bhatthars/nbme_qna huggingface dataset:
Patient Note: 26 Year old highly functioning women presents with history of palpation two weeks. Happened before 5 years ago. No associated prodrome. Palpation lastrs for about 10-15 minutes and then abates. No alleviating factors other than just resting. Mighht be worse when she feel wrroied or stressed about something. 
No chest pain. Nausea assoiated. No vomiting. Does not exercise but has no problem climbing stairs. 
No loss of weight. no concentration problems. no constipation or diarrea. no heat intolerance. 
Surgical History: nil
Allergies Nil
Shx some financial concerns about house
No smoking or alcohol.
Illicit drugs none


Keywords and phrases relevant to diagnosis:
Happened before 5 years ago
women
palpation
No chest pain
Illicit drugs none
Nausea assoiated
lastrs for about 10-15 minutes
26
Patient Note: CC: "heart racing"
HPI: Ms. Whelan is a 26 y/o female with history of 5 years of intermittent episodes of "heart racing" which has been increasing in frequency over the last 3 weeks. Sheexperiences racing heart, SOB, Nausea, and feels cold and clammy, lasting for 15-30 minutes. This used to happen rarely but now every couple of days. She feels as though something very bad is happening when the events occur. She presented to the ED and had workup notable for normal CBC/metabolic panel and normal EKG and cardiac enzymes. She was not symptomatic when EKG was done.
ROS: +Nausea, +palpitations, + SOB, -Constipation/diarrhea, -weight change, -menstrual change
PMH: none
PSH: none
Meds: none
Allergies: none
FHx: family all are healthy
Social: just lost job, searching for a new one. lives alone. never smoker, no alcohol, no illicits

Keywords and phrases relevant to diagnosis:
5 years of
Ms, female
experiences SOB
heart racing, heart racing, racing heart, palpitations
no illicits
experiences Nausea
increasing in frequency over the last 3 weeks, used to happen rarely but now every couple of days
feels as though something bad is happening
lasting for 15-30 minutes
clammy
just lost job
26 y/o
Patient Note: Edie Whelan, 26 y/o female, presents with palpations x5 years but more so in the past few months which nessecitates her ER visit 2-3 weeks ago. She experiences heart pounding; finger numbness; heart racing; breathing fast; tight throat; feel slightly clammy. Reports been laid off work past few months, but coping well, denies sleeping issues but palpatations affect concetration; good mood; appetite; no weight change. The episodes are unexpected. 
ROS: above; general (no fever/chill); neuro (no dizziness; headache); GI (no constipation; diarrhea); gyn (no change to period); endo (no shakiness; no hair/voice change); psy (not anxious) 
FHx - none; Surgery - none; Med - none; allergy - none; social - no drugs/smoking/drinking; Used to be a sale person.

Keywords and phrases relevant to diagnosis:
x5 years
female
experiences breathing fast
palpations, heart racing, palpatations
no drugs
experiences tight throat
feel clammy
finger numbness
affect concetration
laid off work
26 y/o
Patient Note: cc: heart pounding. 
Pt is 26 yo f that presents with "heart pounding" that she says first occured five years ago and happened rarely but has recently increased in frequency within the past three weeks occuring about 1-2 times a week. She also gets numbness in her fingers bilaterally during with the most recent episode. She says the heart pounding occurs at any time of the day and not associated with a particular activity. She presented to the ED a week ago for the same symptoms and was sent home after. She denies any chest pain, dizziness, loss of conciousness and vomiting during episodes. She admits to SOB, nauseas, and clammy skin during episodes. She states that she recently bought a condo and lost her job 2 months ago.
ROS
All negative except mentioned above
PMH : none
Past Surgical Hx: none
Allergies: nkda
Meds: none
SH: no smoking, no EtOH, no illiciti drug use, sexually active with one boyfriend only use condoms cons



Keywords and phrases relevant to diagnosis:
first occured five years ago
f
SOB during episodes
recently bought a condo and lost her job 2 months ago
denies chest pain
no illiciti drug use
nauseas during episodes
increased in frequency the past three weeks, recently increased in frequency, within the past three weeks occuring about 1-2 times a week
clammy
numbness in her fingers
26 yo
Patient Note: 26 yo F presenting to clinic for follow up of ED visit for palpitations
- first began 5 years ago but only once in a while then increased in frequency, duration and severity 3 weeks ago
- 3 weeks ago occured 1-2 times per day, last 2 weeks has decreased to once every few days lasting 15-30 minutes
- associated with SOB, throat tightening, sense of worry, hot/cold, and decreased ability to concentrate afterwards as well as fatigue afterwards
PMH: none
NKDA
Meds: none
Hospial/Surgeries: none
FH: all healthy
SH: no tobacco, EtOH, recreational drugs. Sexually active with boyfriend, uses condoms, no history of stds, LMP 1.5 weeks ago

