bhatthars/nbme_qna huggingface dataset:
Patient Note: 44-year-old female, has come to the doctor's office today to discuss her irregular periods. Periods have been irregular for 3 years, lasting between 2-6 days, alternating between heavy and light changing 5-6 pads for heavy days with no spotting between periods and no pain. Menarchy was at age 14, periods were regular 28 day cycles with 2-3 days of moderate flow for 5 days changing 2-3 pads. Patient reports hot flashes, and one episode of night sweating. She also reports vaginal dryness during sex for which she uses lubricant. No recent weight changes, skin changes, trauma, infections. No masses/lumps in the neck. No feelings of sadness or fatigue. 2 pregnancies to term, no abortions/misscarages.
ROS: negative except above
PMH: HTN
NKDA
Meds: HCTZ - no side effects
Fx: Osteoarthritis in mother
Patient eats healthy and exercises several times weekly. 


Keywords and phrases relevant to diagnosis:
periods were regular 28 day cycles
vaginal dryness
irregular periods, Periods have been irregular
female
hot flashes
lasting between 2-6 days, alternating between heavy and light
for 3 years
night sweating
44
Patient Note: 44yo WF c/o irregular periods for the last 3 years. Periods last 2-6 days every 3w to 4 months and are light to heavy. Pt also reports hot flashes and sweeting 1-2x/months and vaginal dryness. Terminal insomnia since a few months not associated to any worries.  No pattern. No spotting, no vag discharges, no itching. Nothing precipitates symptoms. 
G2P2 2 vaginal deliveries. 
ROS : No hair changes or skin changes. No bowel changes, no urinary complaints. No headaches.  
Last week had nausea and vomitting for 2 days but everything resolves spontaneously. 
PMH : HTN diagnosed  6 years ago
PSH None
Meds : HCTZ
NKDA
FH : Brother has HTN, Mother has obesity and osteoarthritis
Office manager 
No EtOH, tabacco or rec drugs
Sex active with husband only. 


Keywords and phrases relevant to diagnosis:
Sex active
vaginal dryness
irregular periods
Last week had nausea and vomitting for 2 days
WF
hot flashes
Periods last 2-6 days, every 3w to 4 months, are light to heavy
for the last 3 years
sweeting
Terminal insomnia
44yo
Patient Note: Ms Montgomery G2P2 44 yo f here c/o irregular periods for the past 3 years. Her periods are totally unpredictable for 3 years now. Can come in 3 weeks or in 4 months. Can last 2 days or 6 days. She also gets hot flashes in the last year, and woke up drenched in sweat recently. Previosly her menses were always regular, 5d/29d with 2/3 tampons/pads per day. Denies HA, vision/hearing changes, SOB, CP, abdominal pain, dizziness, weakness, numbness or tinglings. 
ROS negative except above 
ObGyn menarche 14 yo, regular 5d/29d with 2/3 pads per day, Pap smear last year normal, never abnormal Pap smear, no abortions or miscarriages, G2P2, no abnormal discharges
PMH HTN 6 yrs Meds HCTZ Allerg NKA
PSH none
FH mom osteoarthritis, dad well
SH denies tobacco, EtOH, drugs, and STIs, sexually active with husband only

Keywords and phrases relevant to diagnosis:
Previosly her menses were always regular
Pap smear last year
sexually active
irregular periods, periods are totally unpredictable
f
hot flashes
Can come in 3 weeks or in 4 months, Can last 2 days or 6 days
for the past 3 years, for 3 years now
drenched in sweat
44
Patient Note: 44 YO F IN CLINIC C/O IRREGULAR PERIODS, WAS INITIALLY EVERY 28D, LASTING 5D OF FLOW, NOW 2-6D, SOMETIMJES HEAVY OR LIGHT, A RANGE OF 5-6 PADS NOW FROM 2-3 PADS. LMP 2 MO AGO. MENARCHE WAS 14Y, A/W VAGINAL DRYNESS, G2P2, NO HX OF ABORTIONS OR MISCARRIAGES, PAP SMEAR DONE NORMAL 2MO AGO. A/W HOT FLASHES, SWEATING, VAGINAL DRYNESS. DENIES VAGINAL ITCHING, DISCVHARGE, BREAST TENDERNESS/FULLNESS, CHANGES IN VOICE/ WTR/ SKIN/ HAIR/ VISION, HA, MOOD, COLD INTOLERANCE, BM/URINARY HABITS, FEVER, CHILLS,,LAD,M ABD PAIN, HIRSIUTISM. SEX ACTIVE WITH HUSBAND, USES IUD X 20Y, CHANGES 4 YA. 
ROS NEG EXCEPT AS  ABOVE
PMH HTN X 6Y MED HCTZ NKDA 
PSH/HOSP/TRAVEL/TRAUMA NONE
FH BROTHER HAS HTN, MUM OSTEOATHRITIS, DOESNT RECALL MUM MENOPAUSAL AGE
SH LIVES WITH HUSBAND AND KIDS, ,INVESTMENT MANAGER. DRINKS ETOH RARELY, DENIES SMOKING, REC DRUGS, EXERCISE REG, HEALTHY DIET

