bhatthars/nbme_qna huggingface dataset:
Patient Note: 67 yo female comes to office complainong of trouble sleeping. she has trouble going to sleep, and wakes up early. This started 3 weeks ago suddnely after her son died in a MVA. She only sleep 4-5 hours a day, without any naps. She reports good sleep hygiene. She reports depressive symptoms of decrease sleep, energy, interest in fond activitys of scrap booking and reading. She doesn ot have any suicidal ideations. Sher concentration and memory are good. She hears her son James make coffee sometimes. She also heard loud music/party where there wasn't one. Her mom had history of depression. Denies chest pain, SOB, Urinary symotoms, bowel changes. 
ROS: as per HPI
PMHx: none, PMSHx; none
NKDA, screening recently normal, no smoking or illicity dugs, drinks 2 glasses of wine 2-3 x week, CAGE neg
famil Hx: mom had depress, dad has high BP and cholesterol
Social Hx: lives iwth husband, feels safe, he is supportive 


Keywords and phrases relevant to diagnosis:
3 weeks ago son died
female
"heard loud music/party where there wasnt one"
67 yo
trouble going to sleep
started 3 weeks ago
without any naps
decrease energy
decrease interest
mom had history of depression, mom had depress
wakes up early
interest doesn ot have any suicidal ideations
decrease sleep, trouble sleeping
Patient Note: 67 yo F presenting with trouble sleeping for 3 wks and fatigue. Her son died 1 month ago in an MVA. She reports early awakening, loss of interest in daily activities, low energy, increased apetite. No guilt or psychomotor retardation, no suicidal ideation. Reports seeing visions of her son and hearing muffled voices and music that she knows are not there. Voices are not saying anything. Tried ambien but nothing makes sleeping problems better or worse 
ROS: Denies headache, dizziness, weight change, chest pain, palpitations, SOB, cough, abdominal pain, hematuria, hematochezia, muscle aches/paines, hair loss. 
PMHx: HTN, breast ca in remission 10 yrs
PSHx: lumpectomy, laparotomy for appendicitis
Meds: HCTZ, lisinopril, Ambien x 5 days
FH: noncontributory
GYN: G1P1, normal vaginal delivery. Menarche 13, Menopasuse 52
SH: Drinks 2 glasses red wine couple times/wk. No smoking/illicit drug use. Retired. Sexually active w/husband

Keywords and phrases relevant to diagnosis:
increased apetite
son died 1 month ago
F
hearing muffled voices and music that she knows are not there
67 yo
for 3 wks
Tried ambien but nothing makes sleeping problems better
fatigue, low energy
loss of interest
seeing visions of her son
early awakening
no suicidal ideation
trouble sleeping
Patient Note: 67 YO post-menopausal female with a history of HTN presenting with about 3 weeks of difficulty sleepng. She notes that on 11/15/17 her son passed away. Since that time she's been having difficulty falling asleep and staying asleep. She also has had fatigue/reduced energy, increased eating, depressed mood, with reduced interest in doing enjoyrable activities. She denies suicidal thoughts. No difficulty concentrating. She has never had anything like this before, although she notes her mother has Major Depressive Disorder. She notes ample family support in this difficult time.No difficulty sleeping with menopause changes. 

ROS: No headahce, vision changes, palpitations, abdominal pain, urinary or BM changes. 
PMH: HTN - on HCTZ and lisinipril
PSHx: none
FHx: dad - HTN, HLD, stroke; Mother - MDD
Social: lives with family. Ample family support.

