Differential Diagnosis

• Single most likely diagnosis
  • Major Depressive Disorder (MDD) with grief reaction: The patient's symptoms of low mood, guilt, fatigue, poor appetite, and disturbed sleep, along with a history of depression and recent significant loss, support this diagnosis. The presence of thoughts of harming others without intent to self-harm and the context of grief also align with a complex grief reaction.
• Other Likely diagnoses
  • Post-Traumatic Stress Disorder (PTSD): Given the patient's history of being the primary carer for his father and his father passing away in his arms, along with feelings of anger and guilt, PTSD should be considered, especially if these symptoms persist or worsen.
  • Anxiety Disorder: The patient's history of anxiety, use of marijuana to calm himself, and current symptoms of low mood and guilt could also suggest an anxiety disorder, which often co-occurs with depression.
  • Chronic Obstructive Pulmonary Disease (COPD) or other chronic respiratory conditions: The patient's long history of smoking and symptoms of coughing up blood (hemoptysis) and night sweats suggest a chronic respiratory condition. COPD is a likely consideration given the smoking history.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Lung Cancer: Given the patient's significant smoking history and symptoms of hemoptysis and night sweats, lung cancer must be considered and ruled out. It is critical due to its potential for severe outcomes if not promptly diagnosed and treated.
  • Tuberculosis (TB): Although less common in some regions, TB can present with hemoptysis, night sweats, and weight loss. Given the patient's symptoms and the potential for severe consequences if missed, TB should be considered, especially if the patient has been exposed or has risk factors.
  • Pulmonary Embolism: While less directly suggested by the patient's symptoms, any condition that could lead to hemoptysis, such as a pulmonary embolism, should be considered due to its acute and potentially life-threatening nature.
• Rare diagnoses
  • Bronchiectasis: A condition characterized by damage to the airways, which can cause hemoptysis among other symptoms. It's less common but could be considered given the patient's respiratory symptoms and smoking history.
  • Cystic Fibrosis (in adults, if not previously diagnosed): Although rare and typically diagnosed in childhood, cystic fibrosis can present in adults with respiratory symptoms, including hemoptysis. It would be an unusual diagnosis in this context but should be considered if other causes are ruled out and symptoms persist.