Simulated Internal Medicine Case
A 45-year-old male patient presents with a 2-week history of progressive dyspnea, fatigue, and swelling in both legs. He has a past medical history of hypertension and hyperlipidemia. His current medications include atorvastatin and lisinopril. He is a non-smoker and consumes alcohol occasionally.
Differential Diagnoses
- Single Most Likely Diagnosis
- Heart Failure: Given the patient's symptoms of dyspnea, fatigue, and leg swelling, along with a history of hypertension and hyperlipidemia, heart failure is the most likely diagnosis. These conditions are risk factors for the development of heart failure.
- Other Likely Diagnoses
- Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Although the patient is a non-smoker, secondhand smoke exposure or other environmental factors could contribute to COPD. The symptoms of dyspnea and fatigue could be indicative of a COPD exacerbation.
- Nephrotic Syndrome: The patient's leg swelling could be a sign of nephrotic syndrome, especially if he has significant proteinuria. His history of hypertension is a risk factor for kidney disease.
- Deep Vein Thrombosis (DVT): The swelling in both legs could also suggest DVT, especially if there are other risk factors such as recent immobility or cancer.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less likely given the gradual onset of symptoms, PE is a potentially life-threatening condition that must be considered, especially if there are risk factors such as recent travel, surgery, or cancer.
- Cardiac Tamponade: This is a life-threatening condition that could present with dyspnea and fatigue. Although less common, it is crucial to consider in the differential diagnosis due to its high mortality if missed.
- Rare Diagnoses
- Amyloidosis: This condition can cause heart failure, nephrotic syndrome, and other systemic symptoms. Although rare, it should be considered if other diagnoses are ruled out and the patient's condition worsens or does not improve with standard treatment.
- Sarcoidosis: This autoimmune disease can affect multiple organs, including the lungs, heart, and kidneys, leading to a variety of symptoms. It is a rare condition but should be considered in the differential diagnosis if other causes are excluded.