bhatthars/nbme_qna huggingface dataset:
Patient Note: Patient is a 35 year old female who presents with change in menstruation. 6 months ago she started having heavier periods lasting 7 days (changing tampon every 2 hours). She has only had two during the past 6 months. Previously her periods were every 4-5 weeks, lasting 3 days without spotting or excessive cramping using 3 tampons per day. her last pap smear was 6 months ago and it was normal. no breast tenderness or discharge. tested for STIs (negative). no decrease in libido, vaginal dryness, no dysperunia, dyschezia, frequency, dysuria, incontinence, difficulty passing urine. sexually active with 1 male partner. 2 lifetime sex parterns; both men. never pregnant; tried for 9 months but couldn't get pregnant. no change in vaginal discharge (amount/smell/color). dark velvety rash bilateral knuckels and left side of neck. 10 pound weight gain with poor diet. no PMH/PSH, allergies, or meds; family hx and social hx noncontributory

Keywords and phrases relevant to diagnosis:
female
weight gain
heavier periods, changing tampon every 2 hours
"couldnt get pregnant"
35 year old
6 months, 6 months
Patient Note: Ms. Thompkins a 35 year old female comes to the office due to dysfunctional uterine bleeding. She states that during the last 5 months she started having heavy bleeding that is continous and intermittently without any pattern, she states that she needs to change her tampons constantly, she denies pain. Before this her menstruation used to be normal at intervals of every 30 to 35 days, lasting 3  days. Menarche was at 12 years old. 
ROS: No pain, No fever, denies bruises in other parts of body or blood dyscrasias.
Allergies: NKDA
Medications: Denied
PMHx: There is a story of infertility that has not had a workup diagnosis
PSHx: Denied
SH: Works in social security, denies smoking and drinks ocasionally, denies drugs. Sexually active with her husband. Uses no contraception


Keywords and phrases relevant to diagnosis:
female
dysfunctional uterine bleeding, heavy bleeding, change her tampons constantly
Uses no contraception
infertility
35 year old
Patient Note: Ms. Tomkins is a 35 F w no PMH who presents today w/heavy periods. She has only had 2 periods in the past 5 months. When they did occur, they were heavy and lasted for 7 days, previously they were for 3 days and came monthly. She has never had any spotting inbetween her periods, no abnormal Pap smears, no hx of any STDs. Further she has had no vaginal discharge or pain. In her prior marriage, she had difficulty geting pregnant but never sought any medical attention. She is currently sexually active w/ her new boyfriend only and, they do not use contraception. Ms. Tomkins further denies any changes to her bowel or urinary habits. No HA, cold intolerance, no belly pain, or hair loss. The only associated symptom is unintentional weight gain. She reports that she eats out alot and doesnt have time to exercise. She works as a scheduler for a social worker, has 2 kids, rarely drinks (beers), & does not smoke or do any illict drugs.

Keywords and phrases relevant to diagnosis:
F
weight gain
heavy periods, 2 periods in the past 5 months, periods heavy, periods 7 days
do not use contraception
difficulty geting pregnant
35
Patient Note: Angela Tompkins is a 35 year old female presenting with heavy periods. Menarche at 12 with abnormal periods for first year, started on OCP at that time and had regular periods every 4-5 weeks lasting 3-4 days requiring 4 tampons daily. stayed regular after stopping OCPs 11 years ago. Last normal period was 6 months ago. Since then has had 2 periods in 5 months, each lasting 7 days, requing multiple changes in first few hours. LMP was 2 months ago. She had tried to get pregnant with her ex-husband but was unable to. Has 2 adopted children. Normal Pap smear 6 months ago. Endorses 10-15 weight gain in 6 months and eating more. Notes rash on fingers and face for past year.
PMH: health.
PSH: none
Meds: none. NKDA
FH: aunt w/ breast cancer. grandmother w/ cervical cancer
SH: etoh 1-2 on rare occasions. no tobacco. no drugs. lives w/ 2 adopted kids. Sexually active with boyfriend. Stopped using condoms in past year.

