Differential Diagnosis
- Single most likely diagnosis
- Chronic bronchitis: Given the patient's history of smoking and ongoing cough for 1 month, chronic bronchitis is a likely diagnosis. The patient's reduction in smoking to 1-2 cigarettes/day may not be sufficient to alleviate symptoms immediately.
- Plantar fasciitis: The left heel pain coinciding with new shoes and pain on stepping suggests plantar fasciitis, a common condition in individuals with new or poorly fitting shoes.
- Oral thrush: The painless white spot on the tongue tip for 6 months could be oral thrush, especially given the patient's history of diabetes and possible immunocompromised state.
- Other Likely diagnoses
- Pneumonia: Although the patient had a hospitalization 6 months ago involving chest consolidation, the ongoing cough could still be related to a respiratory infection such as pneumonia.
- Heel spur: The left heel pain could also be due to a heel spur, which is often associated with plantar fasciitis.
- Lichen planus: The white spot on the tongue could be lichen planus, an inflammatory condition that can cause white patches on the mucous membranes.
- Hypertension exacerbation: The patient reports elevated BP today, which could be related to their history of hypertension, and may require adjustment of their medication regimen.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lung cancer: Given the patient's history of smoking, lung cancer is a possibility that should not be missed, despite the patient's reduction in smoking.
- Tuberculosis: The patient's history of hospitalization with chest consolidation and ID consult raises the possibility of tuberculosis, which can present with cough and chest symptoms.
- Endocarditis: The patient's history of ID consult and hospitalization raises the possibility of endocarditis, which can present with systemic symptoms such as fever and fatigue.
- Diabetic foot infection: The patient's history of diabetes and left heel pain raises the possibility of a diabetic foot infection, which can be serious and require prompt treatment.
- Rare diagnoses
- Sarcoidosis: The patient's history of cough and chest consolidation could be related to sarcoidosis, a rare condition that can cause granulomatous inflammation in the lungs.
- Histoplasmosis: The patient's history of hospitalization with chest consolidation and ID consult raises the possibility of histoplasmosis, a rare fungal infection that can cause respiratory symptoms.
- Oral cancer: The white spot on the tongue could be oral cancer, although this is less likely given the patient's description of the lesion as painless.