Questions
Question
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check
In the attached file are the questions that need to be answered
QUESTION 1
- Scenario 1: Polycystic
Ovarian Syndrome (PCOS)
A 29-year-old female presents to the clinic with a complaint
of hirsutism and irregular menses. She describes irregular and infrequent
menses (five or six per year) since menarche at 11 years of age. She
began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at
that time. The symptoms worsened after she gained weight in
college. She got married 3 years ago and has been trying to get
pregnant for the last 2 years without success. Height 66 inches and
weight 198. BMI 32 kg.m2. Moderate hirsutism
without virilization noted. Laboratory data reveal CMP within
normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total
testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal
value ≤5.6%). Based on this information, the APRN diagnoses the
patient with polycystic ovarian syndrome (PCOS) and refers her to
the Women’s Health APRN for further workup and management.
Question
1. What is the pathogenesis of
PCOS?
QUESTION
2
1. Scenario 1: Polycystic Ovarian
Syndrome (PCOS)
A
29-year-old female presents to the clinic with a complaint
of hirsutism and irregular menses. She describes irregular and infrequent menses (five
or six per year) since menarche at 11 years of age. She began to
develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek
treatment or medical opinion at that time. The symptoms worsened after she
gained weight in college. She got married 3 years ago and has been
trying to get pregnant for the last 2 years without success. Height 66
inches and weight 198. BMI 32 kg.m2. Moderate hirsutism
without virilization noted. Laboratory data reveal CMP within
normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal
0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin
level of 6.1% (normal value ≤5.6%). Based on this information,
the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and
refers her to the Women’s Health APRN for further workup and
management.
Question
How does
PCOS affect a woman’s fertility or infertility?
QUESTION
3
1. Scenario 2: Pelvic Inflammatory
Disease (PID)
A 30-year-old female
comes to the clinic with a complaint of abdominal pain, foul smelling
vaginal discharge, and fever and chills for the past 5 days. She denies
nausea, vomiting, or difficulties with bowels. Last bowel movement this
morning and was normal for her. Nothing has helped with the pain despite
taking ibuprofen 200 mg orally several times a day. She describes the pain as
sharp and localizes the pain to her lower abdomen. Past medical history
noncontributory. GYN/Social history + for having had unprotected sex while
at a fraternity party. Physical exam: thin, Ill appearing
anxious looking white female who is moving around on the exam table and
unable to find a comfortable position. Temperature 101.6F orally, pulse 120,
respirations 22 and regular. Review of systems negative except for chief
complaint. Focused assessment of abdomen demonstrated moderate pain
to palpation left and right lower quadrants. Upper quadrants soft
and non-tender. Bowel sounds diminished in bilateral lower quadrants.
Pelvic exam demonstrated + adnexal tenderness, + cervical motion tenderness and
copious amounts of greenish thick secretions. The APRN diagnoses the
patient as having pelvic inflammatory disease (PID).
Question:
1. What is the pathophysiology of PID?
QUESTION
4
1. Scenario 3: Syphilis
A 37-year-old male
comes to the clinic with a complaint of a “sore on my penis” that has been
there for 5 days. He says it burns and leaked a little fluid. He denies
any other symptoms. Past medical history noncontributory.
SH:
Bartender and he states he often “hooks up” with some of the patrons, both
male and female after work. He does not always use condoms.
PE:
WNL except for a lesion on the lateral side of the penis
adjacent to the glans. The area is indurated with a small round
raised lesion. The APRN orders laboratory tests, but feels the patient has
syphilis.
Question:
1. What are the 4 stages of syphilis


Solution
Question
Scenario
1: Polycystic Ovarian Syndrome (PCOS)
What
is the pathogenesis of PCOS based on scenario 1 above?
The disorder is assumed to be the consequence of an
interaction between genetic and environmental conditions; therefore, there is
no single solution to the issue of what causes polycystic ovarian syndrome
(PCOS). However, it is believed that PCOS develops due to an imbalance in the
levels of certain hormones in the body, including testosterone and insulin. Both
men and women have testosterone, although men have higher concentrations. Excess
body hair and acne can develop in women with PCOS owing to high testosterone
production by the ovaries. Additionally, high testosterone levels can interfere
with the normal development and release of eggs from the ovaries (ovulation). Insulin
is a hormone that aids in blood sugar regulation. Women with PCOS frequently
have high insulin levels, which can cause weight gain and make it difficult for
the body to use glucose adequately. Therefore, insulin resistance, also known
as insulin resistance syndrome, is hypothesized to have a role in PCOS
development. The exact cause of the hormonal imbalance that leads to PCOS is unknown,
but there are several theories about what may contribute to its development.
One theory suggests that PCOS is the
result of changes in hormone levels that occur before
birth.
The pathogenesis of PCOS is not fully understood, but
the condition is thought to result from a hormonal imbalance that begins during
fetal development. This hormonal imbalance results from factors including
genetics, diet, and lifestyle. Treatment for PCOS typically focuses on managing
the signs, such as irregular periods, excess air growth, and fertility
problems. In some cases, medications regulate hormone levels and improve
fertility. Additionally, lifestyle changes such as weight loss, exercise, and
stress reduction may be recommended. For example, the patient’s high testosterone
levels may be due to a genetic predisposition, while her insulin resistance may
result from diet and lifestyle choices. Medication to help control the patient’s
hormonal imbalance and lifestyle adjustments, including weight reduction and
workouts, may be used to treat PCOS. Additionally, the patient may be referred
to a fertility specialist for further evaluation and treatment.