Keywords and phrases relevant to diagnosis:
female
weight gain
heavy periods, requing multiple changes in first few hours
LMP was 2 months ago
Stopped using condoms
get pregnant unable to
35 year old
6 months
Patient Note: The patient is a 35 year old F presenting with heavy irregular periods for the past 6 months. Prior to that her periods were normal, but now they last 7 days, she uses 7 tampons the first day and 1-2 the last. Her LMP was May 13th, 2 months ago. She has minimal cramping with her periods, no abdominal pain, no pain with defecation, no pain with urination. She was sexually active trying to get pregnant for years in the past and was not able to. She is currently sexually active with one male (her boyfriend), does not use condoms, does not have pain with sex, and was tested for STIs in the past year and did not have any. No history of uterine fibroids or ovarian cysts. No nausea or vomiting, +fatigue, + weight gain, +decreased appetite. No abnormal nipple discharge or hair growth.
PMH: none
Fam Hx: none
Social: negative for smoking


Keywords and phrases relevant to diagnosis:
F
+ weight gain
irregular periods, heavy periods, uses 7 tampons the first day
LMP 2 months ago
does not use condoms
+fatigue
trying to get pregnant not able to
35 year old
6 months
Patient Note: 35 year old female presents to the clinic today due to heavy menses, and mentioned that she would have to change her pads every couple of hours because it would soak right through. Patient denied pain with menses or any pain at all, denied vaginal discharge. Patient mentioned that she was fatigued, but it mainly had to do with taking care of her two little girls.

Pap smear: No abnormal pap smear in past

Past medical history, Social history, sexual history are all normal.

Keywords and phrases relevant to diagnosis:
female
heavy menses, change her pads every couple of hours
fatigued
35 year old
Patient Note: CC: Irregular periods.
HPI: 35-yo female complaining of heavy and irregular periods for the past 6 months. She has had 2 periods in the past 6 months, lasting about 7 days. She would soak a pad every couple hours during that time. Has also noticed decreased energy. The patient reports some darkening of the skin around her knuckles and the back of her neck. 7-8 lbs. weight gain in past 6 months, appetite normal. Denies other skin changes. No changes in hair. Denies recent increases in stress, headaches. 
PMH: No significant PMH. No medications.
SH: Scheduler for a social work company. Has one beer on the weekends. Never smoker. Divorced. She has two children, ages 3 and 5, who are adopted. The patient states that she and her ex-husband tried to get pregnant for many years but were unsuccessful. No formal workup for infertility in either her or her ex-husband.
FH: Grandmother with cervical cancer. Aunt with breast cancer.

Keywords and phrases relevant to diagnosis:
female
weight gain, 7-8 lbs gain
Irregular periods, irregular periods, heavy periods, pad every couple hours
decreased energy
but unsuccessful tried to get pregnant, infertility
35-yo
6 months, 6 months, 6 months
Patient Note: 35 YO F , C/O IRREGULAR PERIODS SINCE 6 MONTHS. HER LMP WAS 2 MONTHS AGO . SHE ALSO HAS HEAVY BLEEDING DURING HER PERIODS USING MORE PADS THAN OFTEN.
HER MENARCHE WAS AT 12 YRS OF AGE.  HER PERIODS WERE REGULAR BEFORE.  SHE HAS NO BREAST TENDERNESS OR FULLNESS. 
SHE HAS GAINED 15 POUNDS RECENTLY, WITH PIGMENTATION IN HER NECK REGION. NO BOWEL HABIT CHANGES , NO VOMITING. SHE HAS 2 ADOPTED KIDS AND WAS UNABLE TO CONCEIVE A CHILD FOR 10 YRS
SHE DENIES ANY FEVR , SOB , BELLY PAIN . NO DISCHARGE VAGINA
PMH:NONE
ROS: NEG EXCEPT AS ABOVE
SSH:MONOGAMOUS WITH HUSBAND ,NO USE OF CONDOM
FH: BREAST CANCER IN AUNT, CERVIX CANCER IN GRANDMA
ALLERGY: NONE
MEDS: NONE


