Differential diagnoses

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This is a 55-year-old male presenting to the clinic for the first time with medication refill requests and complaints of worsening shortness of breath for one week and weight gain of ten pounds in one week. He reports taking medication for hypertension and diabetes but does not recall the medication names. His vital signs are normal except for blood pressure of 176/100, heart rate of 112, respiratory rate of 26, and chest pain rated at 4 out of 10.

What other questions would you ask this patient?

To develop an effective plan of care for this patient, a thorough health history must be taken, and previous health records should be obtained from previous providers. To determine which medications this patient was taking, the provider could ask the patient to describe the pill color, size, and how often it was taken, or have the patient bring in the empty pill bottles. The patient’s blood pressure is high, likely due to not taking medication, and asking if he checks his blood pressure or blood sugar at home can provide valuable information about his condition. It is important to ask if he has a family history of heart disease, or if he has any history of heart attack or valve disease. Asking additional questions will provide a more accurate assessment and plan.

What are your top 3 differential diagnoses?
• Acute combined systolic (congestive) and diastolic (congestive) heart failure (I50.41). This is characterized by shortness of breath, fatigue, swelling in the legs, rapid heartbeat, and fluid retention (Ponikowski et al., 2016).
• COPD exacerbation (J44.1). This condition can also present with fatigue, shortness of breath, and swelling in the extremities.
• Acute dyspnea (R06.00). This condition is characterized by acute onset of shortness of breath and rarely is accompanied by edema (ICD10data.com., 2023).

What is your plan for this patient?

 

Sample Solution

Firstly, Vittola discusses one of the just causes of war, most importantly, is when harm is inflicted but he does mention the harm does not lead to war, it depends on the extent or proportionality, another condition to jus ad bellum (Begby et al (2006b), Page 314). Frowe, however, argues the idea of “just cause” based on “Sovereignty” which refers to the protection of political and territorial rights, along with human rights. In contemporary view, this view is more complicated to answer, given the rise of globalisation. Similarly, it is difficult to measure proportionality, particularly in war, because not only that there is an epistemic problem in calculating, but again today’s world has developed (Frowe (2011), Page 54-6).
Furthermore, Vittola argues war is necessary, not only for defensive purposes, ‘since it is lawful to resist force with force,’ but also to fight against the unjust, an offensive war, nations which are not punished for acting unjustly towards its own people or have unjustly taken land from the home nation (Begby et al (2006b), Page 310&313); to “teach its enemies a lesson,” but mainly to achieve the aim of war. This validates Aristotle’s argument: ‘there must be war for the sake of peace (Aristotle (1996), Page 187). However, Frowe argues “self-defence” has a plurality of descriptions, seen in Chapter 1, showing that self-defence cannot always justify one’s actions. Even more problematic, is the case of self-defence in war, where two conflicting views are established: The Collectivists, a whole new theory and the Individualists, the continuation of the domestic theory of self-defence (Frowe (2011), Page 9& 29-34). More importantly, Frowe refutes Vittola’s view on vengeance because firstly it empowers the punisher’s authority, but also today’s world prevents this action between countries through legal bodies like the UN, since we have modernised into a relatively peaceful society (Frowe (2011), Page 80-1). Most importantly, Frowe further refutes Vittola through his claim that ‘right intention cannot be used as an excuse to wage war in response to anticipated wrong,’ suggesting we cannot just harm another just because they have done something unjust. Other factors need to be considered

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