Keywords and phrases relevant to diagnosis:
INITIALLY EVERY 28D, INITIALLY LASTING 5D
IUD
SEX ACTIVE
VAGINAL DRYNESS, VAGINAL DRYNESS
IRREGULAR PERIODS
F
LMP 2 MO AGO
HOT FLASHES
NOW 2-6D, SOMETIMJES HEAVY OR LIGHT, RANGE OF 5-6 PADS NOW FROM 2-3 PADS
SWEATING
44 YO
Patient Note: 44 yo F with chief complaint of irregular periods. The patient states that three years ago her periods became very irregular. They are unpredicatable, there is no longer a regular cycle, the duration varies from 2-6 days. Sometimes the bleeding is very light, sometimes heavy requiring 5 or 6 pads a day. Prior to this she had regular periods every 28 days, lasting about 5 days, requring 2 or 3 pads a day. Menarche was 14. She is G2P2, both deliveries were vaginal. She is sexually active with only her husband, does not use condoms. Has a copper IUD, placed 4 years ago. She follows with an OBGYN and, she had a normal pap smear last year. Denies any urinary frequency, urgency, or dysuria. No changes in bowel habits. No history of STD.

ROS: nause and vomitting last week for a few days
Meds: HCTZ
Allergy: NKA
PMH: HTN
PSH: none
FH: mother-osteoarthritis, brother-HTN
SH: rarely drinks, never smoker, no illicit drugs, sex with husband

Keywords and phrases relevant to diagnosis:
Prior to this she had regular periods
pap smear last year
IUD
sexually active, sex with husband
irregular periods, They are unpredicatable
nause and vomitting last week for a few days
F
periods became very irregular, Sometimes the bleeding is very light, sometimes heavy, duration varies from 2-6 days
three years ago
44
Patient Note: Dolores Montgomery is a 44 year old female with PMH of HTN who presents for 3 years of irregular periods. Pt reports that 1st period was at 14 yo and have been 28 day cycles, 5 days periods with moderate bleeding and mild cramping until 3 years ago when periods started to be irregular with 3 weeks up to 4 months between periods. Denies spotting between periods. Her flow is light and there are no cramps. She has hot flashes 2 amonth and vaginal dryness (treated with lubricant for intercourse).  She is G2P2, with two living children both normal vaginal deliveries. No hx of STIs, monogamous with husband. No change in libido. Last pap nl (no hx of abnormal), last mammo normal. Denies weight changes, palpitations, diarrhea, dry skin, change in hair growth.
ROS: negative except for above
PMH: HTN
Meds: copper IUD and HCTZ
Surgeries:no
social: no tobacco, social ETOH, no recreational drugs.works as office manager. 
Allergies: none

Keywords and phrases relevant to diagnosis:
have been 28 day cycles
IUD
vaginal dryness
irregular periods
female
hot flashes
3 weeks up to 4 months between periods
for 3 years, until 3 years ago
44
Patient Note: 44 y/o G2P2 no pmh here for chronic worsening amenorrhea for the last 3 years with episode of recently drenching the clothes. nl menarche age 14 with 28 day cycles and period lasting for 5 days. now unpredictable, lmp 2 months ago. Sexually active no protections. episode of nausea and vomiting last week that resided.  No fever, cough, chest pain, change in bowel movement, urinary frequency, discharge or abd pain. No bruising or masses. No sick contatcs. 
ROS- as per hpi 
ph- none 
meds- HCTZ no allergies 
fh- noncontributory 
sh- nonsmoker, non alchohol, no drugs, unprotected sex with partner.

