Reference no: EM133916493

Question

HX: Mrs. L is a 63yo female who called the office today asking for an appointment because she has a cough. When you see her in the morning, she relates intermittent cough for the last week and feeling SOB over the last two days. Yesterday, she also felt fatigued by mid-afternoon. She denies any sick contacts at home. She denies any recent travel. She notes a decreased appetite; she has not noticed any significant weight loss. Mrs. L noted being wiped out and became SOB walking up 1 flight of stairs with her laundry last evening. She mentioned she cannot tolerate smoking, as she does regularly. She denies any other medical concerns. FHX: HTN in mother(87yo) and father(89yo). Social: retired Nurse, married with two children(daughter 34yo, son 31yo). Rare wine on holidays, smoker. PMH: HTN since 1993. PSH: hysterectomy 1999, Appendectomy 2007 Current medications: Prempro 0.625mg QD, ECASA 325mg, Lisinopril 40 mg QD. She has no allergies. Vital signs: T: 99.6, HR: 101 Sinus Tachy, RR:20/easy and BP 142/76. Ht 5'8 Wt 168lbs, Room air pulse ox is 93%. PE: This is a 63yo female, appearing her stated age, A&O X3. She is cooperative with the exam and well dressed. Her oral mucosa is moist. Poor dentition. TM's pearly gray BL. PERRLA, EOMI. Neck supple, no JVD or adenopathy. Chest: few scattered wheezes, Rhonchi that clear with a cough. No stridor. No egophony or bronchophony. Cardiovascular: normal S1, S2, without murmur, rub or gallop. There are no heaves or thrills. Calves are non-tender with 1+ edema BL, Non Pitting; Homans is negative. Skin no rashes. No swollen joints. Abdomen: soft, non-tender with BS x 4 quads, there is no rebound or guarding. No hepatosplenomegaly is noted. Rectal is heme negative. STUDIES: EKG shows Sinus Tachycardia with no ST-T wave changes. Chem 7: BUN 19, creatinine 0.7, sodium 139, chloride 104, K+ 4.5, bicarb 22 and glucose 116. BNP 98 CBC: WBC- 16.3, Hgb 13.6, crit 37.9 and platelets 201. LFT's were normal. Urine sample: no WBC's, nitrite negative, sp.gr 1.020, heme neg. 3 main differential diagnosis for this case ?