Differential Diagnosis
The patient's symptoms of cough, nasal congestion, chest tightness, and fatigue, which began 3 weeks ago, improved, and then returned, suggest a respiratory or allergic condition. The following differential diagnoses are considered:
- Single most likely diagnosis
- Allergic Rhinitis: The patient's symptoms of persistent nasal congestion, postnasal drip, and cough, which are not relieved by sinus medication or antihistamines, suggest allergic rhinitis. The occasional productiveness of clear sputum and mild chest tightness secondary to post-coughing fits also support this diagnosis.
- Other Likely diagnoses
- Asthma: The patient's symptoms of cough, chest tightness, and fatigue could be indicative of asthma, especially if the symptoms are triggered by allergens or irritants.
- Chronic Bronchitis: The patient's persistent cough and occasional production of clear sputum could be indicative of chronic bronchitis, especially if the patient has a history of smoking or exposure to irritants.
- Upper Respiratory Tract Infection (URTI): Although the patient's symptoms improved and then returned, a URTI could still be considered, especially if the patient was exposed to a new pathogen.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism: Although the patient denies shortness of breath (SOB) and fever, pulmonary embolism could still be considered, especially if the patient has a history of deep vein thrombosis or is at risk for thromboembolic events.
- Pneumonia: Although the patient denies fever and SOB, pneumonia could still be considered, especially if the patient has a history of underlying lung disease or is immunocompromised.
- Lung Cancer: Although the patient's symptoms are non-specific, lung cancer could still be considered, especially if the patient has a history of smoking or exposure to carcinogens.
- Rare diagnoses
- Sarcoidosis: The patient's symptoms of cough, chest tightness, and fatigue could be indicative of sarcoidosis, especially if the patient has a history of autoimmune disorders or is of African American descent.
- Hypersensitivity Pneumonitis: The patient's symptoms of cough, chest tightness, and fatigue could be indicative of hypersensitivity pneumonitis, especially if the patient is exposed to specific allergens or irritants.
- Cystic Fibrosis: Although the patient's symptoms are non-specific, cystic fibrosis could still be considered, especially if the patient has a family history of the disease or is of European American descent.