Keywords and phrases relevant to diagnosis:
nl menarche age 14 with 28 day cycles and period lasting for 5 days
Sexually active no protections
28 day cycles and period lasting for 5 days, now unpredictable
G2P2
lmp 2 months ago
here for episode of recently drenching the clothes
44 y/o
Patient Note: 44 yo female c/o irregular menstruation x 3 years.  She has associated breast tenderness, lower back pain, vaginal dryness.  She reports mild associated dysnmenorrhea. There is no vaginal discharge, weight changes, cold insensitivity, headache. She has an IUD since 4 years ago. She reports no trouble falling asleep, but has had episodes where she wakes up at night.
Menarche 14 years old, usually lasts 2-6 days, pad consumption varies with flow 
ROS: As per HPI, the rest are negative
ALLERGIES: none
MEDICATONS: HCTZ
PMH: Hypertension x 6 years ago
PSH: No previous surgeries
FH: Older brother with hypertension
Sexual Hx: Sexually active with husband 
SH: works as an office manager, denies smoking tobacco, rarely drinks alcohol on special occasions,

Keywords and phrases relevant to diagnosis:
IUD
Sexually active
vaginal dryness
irregular menstruation
female
lasts 2-6 days
x 3 years
wakes up
44 yo
Patient Note: Mrs. Montgomery is a 44 yo female presenting today with chief complain of irregular menstrual periords for the  past 3 years.  Her periods last 2-6 days and occur anywhere from 3 weeks to 4 months apart.  Her last menstrual period was 2 months ago.  She experiences 2 day day course of nausea and vomitting 1 week ago which resolved on its own. 

She denies weight change, fevers, but reports hot flashes
Denies lumps in her throat.
Denies vaginal discharge, dyspyruneia, dysuria. 
VS: WNL
PMH: HTN
Allergies: none
Medications: HCTZ
FamHx: Noncontributory. 
Obstetric: Last Papp smear three ayears ago. Normal. No h/o abnormal Papp. Last mammorgram one year ago; normal. Previously normal periods since menarche at age 14.
Social: Married. Two sons. denies smoking and illicit drug use.  Sexually active with spouse. Copper IUD for contraception. Inserted 4 years ago. 



Keywords and phrases relevant to diagnosis:
Previously normal periods
IUD
Sexually active
irregular menstrual periords
nausea and vomitting 1 week ago
Mrs, female
last menstrual period was 2 months ago
hot flashes
periods last 2-6 days, occur anywhere from 3 weeks to 4 months apart
for 3 years
44 yo
Patient Note: The patient is a 44 year old female who presents with irregular periods. Her last period was 2 months ago. Over the past 3 years her periods have been "unpredictable," with various amounts of bleeding and frequency of menstrual cycles. She also endorses vaginal dryness, discomfort with intercourse, hot flashes, and nausea and vomiting last week. She has an IUD x 4 years. She typically has mild cramps and breast tenderness with periods. Menarche was age 14, first pregnancy age 30, second pregnancy age 34. Both pregnancies uncomplicated. Patient denies HA, chest pain, SOA, abdominal pain. Denies dysuria, hematuria. Denies seeing blood in her stool. Denies unintentional wt loss, weight gain, dry skin. No breast discharge. 

PMH: HTN 
PSH: none 
Medication: HCTZ
Allergies: none 
FH: unremarkable 
SH: no tobacco, ETOH rare, no drugs. Sexually active with husband only. Feels safe at home. IUD in place. 
ROS otherwise negative 


Keywords and phrases relevant to diagnosis:
IUD, IUD
Sexually active
vaginal dryness
irregular periods, have been "unpredictable,"
female
last period was 2 months ago
hot flashes
various amounts of bleeding, various frequency
Over the past 3 years
44
Patient Note: 44 y/o female presents with 3 year history of irregular periods. Periods have been irregular for 3 years and may occur 2-3 months and lasting 2-6 days. She has had cramping abdominal pain assoc with last menstrual cycle. Pt also compains of vaginal dryness and has been using lubricant that helps. 

