NURS 6501-Module 7 Knowledge Check
A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular
menses. She describes irregular and infrequent menses (five or six per year) since menarche at
12 years of age. She began to develop dark, coarse facial hair when she was
14 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 of 2:
What is the pathogenesis of PCOS?
1.
Polycystic Ovary Syndrome (PCOS) has an underlying genetic component that causes
irregular ovulation, increased androgens, and ovaries with polycystic characteristics (McCance
& Huether, 2019). Glucose intolerance and insulin resistance contribute to increased androgen
secretion via the ovaries' supportive structures and reduces sex-hormone-binding globulin
(McCance & Huether, 2019). Elevated leptin levels act on the hypothalamus interfering with
hormone production. Follicular growth and apoptosis alterations influence the absence of
ovulation, creating inappropriate functioning of FSH and LH. Cortical thickening increased
subcortical stroma, and hyperplasia occurs (McCance & Huether, 2019).
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Elsevier.
A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular
menses. She describes irregular and infrequent menses (five or six per year) since menarche at
12 years of age. She began to develop dark, coarse facial hair when she was
14 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 2 of 2:
How does PCOS affect a woman’s fertility or infertility?
2.
PCOS is the leading cause of infertility in women (McCance & Huether, 2019). The
infertility results due to alterations in androgen production, follicular disturbances, and an
absence of ovulation.
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Elsevier.
A 20-year-old female college student presents to the Student Health Clinic with a chief
complaint of abdominal pain, foul smelling vaginal discharge, and fever and chills for the past 4
days. She denies nausea, vomiting, or difficulties with defecation. 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:
What is the pathophysiology of PID?
3.
Pelvic inflammatory disease (PID) is a condition of inflammation related to infections
and involves the uterus, fallopian tubes, and ovaries, as well as the peritoneal cavity in severe
, cases. Infections combined with the normal vaginal microbiome's failure allow the infecting
microorganism to spread into the upper genital tract causing PID (McCance & Huether, 2019).
Although often caused by gonorrhea or chlamydia, PID's etiology can be caused by multiple
bacteria when the pH of the vagina changes and alter the integrity of mucus of the cervix
(McCance & Huether, 2019). Altering the cervix's integrity allows an inflammatory process to
begin in the uterus and fallopian tubes with edema, obstruction, or necrosis. Gonorrhea
pathogens secrete toxins increasing the inflammation and damage, and chlamydia replicates in
the cells rupturing the cell membrane, with both pathogens capable of spreading into the
abdominal cavity (McCance & Huether, 2019).
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Elsevier.
A 27-year-old male comes to the clinic with a chief complaint of a “sore on my penis” that
has been there for 3 days. He says it burns and leaked a little fluid. He denies any other
symptoms. Past medical history noncontributory. Social history: works as a 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. Physical exam within normal limits 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:
Describe the 4 stages of syphilis.
4.
When syphilis goes untreated, it advances through four stages identified through clinical
manifestations. The first stage is the primary stage and consists of bacterial pathogens
replicating in the epithelium, producing chancre, and draining into lymph nodes, which
stimulates the adaptive immune response (McCance & Huether, 2019). The secondary stage
involves a systemic invasion of pathogens with the immune system fighting the infection and
clearing the chancres. The latent phase follows the secondary stage. There are no clinical
manifestations in
A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular
menses. She describes irregular and infrequent menses (five or six per year) since menarche at
12 years of age. She began to develop dark, coarse facial hair when she was
14 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 of 2:
What is the pathogenesis of PCOS?
1.
Polycystic Ovary Syndrome (PCOS) has an underlying genetic component that causes
irregular ovulation, increased androgens, and ovaries with polycystic characteristics (McCance
& Huether, 2019). Glucose intolerance and insulin resistance contribute to increased androgen
secretion via the ovaries' supportive structures and reduces sex-hormone-binding globulin
(McCance & Huether, 2019). Elevated leptin levels act on the hypothalamus interfering with
hormone production. Follicular growth and apoptosis alterations influence the absence of
ovulation, creating inappropriate functioning of FSH and LH. Cortical thickening increased
subcortical stroma, and hyperplasia occurs (McCance & Huether, 2019).
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Elsevier.
A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular
menses. She describes irregular and infrequent menses (five or six per year) since menarche at
12 years of age. She began to develop dark, coarse facial hair when she was
14 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 2 of 2:
How does PCOS affect a woman’s fertility or infertility?
2.
PCOS is the leading cause of infertility in women (McCance & Huether, 2019). The
infertility results due to alterations in androgen production, follicular disturbances, and an
absence of ovulation.
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Elsevier.
A 20-year-old female college student presents to the Student Health Clinic with a chief
complaint of abdominal pain, foul smelling vaginal discharge, and fever and chills for the past 4
days. She denies nausea, vomiting, or difficulties with defecation. 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:
What is the pathophysiology of PID?
3.
Pelvic inflammatory disease (PID) is a condition of inflammation related to infections
and involves the uterus, fallopian tubes, and ovaries, as well as the peritoneal cavity in severe
, cases. Infections combined with the normal vaginal microbiome's failure allow the infecting
microorganism to spread into the upper genital tract causing PID (McCance & Huether, 2019).
Although often caused by gonorrhea or chlamydia, PID's etiology can be caused by multiple
bacteria when the pH of the vagina changes and alter the integrity of mucus of the cervix
(McCance & Huether, 2019). Altering the cervix's integrity allows an inflammatory process to
begin in the uterus and fallopian tubes with edema, obstruction, or necrosis. Gonorrhea
pathogens secrete toxins increasing the inflammation and damage, and chlamydia replicates in
the cells rupturing the cell membrane, with both pathogens capable of spreading into the
abdominal cavity (McCance & Huether, 2019).
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Elsevier.
A 27-year-old male comes to the clinic with a chief complaint of a “sore on my penis” that
has been there for 3 days. He says it burns and leaked a little fluid. He denies any other
symptoms. Past medical history noncontributory. Social history: works as a 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. Physical exam within normal limits 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:
Describe the 4 stages of syphilis.
4.
When syphilis goes untreated, it advances through four stages identified through clinical
manifestations. The first stage is the primary stage and consists of bacterial pathogens
replicating in the epithelium, producing chancre, and draining into lymph nodes, which
stimulates the adaptive immune response (McCance & Huether, 2019). The secondary stage
involves a systemic invasion of pathogens with the immune system fighting the infection and
clearing the chancres. The latent phase follows the secondary stage. There are no clinical
manifestations in