Keywords and phrases relevant to diagnosis:
increased eating
on 11/15/17 her son passed away
female
67 YO
difficulty falling asleep
with about 3 weeks
fatigue, reduced energy
reduced interest
mother has Major Depressive Disorder, Mother - MDD
denies suicidal thoughts
difficulty sleepng, difficulty staying asleep
Patient Note: 67 y.o female c/o poor sleeps for past month. Pt notes her son, leonard, died in a MVA x3 weeks ago and hasn't been able to get good sleep since. Pt also endorses anhedonia, poor concentration, and fatigue. Pt notes she is only able to get 4-5 hours of sleep every night. Pt has tried ambien pill w/o releif. No snoring per husband. Pt notes good sleep environment. One cup of coffee in the AM only, no energy drinks or eating close to bedtime. Denies any Fever, chills, night sweats, weight loss, GI or GU sxs. 
ROS: negative except as above.
Allergies: NKDA
Meds: HCTZ, Ambien
PMH: breast CA survivor currently in remission. x10 years. 
PSH: Appendectomy x20 years ago. Lumpectomy x10 years ago.
OB: G1P1A0 one uncomplicated normal spontaneous vaginal delivery at term.
FH: Paternal HTN, HLD, and CVA. Mom and 5 brothers in goo dhealth.
SH: No tobacco or drugs. Drinks 2-3 glasses wine per week .No travel. retired ocupation.

Keywords and phrases relevant to diagnosis:
son died x3 weeks ago
female
67 y.o
past month, 3 weeks ago
tried ambien pill w/o releif
fatigue
anhedonia
poor sleeps, "hasnt been able to get good sleep", 4-5 hours of sleep every night
Patient Note: 67 yo F presents with 3 weeks of trouble sleeping
- lost son 3 weeks ago
- notes waking too early and tossing and turinin in sleep
- get 4/5 hours sleep a night
- loss of interest in previou activities as reading
- increase in appetite
-note low energy throughout day
- no suicidal ideation
has tried taking ambien for sleep no help
- hearing voices next door, with no command
-seeing images of her son in dining room,
PMH of HTN, no PSH, on HCTZ, lisinopril , NKDA
SH of retired , nonsmoker, no alcohol, use to drink 2/3 cups of wine
FH of depressin in mother, father passed of stroke


Keywords and phrases relevant to diagnosis:
increase in appetite
lost son 3 weeks ago
F
hearing voices next door
tossing and turinin
67 yo
with 3 weeks
ambien for sleep no help
low energy
loss of interest
seeing images of her son in dining room
depressin in mother
waking too early
no suicidal ideation
trouble sleeping, get 4/5 hours sleep a night
Patient Note: HPI: 67 yo F c/o 3 weeks of trouble sleeping and feeling "drained" with associated early waking, increase in appetite, reduced intrest in activities, no guilt. Onset of insomnia associated with son's death. Associated visual and auditory hallucinations of seeing son and hearing party. Has insight into hallucinations. Denies suicidal or homocidal ideation. No changes in weight, able to carry out activites of daily living. This has never happened before, no history of psychiatric hospitilizations.

ROS: negative except for above
Allergies: none
Meds: HCTZ, lisinopril, ambien for past 5 nights - did not help sleep.
PMH: HTN, breast cancer in remission - 10 years
PSH: lumpectomy, laparatomoty (for appendicitis)
Social: Used to drink 2/3 times per week, now stopped. No smoking/drugs. Lives with husband, retired.
FH: Father - passed at 75 from stroke, had HLD, HTN. Mother - history of depression. 5 brothers - no known issues.

Keywords and phrases relevant to diagnosis:
increase in appetite
"3 weeks sons death"
F
auditory hallucinations
67 yo
c/o 3 weeks
ambien did not help sleep
feeling "drained"
reduced intrest
visual hallucinations of seeing son
Mother - history of depression
early waking
Denies suicidal ideation
trouble sleeping, insomnia
Patient Note: a 67 yo female patient complains of difficulty sleeping for the past 3 months , her son has passed away on february. she doesnt drink caffiene products or smoke before sleep nor watch TV , she now sleeps 4-5 hours per night when she used to sleep 8 hours before, she has difficulty falling asleep and mainatining asleep, she tried Ambien for 5 days but it didnt work ,she denies snoring and night mares however she mentions that she gets auditory hallucination before she fell asleep one night but denies any hallucinations on waking up, she denies any daytime sleepinessl.patient hasnt had changes in weight, apetite,skin or hair,no costipation.however sh complain of sad mood,loss of interest and fatigue.
Allergies:NKDA
meds: Hydrochlorothiazide, Ambien, lisinopril
PMH:HTN , breast cancer 8 years ago and in remission
PSH: lumpectomy for breast cancer, laparotom
SH:retired,non smoker, 2-3 wine week(CAGE 0/4  Fh:dad stroke,mom depression

