bhatthars/nbme_qna huggingface dataset:
Patient Note: 67 yr old woman presents today with difficulty sleeping over the last 3 weeks. she has difficulty falling asleep and maintaing sleep, she has fairly normal sleep hygine practices and does not consume excessive caffinated beverages of note she has a history of traumatic event and now feels tired , has excessive thoughts of her son who passed has a depressed mood and has no issues with memory or concentration she does  not complain of suicidal thoughts but has occasional hallucinations hearing and seeing things that arent there
pmh: HTN x 5 yrs on HCTZ and lisonopril, breast CA in remission
psh: lumpectomy 10 years ago, laparotomy for appendicitis in her 20s
DH: no allergies
social: doesnt smoke 
father HTN, mother: depression

Keywords and phrases relevant to diagnosis:
woman
hearing things that arent there
67 yr old
difficulty falling asleep
last 3 weeks
tired
seeing things that arent there
mother: depression
not complain of suicidal thoughts
difficulty sleeping, difficulty maintaing sleep
Patient Note: 67-year-old female, has come to the physician's office because of trouble sleeping. She said that everything happened 3 weeks ago. At holidays, during Christmas her son died in a car accident. She feels devastated. He is retired and lives with her husband, no alcohol. no smoking. 
ROS as in HPI
Allergies:NKDA
Meds: ACTC, NBN for sleeping
PMH: HTN
PSH: Lumpectomy(breast cancer)
FMH: Mother 90 yo, episodes of depression, Father passed away and had HBP, hypercholesteremia.

Keywords and phrases relevant to diagnosis:
during Christmas her son died
female
67-year-old
3 weeks ago
Mother episodes of depression
trouble sleeping
Patient Note: Patien F 62 yo, C/C: Sleeping problems
-Started 3 weeks ago, wake up many times at night  relate  with her son died, she is eating more than normal 
-She is feeling very sad, she was taking Ambien for sleep but did not work.
-PMH: HTN
-PSH: none
MEds: HCTZ and lisinopril
-ALLs: NKDA
-FH: father HTN, High cholesterol died of stroke, mother Depresion 
ROS:  denied constipation, weight change and headache 
SH: ETOH, 3 or 4 glass of wine 2 or 3 times a week, walking sometime, sexual active with husband, she is retired

Keywords and phrases relevant to diagnosis:
eating more
relate  with her son died
F
62 yo
Started 3 weeks ago
Ambien did not work
mother Depresion
Sleeping problems, wake up many times at night
Patient Note: 67 year old female presenting for trouble sleeping that started 3 weeks prior. She has toruble falling asleep, has been moving alot during sleepin and has early morning awkening. Assocaited with feeling tired throughout the day. prior to symptoms, her son passed away 3 weeks prior from an accident. associated with increase appetite 4 days ago, saw deceased son in kitchen, and 3 days ago heard loud music . Denies changes in concentration, interest, no suicidal thoughts, no guilt. Failed to relieve with ambiant and no exacberaing fact. Drinks 1 cup of coffee
ROS Denies headhace, nausea, vomiting, chest pain, SOB, Abdominal pain, changes in bowel and bladder, numbness and tingling in extremities
Alleriges NKDA
Medication HCTZ, lisoranil, ambiant
PMH Hypertension, Breast cancer 
PSH Lumbectomy with radiation and laptromy for appectectomy
FH - non-contributor
SH retired, denies tobacco and recreational drug use, ocassial drinking,

Keywords and phrases relevant to diagnosis:
son passed away 3 weeks prior
female
67 year old
toruble falling asleep
started 3 weeks prior
Failed to relieve with ambiant
feeling tired
saw deceased son in kitchen
early morning awkening
no suicidal thoughts
trouble sleeping, moving alot during sleepin
Patient Note: 67-year-old female, has come to the physician's office because of trouble sleeping.
pt had this issue for 3 weeks. trouble falling asleep and wake up at night. fatigue. visual and auditory hallucinations for a few days
sadness, no interest in recent activity, low energy, increase in appetite.
pmhx: high cholesterol. b/l mastectomy for 
meds: ambien, hctz, lisinopril
fmhx dad stroke and htn and high cholesterol
depression screening: sadness, no interest in recent activity, low energy, increase in appetite. no suicide, difficulty concentraitin or guilt.

