Polycystic ovarian syndrome (PCOS)

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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.

Question1

1. What is the pathogenesis of PCOS?

Question 2

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).

Question3

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.

Question:4

4. What are the 4 stages of syphilis

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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.

 

Sample Solution

Polycystic ovarian syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a health problem that affects 1 in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don’t ovulate, you can’t get pregnant. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Mullerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels.

Marx’s scorn for the entrepreneur society of which he was encircled in is seen obviously in his Economic and Philosophical Manuscripts written in 1844. These attention on the issue of estranged work of which immerses the early industrialist society he lives in. For Marx, the connection among estrangement and private enterprise is inborn because of the ‘abuse and bad form’ inside the benefit fuelled construction of private enterprise (Pappenheim, 1967: 81). It is critical to take note of that the two specialists and industrialists are distanced inside an entrepreneur framework yet for this exposition, the spotlight will exclusively be on estranged work. Marx parts this distance into ‘four moderate declining faculties’ (Dale, 2016: 91) which this paper will layout prior to surveying the degree that this idea is completely connected to free enterprise or regardless of whether it is available in all of human existence. It will then, at that point, contend that the connection among estrangement and free enterprise can be subverted by Marx’s disconnected appraisal of distance and asses the level that his contentions can be esteemed today.

Prior to assessing the connections among private enterprise and estrangement, one should see the value in that the premise of Marx’s hypotheses are on the Industrial Revolution north of a century prior. Consequently, Marx can work on the industrialist construction of society into the bourgeoisie – who own the method for creation and capital delivered – and the low class – who are the work constrained and can be named as the work here. For Marx, work should be a ‘utilization esteem’, in that it ought to be delivered to fulfill man’s necessities (McLellan, 1978). This is clear in his composition: ‘From each as indicated by his capacity. To each as per his requirements.’ (Marx refered to in Conly, 1978: 90) which can be improved into one should make as much as possible and should deliver. All things being equal, in an entrepreneur society, work turns into an item possessed and constrained by bourgeoisie in this way eliminating the human instinct present in natural creation and making the ‘generalization of work’ (Marx, 1844 refered to in McLellan, 1978: 78). This idea of how the worker is isolated from the result of work is the main type of estrangement that will be examined. As the laborer put exertion and abilities into his items as ‘is vital and general part of human existence’ (Ritzer, 2000: 60), he becomes estranged from his capital as he has no control or responsibility for. All things considered, his item ‘goes up against [the labourer] as an outsider being, as a power autonomous of the maker (Marx, 1844 refered to in McLellan, 1978: 78). This mutilation is a result of industrialist design of society by which the more the specialist delivers, the less expensive his work becomes (McLellan, 1978). Where the industrialist replaces his item with a low pay, the externalization proceeds, as his worth is taken out and he becomes overwhelmed by his capital to get resource to sur

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