Keywords and phrases relevant to diagnosis:
her son has passed away on february
female
gets auditory hallucination
67 yo
difficulty falling asleep
tried Ambien but it didnt wor
fatigue
loss of interest
mom depression
difficulty sleeping, sleeps 4-5 hours per night when she used to sleep 8 hours before, difficulty mainatining asleep
Patient Note: HPI: This is a 67 year old woman with HTN and remote breast cancer history who presents with 3 week history of insomnia. Of note, these symptoms began same day her son died tragically. She reports multiple SIGECAPS symptoms including decreaed energy, difficulty enjoying activites, and increased appetite. She denies SOB, CP, edema, nausea, and bowel/bladder symptoms. 
ROS: Negative except per above.
Allergies: None
Meds: HCTZ, lisinopril. Tried ambien from friend 5x
PMH: HTN, Br Ca 2011
PSH: Lumpectomy 2011, Laparoscopic appendectomy in 20s.
SH: Lives with supportive husband. Is retired receptionist. Walks daily at baseline. No tobacco, 1-2/week redwine, 0/4 CAGE.
FH: Mother with depression (alive). Father with stroke (deceased)

Keywords and phrases relevant to diagnosis:
increased appetite
began same day her son died
woman
67 year old
3 week history
decreaed energy
difficulty enjoying activites
Mother with depression
insomnia
Patient Note: Ms. Wicks is a 67 yo F who presents with difficulty sleeping. 3 weeks ago her son died, since then she's had difficulty falling and staying asleep, tosses and turns in bed, sleeps 4-5 hrs previously 8 hrs per night. She feels devastated and tired but endorses a strong support system, denies suicidal ideation. She endorses losing interest in hobbies and increaed appetite. Last night she heard noises from neighbor's yard that were not present, and few days ago saw image of her son in the kitchen but knows these are not based in reality. Denies intrusive thoughts, auditory hallucinations, skin and hair changes, weight gain. Tried ambien without effect.
ROS: negative except as above
PMH: Htn, remission from breast cancer 10 yrs ago, Meds: ambien, hydrochlorothiazide, lisinopril; NKDA
FHx: noncontributory
SHx: retired, strong support network, denies tobacco, EtOH, illicit drugs; 1 cup coffee per morning

Keywords and phrases relevant to diagnosis:
increaed appetite
3 weeks ago her son died
Ms, F
"heard noises from neighbors yard that were not present"
tosses and turns
67 yo
difficulty falling asleep
Tried ambien without effect
tired
endorses losing interest
saw image of her son in the kitchen but knows these are not based in reality
denies suicidal ideation
difficulty sleeping, difficulty staying asleep, sleeps 4-5 hrs
Patient Note: 67 y/o F complains of problems sleeping for 3 weeks. the symptoms started after her son died. she used to sleep 8 hours a night, now she sleeps 4 hours a night, feels tired and sleepy during the day. She tried some medications for her sleep, but nothing helped. patient feels sad, complains of lack of interest and energy. increased appetite, with no weight changes. reports visual and auditory hallucinations about her dead son, however she knows they are not real.no suicidal nor homicidal ideation.does not feel guilty. No hot or cold intolerance. no changes in her bowel habits. drinks 1 cup of coffee a day.
ROS:negative except as above
Allergies:none
Medication:HCTZ, Lisinopril,Ambien.
PMH:Hypertension,breast cancer
PSH:lumpectomy,laparotomy with removal of the appendex in her 20s
SH:no smoking.2-3 drinks a week. no illicit drugs. sexually active with her husband.
FH:mother had depression. Father had stroke

