Presenting Complaints

• 21-year-old female patient presents with a chronic cough that has been ongoing for the past 6 months.

History of Presenting Complaint

• The patient reports a persistent, dry cough that is worse at night and when she lies down.
• She denies any associated chest pain, shortness of breath, wheezing, or fever.
• The cough is not productive of sputum, and she has not noticed any changes in her voice or difficulty swallowing.
• She reports that the cough is interfering with her sleep and causing some daytime fatigue.
• She has tried over-the-counter cough suppressants, but they have provided only temporary relief.

Significant Positives & Negatives For Differentials

Asthma

Positives:

• Chronic, dry cough that is worse at night and when lying down
• No associated chest pain, shortness of breath, wheezing, or fever

Negatives:

• No history of asthma or allergies
• No reported response to over-the-counter cough suppressants

Chronic Bronchitis

Positives:

• Chronic, dry cough with no associated respiratory symptoms
• No history of respiratory infections or illnesses

Negatives:

• Lack of sputum production
• No history of smoking or exposure to environmental irritants

Interstitial Lung Disease

Positives:

• Chronic, dry cough with no associated respiratory symptoms

Negatives:

• Young age of the patient
• No known risk factors or underlying conditions

Postnasal Drip

Positives:

• Chronic, dry cough that is worse at night and when lying down
• No associated chest pain, shortness of breath, wheezing, or fever

Negatives:

• No reported changes in voice or difficulty swallowing

Gastroesophageal Reflux Disease (GERD)

Positives:

• Chronic, dry cough with no associated respiratory symptoms
• Lack of response to over-the-counter cough suppressants

Negatives:

• No reported gastrointestinal symptoms like nausea, vomiting, or changes in bowel habits

Lung Cancer

Positives:

• Chronic, persistent cough

Negatives:

• Young age of the patient
• No history of smoking or other known risk factors

Past Medical History

• The patient has no significant past medical history.
• She has no history of asthma, allergies, or other respiratory conditions.
• She has not had any recent respiratory infections or illnesses.

Drug/Medication History

• The patient is not taking any regular medications.
• She has tried various over-the-counter cough medicines, but they have not provided lasting relief.

Social History

• The patient is a non-smoker and does not have any exposure to secondhand smoke.
• She lives with her parents in a suburban area of Malaysia and denies any recent travel or exposure to environmental irritants.
• She is a university student and reports no significant occupational exposures.

Family History

• The patient's family history is unremarkable, with no known history of respiratory or chronic lung diseases.

Systems Review

• Cardiovascular: No chest pain, palpitations, or edema.
• Gastrointestinal: No nausea, vomiting, or changes in bowel habits.
• Neurological: No headaches, dizziness, or changes in vision or hearing.
• Musculoskeletal: No joint pain or muscle aches.

Ideas, Concerns & Expectations

• The patient is concerned about the persistent nature of her cough and is hoping to find the underlying cause and appropriate treatment.

Case Presentation

Based on the information provided in the case and the analysis of the differentials, the most likely diagnosis for this patient is either asthma or chronic bronchitis. The patient's chronic, dry cough that is worse at night and the lack of associated respiratory symptoms or response to over-the-counter cough suppressants suggest an underlying respiratory condition like asthma or chronic bronchitis. Interstitial lung disease, postnasal drip, GERD, and lung cancer are less likely given the patient's age, lack of risk factors, and absence of other characteristic symptoms.