Differential diagnoses
QUESTION
Based on the following information, create a list of three differential diagnoses and explain why you would include them on your list.
History
C.R., a 34-year-old man, came to your clinic with an episode of chest pain. He has a previous history of occasional stabbing chest pain for 2 years. The current pain had come on 4 hours earlier at 8 p.m. and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two Tylenol tablets taken earlier at 9 p.m. did not make any difference to the pain.
The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest although the position has varied.
Two weeks previously he had mild to moderate symptoms of COVID-19 which lasted 14 days. This consisted of a sore throat, low-grade fever, loss of taste and smell, and a cough. His wife and two children were ill at the same time with similar symptoms but have been well since then. He has a history of migraines. In the family history, his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level. His mother and two sisters, aged 36 and 38 years, are well. After his father’s infarct, he had his lipids measured; the cholesterol was 5.1 mmol/L (desirable range < 5.5 mmol/L). He is a nonsmoker who drinks two 12-packs of beer per week.
Examination
His pulse rate is 75/min, blood pressure 124/78 mmHg. His temperature is 37.8C. There is nothing abnormal to find in the cardiovascular and respiratory systems. The ECG findings include diffuse concave-upward ST-segment elevation and, occasionally, PR-segment depression.
Sample Solutions
Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Phasellus hendrerit. Pellentesque aliquet nibh nec urna. In nisi neque, aliquet vel, dapibus id, mattis vel, nisi. Sed pretium, ligula sollicitudin laoreet viverra, tortor libero sodales leo, eget blandit nunc tortor eu nibh. Nullam mollis. Ut justo. Suspendisse potenti.
Get sample solution
Sed egestas, ante et vulputate volutpat, eros pede semper est, vitae luctus metus libero eu augue. Morbi purus libero, faucibus adipiscing, commodo quis, gravida id, est. Sed lectus. Praesent elementum hendrerit tortor. Sed semper lorem at felis. Vestibulum volutpat, lacus a ultrices sagittis, mi neque euismod dui, eu pulvinar nunc sapien ornare nisl. Phasellus pede arcu, dapibus eu, fermentum et, dapibus sed, urna.
Morbi interdum mollis sapien. Sed ac risus. Phasellus lacinia, magna a ullamcorper laoreet, lectus arcu pulvinar risus, vitae facilisis libero dolor a purus. Sed vel lacus. Mauris nibh felis, adipiscing varius, adipiscing in, lacinia vel, tellus. Suspendisse ac urna. Etiam pellentesque mauris ut lectus. Nunc tellus ante, mattis eget, gravida vitae, ultricies ac, leo. Integer leo pede, ornare a, lacinia eu, vulputate vel, nisl.
Suspendisse mauris. Fusce accumsan mollis eros. Pellentesque a diam sit amet mi ullamcorper vehicula. Integer adipiscing risus a sem. Nullam quis massa sit amet nibh viverra malesuada. Nunc sem lacus, accumsan quis, faucibus non, congue vel, arcu. Ut scelerisque hendrerit tellus. Integer sagittis. Vivamus a mauris eget arcu gravida tristique. Nunc iaculis mi in ante. Vivamus imperdiet nibh feugiat est.
Ut convallis, sem sit amet interdum consectetuer, odio augue aliquam leo, nec dapibus tortor nibh sed augue. Integer eu magna sit amet metus fermentum posuere. Morbi sit amet nulla sed dolor elementum imperdiet. Quisque fermentum. Cum sociis natoque penatibus et magnis xdis parturient montes, nascetur ridiculus mus. Pellentesque adipiscing eros ut libero. Ut condimentum mi vel tellus. Suspendisse laoreet. Fusce ut est sed dolor gravida convallis. Morbi vitae ante. Vivamus ultrices luctus nunc. Suspendisse et dolor. Etiam dignissim. Proin malesuada adipiscing lacus. Donec metus. Curabitur gravida