Keywords and phrases relevant to diagnosis:
increased appetite
3 weeks after her son died
F
auditory hallucinations
67 y/o
for 3 weeks
tried some medications for her sleep, but nothing helped
feels tired, sleepy during the day, lack of energy
lack of interest
visual hallucinations
mother had depression
no suicidal ideation
problems sleeping, sleeps 4 hours a night
Patient Note: HPI 67yo F with c/o imsomnia. She cannot fell asleep and wakes up earlier than usual for 3 weeks. Since his son James passed away on April 16, her imsomnia started. Ambian does not help her sleep that much. she hear some playful music but other people did not hear that. She also see visual hallusination of her late son. Family and friends are all supportive and she does not feel hopelessness or suicidal thoughts. Appetite is increasing and weight is the same. no chill, no fever. Duration of sleep is 4-5 hours.
ROS n.p. other than mentioned above
PMH HTN PSH Father HTN, Hypercholeterolemia, stroke Allergy NKDA, Med HCTZ statin, smbian Sx -cig, ETOH 2-3 wine/night but after her son's death she stopped drinking. illegal drug(-)

Keywords and phrases relevant to diagnosis:
Appetite is increasing
son passed away on April 16
F
hear some playful music but other people did not hear that
67yo
cannot fell asleep
for 3 weeks
Ambian does not help
visual hallusination
wakes up earlier than usual
does not feel suicidal thoughts
imsomnia, imsomnia, Duration of sleep is 4-5 hours
Patient Note: 67 yr old w f presented with isomnia dec energy low mood inc apetite norma wt has experience hallucinations has seen his decesaed son in home taht dies 3 weeks ago aloso been hearing voices which others dont , dec intersest in daily activities has no feeling of guilt no suicida ideation no memmoer loss, .HAS HTN FROM 15 YRS ON hctz NAD LISINOPRIL FROM 5 YRS on bre=ast ca remission from 10 yrs  takin ambian for sleep from 5 days has appendicetomy done at 20 yrs no traum urination and bowel movemment fine no cold intolerance hair thining dry skin or hoarese voice , FHX mother healty 90 as high cholestrol father died of stroke LMP at age of 52 G1P1A0, SSEXUALLY ACTIVE ONLY WITHY HUSBAND NEVER TESTED FOR STDS, NON SMOKER DRINKS OCCASIONALY 2 GLASS WINE WITH DINNER NO REC DRUGS RETIRED RECEPTIONIST

Keywords and phrases relevant to diagnosis:
inc apetite
son dies 3 weeks ago
f
hearing voices which others dont
67 yr old
dec energy
dec intersest
hallucinations has seen his decesaed son
no suicida ideation
isomnia
Patient Note: Patient is a 67 yo woman who lost her only son 3 weeks ago and now presents with trouble sleeping x3 weeks. She has never had trouble sleeping before. She has trouvble sleeping and when she sleeps, wakes frequently. Get about 4-5 hours of sleep daily. she denies and loss of interest and suiidal thoughts. she sometimes sees her son standing on the kitchen but know it isnt real. She is married and lived with her husband.
PMH_ hypertensive x 15 yrs on HCTZ and lisinopril-compliant. Had breast cancer but has been on remission for 10 years.
SH: no tobbaco, no etoh, no recreatonal drugs.
FH: mpther had depression and is alive and well.

Keywords and phrases relevant to diagnosis:
lost her only son 3 weeks ago
woman
67 yo
x3 weeks
sees her son standing on the kitchen but know it isnt real
mpther had depression
wakes frequently
denies suiidal thoughts
trouble sleeping, trouvble sleeping, 4-5 hours of sleep daily
Patient Note: Mrs. Wicks is a 67 year old woman with history of hypertension on HCTZ/Lisinopril who presents with 3 week history of poor sleep. Her son died three weeks ago, and ever since she has been unable to fall asleep, stay asleep, and she feels as if she spends all night tossing/turning. She also endorses seeing her son at times but she knows he isn't there. She also endorses one episode of auditory hallucinations at night when she thought she heard a party going on only to discover there was not one. She denies any other medical symptoms at this time, including chest pain, shortness of breath, nausea, vomiting, diarrhea, constipation, changes in urination, abdominal pain, or headaches. She denies suicidal ideation or homicidal ideation. She also denies difficulty concentrating, psychomotor agitation/retardation. She endorses an increased apetite with no associated weight changes. She has tried ambien for five nights with no benefit.

