1. Possible Diagnoses
1.1. Intermittent Asthma
1.1.1. Chest tightness, cough, and wheezing. Usually triggered by irritants with symptoms worsening at night. History of atopic conditions and colds that lead to chest congestion. Spasmodic, non-productive cough. Obesity.
1.1.1.1. These symptoms match my patient perfectly and will be my number one diagnosis.
1.2. Allergic Rhinitis
1.2.1. Itching watery eyes, clear thin nasal drainage, post nasal drip, scratchy/sore throat and sneezing triggered by exposure to an allergen.
1.2.1.1. This also fits my patient's complaints of what precedes her shortness of breath and is likely triggering her symptoms due to sensitivity to dust and cleaning chemicals.
1.3. Bronchitis
1.3.1. Productive or nonproductive persistent cough. Often accompanied by fever, malaise, sore throat and chest tightness.
1.3.1.1. Many of these symptoms match my patient when she is actually having an attack but since the cough goes away with the resolution of an exacerbation and she is afebrile this is an unlikely diagnosis.
1.4. Pulmonary Embolism
1.4.1. Sharp stabbing chest pain, tachypnea, shortness of breath, hypoxemia, hypotension, fever, and lightheadedness. These symptoms are persistent with no trigger.
1.4.1.1. The patient symptoms are not persistent or so severe, no hypoxemia or tachypnea at present time. Denies chest pain as well, only complains of a tightness during the episodes.
1.5. Mechanical Obstruction
1.5.1. Dyphagia, coughing, stridor, wheezing, tachypnea, and hypoxemia. These symptoms are generally persistent with no relief other than removal of obstruction.
1.5.1.1. The patient's symptoms are intermittent. No complaints of dysphagia and patient is not hypoxic.
2. Key Negatives: No fever, symptoms not persistent, nonproductive cough, no sharp chest pain, or hypoxia.
3. VINDICATE
3.1. Vascular
3.1.1. Pulmonary Embolism
3.1.2. Anemia
3.1.3. Arrhythmia
3.1.4. Pulmonary hypertension
3.1.5. Congestive heart failure
3.2. Infection/inflammation
3.2.1. Bronchitis
3.2.2. Asthma
3.2.3. Pneumonia
3.2.4. COPD
3.2.5. Bronchiolitis
3.2.6. Tuberculosis
3.3. Neoplasm
3.3.1. Lung or throat mass
3.4. Drugs/degenerative
3.4.1. ACE inhibitor cough
3.5. Iatrogenic/idiopathic
3.6. Congenital
3.6.1. Tracheomalacia
3.6.2. Laryngomalacia
3.7. Autoimmune, allergy, anatomic
3.7.1. Allergic rhinitis
3.7.2. Tracheomalacia
3.7.3. Laryngomalacia
3.7.4. Obesity
3.7.5. Allergic reaction
3.8. Trauma
3.8.1. Inhalation injury
3.8.2. Rib fracture
3.8.3. Pneumothorax
3.9. Endocrine/environmental
3.9.1. Allergic rhinitis
3.9.2. Anxiety