PMHx: HTN dx 6 y/o using HCTZ and compliant; no side effects. 
GYN/Sexual Hx: G2P2; currently sexually active with husband, no barrier contraception
Social Hx: lives with husband and 2 sons. Feels safe at home with good suppport system Pt denies ever smoking. alcohol rarely

Keywords and phrases relevant to diagnosis:
sexually active
vaginal dryness
irregular periods, Periods have been irregular
female
lasting 2-6 days
3 year history of, for 3 years
44 y/o
Patient Note: HPI: Patient is a 44 years old female, complaining of irregular periods for the past 3 years, stating previously as regular, eveyr 28-29 days, lasting 5 days, regular flow (3-4 pads a day). Currently very irregular, with no specific pattern, ranging from 3 weeks to 4 months, light to heavy flow and last 2-6 days, Last mentrual perior 2 months ago. Patient also copmlains of Hot flashes en excessive sweating, with no change in mood or behaviour.  
ROS: negative except as explained above
PMH: HTN diagnosed 6 years ago, treated with HCTZ, with daily compliance
surgery hx: negative
FH: father alive and in good health, Mother alive and overweight with osteoporosis, older brother alive with HTN
SH: works as office manager, drinks 1 glass of whine very sporadically, no smoking, no illicit drugs, diet low on fat and salt, walks 3-4 week
obgyn: g2p2a0, currently sexualy active with husband, birthcontrol with UID., last pap smear 1 yr,normal

Keywords and phrases relevant to diagnosis:
previously as regular, previously eveyr 28-29 days, previously asting 5 days, previously regular flow
last pap smear 1 yr
UID
sexualy active
irregular periods, Currently irregular, Currently no specific pattern
female
Last mentrual perior 2 months ago
Hot flashes
ranging from 3 weeks to 4 months, ranging from light to heavy flow, ranging from last 2-6 days
for the past 3 years
excessive sweating
44 years old
Patient Note: 44 y-o F c/o irregular perios over the last 3 years
- previously regular periods, each 28 days, lasting 5 days, moderate flow, no clots
- since the last 3 years, periods have been irregular, unpredictable, lasting 2 to 6 days, no cramps, no spotting between them
- refers hot flashes and change in sleep pattern (sleeping less, awakes at 4 am and can not sleep again)
- denies change in libido, tremor, or weight change
GYN/OB: G2P2 at ages 30 and 34; vaginal deliveries; no OCP; menarche at age 14
Allergies: NKDA
Medications: HCTZ
PMH: hypertension
FH: mother has ostheoarthritis; father is healthy
SH: no smoking, EtOH socially, sexually active with husband only


Keywords and phrases relevant to diagnosis:
previously regular periods, previously periods, each 28 days, previously periods lasting 5 days, previously periods moderate flow
sexually active
irregular perios, periods have been irregular, periods have been unpredictable
F
hot flashes
lasting 2 to 6 days
over the last 3 years, since the last 3 years
change in sleep pattern, sleeping less, awakes at 4 am
44 y-o
Patient Note: 44 yo F, irregular periods x3 years. There is no pattern, can be every 3 weeks to every 4 months. They typically last 2-6 days and can sometimes be heavy requiring 5-6 pads or light requiring 2-3 pads. There is no pain associated. LMP was 2 months ago and lasted for 4 days. Menarche was at age 14. Her periods were regular before 3 years ago. She reports a recent illness of nausea and vomiting last week for a few days for which she took some peptobismal and it resolved. She also woke up one night last week drenched in sweat. Denies any abdominal pain, diarrhea, constipation, hematochezia, dysuria, hematuria, incontinence, vaginal discharge or itching, fevers, chills, cold intolerance, or palpitations. Has cooper IUD.
pmhx: HTN
meds: HCTZ
social hx: No tobacco, rare alcohol use, no drus. Sexually active with husband. No hx STIs. Walks 3-4 times a week for 30-45 minutes. Has 2 boys, 14 and 10 yo. No miscarriages or abortions.

