations, diarrhea, hot flashes or wt loss.
She sleeps 7 h/d, no daytime sleepiness.
ROS: As per HPI
PMH/PSH/All: None
Med: OCC Tylenol
FH: Father c heart attack
SH: English professor, no smoking/drugs, OCC alc 1-2 wine, SI c husband


Keywords and phrases relevant to diagnosis:
No hot intolerance, No palpitations, No diarrhea, No hot flashes
nervousness
increasing caffeine intake, coffee 4-5 cups/d
No wt loss
f
decrease appetite
45 y/o
Patient Note: HPI; 45 yo F with nervousness for  a couple of weeks
-It is constant, worsens with thinking about her work.
-Stressful for her job, an English professor 
-Difficulyt Sleeping; difficulty of satying asleep
-Appetite loss and coffeine taking 
-Denies fever, weight loss, any chagnes in urinary or bowel habits
OB/GYN; G2P2, LMP 1 week ago, q28-30 days, lasting 5 days. Menarche at age 12. Last pap smear was 10 months ago, normal.
ROS; Negative except as above.
PMH/PSH; None. Alleregies; NKDA. Medications; Tylenol, FH; Fahter died of MI.
SH; No smoking, 1-2 beers a week, Sexually active with husband only no illicit drug

Keywords and phrases relevant to diagnosis:
Denies chagnes in bowel habits
nervousness
coffeine taking
Denies weight loss
Difficulyt Sleeping
F
Appetite loss
45 yo
Patient Note: 45 year old female with persistent feeling of "nervousness" for past 3-4 weeks. Cannot identify any certain event associated with onset. Anxiety is constant but worsens in association with new lecture duties for work. No prior history of anxiety. No major life changes aside from new lecture duties. Describes feeling overwhelmed due to caring for aging mother and work responsibilities. Also endorses difficulty falling asleep. Endorses decreased appetite over the past 2 weeks. No weight changes, skin or hair changes, GI changes, palpitations,, neck masses, or excessive sweating. No mental health history. Denies any other mood changes.  No medicaiton or supplement use. No family history of thyroid disease.

Keywords and phrases relevant to diagnosis:
No hair changes, No skin hanges, No GI changes, No palpitations, No excessive sweating
nervousness, Anxiety
overwhelmed due to caring for aging mother
Denies mood changes
No weight changes
difficulty falling asleep
female
decreased appetite
45 year old
Patient Note: HPI: 45 y/o f c/o nervousness for 2 weeks. she notes that it's present all the time and is worse during Sundays and Mondays (when she usually prepares lectures). nothing relieves the nervousness. she also noticed difficulty sleeping and decreased appetite. denies any tremors, hair loss, heat intolerance, palpitations, shortness of breat, tingling sensations, wt loss and changes in bowel habits. of note, she drinks 5-6 cups of coffee a day. she also denies any stresses in her life, but is worried that the nervousness is somehow affecting her dynamics with her husband.
ROS: negative except above
PMH: none
PSH: none
medications: tylenol occasionally for headaches
FH: noncontributory, no hx of anxiety disorders
SH: LMP 1 wk ago, regular periods; monogamous with husband, works as a professor, nonsmoker, no ETOH use, drinks 5-6 cups of coffee per day

Keywords and phrases relevant to diagnosis:
denies any tremors, denies hair loss, denies heat intolerance, denies palpitations, denies changes in bowel habits
nervousness, nervousness, nervousness
5-6 cups of coffee, 5-6 cups of coffee
denies wt loss
difficulty sleeping
f
decreased appetite
45 y/o
Patient Note: Ms. Moore is a 45 y.o female with no significant past medical history who presents with a 3-4 week history of increased anxiety and feeling nervous all the time. She reports feeling anxious and overwhelmed throughout the day regardless of what is going on during her day. She denies feeling down or depressed but this anxiety is "overwhelming." In addition, she has had difficulty falling asleep and has noticed decreased appetite for the past 1-2 weeks. She denies palpitations, change in bowel habits, skin rashes, fevers or chills, or dyspnea. She recently had to start giving lectures at work. She also experiences stress from caring for her mother at home but has no other identifiable changes in her stress levels.
PMH: None
PSH: None
Fam Hx: Father died of MI at 65 yo
Social: Social alcohol use 1-2/month, never smoker, no drugs. Lives with husband, son away at college

Keywords and phrases relevant to diagnosis:
denies palpitations, denies change in bowel habits
anxiety, nervous, anxious, anxiety
stress from caring for her mother
denies feeling down, denies feeling depressed
difficulty falling asleep
female
decreased appetite
45 y.o
Patient Note: Karin Moore is a 45 year olf F presenting with episodes of nervousness for about 2-3 weeks. Not present immediately prior and she has never had this problem before. This started when she began giving lectures not research. No headache, palpitations, N/V, jitteryness, or sweatiness. She has felt like not eating, although forces herself to have adequate nutrition. She has a normal energy level, and gets 7 hours of sleep per night, although has difficulty falling asleep. Nothing makes her anxiety better, and it is worse on Sunday evenings and Monday mornings before lectures. She is also anxious about things in her daily life (shopping, transportation) unrelated to work duties. She has no significant PMH and no past SHx. She occasionally takes Tylenol for headaches but can't recall her last dose. She drinks 2 times per month, does not used tobacco or illicit drugs. She is sexually active with husband, although less often due to anxiety.