Keywords and phrases relevant to diagnosis:
increase in appetite, increase in appetite
female
auditory hallucinations
67-year-old
trouble falling asleep
for 3 weeks
fatigue, low energy, low energy
no interest, no interest
visual hallucinations
no suicide
trouble sleeping, wake up at night
Patient Note: Ms. Wicks is a 67 y/o f presenting with a 3 week history of difficulty sleeping. She states that she gets 4-5 hours per night of restless, intermittent sleep. She has tried taking Ambien for the last 5 nights but that has not helped. She states that her son died in an MVC a few days before this problem started and that she has been devastated since his accident. She notes that four days ago she saw and heard her son in the kitchen even though she knew it wasn't really him, and then the next night heard a party going on next door which didn't really happen. She states that she is really depressed, has lost interest in her daily activities, has no energy, is feeling slow, and has an increased appetite. She has a good support system but would be open to seeing a psychiatrist/psychologist. ROS is negative except as per mentioned above.

Keywords and phrases relevant to diagnosis:
increased appetite
son died a few days before this problem started
Ms., f
"heard a party going on next door which didnt really happen"
67 y/o
3 week history
tried taking Ambien but that has not helped
has no energy
has lost interest
"she saw and heard her son in the kitchen even though she knew it wasnt really him"
difficulty sleeping, gets 4-5 hours per night of restless, intermittent sleep
Patient Note: 67 y/o F c/o insomnia for the past 3 weeks. Her son passed away in a MVA 3 weeks ago and she is upset over her loss. She has difficulty falling alseep and wakes up at odd hours (4/5am). She has lost interest in daily acitivies and feels fatigued. She notes an increased appetite and no changes in weight. She states she often hears noises from her neighbors home right before falling alseep. She is in remission from breast cancer. She does not nap in the day. She denies loss of concentration and feelings of guilt. She has a good support system at home and lives with her husband. Denies skin changes and cold intolerance. 
ROS: negative except above
Allergies: NKDA
Medications: HYdrochlorothiazide, Lisinopril, Ambien
PMH: breast cancer, HTN
PSH: lymphectomy of breast, Laparotomy for  burst appendix
FH: Father passed of stroke, Mother alive and healthy
SOcial: does not smoke, drinks 2/3 glasses of wine a week(CAGE negative),

Keywords and phrases relevant to diagnosis:
increased appetite
son passed away 3 weeks ago
F
67 y/o
difficulty falling alseep
past 3 weeks
feels fatigued
lost interest
wakes up at odd hours (4/5am)
insomnia
Patient Note: 67 yo f presents with trouble sleeping for past few weeks, related to death of only child, a son, in an MVA. Since the MVA on July 30th, 2019, pt has had difficulty falling asleep, as well as increased early morning awakenings.  Pt reports lack of interest in things she typically does, decreased energy, increased appetite, no weight gain.  Denies SI.  Pt has extended support system of of, family and close friends. No CV sx. No Chest sx. No ABD sx or constipation.

PMH: HTN x 15 years, Breast Cancer (in remission x 10 years)
Allergies: NKDA
Meds: HCTZ, Lisinopril, Ambien
PSH: Lumpectomy, Appendectomy in 20s
SH: married x 15 years. no smoking, no ETOH, no drugs. Retired.

Keywords and phrases relevant to diagnosis:
increased appetite
death of only child on July 30th
f
67 yo
difficulty falling asleep
past few weeks
decreased energy
lack of interest
early morning awakenings
Denies SI
trouble sleeping
Patient Note: Identity: Loraine Wicks, a 67-year-old female
CC: trouble sleeping
HPI: For the past 3-weeks she has had trouble falling asleep, she is waking up earlier and is also experincing "tossing and turning", where she awakens feeling poorly rested - she is not waking to use restroom. This is affecting her life and ability to do things around the house.
Of note, her son unfortunately passed away 3 weeks ago.
In addition to trouble with sleep, she has lost interest in things she enjoy, her energy is poor, her appetite is increased.
Denies any guilt over son's death, reports no trouble with concentration, denies psychomotor slowing, and denies any acitve/passive suicidality or intent to harm others.
Pt. tried Ambien from friend 5 days ago, and 4 days ago reports AVHs.

