Differential Diagnosis for 46-year-old Female with Worsening Cough and Nausea/Vomiting

• Single most likely diagnosis:
  • Acute bronchitis: This is the most likely diagnosis given the patient's history of asthma and the description of a harsh, dry cough that has worsened over 7 days. The absence of nasal congestion or rhinorrhea and the presence of nausea and vomiting, which could be secondary to the cough, also support this diagnosis.
• Other Likely diagnoses:
  • Gastroesophageal reflux disease (GERD): The patient's symptoms of nausea, vomiting, and a harsh, dry cough could be indicative of GERD, especially if the cough is triggered by acid reflux. The lack of correlation between the cough and vomiting might suggest two separate issues.
  • Viral gastroenteritis: Although the patient denies diarrhea, viral gastroenteritis could still be a consideration given the nausea and vomiting. The cough could be a separate, unrelated issue.
  • Asthma exacerbation: Given the patient's history of asthma and the presence of a worsening cough, an asthma exacerbation should be considered, especially since she has not used her inhaler.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Pneumonia: Although the patient denies chest pain and does not have typical symptoms of pneumonia like fever or productive cough, pneumonia can sometimes present atypically, especially in patients with underlying conditions like asthma. It's crucial to consider and rule out pneumonia due to its potential severity.
  • Pulmonary embolism: This is a critical diagnosis to consider in any patient with a new or worsening cough, especially if there are other risk factors present (though none are mentioned in this scenario). The absence of chest pain does not rule out pulmonary embolism.
  • Cardiac causes (e.g., heart failure): A new or worsening cough can be a symptom of heart failure, and while less likely given the patient's presentation, it's a diagnosis that could have significant implications if missed.
• Rare diagnoses:
  • Interstitial lung disease: Given the patient's history of asthma, it's possible that she could have an underlying interstitial lung disease that is contributing to her symptoms. However, this would be less likely without other supporting symptoms or findings.
  • Foreign body aspiration: Although rare in adults, foreign body aspiration could cause a sudden onset of cough and should be considered, especially if the patient reports any history of choking or difficulty swallowing.