Keywords and phrases relevant to diagnosis:
began 5 years ago
F
associated with SOB
palpitations
no recreational drugs
increased in frequency 3 weeks ago
associated with sense of worry
lasting 15-30 minutes
associated with throat tightening
hot
decreased ability to concentrate, fatigue
26
Patient Note: Pt is a 26 yo F presenting with c/o heart pounding, numbness, claminess and coldness in both hands. Symptoms started approx 5 yeras ago but was more prominent about 3 weeks ago. It last about 15-30mins. No particular events assoc to it. Freq has reduced from 1-2x/day to 1x/2 days. Nothing makes it better or worse. Pt c/o SOB, throat tightness and nauseas. Denies heat intolerance, changes in skin or hair. No fever/chilss/vomiting/diarrhea/constipation. No weight loss. NO drugs or coffee intake. No dysuria. No LOC
ROS: neg except for above
all/meds: none
PMH/Hosp: none/2 weeks ago to ER for palpitations
PSH: none
SH: None
Exercises, Regular diet, unemployed


Keywords and phrases relevant to diagnosis:
started approx 5 yeras ago
F
NO coffee intake
NO drugs
more prominent about 3 weeks ago
last about 15-30mins
claminess
numbness in both hands
26
Patient Note: Patient is a 26 y/o female presenting with palpitations. She reports feelings of impending doom during these episodes. She first had these symptoms 5 years ago when she was in college, but would come on infrequently. Three weeks ago, she was having them 1-2x/day, and 2 weeks ago was having them every 1-2 days. She states the palpitations are associated with SOB, nausea, and tingling/numbness 1x. She denies dizziness, diarrhea, flushing, or headache. Patient states she lost her job 2 months ago, and that is her only recent stressor.

PMH/PSH/Meds/All: denies
SHx: unemployed, was a sales consultant. Lives alone with cat. Denies alcohol, drugs, tobacco

Keywords and phrases relevant to diagnosis:
first had 5 years ago
female
associated with SOB
palpitations, palpitations
Denies drugs
associated nausea
would come on infrequently 2 weeks ago was having them every 1-2 days, would come on infrequently Three weeks ago, she was having them 1-2x/day
feelings of impending doom
associated with numbness
lost her job, stressor, unemployed
26 y/o
Patient Note: HPI: Patient is a 26F here for ED followup for palpitations. 5 years ago in college, no specific context, felt heart pounding, associated w/ anxiety, SOB, throat tightness, rapid breathing, cold and clammy skin, lasts for 15-30min, followed by fatigue and difficulty concentrating. Were sporadic until 3 weeks ago, started every day, 2 weeks ago had associated finger numbness went do ED, negative CBC, electrolytes, cardiac enzymes, EKG. Patient denies chest pain, abdominal pain, fever/sweats, dizziness, changes to vision, sleep disturbances. No changes in weight, no menstrual disturbances, denies syncope. Recent social stressors, 3 mo ago bought condo, 2 mo ago lost job, currently unemployed. 
ROS as above. PMH none, PSH none, Meds none, NKDA, FHx none.
SHx: lives alone, feels safe, was sales consultant currently unemployed. Denies ever using tobacco, no alcohol or drugs. Walks few times a week, LMP one month ago.

Keywords and phrases relevant to diagnosis:
5 years ago
F
associated SOB, associated rapid breathing
palpitations
2 weeks ago went do ED, negative CBC, electrolytes, cardiac enzymes, EKG
denies chest pain
Denies drugs
3 weeks ago, started every day
lasts for 15-30min
associated throat tightness
clammy skin
finger numbness
fatigue, difficulty concentrating
stressors, 3 mo ago bought condo, 2 mo ago lost job, unemployed, unemployed
26
Patient Note: Edie Whelan is a 26 year old female here for follow up for palpitations. She was seen in the ER 2 weeks ago for episodes of palpitations that have been occuring for 5 years but started increasing in frequency 2 weeks ago up to 1-2x day. They are less frequent now wiht only 1x every few days. She describes these episodes as lasting a few mintues with palpitations, SOB, throat tightening and with nausea and feeling hot then clammy after it subsides. She recently bought a condo 3 months ago then lost her job 2 months ago due to downsizing which has been a source of stress. She denies any recent illnesses, consitpation, diarrhea, headaches or other symptoms besides these episodes.
PMH: no medical diagnoses
meds: none
Allergies: NKA
FMH: family is "healthy"
SH: lives alone in condo, has boyfriend with whom she is sexually active using condoms, denies smoking, drugs, or alcohol.