Keywords and phrases relevant to diagnosis:
F
GAINED 15 POUNDS
IRREGULAR PERIODS, HEAVY BLEEDING, USING MORE PADS
LMP WAS 2 MONTHS AGO
NO USE OF CONDOM
UNABLE TO CONCEIVE A CHILD
35 YO
6 MONTHS
Patient Note: hpi- 35 F c/o irregular periods for the past 6 months, lmp was 2 months ago, and menarche at age 12, she states that her periods have been happening every other month as of the past 6 months but were regular previously, she states that her cycles are now 7 days in length and are heavy, requiring her to change her tampons every hr, she denies any cramping, vaginal discharge or spotting in between her cycles, last pap smear was 6 months ago and was normal, shehas been experiecing infertility issues for the past 9 years, she also states that she has gained approx 10-15 
ros- she denies breast tenderness, hirsutism, acne, headache, vision change
pmh/psh- none, no previous hospitalizations, surgeries, or trauma  
NKDA 
fh- aunt- breast ca, grandmother- cervical ca 
social hx- social worker coordinator, beer rarely/ no tobacco or illicit drugs 
sexual hx- active w/ boyfriend, irregular condom use 


Keywords and phrases relevant to diagnosis:
F
gained 10-15
irregular periods, cycles heavy
lmp was 2 months ago
irregular condom use
infertility
35
6 months, 6 months
Patient Note: 35 yo F presents with a 6m history of menorrhagia  (changes tampons every couple of hours), irregular periods (every other month), increased duration of periods (7d, vs the usual 3d). Also presents weight gain: 10 lb in 6m, but attributes to eating "outside" more often. Incapable of getting pregnant for 9 yr. Denies vaginal itching or discharge, cramps, spotting, changes in appetite. 1yr history of acanthosis nigricans in arms and neck. Denies weakness, fever, hair loss.
OB/GYN: LMP 5wk ago. Menarche 12y/o. G0. Last pap 6m ago, normal. 
PMH: Never experienced before. Denies other diseases.
NKDA. Takes no medications.
No recent hospitalizations, infections, trauma, surgery.
FH: Aunt, breast cancer. Grandmother, cervical cancer. Mom and dad healthy.
Sexual history: 1 partner in the past year, no contraception use. No STD history.
Social history: Alcohol1 beer sporadically. Denies smoking, drugs. Scheduling coordinator. Sedentary

Keywords and phrases relevant to diagnosis:
F
weight gain, gain 10 lb
tampons every couple of hours, irregular periods, menorrhagia
LMP 5wk ago
no contraception use
Incapable of getting pregnant
35 yo
6m, 6m
Patient Note: 35 YO F G2P2 C/O IRREGULAR PERIODS X 6 MOMTHS.IT STARTED SUDDENLY,IS PROGRESSIVE,WITH NO ALLIEVIATING/AGGRAVATING FACTORS.PT ALSO MENTIONS ACANTHOSIS NIGRICANS ON HER NECK .ALSO SHE GAINED 10-15 LBS IN 6 MONTHS UNINTENTIONAL.PT USUALLY FAST FOOD AND STRESSED OUT WITH KIDS AND JOB.SHE DONT EXCERCISE REGULARLY
PT DENIES BELLY PAIN,CHANGES IN SLEEP,CHANGES IN URINARY HABITS/BOWEL HABITS
OBG/GYN LMP 2 MONTHS AGO,IRREGULAR,7 TAMPOON OJN HEAVY DAY,NO CRAMPS,G2P2,PAPS SMEAR 6 MONTHS AGO NORMAL



Keywords and phrases relevant to diagnosis:
F
GAINED 10-15 LBS
IRREGULAR PERIODS, 7 TAMPOON OJN HEAVY DAY
LMP 2 MONTHS AGO
35 YO
6 MOMTHS, 6 MONTHS
Patient Note: 35 year old woman presents with menstrual irregularity, menorrhagia. In past, patient's periods occurred 30-35 days apart, lasting 3 days and controlled with tampons. Last normal period 6 months ago. Over past 5 months, periods have been occurring every other month, last 7 days, and require tampon changes every "couple of hours" due to excessive bleeding. Patient reports feeling more tired over past few months. Patient has never been pregnant, despite trying to get pregnant for 9 years. No hx of STDs. Sexually active with male partner over past year. No changes in bowel habits. No fever/chills. No cold intolerance. No bleeding elsewhere in body. No extra tissue behind neck. Has gained 10-15 lbs over past 6 months. No excess hair on arms or legs
PMH: unremarkable
PSH: None
FH: Unremarkable
SH: Never smoker, occasional beer every few weeks. No rec drugs. Eating out more often recently.


