Differential Diagnosis

• Single most likely diagnosis
  • Acute Bronchitis: The patient's symptoms of cough with thick mucus, sore throat, and headache, along with a history of smoking, are consistent with acute bronchitis. The fact that Advil helps alleviate some symptoms also points towards an inflammatory process, which is typical in bronchitis.
• Other Likely diagnoses
  • Upper Respiratory Infection (URI): The patient's symptoms of cough, sore throat, and headache could also be indicative of a URI, which is a common condition that can present with similar symptoms.
  • Sinusitis: The patient's complaint of headache and the ineffectiveness of OTC decongestants could suggest sinusitis, especially if the headache is facial or frontal.
  • Pharyngitis: The sore throat could be due to pharyngitis, which might be viral or bacterial in nature, although the absence of fever and the improvement with Advil might lean more towards a viral or inflammatory cause.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pneumonia: Although less likely given the duration and nature of symptoms, pneumonia is a critical diagnosis to consider, especially in a smoker, due to its potential severity and the need for prompt antibiotic treatment.
  • Lung Cancer: Given the patient's smoking history, lung cancer, although rare and less likely to present with these exact symptoms, must be considered, especially if the symptoms persist or worsen over time.
  • Epiglottitis: This condition, although rare, is a medical emergency and can present with severe sore throat, difficulty swallowing, and in severe cases, respiratory distress. The left-sided neck stiffness could be a red flag for this condition.
• Rare diagnoses
  • Pulmonary Embolism: While unlikely given the symptoms, pulmonary embolism can present with cough and chest discomfort and is a critical diagnosis to consider, especially in patients with risk factors for thromboembolic disease.
  • Tuberculosis (TB): Given the chronic nature of the cough and the patient's smoking history, TB, although rare in many populations, could be considered, especially if the patient has been exposed to TB or has risk factors for it.
  • Sarcoidosis: This condition can present with respiratory symptoms, including cough and can affect the lungs, but it is less common and would typically require further diagnostic testing to confirm.