Keywords and phrases relevant to diagnosis:
occuring for 5 years
female
with SOB
episodes of palpitations
was seen in the ER 2 weeks ago for episodes of palpitations
denies drugs
with nausea
increasing in frequency 2 weeks
with throat tightening
feeling hot, clammy
bought a condo then lost her job, source of stress
26 year old
Patient Note: This is a 26 year old female presenting with palpitations. The palpitations has started 5 years ago but has been worsening during the last three weeks (2-3 episodes per week). The palpitations is associated with tingling in the 10 fingers and she also has shortness of breath and rapid breathing. During these episode she feelslike her heart might stop and she might die. The is also throat tightening after which she feels hot and then clammy. The patient does not have any trmor weight or appetite changes and does not drink caffiene. She has nausea but has not vomited. She has no change in bowel or urinary habits. No avoidance or agrophobia
ROS: negative other than what stated above
Medication: none
Surgeries: none
PMH: none
FH: none
Social: non smoker and does not drink. Sexually active with her boyfriend.
Allergies: none

Keywords and phrases relevant to diagnosis:
started 5 years ago
female
does not drink caffiene
associated with shortness of breath, associated rapid breathing
palpitations, palpitations
worsening during the last three weeks
feelslike her heart might stop, feelslike she might die
associated throat tightening
feels hot, clammy
tingling in the fingers
26 year old
Patient Note: 26 F presents for follow up for episodes of palpatations, shortness of breath, feeling clammy, nauseated, and feeling hot and cold. The patient first experienced this 5 yrs ago in college but hass gotten worse in the last 3 wks. The last episode was a day ago. The patient states that the episodes come on without warning and she has not linked certain events that bring it on. The patient purchaesd a condo 3 months ago and lost her job 2 months ago. She states that she doesnt believe it is associated with stress. The patients labs and workup in the ER 2wks ago was all WNL. The patient denies feeling depressed. 

PMhx none
Social no alcohol or drugs worked as a sales consultant and is looking for work 


Keywords and phrases relevant to diagnosis:
first experienced 5 yrs ago, first experienced this 5 yrs ago
F, 26 F
shortness of breath, presents for shortness of breath
episodes of palpatations, presents for episodes of palpatations
workup in the ER 2wks ago was all WNL, The patients labs and workup in the ER 2wks ago was all WNL
no drugs
nauseated
worse in the last 3 wks, hass gotten worse in the last 3 wks
feeling clammy, feeling hot, presents for feeling clammy, presents for feeling hot
purchaesd a condo 3 months ago and lost her job 2 months ago
26, 26 F
Patient Note: 26 y/o F presents for 5 year history of intermittent palpitations, SOB, diaphoresis, and throat tightness at rest.  She visited the ER most recently 2 weeks ago for symptoms and was worked up for cardiac chest pain with normal ECG, troponins, BMP, and CBC. As of three weeks ago she is experiencing symptoms randomly at rest about 1-2 times daily with symptoms lasting 15-30 minutes and self resolving. patient states she moved to new condo 3 months ago and has no other stressors. No use of caffeine or other stimulants. Patient is not able to identify any actions that make symptoms better or worse. Symptoms not worse with exertion. Denies anxiety

ROS: denies chest pain, nausea, vomiting, fatigue, heat/cold intolerance, increased metabolism, depression, fatigue, or mood changes. 

Medical  hx, Surgical hx, allergies, family hx: none
Social history: unemployed, getting job as sales consultant. Lifelong non-user of alcohol and tobacco.

Keywords and phrases relevant to diagnosis:
5 year history
F
No use of caffeine
palpitations SOB
palpitations
visited the ER most recently 2 weeks ago for symptoms and was worked up for cardiac chest pain with normal ECG, troponins, BMP, and CBC
denies chest pain
symptoms lasting 15-30 minutes
palpitations throat tightness
moved to new condo 3 months ago
26
Patient Note: 26 yo f presents with palpitations. Reports palpitations started 5 years ago, occured 1-3/month and then rarely, until 3 weeks ago when they occured 1-2x/day. 2 wks ago went to ED due to palpitations and numbness in fingers, had nl ECG, CBC, metabolic panel and cardiac enzymes. Presents today for followup. Feels the past 2 weeks the episodes have become less frequent (once every few days). Episodes last 15-30 mins and sxs include palpitations, SOB, "feels hot," cold and clammy hands, throat tightness, "feels like something bad is gonna happen." Denies dizziness, lightheadedness, confusion, headaches, vision changes, weight changes, chest pain. No inciting factors. Does not avoid situations due to episodes. PMHx/Sx: none. Meds: none. Allergies: NKDA. Gyn: LMP 1mo ago, regular periods, G0. SH: no tobacco, EtOH, rec drug use. Sexually active with boyfriend, always uses condoms. FMH: none.