Keywords and phrases relevant to diagnosis:
increased apetite
son died three weeks ago
Mrs., woman
one episode of auditory hallucinations at night when she thought she heard a party going on only to discover there was not one
tossing/turning
67 year old
unable to fall asleep
3 week history
tried ambien with no benefit
"seeing her son at times but she knows he isnt there"
denies suicidal ideation
poor sleep, unable to stay asleep
Patient Note: Lorainne Wick is a 67 y.o. female who presents due to trouble sleeping.  She states that she has problems falling asleep as well as waking up early.  She usually goes to sleep with the help of a warm bath, doesn't watch TV before sleepign, and takes no naps during the day.  She drinks one cup of caffeine in the morning. These symptoms are occuring following the death of her son on Dec. 10 from a MVA.   She has had decreased sleep, decreased interest level in things she once enjoyed, decreased energy, increased appetite. She has no thoughts of active or passive suicide or self harm.   ROS is neg for fever, skin changes, hair changes, pain, heat/cold intolerance, lumps, or swelling.  She has a good support system

Med:  HTN
Medications: HCTZ, lisionpril
PSH: none
FMH: Mom with depression

Social: no smoke, alcohol +, CAGE -, sexually active with husband, does not exercise since death.

Keywords and phrases relevant to diagnosis:
increased appetite
death of her son on Dec. 10
female
67 y.o.
problems falling asleep
decreased energy
decreased interest level
Mom with depression
waking up early
no thoughts of active or passive suicide
trouble sleeping, decreased sleep
Patient Note: Loraine Wicks, a 67-year-old female, presents because of trouble sleeping. She has had trouble falling and staying asleep for the last 3 weeks, and recently experienced the death of her son on August 29th. Her mood is "devastated" and she feels "drained" and uninterested in her normal activites and has been eating more than usual. 3 days ago she also experienced seeing her son at the kitchen table and heard what she described as a party later than evening, but she knows that both of these things did not actually happen. She has no previous episodes like this and her FH is negative. She denies thoughts of hurting herself or others, denies psychomotor changes, denies difficulty concentrating. She reports a good support  system at home with her family. She has good sleep hygiene.

ROS:negative
FH:non-contributory
SH: normally 1-2 glasses of wine, none last few weeks, no tobacco, no recreational drugs
SurgH: negative
PMH: none

Keywords and phrases relevant to diagnosis:
eating more
death of her son on August 29th
female
heard what she described as a party later than evening these things did not actually happe
67-year-old
trouble falling asleep
last 3 weeks
feels "drained"
uninterested
experienced seeing her son at the kitchen table these things did not actually happe
denies thoughts of hurting herself
trouble sleeping, trouble staying asleep
Patient Note: Ms. Wicks is a 67 year old woman with a history of HTN and breast cancer who presents with difficulty sleeping. This began 3 weeks ago at the time of her son's death. She has trouble falling asleep, staying asleep, and wakes up early in the morning. Her mood is sad. She has decreased interest in her normal activites, fatigued. Denies feeling guilty, decreased concentration or attention, feeling hyperactive or lethargic, denies suicidality. She reports having 1 auditory and 1 visual hallucination in past few days. No prior mood disorders.
Denies - HA, weight change, vision changes, chest pain, SOB
PMH: HTN, breast cancer 10 years prior
PSH: lumpectomy, laparotomy for appendectomy
Medications: HCTZ, lisinopril, ambien x5 days
Allergies: NKDA
FH: father died of stroke at 70, HTN, HLD. mother with prior depression
SH: lives with husband, drinks less than 7 drinks per week, never smoker, no drugs
ROS: as above, otherwise negative