Keywords and phrases relevant to diagnosis:
No palpitations, No jitteryness, No sweatiness
nervousness
normal energy level
difficulty falling asleep
F
felt like not eating
45 year
Patient Note: Karin is a 45 yo woman with no PMH who presents with 2-3 weeks of feeling "nervous all the time" at work, at home, and other situations. She states this all happened around the time she began a new job task of giving lectures at work. She works full time as well as providing support for her aging mother and in-laws. She does find some relief when going for walks 3 times per week. She states that she gets so nervous the night before giving her lectures that she loses her appetite. This has had negative impacts on her libido and intimate relationships with her husband, who remains supportive. She denies any sweating, SOB, chest pain, syncope, or NV associated with these episodes.

Keywords and phrases relevant to diagnosis:
denies any sweating, denies NV
nervous, nervous
providing support for her aging mother and in-laws
woman
loses her appetite
45 yo
Patient Note: Mrs. Moore is a 45 y/o female presnting with anxiety. Pt states that over the last 3 weeks she has been having contant feelings of anxiety through out the day. She does not have particular triggers. Pt also c/o decreased appetite  and insomnia for 3 weeks. Having difficulty falling asleep, lays in bed for 30 minutes. No fever, chills, N/V, palpitations, changes in weight, changes in bowel or bladder function. Pt notes that she has stressors in her life that include taking care of her elderly mother, her 2 kids aged 17 and 19, and she works full time as an English professor. 2 weeks ago she started giving lectures at her job but states she has done this in the past with no anxiety. 
PMH: None. PSurgical hx: None. Meds: OTC tylenol. Family Hx: Dad dies of MI at 65. 
OB/GYN history: G2P2. LMP: 1 week ago. 
Risk: Denies tabcoo and drug use. 1-2 drinks a month. 
Drinks 5-6 coffee cups
Is sexually active with husband who had vasectomy.

Keywords and phrases relevant to diagnosis:
No palpitations, No changes in bowel function
anxiety, anxiety
stressors taking care of her elderly mother
Drinks 5-6 coffee cups
No changes in weight
insomnia, difficulty falling asleep
female
decreased appetite
45 y/o
Patient Note: Karin Moore is a 45yo female who present with feelings of nervousness. The patient reports feeling nervous over the past few weeks. It is a constant nervousness that gets worse before she gives a lecture and gets somewhat better after but never remits. She has noted a decrease in appetite and trouble falling asleep during this period. She also reports decreased sex drive but no problems engaging in sex. She has been under increased stress at work as she started lecturing at the time this nervousness began and her elderly mother has also been requiring more help. Denies fever, chills, nasuea, vomiting, diarrhea, constipation, feelings of depression and anhedonia.
ROS: Negative except above
PMH: Denies
PSH: Denies
SH: Never smoker, social drinker. English professor and likes her job.
FH: Denies history of thyroid or adrenal gland disorders. Deneis history of depression and bipolar.
Medications: None
Allergies: None

Keywords and phrases relevant to diagnosis:
Denies diarrhea, Denies constipation
nervousness, nervous, nervousness, nervousness
elderly mother has also been requiring more help
Denies feelings of depression, Denies anhedonia, Deneis history of depression
trouble falling asleep
female
decrease in appetite
45yo
Patient Note: CC: nervousness
HPI: Pt is a 45 y/o WF who presents with nervousness. Pt reports that she has been feeling nervous for a few weeks. States she has decreased appetite and difficulty sleeping. Pt reports she has had increased stressors in her life involving taking care of her mom and children at home as well as her inlaws with their health issues. Pt has also switched job roles from research to teaching recently and been feeling overwhelmed since. Pt denies any thoughts of wanting to harm herself or others. Denies CP, palpitations, SOB, n/v, constipation and dizziness.
ROS: negative except as above
PMH: none
Meds: none
Allergies: NKA
FH: father deceased from MI
SH: denies smoking, occasional alcohol use, denies drug use, currently working as an English professor

