Common Differential Diagnoses

Common Differential Diagnoses
Based on the following scenario, state relevant/pertinent positive and negative clues for differential diagnosis as to:

a) Review of Symptoms (ROS), history to identify symptoms and associated symptoms

b) Past medical, family, and social history to include:

i) Cultural age variables

ii) Physical examination considerations

iii) Diagnostic findings

iv) Etiology presentation and prospective course of illness by age group
47 y/o female with one month of increasing chest palpitations, described as ?like a trout flopping on the dock?. She feels this throughout the day and night, and it interrupts her sleep. I began with an occasional sense of an irregular beat, which became more noticeable over time, until this last week when it became more severe and constant. Denies chest pain, but is aware of her heart. At work she feels mildly short of breath when standing and walking, but only the palpitations when sitting. Nothing she does relieves her symptoms, however they increase with caffeinated beverages. Meds: As noted herein. Allergies: Neomycin. PMHx includes a 20 y/o history of hypothyroidism for which she takes Synthroid, and mild hypertension for which she was prescribed Maxide. The only change in her regimen she can offer is that she has gained about thirty pounds over the last year which she attributes to lack of exercise, and she changed her meds to generic equivalents about two months ago to save money. Meds: As noted herein. Allergies: Neomycin. No significant PSxHx. FSHx: She quit smoking 15 years ago (25 PYHx), stopped drinking 10 years ago. Mother has hypothryroidism and hypertension as well, father died of lung cancer. VS: Temp: 97.7; P: 102 strong but irregular; R: 18 eupneic with occasional deep sighing respiration; BP: 144/94. Wt: 194; Ht: 68?.

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