She lives at home where she feels very safe with her extremely supportive husband.
She says she has a strong support group. Safety plan was discussed. 


Keywords and phrases relevant to diagnosis:
appetite is increased
son unfortunately passed away 3 weeks ago
female
tossing and turning
67-year-old
trouble falling asleep
past 3-weeks
energy is poor
lost interest
waking up earlier
denies any acitve/passive suicidality
trouble sleeping, trouble with sleep
Patient Note: Loraine Wicks is a 67 yo F with a history of HTN, breast cancer s/p lumpectomy in 2009 who presents to the offive with trouble sleeping. She reports her son dying 3 weeks ago, after which she has difficulty falling asleep and staying asleep. She reports her mood is down but is still able to do chores. Denies feelings of guilts or concentration issues. Her appetite has increased but no weight change. She reports seeing her son last night even though she knows he died. Denies memory loss, nocturia, constipation, skin changes, or TV watching in bed. Denies suicidal i
PMH: HTN, breast cancer s/p lumpectomy
Medications: HCTZ, lisinopril
Allergies: NKDA
FH: Father with HTN, HLD, and died of stroke. Mother with depression.
PSH: Lumpectomy in 2009. Laparatomy around 20 yo for appendiceal perforation.
SH: Retired. Lives with husband. Drinks 2 glasses of wine 2-3 times per week. Denies tobacco or illicit drug use.
ROS: wnl except as above.

Keywords and phrases relevant to diagnosis:
appetite has increased
son dying 3 weeks ago
F
67 yo
difficulty falling asleep
reports seeing her son last night even though she knows he died
Mother with depression
Denies suicidal i
trouble sleeping, difficulty staying asleep
Patient Note: HPI: 67 yo F, G1P1, c/o trouble sleeping for the past 3 weeks, Pt is tossing and turning at night, has trouble falling asleep, staying asleep and wakes up early in the morning. Total hours of sleep are usually 4-5. Pt's son died 3 weeks in MVA. Since then pt reports seeing her son 4 days ago at the kitchen counter, reports hearing strange muffled noises in the distance. Pt feels extremely devastated and sad due to the death of her son, she has no suicidal ideation. She eats a balanced diet and her appetite has increased, she has a great support system however she has lost interest in things that were once pleasurable and is fatigued throughout the day. Denies weight or skin changes.
ROS:  Negative except for above
Allergies: NKDA; Medications: Lisinopril, HCTZ, Ambien to help with sleep in the past 4 nights which had no affect. 
PMH: Hypertension, complient with medication and monitors BP regularly. Breast CA
FH: mom with depression

Keywords and phrases relevant to diagnosis:
appetite has increased
son died 3 weeks
F
reports hearing strange muffled noises in the distance
tossing and turning
67 yo
trouble falling asleep
past 3 weeks
Ambien had no affect
fatigued
lost interest
reports seeing her son
mom with depression
wakes up early
no suicidal ideation
trouble sleeping, trouble staying asleep, hours of sleep are usually 4-5
Patient Note: 67F w/ PMH of breast CA in remission, presenting w/ insomnia for 3 weeks. Pt has troubles falling asleeping and wakes up early. No changes in sleeping habits, sleeps around 11pm, drinks 1 cup of coffee per day. Increased appetite, no changes in weight. Reports fatigue and decreased interest, but no difficulties concentrating. Feels sad about son passing away 3 weeks ago, no suicidal ideations. Has good support system w/ husband and family. hallucinations Started taking Ambien 5 days ago for insomnia, no improvement. Denies fevers, chills, chest pain, SOB, back pain, leg edema. PMH: breast CA in remission for 10 yrs s/p chemoradiation and surgery PSH: lumpectomy, laparotomy for ruptured appendix, Meds: HCTZ 25mg, lisinopril 20mg, Ambien 5mg, Social: No tobacco, 3-4 wine/week, no illicit drugs. Sexually active w/ husband, no protection. Menopause at age 52. FH: Grandfather stroke, HTN. Grandmother w/ depression.