Keywords and phrases relevant to diagnosis:
Denies palpitations, Denies constipation
nervousness, nervous, feeling overwhelmed
stressors taking care of her mom
denies wanting to harm herself
difficulty sleeping
F
decreased appetite
45 y/o
Patient Note: CC: Nervousness
HPI: Ms. Moore is a 45 yo f who who is nervous for the past few wks. A few wks ago, she started giving lectures instead of doing research at her work as a literature professor which brought on anxiety. She thinks about her lectures and then worries about other parts of her life outside of work. Denies any alleviating factors. Aggravating factors include thinking about lectures on Sunday and Monday. Associated symptoms are decreased appetite and difficulty falling asleep. She feels overwhelmed. Denies SI, HI, AVH.
PMH: Denies
PSH: Denies
Allergies: NKDA
Meds: Tylenol for migraines
ROS: decreased appetite, insomnia
FH: father - MI at 65
SH: Literature professor. Occasional EtOH use. Denies drug, tobacco use. Drinks caffeine 5-6 times/day. Exercises 3 times/wk. Healthy diet. No recent travel or pets. Married 25 yrs. Sexually active with husband but reports decreased activity recently. No hx of STDs. Has two sons.

Keywords and phrases relevant to diagnosis:
Nervousness, nervous, anxiety, feels overwhelmed
Drinks caffeine 5-6 times/day
Denies SI
difficulty falling asleep, insomnia
f
decreased appetite, decreased appetite
45 yo
Patient Note: CC: Nervousness
HPI: 45/F complains of nervousness which started 2 weeks ago. Patient has more  added workload which started two weeks ago. Her nervousness starts Sunday night during preparation of lectures and happens throughout the week. Nothing makes it better. It affects her business and personal life, she had difficulty falling asleep, she also lost appetite. Enjoys work. No weight loss, no suicidal ideation. Consumes 5-6 cups of coffee per day. No cold sweats, palpitations, no chest pain and no light headedness. No abdominal pain, no changes in bowel, no urinary changes. 
ROS: none
Allergies: None
Medications: Tylenol
PMH: None
PSH: None
SH: Professor, non smoker, consumes 1-2 glasses of wine per week, no illicit drug use, sexually active with husband but sexual desire decreased due to nervousness


Keywords and phrases relevant to diagnosis:
No cold sweats, No palpitations, no changes in bowel changes
Nervousness, nervousness, nervousness, nervousness
5-6 cups of coffee per day
no suicidal ideation
No weight loss
difficulty falling asleep
F
lost appetite
45
Patient Note: 45 y/o F visits clinic due to constant nervousness that started a few weeks ago. Patient states these episodes have gotten worse since her job changed from research to give lectures in English literature and has increased responsibilities, as well as has to take care of her mom and her husband's parents. Patient refers anxious, stressed, overwhelmed due to these changes, sleep changes such as taking more time to fall asleep & decreased appetite. Denies fever, chills, nausea, vomiting, skin changes, hair changes, cold/heat sensitivity, numbness, night sweats, tingling, dizziness, changes in bowel or urinary habits, SOB, cough, weight changes, chest pain, abdominal pain or joint pain.
ROS: Negative except as above
PMH/PSH: None  ALL: NKDA  Med: Tylenol
FH: Father had a hear attack
SH: Patient is an English professor. Denies tobacco, alcohol or recreational drug use. Sexually active with husband, who had a vasectomy. G2P2 SVD no compli

Keywords and phrases relevant to diagnosis:
Denies skin changes, Denies hair changes, Denies cold/heat sensitivity, Denies changes in bowel habits
nervousness, anxious
has to take care of her mom
Denies weight changes
taking more time to fall asleep
F
decreased appetite
45 y/o
Patient Note: 45 year old female presents for nervousness over "a few weeks." Symptoms impact "everything" in patient's life. Anxiety is constant, no alleviating factors, no exacerbating factors. Patient had change of responsibilities at work, but no particularly stressful in nature; no other major life events preceding onset. Patient has associated decreased appetite, difficulty with sleep onset.
ROS: Occasional headaches, but not since onset of symptoms.
Allergies: NKDA
Meds: Tylenol for headaches
Medical History: Occasional headaches associated with reading. No surgeries. Hospitalizations x 2 for child birth. otherwise, unremarkable. Last pap smear and Mammogram were 10 months ago, normal results.
Family: Father died of MI at age 66, mother is living and well.
Social: Lives with husband, mother, and two children (no recent move-ins or move-outs). Social alcohol, no tobacco or drug use. Patient drinks 5-6 cups of coffee daily.

Keywords and phrases relevant to diagnosis:
nervousness, Anxiety
5-6 cups of coffee
difficulty with sleep
female
decreased appetite
45 year
Patient Note: Mrs Moore, 45 yo f, no significant PMH, presents with nervousness, lack of appetite, difficulyt falling asleep. "I feel nervous all the time" She is the caretaker of her older mother and has in home nursing for her in-laws. Works has been more stressful since she is now lecturing (she is a professor)  no psychiatric hx, Family hx is signficant for father who died of heart attack at 65. 