Keywords and phrases relevant to diagnosis:
started 5 years ago
f
Episodes include SOB
palpitations, palpitations
2 wks ago went to ED due to palpitations and numbness in fingers, had nl ECG, CBC, metabolic panel and cardiac enzymes
Denies chest pain
no drug use
occured 1-3/month and then rarely, until 3 weeks ago when they occured 1-2x/day
Episodes include feels like something bad is gonna happen
Episodes last 15-30 mins
Episodes include throat tightness
feels hot, clammy
26
Patient Note: 26-year-old female, has come to the outpatient clinic for a follow-up visit for palpitations. Intermittent palpitations for 5 years, worsened over last 3 weeks with 2 episodes/day. Pt feels like something terrible is happening, like she is going to die, throat gets tight, +nausea, feels cold/clammy, +SOB. They last 15-30 minutes with no aggravating/alleviating factors. She gets tired and difficulty concentrating after the episodes. There is associated numbness of fingers. 
ROS: No chest pain, syncope, vomiting, fever/chills, dizziness/lightheadedness, abd. pain, heat or cold intolerance, appetite changes, weight gain or weight loss
Sexual hx: sexually active with boyfriend, uses protecton, G0P0
PMhx: none
Medications: none
Allergies: none
Family hx: noncontributory
Social history: Lost job 2 months ago in sales and recently bought condo, which has been stressful. No alcohol, tobacco or drugs. Has good family support.

Keywords and phrases relevant to diagnosis:
palpitations for 5 years
female
palpitations
No chest pain
No drugs
worsened over last 3 weeks
associated numbness of fingers
gets tired after the episodes, difficulty concentrating after the episodes
Lost job 2 months ago, recently bought condo
26
Patient Note: Edie Whelan, a 26-year-old female, has come to the outpatient clinic for a follow-up visit for palpitations. Patient reports that since she bought a home 3 months ago, then lost her job 2 months ago that she has been having episodes of heart pounding, SOB, throat tightness, feeling hot, nausea, and fingers going numb. She denies her fingers changing color, loss of concioussness. Not feeling depressed or lack of interest in things. She denies heat or cold intolerance, weight loss, and skin changes. She does not drink, smoke or use recreational drugs. Last menstrual period was last week. Sexually active with boyfriend and use condoms. No PMH or surgeries. No FH and no meds.

Keywords and phrases relevant to diagnosis:
female
episodes of SOB
palpitations
does not use recreational drugs
episodes of nausea
episodes of throat tightness
feeling hot
fingers going numb
bought a home 3 months ago, then lost her job 2 months ago
26-year-old
Patient Note: 26 years old female comes for check of palpitations, she has had this for 5 years, and its getting worse in the past 3 wks, she has it 2-3 times a day each time lasts for 15-30 minuties accompanied with feeling of warmth, shortness of breath, sweating, and numbness, she does not reacall any triggiring events, no alleviating or aggravating factores, 
she states that she lost her job recently, in a lot of stress latley. 
medication: none
allergy NKDA 
g0p!: lmp 2 weeks ago, regular, no contraceptives, condoms use regulary
PMH: healthy
PSh: no surgeries
PF: none
SH: no alcohol no drinking, no recreatioanl drug use, sexually active with her boyfried for the pas t 1 year

Keywords and phrases relevant to diagnosis:
for 5 years, getting worse in the past 3 wks
female
accompanied with shortness of breath
palpitations
no recreatioanl drug use
lasts for 15-30 minuties
feeling of warmth
lost her job recently, lot of stress
26 years old
Patient Note: Ms. Whelan is a 26 year old female who presents to clinic complaining of heart palpitations. The y first started about 5 years ago but have gotten worse in the last 3 weeks. She went to the ER 2 weeks ago and is here as a follow up. At that time she also complained of a feeling of numbness in her fingers. She denies ever pasing out due to the palpitations. When the palpitations occur, she feels hot and clammy, and also experiences some shorntess of breath. She also feels nauseous. During these episodes she feels an impending sense of doom, and is worried that her heart might stop. She has not identified a trigger.
PMH: noncontributory; no surgeries
Medications: none; Allergies: NKDA
FH: noncontributory. everyone is healthy.
SH: Denies EtOH use. Denies tobacco or recreational drug use. Sexually active oinly with boyfriend and uses condoms. She has currently been unemployed for 2 months.
ROS: Negative except as noted in HPI

