Differential diagnosis

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The patient is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep.

She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea.

She reports difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled, requiring blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that are new-onset and worsening. Subsequently, she has not ambulated from bed for several days except to use the restroom due to feeling weak, fatigued, and short of breath.

There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies.

Past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease, tobacco usage, and obesity. Past surgical history is significant for an appendectomy, cardiac catheterization with stent placement, hysterectomy, and nephrectomy.

Question:

What is your differential diagnosis?
What is your treatment plan?

Sample Solution

A differential diagnosis is a list of possible conditions that could be causing a patient’s symptoms. It is an important part of the diagnostic process, as it helps to narrow down the possibilities and ultimately arrive at the correct diagnosis.

There are many different ways to do a differential diagnosis, but the basic steps are as follows:

  1. Gather information: This includes taking a medical history, performing a physical examination, and ordering any necessary tests.
  2. Identify the key symptoms: These are the symptoms that are most likely to be caused by the underlying condition.
  3. Consider all possible causes: This includes both common and uncommon conditions, as well as any conditions that the patient is at particular risk for.
  4. Rank the possibilities: This is done based on how well each condition explains the patient’s symptoms.
  5. Order tests: Tests are used to rule out or confirm the most likely diagnoses.
  6. Make a diagnosis: Once the tests are complete, the doctor will be able to make a definitive diagnosis.

The differential diagnosis process can be complex, and it is important to remember that there is no single right way to do it. The best approach will vary depending on the individual patient and the specific circumstances.

Here are some examples of differential diagnoses:

  • Chest pain: The differential diagnosis for chest pain includes heart attack, angina, pleurisy, pneumonia, and pulmonary embolism.
  • Headache: The differential diagnosis for headache includes migraine, tension headache, sinus headache, and brain tumor.
  • Abdominal pain: The differential diagnosis for abdominal pain includes appendicitis, gastroenteritis, pancreatitis, and kidney stones.

It is important to note that I am not a medical professional, and this information should not be taken as medical advice. If you are experiencing any symptoms, please see a doctor for diagnosis and treatment.

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