Answer the following 4 questions and explain your answer as related to the scenario
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.
1. What is the pathogenesis of PCOS?
2. How does PCOS affect a woman’s fertility or infertility?
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).
3.. What is the pathophysiology of PID?
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.
4. What are the 4 stages of syphilis
Review this for answers
1. What is the pathogenesis of PCOS?
Functional ovarian hyperandrogenism due to ovarian steroidal dysregulation is at the center of the pathogenesis of polycystic ovary syndrome. This has both genetic and environmental factors. The genetic factors are polycystic ovary morphology, insulin resistance, hyperandrogenemia, defects in insulin secretion. Obesity , prenatal estrogen exposure and poor fetal growth are some of the environmental factors.
The steroidal dysregulation may lead to anovulation, irregular menses, virilization, hirsutism and infertility. Insulin resistance may also occur.
Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine reviews, 37(5), 467-520.
3.Pathophysiology of PID
It is assumed that most cases of PID occur in 2 phases .Acquisition of a vaginal or cervical infection is the first step. This infection may be asymptomatic and is frequently sexually transmitted. The second stage is the direct ascent into the upper genital tract of microorganisms from the vagina or cervix, with infection and inflammation of these structures. It is unknown the mechanism (or mechanisms) by which microorganisms rise from the lower genital tract. Studies say that there could be several factors involved. While cervical mucus offers a functional barrier against upward spread, vaginal inflammation and hormonal changes that occur during ovulation and menstruation can decrease the effectiveness of this barrier.
Furthermore, antibiotic treatment of sexually transmitted infections in the lower genital tract can disturb the balance of endogenous flora, causing overgrowth and ascension of normally nonpathogenic species. Opening the cervix during menstruation can also promote the rise of microorganisms, along with retrograde menstrual flow. Via rhythmic uterine contractions that happen during orgasm, intercourse may lead to the rise of infection. Bacteria can also be taken into the uterus and fallopian tubes along with sperm.
A number of microbial and host factors seem to affect the degree of inflammation that occurs in the upper genital tract and, therefore, the amount of subsequent scarring that develops. The mucosa is initially affected by infection of the fallopian tubes, but inflammation may quickly become transmural. With subsequent infections, this inflammation, which appears to be mediated by complement, can increase in strength. Inflammation can extend to parametrial structures that are uninfected, including the intestine. Infection can spread to cause acute peritonitis and acute perihepatitis (Fitz-Hugh-Curtis syndrome) via spillage of purulent materials from the fallopian tubes or via lymphatic spread beyond the pelvis.
Syphilis is a sexually transmitted infection (STI) caused by bacteria, that can cause serious health problems if it is not treated.
4. There are 4 stages of syphilis:
Signs and symptoms of syphilis differ according its stage.
1. Primary stage
· painless sores called chancres that appear at the infection site (rectum, penis, vagina, anus, mouth).
· sores are easily treated and cured by medicine, but it can heal on its own after 3-6 weeks and can still be infectious
2. Secondary stage
· skin rash (rough red or reddish brown rash on palm of hands and sole of feet)
· swollen lymph nodes
· sore throat
· patchy hair loss
· headaches and body aches
· symptoms may go away even without treatment, but it can get worse if not treated.
· There are no signs and symptoms during this stage
· Not infectious, but syphilis may still affect the heart, brain, nerves, bones, and other parts of the body.
· This phase can last for years.
· Not everyone will go through this stage, some will enter tertiary stage.
· Tertiary stage starts when symptoms from secondary stage disappears.
· Not infectious at this stage but can affect heart, brain and other body organs and can lead to death.
· Problems controlling muscle movements
· Vision problems (may start going blind)