Differential Diagnosis for 75-year-old Female Patient
- Single most likely diagnosis
- Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): The patient's history of asthma, symptoms of wheezing, shortness of breath with exertion, and lack of improvement with nebulizer treatments suggest an exacerbation of COPD. The patient's age and history of smoking (although not explicitly mentioned, it's a common risk factor for COPD) also support this diagnosis.
- Other Likely diagnoses
- Acute Bronchitis: The patient's symptoms of productive cough, nasal congestion, and rhinorrhea are consistent with acute bronchitis. The lack of improvement with nebulizer treatments may indicate a viral or bacterial infection.
- Pneumonia: The patient's symptoms of shortness of breath, productive cough, and fatigue could be indicative of pneumonia, especially in an elderly patient with underlying respiratory disease.
- Asthma Exacerbation: Although the patient has been using her nebulizer treatments with no improvement, an asthma exacerbation is still a possible diagnosis, especially given her history of asthma.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism (PE): Although the patient denies chest pain at rest, PE can present with shortness of breath and wheezing, especially in elderly patients. A high index of suspicion is necessary to rule out this potentially life-threatening condition.
- Cardiac Ischemia: The patient's history of hypertension and hyperlipidemia increases her risk for cardiac disease. Although she denies chest pain at rest, cardiac ischemia can present with shortness of breath and fatigue, especially in elderly patients.
- Rare diagnoses
- Interstitial Lung Disease (ILD): Although less likely, ILD can present with shortness of breath, cough, and fatigue. The patient's age and symptoms could be consistent with an underlying ILD.
- Tuberculosis (TB): Given the patient's Nepali background, TB is a possible diagnosis, although less likely. The patient's symptoms of cough, shortness of breath, and fatigue could be consistent with TB.