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

Bates visual guide for physical examination

For the last two weeks, a 27-year-old woman has had chest pains, shortness of breathe, and fever. The woman is otherwise healthy and has never had any major medical problems in the past.

She appears to have afebrile on physical examination, but has a slight rash in the chest area and upper region of her back. She has clear lungs and no wheezes or crackles can be heard on auscultation. The room-air pulse oximetry of hers is at 98%.

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

The appropriate next diagnostic workup will vary depending on which condition is suspected to be causing the patient’s symptoms. In the case of pneumonia, imaging tests like X rays or complete blood counts are useful.

It may be helpful to also order additional laboratory tests like liver function tests and urinalysis to eliminate other possible causes for her symptoms, such as hepatitis A.

Additional investigations which could possibly provide further information about her clinical manifestation would be allergy skin testing, spirometry/diffusion capability measurements or asthma/allergy tests if these are considered to be possible causes of the illness.