Keywords and phrases relevant to diagnosis:
IUD
Sexually active
irregular periods, periods no pattern
recent illness of nausea and vomiting, nausea and vomiting last week, nausea and vomiting for a few days
F
LMP was 2 months ago
every 3 weeks to every 4 months, last 2-6 days, can be heavy or light, can requiring 5-6 pads or requiring 2-3 pads
x3 years
44 yo
Patient Note: 3 years of irregular periods. LMP 2 mo. ago. Frequency of menses ranges from 3 weeks to 4 months. Menarche at age 14 - until age 41, had regular menses every 28-29 days, lasting 4 days, and associated with breast tenderness, cramping and back pain. Associated menstrual symptoms have resolved over the past month. Has been having night sweats, hot flashes. Describes vaginal dryness with sexual intercourse. No weight loss or gain. No fevers. No skin/hair changes. No change in bowel movements, or mood.
Normal pap smear, mammogram 1 yr ago.
OBGYN Hx: 2 uncomplicated pregnancies. Normal pap and mammogran 1 y
PMHx: Hypertension, well-controlled with no recent changes in meds. No prior STIs
PSH: None
Meds: HCTZ, daily. Full complicance. 
Allergies: none
Fhx: maternal osteoporosis. paternal HTN
SHx: sexually active with husband

Keywords and phrases relevant to diagnosis:
until age 41 menses every 28-29 days, until age 41 menses lasting 4 days, until age 41, had regular menses, had regular menses
pap 1 y, pap smear 1 yr ago, Normal pap 1 y
sexually active, sexual intercourse
vaginal dryness
irregular periods
menstrual symptoms have resolved, Associated menstrual symptoms have resolved over the past month
LMP 2 mo. ago
hot flashes, Has been having hot flashes
Frequency of menses ranges from 3 weeks to 4 months
3 years of
night sweats, Has been having sweats
Patient Note: 44 y/o G2P2 F complains of irregular period over the past 3 years. Her periods were last regular 3 years ago. Her periods no occur anywhere from 3 weeks to 4 months, 2-6 days of bleeding, and her periods are heavy or light. She also notes hot flashes and sweating for the past year. She did note 1 night last week she awoke drenched in sweat. She complans of vaginal dryness, but denies vaginal discharge, HA, fatigue, or recent STDs. Her last pap smear was 1 year ago and normal. She denies any anormal pap smears in the past. She denies heat or cold intolerance, hair loss, change in her weight, or nipple discharge. She denies dysparunia, dysuria, or dysmenorrhea. 
ROS: no CP, N/V, SOB, abd pain, rashes, msk pain
PMH: HTN for 6 years
Medication: HCTZ
FH: osteoarthritis in mother, HTN in brother
SH: office manager, no tobacco use, occasional alcohol use, no illicit drug use

Keywords and phrases relevant to diagnosis:
periods regular 3 years ago, Her periods were last regular 3 years ago
pap smear was 1 year ago, Her last pap smear was 1 year ago
vaginal dryness, She complans of vaginal dryness
irregular period, complains of irregular period
F, G2P2 F
hot flashes, She also notes hot flashes
periods occur from 3 weeks to 4 months, periods 2-6 days of bleeding, periods are heavy or light, Her periods no occur anywhere from 3 weeks to 4 months, 2-6 days of bleeding, and her periods are heavy or light, 2-6 days of bleeding, occur anywhere from 3 weeks to 4 months
over the past 3 years, complains of irregular period over the past 3 years
sweating, drenched in sweat, She also notes sweating
1 night awoke
44 y/o
Patient Note: Dolores Montgomery 44 yo F presenting today due to irregular periods for the last 3 years. They were very regular before this time but have recently been irregular and random. Can be 3 weeks apart to 4 months apart. She also notes some hot flashes and sweating at random times over the last few years about 1-2 times per month. She notes vaginal dryness and discomofort on intercourse with husband as well during this time. She uses 3-4 pads per day usually, but sometimes experiences slightly heavier periods now as well. She notes one episode of PMS symptoms with breast tenderness, cramps, and low back pain that was mild before the last period. She denies vaginal discharge, no vision changes, no HA, no nipple d/c
PMH: 2 vaginal deliveries, normal; last Pap 1 year ago, normal; Menarche at 14; hx of HTN 6 yrs, has IUD
Meds: HCTZ
Allergies: NKA
FH: Non-contributory
SH: Happy home, works in office, social drinker, never smoked, never drugs