Keywords and phrases relevant to diagnosis:
Increased appetite
son passing away 3 weeks ago
F
67
troubles falling asleeping
for 3 weeks
Started taking Ambien no improvement
fatigue
decreased interest
wakes up early
no suicidal ideations
insomnia
Patient Note: Ms. Wicks is a 67 year old F PMH HTN, Breast CA (in remission 10 years) who presents with sleep isues in the setting of the loss of her son. Her son passed away October 20th (3 weeks ago) and since then she has had trouble initiating sleep, waking early, tossing and turning. Her bed partner (husband) has not had sleep disturbance. She has tried taking ambien x5nights without relief. Over the last 3 weeks, her sleep issues have been stable. Before, she was getting 8 hours, now 4 hours of sleep/night. She is fatigued and unable to take naps. She reports no changes in diet/increased caffeine. Incr appetite, dec energy, no suicidal no wt change,  PHQ2 1/2 (positive for anhedonia).suppor
PMH: HTN, breast ca
PSH: lumpectomy, laparotomy (appendicitis)
Fhx: father stroke HTN, HLD, mother w/ depression
shx: lives w/ husband, feels safe, is retired. No smoking, 1-2 glasses wine 2-3x/wk, no drugs
Meds: HCTZ, lisinopril, ambien 
all: none
RO

Keywords and phrases relevant to diagnosis:
Incr appetite
son passed away October 20th, loss of her son 3 weeks ago
Ms., F
tossing and turning
67 year old
trouble initiating sleep
Over the last 3 weeks
unable to take naps
tried taking ambien without relief
fatigued, dec energy
anhedonia
mother w/ depression
waking early
no suicidal
sleep isues, sleep issues, now 4 hours of sleep/night
Patient Note: CC: Headache
HPI: Ms Maddon is a 20 year old female who presents with a headache that began suddenly yesterday morning. It is unlike any headache she has previously experienced that she describes as "the worst headache of her life." She tried sleep, tylenol, and ibuprofen and found no relief. She endorses photophobia, nausea, and 3 episodes of vomiting. She may have had a subjective fever this moroning. She denies any recent illness and sick contacts. She denies phonophobia, aura preceeding the headache onsent, and cannot think of anything the alleviates the pain. She reports no trauma.
Meds: OCP
PMH: none
PSH: none
SH lives with roommate, works at sporting good store, no tobacco, 3-4 EtOH on weekends, marijuana use 3-4 times per week

Keywords and phrases relevant to diagnosis:
tylenol no relief, ibuprofen no relief
20 year old
yesterday
vomiting
nausea
lives with roommate
female
photophobia
denies any recent illness and sick contacts
subjective fever
Patient Note: 20 yo F presented for headache of 1 day duration. Pain is 8/10 in intensity and it is the first episode of such pain. Pain is contant and alleviated by dimming the light and lying in the bed. It is aggravated by light and walking. There weren't any associated aura, weakness, numbness. there wear mild runny nose during the episode. The patient has a family history of her mother who suffers from migraine. there is associated decreased appetite as well. the patient feel warm but didn't measure the fever. No chills, night sweats. there is asssociated nausea and the patient vomitted 3 time since yesterday. the patient tried ibuprofen but the pain didnt go away.
ROS: negative except as above
Allergies: NKDA
Medications: OCPs since 2 yrs, ibuprofen
PMH: negative
PSH: negative
FH: mother has migraine
SH: marjuana 3-4 times a week, no tobbaco, alcohol occasionally

Keywords and phrases relevant to diagnosis:
ibuprofen pain didnt go away
20 yo
1 day duration
vomitted
nausea
runny nose
mother migraine, family history migraine, mother migraine, FH migraine
F
aggravated by light
feel warm
Patient Note: Ms. Madden is a 20 yo African american female with no PMH that presents with 1 day complaint of headache
- located throughout head
- Constant in duration
- Dull in characteristic, achy
- Alleviated by nothing, tried ibuprofen and tylenol with no effect
- Aggravated by movement
- Nonradiating
- constant in timing
- 9-10/10 on pain scaleAssociated with malaise, mylagias, nausea, and vomiting
ROS: denied fevers, chills, head trauma, double or blurry vision, discharge from ear or ringing in ear, throat pain, SOB, dyspnea, chest pain, palpitations, abdominal pain, diarrhea, constipation, rashes, pain in joints or bones, dizziness or loss of consciousness
PMH: denied
Surgical hx: denied
MEdication: generic birth control pill


