Case study: I have pain in my belly
A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex
Patient denies past medical history
Is on Birth control
Has no known allergies
Subjective data: Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination
Physical exam- Objective data: B/P 138/90; temperature 99F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10
acute distress and severe pain
HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Lungs: CTA AP&L
Cardio: S1S2 without rub or gallop
Abdominal: INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area
Genitalurinary: EXTERNAL: mature hair distribution; no external lesions on labia
INTROITUS: slight green-gray discharge, no lesions
VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
UTERUS: ante-flexed, normal size, shape, and position
ADNEXA: bilateral tenderness with fullness; both ovaries without masses
RECTAL: deferred
VAGINAL DISCHARGE: green in color
ext: no cyanosis, clubbing or edema
integument: intact without lesions masses or rashes
Neuro: No obvious deficits and CN grossly intact II-XII
Once you received your case number, answer the following questions:
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
References
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.
Sample Answer
Sample Answer
Case Evaluation: Abdominal Pain in a Young Female
Additional Assessment and Diagnosis
Additional Subjective Data:
– Menstrual History: Menstrual regularity, duration, and flow pattern.
– Sexual History: Number of sexual partners, contraceptive use, history of sexually transmitted infections (STIs).
– Gastrointestinal Symptoms: Changes in bowel habits, presence of bloating, gas, or diarrhea.
– Pain Characteristics: Onset, severity, aggravating or alleviating factors, radiation of pain.
Additional Objective Findings:
– Pelvic Exam: Assess for cervical motion tenderness, uterine position, adnexal tenderness or masses.
– Laboratory Tests: Complete blood count (CBC), urinalysis, pregnancy test, STI screening.
– Imaging Studies: Pelvic ultrasound to evaluate pelvic organs, especially the ovaries.
– Diagnostic Procedures: Endometrial biopsy if indicated based on findings.
Differential Diagnoses:
1. Pelvic Inflammatory Disease (PID):
– Rationale: Green discharge, cervical motion tenderness, recent new sexual partner without condom use are consistent with PID. Can lead to chronic abdominal pain if left untreated.
2. Ovarian Cyst:
– Rationale: Bilateral ovarian tenderness and fullness suggest possible ovarian pathology. Ovarian cysts can cause sharp abdominal pain and discomfort during physical activities.
3. Endometriosis:
– Rationale: Severe menstrual cramps, pain during intercourse, and green vaginal discharge may indicate endometriosis. It can lead to chronic pelvic pain and discomfort.
Diagnostic Exams:
1. Pelvic Ultrasound: To assess the pelvic organs, including the uterus, ovaries, and fallopian tubes.
2. STI Screening: To rule out or confirm the presence of sexually transmitted infections.
3. Cervical Cultures: To identify any bacterial or fungal infections that may be causing the symptoms.
Treatment Plan:
– Empiric antibiotic therapy for suspected PID.
– Pain management for symptom relief.
– Follow-up pelvic exams and imaging studies for further evaluation and monitoring.
By conducting a comprehensive assessment, ordering appropriate diagnostic exams, and considering differential diagnoses, healthcare providers can formulate an accurate diagnosis and tailored treatment plan for young female patients presenting with abdominal pain and gynecological symptoms.
