Womens and Mens Health, Infections, and Hematologic Disorders

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?

Scenario 2: 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? 

Scenario 3: 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? 

Scenario 4: 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