She denies depression, difficulty concentrating, wt loss, changes in her BM,no chest pain, no SOB, no edema, 
Anxiety - denies recurring thoughts, no nighmares 
Exercises regularly. 
Takes Tylenol, 
healthy relationship with husband
NKDA
dneis arthrl

Keywords and phrases relevant to diagnosis:
denies changes in her BM
nervousness, nervous, Anxiety
caretaker of her older mother, caretaker of her in-laws
denies depression, denies difficulty concentrating
denies wt loss
difficulyt falling asleep
f
lack of appetite
45 yo
Patient Note: CC: 45 yo F with nervousness
HPI: Patient comes in for 2-3 weeks of nervousness. Symptoms have been constant and associated with diminished appetite and difficulty falling asleep. They intensify on Sunday nights and Monday before she gives lectures. Patient is a college English literature professor. Of note, patient mentions many stressors and responsiblities and feels as if she is "overwhelmed" and "losing her mind" at times.
ROS: - weight loss, palpitations, diaphoresis, headache, heat intolerance, suicidal ideation
PMH: none, only hospitalized twice for the birth of her two kids
NKDA
meds: tylenol as needed for headaches
FH: father had MI at 65
SH: drinks socially, no smoking or drug use, college English literature teacher, 2 kids



Keywords and phrases relevant to diagnosis:
- palpitations, - diaphoresis, - heat intolerance
nervousness, nervousness, feels as if she is "overwhelmed", feels as if "losing her mind"
- suicidal ideation
- weight loss
difficulty falling asleep
F
diminished appetite
45 yo
Patient Note: A 45 y/o F came to the clinic c/o nervousness. Started gradually for the first time 3-4 weeks ago and since it started it is getting progressively worse. Describes it as anxiety over work achievements, constant throughout the day, relate to change in her work from research to lectures, worsen before the lectures and no improvements factors. Associated w/ decreased apetite, headache and difficulty falling asleep. Denies fever, chills, nausea, vomit, changes in weight, weakness, numbness, dizziness, palpitations, sweating or tremors. 

ROS: negative, except as above; PmHx: none; PSH: none; ALL: NKDA; MEDS: tylenol for headaches; FH: non relevant; SH: Married. Sexually active w/ husband. Works as a english professor. No h/o smoking or illicit drug use. EtOH: occ.; Caffeine: 5-6 cupps/day.

Keywords and phrases relevant to diagnosis:
Denies palpitations, Denies sweating, Denies tremors
nervousness
Caffeine: 5-6 cupps/day
Denies changes in weight
difficulty falling asleep
F
decreased apetite
45 y/o
Patient Note: 45 y/o f with a h/o nervousness since few weeks. Patient has recently changed her job from research to lecturing her audience. The nervousness starts suddenly and is more on mondays and sundays. She thinks frequently about her work and performance on mondays. It is however also present throughout the week. It has never happened before. She has no h/o tremors, palpitations, SOB, headaches, sensation of doom, heat intolerance or weight loss. Patient has been eating less due to anxiety. She consumes 5-6 cups of caffeine everyday. She takes tylenol and was hospitalized for delivery. NKDA, she has reached menopause. Patient has no h/o smoking, alcohol consumption 1 drink socially. Husband has had a vasectomy. She is sexually active. 
ROS- occasional headaches+, No h/o Abdominal pain, nausea, vomiting, bowel or bladder changes, facial pain, sleep changes

Keywords and phrases relevant to diagnosis:
no h/o tremors, no palpitations, no heat intolerance, bowel changes No
nervousness, nervousness, anxiety
5-6 cups of caffeine
no sensation of doom
no weight loss
f
eating less
45 y/o
Patient Note: 45 yo F p/w 6-wk hx of "nervousness". She reports feeling a lot anxiety, moreso than usual, with her responsibilities in taking care of her mother and other family. She also has had to give presentations at work which exacerbate her nervousness leading up to it. She denies any palpitations, tremors, CP, or SOB when she is nervous. Her nervousness is constantly high and she has not been able to talk to anyone about it or tried ways to relieve it. She also reports a lack of appetite but is making herself eat so she has not been losing weight. Also has been having trouble falling asleep. Drinks 5-6 cups of coffee a day. Denies depressive thoughts or sadness.
ROS: negative except for above
Meds: none
Allergies: none
PMH: none
PSH: none
FH: non-contributory
SH: English professor. Lives at home with mother, husband and two daughters. Feels safe at home. Occasional ETOH use, denies tobacco, illicit drugs.

Keywords and phrases relevant to diagnosis:
denies palpitations, denies tremors
nervousness, anxiety, nervousness, nervous, nervousness
responsibilities taking care of her mother
5-6 cups of coffee a day
Denies depressive thoughts, Denies sadness
has not been losing weight
trouble falling asleep
F
lack of appetite
45 yo