Keywords and phrases relevant to diagnosis:
woman
gained 10-15 lbs
menstrual irregularity, menorrhagia, tampon changes every "couple of hours, excessive bleeding
tired
never been pregnant, despite trying
35 year old
6 months, 6 months
Patient Note: 35 y/o F c/o menstrual cycle abnormalities. 6 mo ago she began to have irregular cycles and increased flow, 2 periods in the last 5 mo that last for 7 d and day 1 requires 7 pads/d and the need for pads lessens as the days go on. Previously her cycles occurred every 4-5 wks, lasted 3-4 d, and she used 3-4 pads/d. LMP was 5 mo ago, menarche was at age 12 yrs, pt has never been pregnant, she took OCPs as a teen for 11 yrs for irregular periods (orthotricyclin). Denies vaginal discharge or dryness, dyspareunia, itchiness, SOB, mouth ulcers, HA.
ROS neg except as above
PMH none, NKDA, Meds none
Received the HPV vaccine
PSH/HOSP/Travel/Trauma none
FMH aunt had breast cancer and mother had cervical cancer
SH social worker administrator, denies smoke, EtOH, REC drug use
Sex hx active with boyfriend in past year, don't use condoms, no h/o STI or HIV

Keywords and phrases relevant to diagnosis:
F
menstrual cycle abnormalities, irregular cycles, increased flow, 7 pads/d
"dont use condoms"
35 y/o
6 mo
Patient Note: Ms. Tompkins is a 35 yo F who presents with irregular and heavy periods for the last 5 months. Prior to this, her periods came every 30-35 days and she used 4 tampons on the first day. Now they occur every other month, and she requires a tampon change every 2 hours. She also reports a history of infertility. She tried to get pregnant for 9 years and was unable to, she has two adopted daughters. She has no associated pain, nausea, vomiting, diarrhea, or constipation. Reports no burning or pain with urination. She has gained 10-15 lbs over the last 6 months, with more eating out. No changes in hair or hair loss. 
ROS-  otherwise negative 
PMH - none PSH - none 
FH - parents healthy - aunt had breast cancer - gma had cervical cancer 
no medications, no allergies 
Social - never smoker, no maijuana or illicit drugs. drinks alcohol rarely. lives with boyfriend and two daughters. monogamous. Has never had an STD and does not use condoms

Keywords and phrases relevant to diagnosis:
F
gained 10-15 lbs
irregular periods, heavy periods, periods every other month, tampon change every 2 hours
does not use condoms
infertility, tried to get pregnant unable
35 yo
Patient Note: 35 YO FEMALE PRESENTS W/ IRREGULAR HEAVY PERIODS FOR THE PAST 6 MONTHS, HER LAST PERIOD WAS 2 MONTHS AGO AND SHE ONLY HAD 2 PERIODS IN THE PAST 5 MONTHS, EACH PERIOD LASTS 7 DAYS W/ PADS CHANGING EVERY 2 HRS, DENIES DYSMENORRHEA AND DYSPAREUNIA, NO VAGINAL DYSCHARGE OR PELVIC PAIN, LAST PAP WAS NML 6 MONTHS AGO. SHE ALSO COMPLAINS OF DARKNESS OF SKIN AROUND KNUCKLES AND NECK. SHE HAD PRIMARY INFERTILITY FOR 9 YEARS OF UNPROTECTED SEX W/O CONCEPTION W/ PREVIOUS HUSBAND. SHE IS G0P0 WITH 2 ADOPTED CHILDREN.
ROS NEGATIVE EXCEPT ABOVE
PMHX, SHX, MEDS, ALLERGIES: NONE
FHX:  GRANDMOTHER W/ CERVICAL CANCER, AUNT W/ BREAST CANCER
SHX: DENIES SMOKING AND ILICIT DRUG USE, OCCASIONAL BEER, UNPROTECTED SEX W/ BYFRIEND ONLY, HIGH FAT DIET, NO EXERCISE.

