take on the role of a clinician who is building a health history for the following case:
chief complaint: A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12-day history of a runny nose
subjective: States that her symptoms began about 12 days ago. She suffers from allergies; she gets a runny nose during the spring-time, pollen season. However, in the winter, her allergies are not a problem.
objective: vital signs: (BP) 115/75, (P) 89, (RR) 16, (T) 100.4F (38C), O2 sat 98% on room air general: No signs of acute distress. Patient appears mildly fatigued. She is breathing through her mouth. Breathing easily. Voice has a nasal quality to it.
HEENT: Ear canals: normal; EYES: normal; NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages respiratory: CTA AP&L neck/throat: Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no cobblestoning heart: Regular rate and rhythm, no murmur, S3, or S4
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic tessts do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
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.
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
Understanding Health History: A Comprehensive Assessment of a 25-Year-Old Hispanic Female with Allergic Symptoms
Thesis Statement
In evaluating a young Hispanic female with a 12-day history of a runny nose and previous seasonal allergies, it is essential to gather comprehensive subjective data, perform detailed objective evaluations, and consider differential diagnoses to ensure an accurate diagnosis and effective treatment plan.
Introduction
As a clinician, the ability to build a thorough health history is crucial for diagnosing and treating patients effectively. In the case of a 25-year-old Hispanic female computer programmer presenting with a runny nose, it is vital to delve deeper into her symptoms and medical history to provide the best care. This essay will outline additional subjective data to obtain, objective findings to look for, necessary diagnostic tests, and differential diagnoses based on the patient’s presenting symptoms.
Additional Subjective Data to Obtain
To gain a clearer understanding of the patient’s condition, several additional subjective data points should be explored:
1. Allergy History: Detailed information about her known allergies, including specific triggers and any past episodes of allergic rhinitis.
2. Duration and Severity: Inquiry about the severity and duration of her nasal symptoms, including any associated symptoms such as sneezing, itching, or eye irritation.
3. Environmental Exposures: Questions regarding recent exposure to allergens (e.g., pets, dust, changes in environment) that could exacerbate her symptoms.
4. Medications: A review of any over-the-counter medications or home remedies she has tried for relief and their effectiveness.
5. Family History: Information about any family history of allergies or respiratory conditions that may provide insights into her health risks.
Additional Objective Findings to Look For
Alongside the initial assessments, further objective evaluations could help clarify the diagnosis:
1. Nasal Examination: A more detailed nasal examination to assess the degree of obstruction and any polyps or structural abnormalities.
2. Sinus Tenderness: Palpation for tenderness over the sinuses (frontal and maxillary) to evaluate for sinusitis.
3. Lung Auscultation: Continued assessment of breath sounds to rule out any underlying respiratory issues.
4. Throat Examination: Closer examination of the throat for any additional signs of infection or inflammation that may not have been initially noted.
Necessary Diagnostic Tests
To confirm a diagnosis and rule out other conditions, the following diagnostic tests may be warranted:
1. Nasal Swab or Culture: To identify any bacterial or viral infections present in the nasal passages.
2. Allergy Testing: Skin prick tests or serum-specific IgE testing to confirm specific allergies that may be contributing to her symptoms.
3. Sinus X-rays or CT Scan: Imaging studies may be needed if sinusitis is suspected based on clinical evaluation.
Differential Diagnoses
Based on the patient’s symptoms and clinical findings, three differential diagnoses include:
1. Allergic Rhinitis
– Rationale: The patient’s history of seasonal allergies aligns with allergic rhinitis, characterized by nasal congestion, rhinorrhea, and postnasal drainage during allergen exposure periods.
2. Sinusitis
– Rationale: The presence of significant yellow drainage, nasal obstruction, and facial discomfort may indicate sinusitis, which often presents after a viral upper respiratory tract infection.
3. Viral Upper Respiratory Infection (URI)
– Rationale: The acute onset of symptoms, low-grade fever (100.4°F), and mild fatigue suggest a viral URI could be causing her current symptoms.
Conclusion
In summary, accurately diagnosing the 25-year-old Hispanic female with a 12-day history of a runny nose requires comprehensive data gathering encompassing both subjective and objective findings. By considering potential differential diagnoses such as allergic rhinitis, sinusitis, and viral URI, clinicians can provide targeted care that addresses the underlying causes of the patient’s symptoms. A thorough health history not only ensures accurate diagnosis but also contributes to a successful treatment plan that enhances the patient’s quality of life.
