Initial Impression and Differential Diagnosis

Connie's presentation suggests a respiratory infection, given her symptoms of productive cough, fever, shortness of breath, and pleuritic chest pain. Her past medical history, including COPD, hypertension, type 2 diabetes, and chronic kidney disease, complicates her presentation and increases her risk for certain conditions.

Single Most Likely Diagnosis

• Community-Acquired Pneumonia (CAP): Given Connie's symptoms of productive cough, fever, pleuritic chest pain, and shortness of breath, CAP is the most likely diagnosis. Her age, smoking history, and lack of pneumococcal vaccination also increase her risk for CAP.

Other Likely Diagnoses

• Exacerbation of COPD: Connie's history of COPD and current symptoms could indicate an exacerbation of her disease, potentially triggered by a respiratory infection.
• Acute Bronchitis: Although less likely than CAP, acute bronchitis could be considered given Connie's productive cough and pleuritic chest pain.
• Influenza: Despite being vaccinated against influenza, Connie could still be at risk, especially if the vaccine was not well-matched to the circulating strains.

Do Not Miss Diagnoses

• Pulmonary Embolism (PE): Although less likely, PE is a potentially life-threatening condition that must be considered, especially given Connie's history of smoking and possible immobility due to her symptoms.
• Tuberculosis (TB): Given Connie's age and potential exposure history, TB should be considered, although it is less likely.
• Lung Cancer: Connie's smoking history increases her risk for lung cancer, and her symptoms could be indicative of a malignancy, although this would be a less common presentation.

Rare Diagnoses

• Pneumocystis jirovecii Pneumonia (PCP): Although rare, PCP could be considered in immunocompromised patients, and Connie's diabetes and COPD may increase her risk.
• Q Fever: A rare bacterial infection that could cause pneumonia, Q fever is unlikely but should be considered in patients with exposure to animals or contaminated environments.

Connie's history, including her smoking status, lack of pneumococcal vaccination, and comorbidities, will be crucial in assessing her presentation and guiding potential decisions. Her medication allergies, particularly to moxifloxacin and Bactrim, will also impact antibiotic choices if needed.