Differential Diagnosis for Maria Barragan
- Single most likely diagnosis
- Chronic bronchitis: This is the most likely diagnosis given Maria's persistent cough, which has been ongoing for 2 months, and is productive with a clear yellow color. The presence of expiratory wheezing and postnasal drip also supports this diagnosis. Although she denies a history of smoking, she may have been exposed to secondhand smoke or other environmental irritants.
- Other Likely diagnoses
- Postnasal drip syndrome: Maria's symptoms of postnasal drip, cough, and expiratory wheezing are consistent with this diagnosis. The fact that her cough worsened at night, particularly when lying down, also supports this diagnosis.
- Gastroesophageal reflux disease (GERD): GERD can cause a chronic cough, especially at night, and can be exacerbated by lying down. Maria's history of prediabetes and osteoporosis may also increase her risk for GERD.
- Allergic rhinitis: Although Maria's symptoms initially improved with Robitussin, the fact that her cough worsened again, particularly at night, and is productive with a clear yellow color, may suggest an allergic component.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although Maria denies shortness of breath, chest pain, or dizziness, a pulmonary embolism can present with a cough and wheezing. Her history of carotid body paraganglioma and recent hospitalization for hypoxia increase her risk for thromboembolic events.
- Lung cancer: Although Maria denies a history of smoking, her age and history of carotid body paraganglioma increase her risk for lung cancer. A persistent cough, especially with wheezing and postnasal drip, should prompt further evaluation.
- Tuberculosis: Although Maria denies any ill contacts, tuberculosis can present with a chronic cough, wheezing, and postnasal drip. Her recent hospitalization and history of hypoxia increase her risk for reactivation of latent tuberculosis.
- Rare diagnoses
- Churg-Strauss syndrome: This rare autoimmune disorder can present with a chronic cough, wheezing, and postnasal drip. Maria's history of asthma-like symptoms and eosinophilia (if present) would support this diagnosis.
- Bronchiectasis: This rare condition can cause a chronic cough, wheezing, and postnasal drip. Maria's history of recurrent infections and hypoxia increase her risk for bronchiectasis.