Differential Diagnosis

The patient's presentation is complex, with multiple symptoms and a significant medical history. The differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Malignancy: The patient's significant weight loss, decreased appetite, and fatigue are concerning for an underlying malignancy, particularly given her history of basal cell carcinoma and family history of non-Hodgkin's lymphoma. The episode of chest pain and jaw pain could be related to a cardiac issue, but in the context of her other symptoms, a malignancy affecting multiple systems is a strong consideration.
• Other Likely Diagnoses
  • Cardiovascular Disease: The patient's episode of chest pain with radiation to the jaw is suggestive of cardiac ischemia, and her family history of cardiovascular disease increases her risk. Her shortness of breath and fatigue could also be related to heart failure or coronary artery disease.
  • Gastrointestinal Disorder: The patient's history of bowel resection, decreased appetite, and difficulty swallowing could suggest a gastrointestinal disorder such as gastroesophageal reflux disease (GERD), dysphagia, or a motility disorder.
  • Endocrine Disorder: The patient's increased fatigue, excessive sleep, and weight loss could be related to an endocrine disorder such as hypothyroidism or adrenal insufficiency.
• Do Not Miss Diagnoses
  • Pulmonary Embolism: Although the patient's pulse oximetry readings are normal, her shortness of breath and history of recent surgery (Mohs procedure) increase her risk for pulmonary embolism.
  • Myocardial Infarction: The patient's episode of chest pain and jaw pain could have been a myocardial infarction, and it is essential to rule out cardiac disease given her symptoms and risk factors.
  • Infection: The patient's history of recent surgery and immunocompromised state (due to possible malignancy or other underlying conditions) increase her risk for infection, which could present with non-specific symptoms such as fatigue and weight loss.
• Rare Diagnoses
  • Amyloidosis: The patient's weight loss, fatigue, and shortness of breath could be related to amyloidosis, a rare condition characterized by the deposition of abnormal proteins in various organs.
  • Pheochromocytoma: The patient's episode of chest pain and jaw pain could be related to a pheochromocytoma, a rare tumor of the adrenal gland that can cause episodic hypertension and cardiac symptoms.