Differential Diagnosis for 83-year-old Male with Cough and Sore Throat
- Single most likely diagnosis:
- Acute Viral Pharyngitis: This is the most likely diagnosis given the patient's symptoms of cough, sore throat, and nasal congestion, which are typical of a viral upper respiratory infection. The fact that symptoms improve with over-the-counter medication but then return is also consistent with a viral etiology.
- Other Likely diagnoses:
- Acute Bronchitis: Although the patient denies shortness of breath or wheezing, the presence of a wet cough could suggest acute bronchitis, especially in a patient with a history of hypertension and hyperlipidemia, which may increase the risk of cardiovascular complications.
- Allergic Rhinitis: The symptoms of nasal congestion and irritating sore throat could also be indicative of allergic rhinitis, particularly if the patient is exposed to allergens.
- Sinusitis: Given the nasal congestion and sore throat, sinusitis is a possible diagnosis, although the absence of facial pain or purulent discharge makes it less likely.
- Do Not Miss diagnoses:
- Pneumonia: Although the patient denies shortness of breath, chest pain, or fever, pneumonia is a critical diagnosis to consider, especially in an elderly patient, as it can present atypically and may be life-threatening if not promptly treated.
- Pulmonary Embolism: This is another potentially life-threatening condition that can present with cough and may not always have typical symptoms like shortness of breath or chest pain, especially in the elderly.
- Cardiac Causes (e.g., Heart Failure): Given the patient's history of hypertension and hyperlipidemia, cardiac causes of cough, such as heart failure, should be considered, especially if there are any signs of fluid overload or if the patient's symptoms worsen.
- Rare diagnoses:
- Pertussis (Whooping Cough): Although less common, especially in vaccinated populations, pertussis can cause a persistent cough and should be considered, particularly if the cough has a characteristic whoop or if there's exposure history.
- Tuberculosis: This is a rare but important consideration, especially if the patient has been exposed to someone with TB or has risk factors such as immunocompromise. However, the acute presentation and lack of systemic symptoms like fever, night sweats, or weight loss make this less likely.