Keywords and phrases relevant to diagnosis:
ibuprofen no effect, tylenol with no effect
20 yo
1 day
mylagias
headache located throughout head
vomiting
denied rashes
nausea
female
Patient Note: Ms. Stephanie Madden is a 20 year old female pressening for a headache that started yesterday morning. States she woke up with heachache
-Descrbed as dull, constant ache, all over. Worst headache of life. Endorses photohobia. Also states she feels warm all over and nausease and vomiting. 
-No CP, SOB, numbess/tingling. 
-No relief with Ibuprofen, tylenol, or sleep. 
-Denies any sick contacts or recent travel. 
PMHx: None
PSHx: none
Meds: Birth control-the pill
Allergies: None
Social: Never smoker. Drinks 2-3 beers on weekends. Smokes marijuana. Lives in apartment with roomate.

Keywords and phrases relevant to diagnosis:
No relief with Ibuprofen, No relief with tylenol
20 year old
yesterday
headache all over
vomiting
nausease
Lives in apartment with roomate
Ms, female
photohobia
Denies any sick contacts
feels warm
Patient Note: 20y/o F presents with c/o headache sx 1 day, sudden onset, woke up from sleep, sates its dull psychadelic HA, diffuse over head, associated with neck stiffness, 8/10 intensity, worsens with bending forward and tying shoes, tylemnol didnt help,. Had associated vomiting yesterday 3 episodes, initially food then green material. Has photophobia no phonophobia, feels mildly warm, body aches. 
ROS None except as above. 
PMH PSH Hosp None
FH Mother migraine Father High CHOL
SH works as sales person, lives with friend, no sick contacts. 
denies smoking but uses alcohol 3-4beers/wines/week. CAGE negative. Uses marijauna 3-4times /week.
Menstrual cycles regular.

Keywords and phrases relevant to diagnosis:
tylemnol didnt help
20y/o
1 day
body aches
headache diffuse
neck stiffness
vomiting
lives with friend
Mother migraine, FH migraine
F
photophobia
no sick contacts
feels warm
Patient Note: 20 y/o female presents with c/o 2 days of constant global HA associated with photophobia, nausea and 3 episodes of vomiting. She woke up with the headache 2 days ago and states it is now 8/10 and makes her tired and sleepy. She has used Ibuprofen and tylenol without relief. She usually gets one or two headches a year, but she usually just needs to sleep and they go away. She also notes she has felt warm, and has a scratchy throat and has had a decreased appetite, but denies sore throat, fever , sick contacts, abdominal pain, CP, SOB< focal wekness, or numbness, visual chnages, or problems hearing. 
Medical history: none
Surgical history: none
Social history: THC smoker 3-4 times a week, Alcohol, 2-3 drinks a wekend, sexually active with one partner and uses barrier protection consistently.

Keywords and phrases relevant to diagnosis:
used tylenol without relief, used Ibuprofen without relief
20 y/o
2 days, 2 days
global HA
vomiting
nausea
scratchy throat
female
photophobia
denies sick contacts
felt warm
Patient Note: HPI: PT IS 20 YO F C/O HEADACHE FROM YESTERDAY WHICH IS GETTING WORSE. PT NOTES THAT ITS THE WORST HEADACHE OF HER LIFE. ITS ALL OVER THE HEAD. ITS DULL, AND CONSTANT.PT USED TYLENON BUT DIDNT WORK. PT FELT WARM INSIDE. HEADACHE GETS WORSE BY BENDING OVER AND WALKING. PT HAS N/V WITH NO BLOOD. PT HAD PHOTOPHOBIA. PT STARTED TO HAVE URI SYMPTOMS YESTERDAY. PT REPORTS NECK AND SHOULDER PAIN AND STIFFNESS. 
ROS NEG EXCEPT AS ABOVE
PMH NEG
MED OCP 
ALLERGIES  NKDA
FH MOTHER HAD MIGRAINE
PSH NEG  
SH SEXUALLY ACTIVE WITH BOYFRIEND WITH CONDOM. NEG FOR TOBACCO, OCCASIONAL ALCOHOL AND RECREATIONAL DRUGS: LAST TIME A COUPLE OF DAYS BEFOR HEADACHE

