Differential Diagnosis
- Single most likely diagnosis
- Upper Respiratory Infection (URI): The patient's symptoms of nasal congestion, productive cough, chest pain with coughing, and rhinorrhea, along with a recent history of being outdoors and attributing her symptoms to allergies, are consistent with a URI. The use of over-the-counter antihistamines and nasal saline also supports this diagnosis.
- Other Likely diagnoses
- Exacerbation of Allergic Rhinitis: Given the patient's history of allergic rhinitis and recent outdoor activities, an exacerbation of her allergies could be contributing to her symptoms.
- Acute Bronchitis: The patient's productive cough and chest pain with coughing could be indicative of acute bronchitis, especially in the context of a recent URI.
- Pulmonary Aspergillosis Exacerbation: Although the patient is being monitored by pulmonology for her pulmonary aspergillosis, an exacerbation of this condition could present with similar symptoms, especially the cough and chest pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumonia: Although the patient denies shortness of breath or wheezing, pneumonia could present with similar symptoms, especially in an elderly patient. It is crucial to consider this diagnosis due to its potential severity.
- Pulmonary Embolism: Chest pain and cough can be symptoms of a pulmonary embolism, which would be a medical emergency. Although the patient's symptoms seem more consistent with a URI, this diagnosis should not be overlooked.
- Cardiac Ischemia: The patient's history of hypertension and chest pain with coughing raises the possibility of cardiac ischemia, which could be precipitated by the increased respiratory effort associated with a URI.
- Rare diagnoses
- Invasive Aspergillosis: Although the patient has a history of pulmonary aspergillosis, invasive aspergillosis is a rare but potentially life-threatening condition that could present with similar symptoms.
- Lung Cancer: Given the patient's history of breast cancer and age, lung cancer could be a consideration, although it would be less likely without a history of smoking or other risk factors.