Polycystic
Ovarian Syndrome (PCOS)
How
does PCOS affect a woman’s fertility or infertility based on the case above?
PCOS is a hormonal condition affecting 5-10% of
reproductive-aged women. PCOS disorder associated with inconsistent periods
timeline, uncontrolled androgen production, and polycystic ovaries. These
symptoms can lead to fertility problems. In addition, PCOS can cause irregular
ovulation or anovulation when ovulation does not occur. This can make it
difficult to become pregnant because there is no egg to be fertilized. An
increased incidence of miscarriage has also been associated with PCOS. This is
assumed to be owing to hormonal imbalances in PCOS women, which causes the
uterine lining to thin and become less supportive of conception.
For example, based on the above case, the patient has
PCOS and is trying to get pregnant. The APRN has diagnosed her with PCOS and
referred her to the Women’s Health APRN for further management. The main
features of PCOS are irregular menstrual cycles, excess androgen production,
and polycystic ovaries. These symptoms can lead to fertility problems. In
addition, PCOS can cause irregular ovulation or anovulation when ovulation does
not occur. This can make it difficult to become pregnant because there is no
egg to be fertilized. PCOS can also cause the development of small cysts on the
ovaries, interfering with the normal function of the varies and leading to
fertility problems. This is thought to be due to the hormonal imbalances in
women with PCOS, which can cause the uterine lining to be thinner and less
supportive of a pregnancy. The best way to treat PCOS is with a team approach
that includes a doctor, dietitian, and mental health provider. The goal of
treatment is to manage PCOS symptoms and improve fertility. Lifestyle
modifications, such as eating a well - balanced and exercising frequently, are
among the treatment choices, as is medication, such as birth control pills or
metformin, and surgery, such as laparoscopic ovarian drilling.
Scenario
2: Pelvic Inflammatory Disease (PID)
What
is the pathophysiology of PID?
PID is a female-specific disease that affects the
uterus, ovaries, and fallopian tubes. When sexually transmitted germs move from
the vaginal to the higher reproductive organs, this happens frequently. PID can
disrupt genitalia, causing in sterility, extrauterine pregnancy, chronic pelvic
pain, and other critical medical complications. The most common symptoms of PID
are pelvic pain, vaginal discharge, and fever. However, some women with PID may
not have any symptoms. If you think you might have PID, it is important to see
a healthcare provider right away so that you can be treated before the
infection causes serious damage. Bacterial that migrate from the vaginal to the
upstream genitals cause PID. The most common bacteria that cause PID are
chlamydia and gonorrhea, which are sexually transmitted infections (STIs).
Other bacteria that can cause PID include those that cause pelvic inflammatory
disease: Mycoplasma genitalium, Ureaplasma urealyticum, and Trichomonas vaginalis. Pelvic
inflammatory disease can also be caused by bacteria that are not STIs, such as
those that cause pelvic organ prolapse: Enterococcus
faecalis, Streptococcus agalactiae,
and Staphylococcus aureus. The symptoms of the pelvic inflammatory disease can
vary from mild to severe.
The most common symptoms are Pelvic pain, Vaginal
discharge, and fever. For example, the patient in this case scenario likely has
a pelvic inflammatory disease (PID) due to an infection with bacteria such as
chlamydia or gonorrhea. The infection likely started when the patient had unprotected
sex with a partner carrying these bacteria. The germs travel from the
vaginal area to the upper reproductive organs, producing irritation and
infection. The symptoms of PID can vary from mild to severe but often include
pelvic pain, vaginal discharge, and fever. Therefore, it is important to see a
healthcare provider if you think you might have PID so that you can be treated
before the infection causes serious
damage.
Scenario
3: Syphilis
What
are the 4 stages of syphilis?
The four stages of syphilis are primary, secondary,
latent, and tertiary. The appearance of a single sore characterizes primary
syphilis, called a chancre. The chancre typically appears 10-90 days after
exposure to the bacteria that causes syphilis. Secondary syphilis is
characterized by rashes on the palms and feet. The rash may also appear on
other body parts, including the trunk, arms, and legs. It frequently comes with
flu-like signs like fever, tiredness, and muscle aches. When the original sore
heals or the secondary rash fades, the hidden phase of syphilis follows.
No indications at this point. However, the bacteria are still active in
your body and can damage your “internal organs,” including your brain, eyes,
blood vessels, nerves, liver, and heart. The tertiary stage is the final stage
of syphilis and can occur 10-30 years after initial infection. Damage to
the liver, blood vessels, joints, brain, bones, eyes,
neurological and the system heart are among the symptoms. This
phase may result in death. For example, based on the above case scenario, the
initial sore (chancre) would be considered the primary stage, while the appearance
of a rash would characterize the secondary stage. The latent stage would begin
when the chancre heals, or the rash disappears. The tertiary stage may occur
years later and is characterized by damage to various “internal organs.”



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