QUESTION 1
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.m 2 . 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.m 2 . 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
Nurse 6521_Module 7 Knowledge Check
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Nurse 6521_Module 7 Knowledge Check
PCOS Pathogenesis
There is no one cause of PCOS; rather, it is a result of interactions between genetics and the environment (McCance & Huether, 2019). Some people have a higher risk of developing type 2 diabetes because of hereditary factors, including insulin resistance or elevated levels of androgens. The increased levels of HgA1C suggest she has insulin resistance. Prenatal exposure to androgens is one environmental influence.
There is a rise in free testosterone due to the insulin’s stimulation of androgen release. That would explain why the face has so much coarse, black hair. Free estradiol levels rise because of the feedback loop between elevated testosterone and decreased serum sex hormone-binding globulin (McCance & Huether, 2019). The patient’s insulin resistance and other symptoms may likely worsen because she is overweight.
In addition to being linked to obesity and thyroid issues, polycystic ovaries are a risk factor for developing endometrial cancer. The patient’s TSH is within the normal range, but it is on the low side, suggesting she may suffer from hypothyroidism, which can also lead to weight gain.
Effects of PCOS on a woman’s fertility or infertility
Due to PCOS, a woman’s ovaries may develop new follicles, but these follicles never mature and result in anovulation (McCance & Huether, 2019). Without an egg, or at least a developed egg, the sperms have nothing to fertilize, and anovulation occurs.
PID pathophysiology
Infection of the genital tract is the root cause of pelvic inflammatory disease. The entire peritoneal cavity can become infected, not only the uterus or ovaries. In most cases, the etiological agent is an organism transferred through sexual contact (McCance & Huether, 2019). The infection triggers
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