Differential Diagnosis for 52-year-old Female with Worsening Respiratory Symptoms

• Single most likely diagnosis:
  • Acute bronchitis: This is the most likely diagnosis given the patient's history of smoking, recent onset of respiratory symptoms such as chest congestion, cough, and the absence of systemic symptoms like nausea, vomiting, or diarrhea. The fact that she stopped smoking about a year ago may have reduced her risk slightly, but her history still predisposes her to respiratory issues.
• Other Likely diagnoses:
  • Upper respiratory tract infection (URTI): The symptoms of nasal congestion, rhinorrhea, cough, and sore throat are consistent with a viral URTI, which is common and often self-limiting.
  • Influenza: Although the patient has been taking over-the-counter medications with no improvement, influenza could still be a consideration, especially given the time of year and the presence of systemic symptoms like fatigue.
  • Asthma exacerbation: Given her history of smoking and recent respiratory symptoms, an asthma exacerbation could be a possibility, especially if she has a pre-existing diagnosis of asthma.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Pneumonia: Although less likely given the absence of high fever, severe shortness of breath, or other systemic symptoms, pneumonia is a critical diagnosis not to miss due to its potential severity and the need for prompt antibiotic treatment.
  • Pulmonary embolism: This is a life-threatening condition that can present with sudden onset of chest pain, shortness of breath, and cough. Although the patient's symptoms have developed over several days, it's essential to consider this diagnosis, especially in a patient with a history of smoking, which increases the risk of thromboembolic events.
  • Lung cancer: Given the patient's history of smoking, even though she stopped a year ago, lung cancer is a possibility that should not be overlooked, especially if her symptoms persist or worsen over time.
• Rare diagnoses:
  • Tuberculosis (TB): Although rare in non-immunocompromised individuals without specific risk factors, TB can present with chronic cough, chest congestion, and systemic symptoms like fatigue.
  • Sarcoidosis: This is an autoimmune disease that can affect the lungs and present with respiratory symptoms, but it is less common and would typically require further diagnostic testing to confirm.