Keywords and phrases relevant to diagnosis:
FEMALE
IRREGULAR HEAVY PERIODS, ONLY HAD 2 PERIODS IN THE PAST 5 MONTHS, PERIOD LASTS 7 DAYS, PADS CHANGING EVERY 2 HRS
UNPROTECTED SEX
INFERTILITY
35 YO
6 MONTHS
Patient Note: HPI: 35 yo F with heavy uternine bleeding. Last normal period was 6 month ago. LMP with heavy bleeding 2 months ago. No clots. Changes tampon every few hours, previously 4/day. Menarche at 12. Minimal cramping. Never been pregnent, tried previously but unsuccesful. Two adopted children and feels fatigued at home. Last PAP 6 months ago was normal, never abnormal. Gained 10-15 lbs past few months, eating out more though. Hyperpigmented spots on hands and LT neck that she noticed 1-2 years ago. No breast changes. ROS: neg except above. PMH: none. Allergies: none. Meds: none. PSH: none. FH: aunt died of breast cancer. SH: state social worker; no smoking or drug use; beer or two on weekends; sexually active with boyfriend of 14 months, used condoms at first but no longer uses them, no concerns for STDs

Keywords and phrases relevant to diagnosis:
F
Gained 10-15 lbs
heavy uternine bleeding, heavy bleeding
LMP 2 months ago
condoms no longer uses
fatigued
Never been pregnent, tried previously but unsuccesful
35 yo
6 month
Patient Note: 35 yo F presenting with 6 months of heavy periods. She reports having her most recent normal period (4-5 tampons for the first day, then fewer over following days) 6 months ago. Since then, she has been experiencing heavy periods (8-10 tampons for the first day, then fewer) occuring once every 2 months. She denies any other discharge, any fevers, any abdominal pain, and any constipation. She notes 10-15 lbs of weight gain over the past 6 months, as well as discoloration of her neck and hands over the past year. She denies any hot flashes, constipation, or changes in diet/exercise habits.
PMH: None.
OBHx: Denies, tried unsuccessfully for 9 years to become pregant)
GYNHx: Last pap smear 6 months ago, no history of abnormal paps. Menstrual history per HPI. Denies history of fibroids
PSH: None
Meds: None
All: NKDA
FH: Breast cancer in aunt, cervical cancer in grandmother
Sh: Lives at home with 2 adopted children

Keywords and phrases relevant to diagnosis:
F
weight gain
heavy periods, heavy periods, 8-10 tampons for the first day
tried unsuccessfully to become pregant
35 yo
6 months, 6 months, 6 months
Patient Note: 35-year-old female with 6 month history of heavy, irregular menstrual periods. She is P0, with two adopted children, she has tried to get pregnant in the past, trying for 9 years with her ex husband. Her menstrual periods previous to this year were once every 4-5 weeks, lasted a few days, and used 4 tampons the first day, tapering off for the other days. Now she has had 2 periods in the past 5 months, using a tampon every two hours, and her period often only lasts a day. She has no pain, light cramping. No fever, chills, nausea. She has had some feeling of tiredness but no new hair growth or cold/heat intolerance. She has gained 10-15 pounds in the past 6 months. 
PMH/surge: denies
social: Diet: says she is eating a little more "easy" food. Never smoker, 1-2 beers very rarely  Sexually active boyfriend no condom use.
Meds: none currently, previously took contraceptive pills with no side effects
allergies: none

Keywords and phrases relevant to diagnosis:
female
gained 10-15 pounds
irregular menstrual periods, heavy periods, tampon every two hours
no condom use
tiredness
P0 tried to get pregnant in the past, trying for 9 years
35-year-old
6 month, 5 months, 6 months
Patient Note: Ms Tompkins is a 35 year old woman presnting with a 6 month history of abnormal menses. Pt says that her menses have become heavier over the past 6 months and can require changes in tampons every couple of hours. She has not noticed any clots. They have also become irregular and her last menstrual period was 2 months ago. The pt has not had an increase in cramps during her menses and has not felt any abdominal fullness. Menses started at age 12 and had been regular until 6 mo ago. Of note, pt believes she cannot get pregnant because she tried to conceive for years unsuccessfully with ex-husband. 

ROS: Weight gain of 10-15 lbs over 6 months, denies hot or cold intolerance, denies fevers, chills, headaches. 
PMH: No previous medical problems, no medications.  
Allergies: NKDA
FH: parents healthy, breast cancer in aunt, cervical cancer in grandmother. 
SH: occasional alcohol, - smoking, - illicits. Pt sexually active w boyfriend.

