Heent

Skull is normocephalic, atraumatic. Hair with average texture. Visual acuity 20/20. Sclera white, conjunctiva with erythema. Pupils constrict from 3 to 1.5 mm, equal, round, and reactive to light and accommodation; disc margins sharp without hemorrhages, exudates, or arteriolar narrowing

External ear canals patent; tympanic membranes dull, with decreased cone of light

Nasal mucosa pale and boggy; septum midline, no sinus tenderness. Oral mucosa pink, dentition good; pharynx without exudates

Neck

Trachea midline, neck supple without thyromegaly

Lymph nodes

No cervical, axillary, epitrochlear, or inguinal adenopathy

Thorax and lungs

Thorax symmetric with good expansion

Lungs with decreased resonance. Expiratory wheezes diffusely in all lung fields

Cardiovascular

JVP 6 cm above the right atrium; carotid upstrokes brisk without bruits PMI tapping, 7 cm lateral to the midsternal line in the 5th intercostal space.

Good S1, S2; no S3, S4; no murmurs, or extra sounds

Based on this information, what is your differential diagnosis?

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