Keywords and phrases relevant to diagnosis:
TYLENON DIDNT WORK
20 YO
YESTERDAY, YESTERDAY
HEADACHE ALL OVER THE HEAD
NECK PAIN, NECK STIFFNESS
V
N
URI SYMPTOMS
FH MIGRAINE, MOTHER MIGRAINE
F
PHOTOPHOBIA
FELT WARM
Patient Note: 20 yo F with c/o Headache for 1 day.  She states this head ache is nthing like her usual headaches that she gets 1-2x a year. This one has been associated with nausea and vomiting. she has vomited 3x yesterday food then green liquid (no blood). today she has had no new episodes. She has subjective fevers, and has had a runny nose since yesterday. The headache is located all over the ghead and she describes it as a dull constant HA that has woserned. Ibuprofen/ tylenol provided little relief. Walking and bending forward made it worse. She states light hurts her eyes but doesnt hurt her haead. Noise does not worsen it
ROS: as per HPI
PMH: none
PSH: none
Meds: birth control pills for 2 years. 
Social: single, Sports store employee, non smoker, ocasional EtOH on weekends. 2-3 joints of marihuana no other drugs
Sexual: LMP 1 week ago, normal, uses condoms and BC.
FH: mom has migarine HA, Dad HLD

Keywords and phrases relevant to diagnosis:
tylenol provided little relief, Ibuprofen provided little relief
20 yo
1 day
headache is located all over
vomiting, vomited
nausea
runny nose
mom has migarine, FH migarine
F
light hurts her eyes
subjective fevers
Patient Note: 20 YO F C/O severe constant ache headace that started suddenly after she woke up 1 day ago. The headache is 8/10, and is persistent despite tylenol, ibuprofen, and sleep, and increases with walking and bending forward, and is associated with photophobia.  She also c/o subjective fever, nasal congestion, rihnorrhea, and scratchy throat, and she vomited digested food and green fluid 3 times since yesterday, denies blood in vomit. Denies changes in vision, seizures, head trauma, dizziness, LOC.
ROS negative except above
PMH/PHS NONE
MED oral contraceptive pill, NKDA 
ILL contacts NONE
OBGYN LMP 2 WEEKS ago, q 28 days, last 4-5 days, moderate flow, G0P0A0.
SH denies smoking, drinks 2-3 beers/week, smokes marijuana 2-3 times/week. Sexually active with 1 partner, uses condoms consistently.

Keywords and phrases relevant to diagnosis:
persistent despite tylenol, persistent despite ibuprofen
20 YO
started 1 day ago
vomited
nasal congestion, rihnorrhea, scratchy throat
F
photophobia
subjective fever
Patient Note: Stephanie Madden is a 20 year old female who presents for the evaluation of a headache. Stephanie reports the headache as progressively worsening, bilateral, 8/10, and as an achy pain not relieved by tylenol, ibuprofen, or sleep. She report rhinorrhea and sore throat that began yesterday as well as three episodes of emesis today. She reports neck stiffness and photophobia. She denies any confusion or exposure to sick contacts. She has headaches in the past but this is the worst she has felt. She denies visual or auras and denies any motor weakness or numbness. 
Past Medical History: None 
Meidcations: Oral Contraceptives, Tylenol, Ibuprofen 
Surgeries; None 
Hospitalizations None
Never pregnant before 
Family History Migraines in mother, High cholesterol in father 
Social History: 3-4 marijuana cigarettes/week, 2-3 glasses of alcohol on weekend outings, sexually active with one partner, uses barrier contraception, works in retail

Keywords and phrases relevant to diagnosis:
not relieved tylenol, not relieved ibuprofen
20 year old
yesterday
neck stiffness
emesis
rhinorrhea, sore throat
Migraines mother, Family History Migraines
female
photophobia
denies exposure to sick contacts