Case Study: Respiratory

by | Dec 24, 2024 | biology

 

A 30-year-old woman comes to your office because of a persistent cough that has been bothering her for the past 3 months. Her cough is dry and is more frequent during the evenings. She also notes frequent nasal congestion, especially when she is exposed to dust and cold weather. She reports no hemoptysis, weight loss, wheezing, fever, or changes in his appetite.

What additional questions would you ask to learn more about her cough?
What would be included in your HPI and your subjective questioning?
How would you classify her cough based on the duration to help with the diagnosis?
What diagnostic tests do you want to include to help you with your diagnosis?
Create a differential diagnosis flow sheet for this patient and include the diagnostics as well as the pharmacological management and rationale related to the differentials.

 

Sample solution

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.


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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.

Additional Questions:

  • Character of Cough:
    • Is the cough productive (with sputum) or non-productive (dry)?
    • If productive, what is the color and amount of sputum?
    • Is the cough worse at night or in the morning?
    • Does anything seem to worsen or improve the cough? (e.g., lying down, exercise, specific allergens)
  • Nasal Congestion:
    • Is the nasal congestion accompanied by any other symptoms, such as runny nose, sneezing, or postnasal drip?
    • Are there any nasal polyps or sinus pain?
  • Past Medical History:
    • Any history of asthma, allergies, smoking, GERD, or other respiratory conditions?
    • Any recent upper respiratory infections?
    • Any recent travel history?
    • Any history of chronic medical conditions (e.g., diabetes, autoimmune diseases)?

Additional Questions:

  • Character of Cough:
    • Is the cough productive (with sputum) or non-productive (dry)?
    • If productive, what is the color and amount of sputum?
    • Is the cough worse at night or in the morning?
    • Does anything seem to worsen or improve the cough? (e.g., lying down, exercise, specific allergens)
  • Nasal Congestion:
    • Is the nasal congestion accompanied by any other symptoms, such as runny nose, sneezing, or postnasal drip?
    • Are there any nasal polyps or sinus pain?
  • Past Medical History:
    • Any history of asthma, allergies, smoking, GERD, or other respiratory conditions?
    • Any recent upper respiratory infections?
    • Any recent travel history?
    • Any history of chronic medical conditions (e.g., diabetes, autoimmune diseases)?
  • Social History:
    • Smoking history (current or past), including pack-years.
    • Occupational exposures (e.g., dust, fumes, chemicals).
    • Alcohol and drug use.
    • Exercise habits.
  • Family History:
    • Any family history of lung diseases (e.g., asthma, COPD, lung cancer, tuberculosis).

HPI and Subjective Questioning:

  • HPI: A 30-year-old female presents with a 3-month history of a persistent, dry cough, more prominent in the evenings. She also reports frequent nasal congestion, particularly when exposed to dust and cold weather. She denies hemoptysis, weight loss, wheezing, fever, or changes in appetite.
  • Subjective:
    • Past Medical History: No significant past medical history.
    • Social History: Non-smoker, no alcohol or drug use, no recent travel.
    • Family History: No significant family history of lung disease.

Classification of Cough:

  • Chronic Cough: A cough lasting longer than 8 weeks.

Diagnostic Tests:

  • Chest X-ray: To rule out pneumonia, lung nodules, or other lung abnormalities.
  • Pulmonary Function Tests (PFTs): To assess lung function and rule out conditions like asthma or COPD.
  • Complete Blood Count (CBC): To rule out infection or other underlying conditions.
  • Sputum Culture and Sensitivity: If the cough becomes productive, to identify any bacterial infections.
  • Allergy Testing: To assess for allergies to environmental allergens.
  • Endoscopy: In some cases, an endoscopy may be necessary to evaluate the upper airways for potential causes of cough, such as GERD or vocal cord dysfunction.

Differential Diagnosis Flow Sheet

Diagnosis Possible Causes Diagnostic Tests Pharmacological Management Rationale
Upper Respiratory Tract Infection (URI) Viral or bacterial infection CBC, nasal swab for culture (if indicated) Supportive care (rest, fluids, antipyretics as needed), consider decongestants or antihistamines if symptoms are severe Most common cause of acute cough
Post-Nasal Drip Allergic rhinitis, sinusitis Nasal endoscopy, sinus imaging (if indicated), allergy testing Nasal corticosteroids, antihistamines, decongestants Relieving nasal congestion may improve cough
Asthma Airway inflammation PFTs, methacholine challenge test Inhaled corticosteroids, bronchodilators To control airway inflammation and improve airflow
GERD Acid reflux Upper endoscopy (if indicated), esophageal manometry Proton pump inhibitors (PPIs), lifestyle modifications (elevating the head of the bed, avoiding late-night meals) To reduce acid reflux and its effects on the airway
Chronic Bronchitis Chronic inflammation of the airways PFTs, chest X-ray Bronchodilators, mucolytics To improve airway clearance and reduce inflammation
Lung Cancer Malignant growth in the lungs Chest X-ray, CT scan, bronchoscopy Varies depending on stage and type of cancer To identify and treat lung cancer
Tuberculosis Bacterial infection Sputum culture for acid-fast bacilli, chest X-ray Anti-tuberculosis medications To eradicate the infection and prevent spread

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