Keywords and phrases relevant to diagnosis:
"3 weeks ago time of her sons death"
Ms, woman
1 auditory hallucination
67 year old
trouble falling asleep
began 3 weeks ago
fatigued
decreased interest
1 visual hallucination
mother with prior depression
wakes up early in the morning
denies suicidality
difficulty sleeping, trouble staying asleep
Patient Note: HO1 67 F presenting with difficulty sleeping past 3 weeks, diufficulty initialting sleep and getting up early. previosuly no similar episodes . son passed away 3 weeks ago and has been notices lack of energy and low mood since visual and auditory hallucinations once since then.lack of interest in daily activities,no change in weight but has been eating more than usual.
denies snoring.or any urinary or bowl complaints.
ros -ve except as above 
pmhx htn on medication past 15 year s
pshx nil 
fhx mother alive and well has a history of major depression 
medications lisinopril and hctz 
shx non smoker 
drink 2-3 glasses of wine a week cage 0/4 monogamous with hysband retired receptionist excersise regularly till 3 weeks ago

Keywords and phrases relevant to diagnosis:
eating more than usual
son passed away 3 weeks ago
F
auditory hallucinations
67
diufficulty initialting sleep
past 3 weeks
lack of energy
lack of interest
visual hallucinations
mother history of major depression
getting up early
difficulty sleeping
Patient Note: 67year old female with pmh of breast cancer in remission 11yrs presents with difficulty sleeping. Patient notes poor sleep began 3 weeks ago. Baseline sleep 8hrs, but now only gets 4-5hrs sleep, difficulty failing asleep as well as waking up early. Bed hygiene- only uses bed for sex and sleep, no changes in last 3 wks. NOtes lows of her son Leonard january 31 at around the same time. Notes decreased interest in hobies, denies hopelessness/guilt, notes decreased energy, increased appetitie, denies suidical ideation of hx of suicide attempts. Notes "saw Leonard" 4 days ago, and heard muffled voices from neighbor (neigbor denies). Denies command hallucinations. Pt has triend ambien without relief, nothing helps, nothing makes worse. Denies drug/substance use, 1 cup of coffee in morning. Per pt, husband denies snoring, no daytime fatigue

pmh- htn, br cancer
psh - laparotomy appendix
med - hctz, lisinopril, ambien
famhx- mom depression

Keywords and phrases relevant to diagnosis:
increased appetitie
lows of her son around the same time
female
heard muffled voices from neighbor (neigbor denies)
67year old
difficulty failing asleep
began 3 weeks ago
triend ambien without relief
decreased energy
decreased interest
saw Leonard" 4 days ago
mom depression
waking up early
denies suidical ideation
difficulty sleeping, Baseline sleep 8hrs, but now only gets 4-5hrs sleep
Patient Note: 67 yo F present with trouble sleeping. Pt states that it began 3 weeks ago and describes as difficulty falling asleep, waking up early, and tossing and turning at night. Never had this problem before, tried taking a friends ambien, and it did not help. Pts son died on Aug 17 in an MVA. Pt states that she has a sad mood, loss of interest in activites, decreased energy level, difficulty sleeping, increased appetite, and hallucinations of seeing son, and hearing people next door.

ROS: negative except for above
allergies: none
meds HCTZ 25 mg QD, lisinopril 20 mg QD
PMH: HTN (15 years), in remission for breast cancer (10 years), ruptured appendicitis
PSHx: lumpectomy, laperatomy in 20s
FH: father with HTN, hypercholesterolemia, died of stroke, mother with DM
SH: married (45 years), drinks EtOH 2-3 times per week (-) cage, good support system, denies tobacco and recreational drug use

Keywords and phrases relevant to diagnosis:
increased appetite
son died on Aug 17
F
hallucinations of hearing people next door
tossing and turning
67 yo
difficulty falling asleep
began 3 weeks ago
ambien did not help
decreased energy level
loss of interest
hallucinations of seeing son
waking up early
trouble sleeping, difficulty sleeping