What are the three most common, most likely differential diagnoses for this visit thus far with pathophysiology and evidence-based rationale?

Week 3: PBL Case Discussion: Cardiovascular Part One
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Setting: large urban city; family practice clinic that employs physicians and nurse practitioners

It’s another busy day at the clinic. You open the chart to review for your next patient, and you see it is Jeremy M. Jeremy is a 52 year-old white male with a history of hypertension. He was taken off HTN meds at last visit almost three months ago. You note he is not due for a follow up at this time, so you look at the chief complaint.

CC: chest pain three days ago

You enter the room and introduce yourself. Jeremy is sitting in the chair texting on his cell phone. You ask what brings him in today. Jeremy smiles, shaking his head and says “My wife made me come, I feel fine.” Three days ago Jeremy felt short of breath, had this heavy feeling in his chest, and he got kind of nauseous and sweaty. It lasted only about 3 minutes, and it has not happened again, but he does feel a little more tired. “It could be that I have not worked out since it happened, and I have more energy when I walk on the treadmill.”

PMHx: Reports general health as good. Had been feeling great since starting to work out and lost weight. Had lots of energy and felt great until this episode three days ago. Now he is a little concerned because he feels a little more tired when he works out. He has not done as much strenuous running and shortened his workout since the episode.

Childhood/previous illnesses: chicken pox.

Chronic illnesses: Hypertension, medication stopped three months ago. He cannot recall the medication. Elevated cholesterol, lifestyle management was initiated.

Surgeries: T and A, cholecystectomy, vasectomy

Hospitalizations: None aside from surgeries listed above

Immunizations: Does not receive the flu shot.

Allergies: NKDA

Blood transfusions: None

Enjoys a beer or a glass of whiskey and the occasional cigar when playing poker with his buddies

Current medications: None

Social History: Married for 20 years, works as an architect.

Family History: Parents are deceased. Father had lung cancer and mother died from complications of a stroke. Brother died at 44 from malignant melanoma. Other sister and brother are healthy.

Discussion Questions Part One:

List any further questions you have for Jeremy and link them to their respective differential diagnoses.
What are the three most common, most likely differential diagnoses for this visit thus far with pathophysiology and evidence-based rationale? Include any pertinent info from the case study that leads you to consider this diagnosis.
Based on your differential diagnosis list, identify what body systems will you examine along with pertinent positive/negative symptoms you’d be looking for to support or rule out your differential diagnoses.
List any relevant labs/diagnostic tests and link them to each diagnosis in the differential list.

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