Keywords and phrases relevant to diagnosis:
were regular before
Pap 1 year ago
IUD
on intercourse
vaginal dryness
irregular periods, recently been irregular, recently been random
F
hot flashes
Can be 3 weeks apart to 4 months apart
for the last 3 years, for 3 years
sweating
44 yo
Patient Note: Ms. Montgomery os a 44 y.o G3P3 female with PMH of HTN who presents with 3 years of irregular periods. Prior to three years has had regular periods every 28 days with normal flow. she also complains of occasional hot flashes and sweating along with vaginal dryness. she denies any abdominal pain or changes in bowel or urinary habits. First had her period when 14. she has had two uncomplicated pregnancies.
PMH: HTN
Meds: HCTZ
FH: Mother has OA, father with HTN
SH: None
Allergies: None
SH: Never smoked, drinks ocassionally, no recreational drug use. sexually active with husband does not use barrier contraception. No history of prior STI.

Keywords and phrases relevant to diagnosis:
Prior to three years has had regular periods, every 28 days with normal flow
sexually active
vaginal dryness
irregular periods
female
hot flashes
presents with 3 years of
sweating
44
Patient Note: 44 yo with PMH of HTN, presents w/ irregular periods.  Reports that she used to have regular periods, but for the past three years has had periods that range from 2-6 days in length, and that can be light to heavy bleeding.  She is not sure how many periods she has had in the past 12 months, but she has not had a period every month.  Her LMP was 2 months ago.  She has also been exerpiencing vaginal dryness and hotflashes several times a month.   1 week ago, she woke up in a drenching sweat, which is what prompted her to come to the doctor today.  She used to have pre-menstrual cramps regularly but had not had them recently until her LMP.  She has no family history of endometrial/ovarian or breast cancer.  She is unsure when her mother went through menopause.  She denies smoking and drinks infrequently.  she denies abdominal pain or changes in urination.  She denies recent weight loss.

Keywords and phrases relevant to diagnosis:
used to have regular periods
vaginal dryness
irregular periods
LMP was 2 months ago
hotflashes
periods that range from 2-6 days in length, can be light to heavy bleeding
for the past three years
drenching sweat
44
Patient Note: 44yo F presents with menstrual irregularities which began 3 years ago. She state they are getting unpredictable and she is getting worried. LMP was 2mo ago, menarche at 14, period last about 4 days and are irregular. denies vaginal discharge, cramping, spotting, and her last pap smear was normal last year. She is sexually active with husband, and has a copper IUD in place. no history of STIs. Denies abdominal pain, headache, edema, problems with urination or deffication.
ROS: Neg except as per HPI
PMH: HTN  Meds: HCTZ  SH: none  FH: brother has HTN
Social: Lives at home with 2 kids and husband. Sex with husband, drinks on occasion, no smoking or drugs.

Keywords and phrases relevant to diagnosis:
last pap smear last year
IUD
sexually active, Sex with husband
menstrual irregularities, period are irregular, they are getting unpredictable
F
LMP was 2mo ago
began 3 years ago
44yo
Patient Note: 44yo F patients comes complaining of irregularity in her periods that has been going on for 3 years. Periods range between 2-6 days and they happen in a range every 3 weeks-4 months. She also complains of hot flashes, sweating, and vaginal dryness. Denies mood changes, no skin dryness and her cramps are less prominent. Also wakes up earlier than usual
ROS: negative except as above/
PMH: high BP treated with ace inhibitors
A:NKDA
PSH: none
FH:mother with osteoarthritis, brother high BP
SH: lives with husband and kids. Office manager, drinks champane in special ocassions, No smoke no illicits.
OBGYN: LMP: 2 months ago, P2G2 normal vaginal deliveries. Last PAP smear normal

Keywords and phrases relevant to diagnosis:
vaginal dryness
irregularity in her periods
F
LMP: 2 months ago
hot flashes
Periods range between 2-6 days, happen in a range every 3 weeks-4 months
going on for 3 years
sweating
wakes up earlier than usual
44yo