What is the diagnosis and management for an 84-year-old patient with a past medical history (PMH) of hypertension, hyperlipidemia, gastroesophageal reflux disease (GERD), allergies, chronic pain, chronic kidney disease (CKD) (noncompliant with nephrology referral), asthma, degenerative disc disease of the lumbar spine, and rheumatoid arthritis, presenting with intermittent left lower rib pain, exacerbated by activity and bending, with a pain scale of 0/10 currently and 8/10 at its worst, which occurred last week after performing heavy house chores, possibly after lifting laundry?

Differential Diagnosis for Rib Pain in an 84-year-old Patient

Single Most Likely Diagnosis

• Musculoskeletal strain: Given the patient's history of lifting heavy objects (laundry) and the exacerbation of pain with activity, particularly bending down, a musculoskeletal strain is the most plausible diagnosis. The intermittent nature of the pain and its location at the lowest rib on the left side also support this diagnosis.

Other Likely Diagnoses

• Costochondritis: This condition, which involves inflammation of the cartilage that connects the ribs to the breastbone, could explain the patient's rib pain, especially if it's related to physical activity.
• Osteoporotic fracture: Although less likely without a history of significant trauma, the patient's age and history of rheumatoid arthritis (which can increase the risk of osteoporosis) make this a consideration, especially if the pain persists or worsens.

Do Not Miss Diagnoses

• Pulmonary embolism: Although the patient's presentation does not strongly suggest this, pulmonary embolism can cause chest pain that may be referred to the ribs. Given the potential severity of this condition, it should be considered, especially in the context of recent increased activity.
• Cardiac ischemia: Chest pain referred to the ribs could also be a sign of cardiac ischemia. The patient's history of hypertension and hyperlipidemia increases her risk for cardiovascular disease.
• Pneumonia: Infection can cause pain that is perceived in the chest or rib area, especially if the patient has a history of asthma or other respiratory conditions that might predispose her to respiratory infections.

Rare Diagnoses

• Rib metastasis: In patients with a history of cancer, metastasis to the ribs could be a cause of rib pain. However, there's no mention of a cancer history in the provided information.
• Herpes zoster: Shingles can cause severe pain in a dermatomal distribution, which might be perceived as rib pain if it involves the intercostal nerves. However, this would typically be accompanied by a rash.