Keywords and phrases relevant to diagnosis:
Ms, woman
Weight gain, gain of 10-15 lbs
abnormal menses, menses heavier, changes in tampons every couple of hours, menses irregular
last menstrual period was 2 months ago
cannot get pregnant, tried to conceive for years unsuccessfully
35 year old
6 month, 6 months, 6 mo, 6 months
Patient Note: This is a 35yo F who presents with abnormal periods. Patient states 6 months ago she noticed increased bleeding with her periods. They now last 7 days (previously 3 days) and she now is changing her tampon with increased frequency. She denies bleeding anywhere else (ginvival), denies bruises, vaginal discharge. Patient states she tried to have a child with her exhusband for 9 year but was unable to, she never saw a doctor about this problem. She is currently sexually active with her boyfriend, and has never had an STI. Her last pap smear was 6 months ago and was regular. Menarche at age 12, periods previously occurred every 4-5 weeks

denies PMH, PSHx, meds, allergies
FH: grandmother - cervical cancer at 65; aunt - breast cancer at 51
Social: denies tobacco or recreational drug use, occasinal alcohol use

Keywords and phrases relevant to diagnosis:
F
increased bleeding, now last 7 days, changing her tampon with increased frequency, abnormal periods
tried to have a child but was unable to
35yo
6 months
Patient Note: 35 yo F with heavy periods for the past 5 months. Periods now occur every other month, last 7 days, and increased flow requiring a tampon change every other hour. Previous periods occurred every 30-35 days, lasted 3 days, and only required a couple of tampons daily. Her last regular menses was 6 months ago. LMP was 5 weeks ago. Menarche was at 12 yo. Pap smear 6 months ago was normal, no abnormal results. Also has 9 years of infertility, requiring her to adopt. No workup previouusly done for this. Sexually active with one male partner, unprotected sex. 
Denies urinary frequency, dysuria, nocturia, appetite changes. 
PMH none
Allergies none
Meds none
FH none
Denies alcohl, drug, smoking

Keywords and phrases relevant to diagnosis:
F
heavy periods, increased flow, tampon change every other hour
LMP was 5 weeks ago
unprotected sex
infertility
35 yo
5 months
Patient Note: CC-period problems
hpi-Angela Tompkins is a 35 yo female who presents for period problems. She has had heavy period for the past 6 months. Her LMP was 2 months ago, with last normal period being 6 months ago. Her periods now last 7 days, and require 7 tampons on the first day up from 4 previously. She had menarche at age 12, has not experienced vaginal pruritis, dryness, or burning. Never been pregnant, has had no vaginal discharge or bleeding between periods, had a normal Pap smear 9 months ago, and has not noticed breast lumps. She has not had thought of depression.
ROS:+ fatigue, weight gain (10-15 pounds over 6 months), dry skin; - for dyschezia, constipation, diarrhea, fever
pmh-none
psh:none
SH:sexually active with boyfriend, monogomous, no male condom use; no cigarettes, alcohol socially 0/4 CAGE, no drugs; social worker
FH:mom&dad alive and well; aunt died breast cancer, grandma cervical cancer
meds:none
Allergy:none

Keywords and phrases relevant to diagnosis:
female
weight gain, gain 10-15 pounds
heavy period, require 7 tampons
LMP was 2 months ago
no condom use
fatigue
35 yo
6 months, 6 months, 6 months
Patient Note: 33 yo F c/o problems with periods.
-has had heavy periods for 6mo, used to use 3-4 tampons/day now changes tampon every couple of hours
LMP 2 months ago, periods used to occur every 4-5 weeks regularly and last 3 days, now has only had 2 periods in the last 5 months, and they last 7 days
-no dysmenorrhea, no intermenstrual/postcoital bleeding, no dyspareunia, no abdominal/pelvic pain
-fatigue, weight gain 10lbs in 6mo, hyperpigmentation over knuckles and side of neck
PMH: no medical conditions, no meds, PSH none, allergies none, last pap smear 6mo ago normal, possible infertility 
FH aunt breast cancer died 51, grandmother died cervical cancer 65 
SH non smoker, occasional EtOH, no recreational drugs, poor diet/exercise, sexually active with boyfirned, no use of condoms, 2 partners in 10yrs, no STIs

Keywords and phrases relevant to diagnosis:
F
weight gain, gain 10lbs
heavy periods, changes tampon every couple of hours
LMP 2 months ago
no use of condoms
fatigue
infertility
33 yo
6mo