Develop an assessment and differential diagnosis as well as an appropriate next diagnostic workup. 

Bates’ visual guide for physical examination

A 27 year-old woman presents with chest pains, fever and shortness-of-breath for 2 weeks. The patient is otherwise well and has never had significant medical problems in her past.

She appears to be healthy, but she has mild skin rashes on her chest area and back. She has no wheezes or crackles on auscultation and her lungs appear clear. She has a pulse oximetry of 98% in room air.

The initial assessment should include a differential diagnosis based on the patient’s history, symptoms, physical examination findings and lab results. You can consider bronchitis/pneumonia, viral or bacterial asthma, exacerbation of symptoms or interstitial lung diseases or pulmonary embolism.

The appropriate next diagnostic workup will vary depending on which condition is suspected to be causing the patient’s symptoms. To confirm the diagnosis of interstitial lung diseases, additional testing such as CT scans or pulmonary function tests are required.

To rule out possible other causes for her symptoms, you may want to run additional laboratory tests.

Additional investigations that may provide information about her clinical presentation include allergy skin testing and spirometry/diffusion capability measurements, if she has asthma or allergies.

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