Differential Diagnosis for 69-year-old Female with Respiratory Symptoms
- Single most likely diagnosis
- Asthma exacerbation: The patient has a past medical history of asthma and presents with worsening cough, wheezing, and shortness of breath, which are classic symptoms of an asthma exacerbation. The fact that she hasn't used her rescue inhaler due to misplacement suggests that her symptoms may have worsened due to lack of treatment.
- Other Likely diagnoses
- Chronic bronchitis exacerbation: Given her history of bronchitis, an exacerbation of this condition could explain her worsening cough and shortness of breath. The presence of intermittent phlegm also supports this diagnosis.
- Acute bronchitis: This is a common condition that could present with a dry cough that later becomes productive, along with wheezing and shortness of breath, especially in someone with a history of respiratory issues.
- Pneumonia: Although the patient denies fever, pneumonia can sometimes present without typical symptoms, especially in older adults. The worsening cough and shortness of breath could be indicative of a lower respiratory tract infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: This is a life-threatening condition that can present with sudden onset of shortness of breath and wheezing. Although the patient's symptoms have developed over time, it's crucial to consider this diagnosis, especially given her age and potential for underlying risk factors.
- Cardiac causes (e.g., heart failure, myocardial infarction): These conditions can present with shortness of breath and wheezing, and it's essential to rule them out, especially in an older adult with multiple comorbidities.
- Lung cancer: Given the patient's history of skin cancer, there may be an increased risk of other cancers, including lung cancer. Although less likely, this diagnosis should be considered, especially if the patient has a history of smoking or other risk factors.
- Rare diagnoses
- Interstitial lung disease: This is a broad category of diseases that affect the lung tissue and can present with progressive shortness of breath and cough. Although less likely, it's essential to consider this diagnosis, especially if the patient has a history of exposure to certain substances or underlying autoimmune conditions.
- Sarcoidosis: This is a rare condition that can affect the lungs and present with cough, shortness of breath, and wheezing. Although unlikely, it should be considered in the differential diagnosis, especially if the patient has other systemic symptoms or findings suggestive of sarcoidosis.