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Differential Diagnosis for Nancy

Single Most Likely Diagnosis

  • Depression: Nancy's complaint of ongoing depression, which has been worsening, and her history of previous treatment for depression make this the most likely diagnosis. The recent increase in depression since her friend's child passed away also supports this diagnosis.
  • Chronic Venous Insufficiency: Nancy's complaint of leg swelling, pain, and heaviness, particularly after long periods of sitting, suggests chronic venous insufficiency, which is also consistent with her smoking history.

Other Likely Diagnoses

  • Anxiety Disorder: Nancy's history of anxiety and depression, as well as her current symptoms of mind racing at night and difficulty sleeping, suggest an anxiety disorder.
  • Migraine Disorder: Nancy's frequent migraines, which are preceded by blurred vision and can be alleviated with ibuprofen, support this diagnosis.
  • Hypothyroidism: Nancy's weight gain, hair loss, and joint aches could be indicative of hypothyroidism, although this would require further testing to confirm.
  • Rheumatoid Arthritis: Although Nancy's ANA was negative, her positive anti-CCP and history of joint aches and pains suggest the possibility of rheumatoid arthritis, particularly given her previous evaluation by a rheumatologist.

Do Not Miss Diagnoses

  • Deep Vein Thrombosis (DVT): Nancy's leg swelling, pain, and heaviness, particularly if sudden in onset, could be indicative of a DVT, which is a medical emergency.
  • Pulmonary Embolism: Given Nancy's smoking history and leg symptoms, pulmonary embolism is a potential diagnosis that should not be missed.
  • Lupus: Although Nancy's ANA was negative, her previous evaluation for lupus and positive anti-CCP suggest that this diagnosis should still be considered, particularly if she is experiencing other systemic symptoms.

Rare Diagnoses

  • Mixed Connective Tissue Disease: Given Nancy's positive anti-CCP, joint aches, and previous evaluation for lupus, mixed connective tissue disease is a rare diagnosis that could be considered.
  • Sjögren's Syndrome: Nancy's dry eyes (implied by her blurred vision prior to migraines) and joint aches could suggest Sjögren's syndrome, although this would require further testing to confirm.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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