Rene has come in today for follow-up of his hyperglycemia. He has been using an OTC “magic pill” – taken po, qd that his co-worker gave him to use since about a week after his last visit (3 months ago). He has noticed a change in his symptoms – the polyuria and polydipsia have resolved. In the past two months, he has also noticed changes in his previously increased difficulties performing his ADLs – previously he had numbness and bilateral tingling of his lower extremities that he wasn’t sure the cause of.
He has a history of hypercholesterolemia and DM that were diagnosed earlier this year. His DOB is 11/19/1980 and his BMI is 36.9. He is concerned about his abdomen due to recent weight gain and he is worried about a “rash on his neck.” He thinks maybe he needs a biopsy since it might be “malignant melanoma,” which he has been reading about. His wife thinks he might be a hypochondriac but she is also worried that he has decided to take the “magic pill” instead of the antidiabetic he was prescribed. He has a glucometer and checks his sugar BID, post-prandial. He also describes occasional photophobia, was seen by an opthalmologist. His mother has diabetes, but she lives in the Philippines – he is unsure what her medications are but he thinks she might take insulin and everyone he knows that has taken insulin has problems with their kidneys and some have even had amputations
His physical exam was essentially normal, but significant for acanthosis nigricans, elevated blood pressure (this is the third visit with elevated blood pressure, indicating the presence of hypertension). He will have his labs ordered with the new diagnosis but also will have his A1C checked.
Discuss each of the bolded, italicized words as you discuss any aspect of this case you’d like to address as Rene’s PCP. And, always – have fun!
Advanced Pharmacology
1. What medications might you change or add today?
2. What are the main classes of medication for Rene’s conditions?
3. How might you start medications for Rene and over what period of time would you increase and why?
Advanced Pathophysiology
1. Be sure you understand each of the bolded, italicized words of this case.
2. As Rene’s PCP, select 5 bolded, italicized words (except antidiabetics, prescribed and acanthosis) and describe them in detail and their significance pathophysiologically.


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.



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 Studies4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.