Keywords and phrases relevant to diagnosis:
started 5 years ago
Ms, female
experiences shorntess of breath
palpitations, palpitations, palpitations
recreational drug use Denies
feels nauseous
worse in the last 3 weeks
feels an impending sense of doom, worried her heart might stop
feels hot, feels clammy
numbness in her fingers
unemployed
26 year old
Patient Note: Ms. Whelan is a 26 yo F complaining of palpitations. She reports episodes of palpitations for past five years, however, recently they have increased in frequency without clear trigger. During an episode she reports feeling shortness of breath, nausea, feeling overheated and then clammy and cold, and sometimes a sense that she might die. These episodes are unpleasant and have caused her quite a bit of distress. She visited ED two weeks ago for such an episode where she also experienced hand numbness. At that time cardiac enzymes, ECG, CBC and metabolic panel were normal, but Ms. Whalen reports she was no longer feeling her symptoms when they performed the ECG.
No pyschiatric or thyroid history. No chest pain. No headche, weakness, numbness, heat intolerance, skin/hair changes.
PMH/PSH: none
Meds: none
Allergies: NKDA
FMHx: no history of palpitations
Social: minimal alcohol usage, no smoking/drugs, under stress due to unemployment

Keywords and phrases relevant to diagnosis:
for past five years
F
During an episode she reports feeling shortness of breath
palpitations, palpitations
visited ED two weeks ago for such an episode cardiac enzymes, ECG, CBC and metabolic panel were normal
No chest pain
no drugs
During an episode she reports feeling nausea
recently they have increased in frequency
During an episode she reports feeling a sense that she might die
feeling overheated, feeling clammy
hand numbness
under stress
26
Patient Note: 26 yo F, f/u after ED visit for heart pounding
- over past 5 years, has had intermittment epidoes where she "feels like something bad is going to happen"; during these epidoes, she feels like her heart is pounding out of her chest; she halso has associated shortness of breath, nausea, and feeling like her throat is tightening
- over the last 3 weeks, epidoes are more freuqent, ocurring once or twice/day
-2 weeks ago, an episode was associated w/ numbness in her fingers; she went to the ED after this episode, where she was found to have a normal CBC, CMP, cardiac enzymes, & EKG
- worried about something being wrong; no triggers, not associated with time of day, epidoes occur "out of the blue"
- more stressed than usual lately; bought a condo, but then lost her job; has support system and coping with reading/relaxing
ROS: no fevers, chest pain, vomiting, heat intolerance, weight loss
PMH/PSH/FH: none, SH: no alcohol/drugs; No meds

Keywords and phrases relevant to diagnosis:
over past 5 years
F
associated shortness of breath
heart is pounding out of her chest
2 weeks ago went to the ED found to have a normal CBC, CMP, cardiac enzymes, & EKG
no chest pain
no drugs
associated nausea
over the last 3 weeks, epidoes are more freuqent
feels like something bad is going to happen, worried about something being wrong
associated feeling like her throat is tightening
numbness in her fingers
stressed, bought a condo, but then lost her job
26 yo
Patient Note: Patient is a 26yo f presenting for 2 week follow up following ER visit for palpitations. Labs drawn at ER visit were shown to be within normal limits. Her first occurrence of palpitations was 3 weeks ago and seemed to come on suddenly with no known trigger. Palpitations were first occurring once every few days but now occur more often. Palpitations last for about 15-30 minutes and resolve on their own. She has been under stress due to losing her job but is not overly anxious or worried. During episodes, she feels short of breath, nauseous, and skin feels clammy. She denies any excessive diaphoresis, weight loss, constipation, diarrhea, or chest pain. She has had no recent sickness or sick contacts. 

PMH - none
PSH - none
MEds - none
NKDA
FH - none
SH - no tobacco, illicit drug use, EtOH; well-balanced diet and exercises regularly; sexually active and uses condoms; does not drink caffeine

Keywords and phrases relevant to diagnosis:
f
does not drink caffeine
feels short of breath
occurrence of palpitations
2 week follow up ER visit Labs were within normal limits
denies chest pain
no illicit drug use
feels nauseous
first occurring once every few days but now occur more often
last 15-30 minutes
feels clammy
under stress, losing her job
26yo