Module 18: Reproductive Disorders

Module Authors

Amelia Naccarto-Coleman, PA-C
Assistant Professor, Department of Physician Assistant Education
Western University of Health Sciences, Pomona, CA

Debbie Santivañez-Williams, MSc, FNP
Instructor, Master of Science in Nursing/Family Nurse Practitioner Program
Western University of Health Sciences, Pomona, CA

Tina M. Meyer, PA-C
Clinical Consultant and Adjunct Professor
Western University of Health Sciences, Pomona, CA

Review Concepts

By the end of this Review Concept you should be able to:

• Describe the epidemiology of contraceptive use and the factors that influence the choice and success of a contraceptive method
• List types of hormonal contraceptives
• Describe the mechanism of action, effectiveness, advantages, disadvantages. contraindications, and side effects for combination oral contraceptives (OCs)
• Outline procedures for the pre-evaluation and long-term management of women using combination OCs
• Describe the mechanism of action, effectiveness, advantages, disadvantages. contraindications, and side effects for the following methods of contraception:
  • Progestin-only OCs (Minipills)
  • Medroxyprogesterone acetate (Depo- Provera®)
  • Subdermal levonorgestrel implants (Norplant®)
  • Intrauterine devices (IUD)
  • Barrier methods
  • Post-coital methods
• Define infertility
• Describe common causes of infertility and associated risk factors
• Outline techniques used in the diagnostic workup of women with potential fertility problems
• List reproductive technologies currently used to assist infertile couples

By the end of this Review Concept you should be able to:

• List common complications of pregnancy and associated risk factors
• Describe the epidemiology, associated risks, and congenital effects of diabetes during pregnancy
• Describe the epidemiology, clinical presentation, and clinical management of pre-eclampsia
• Describe the mortality and morbidity associated with multiple gestations
• List etiologies for fetal growth complications
• Describe the clinical presentation and complications that characterize infants who are small for gestational age
• Differentiate complete and incomplete spontaneous abortions
• List other types of abortions

By the end of this Review Concept you should be able to:

• Describe the epidemiology and risks associated with the following conditions:
  • Placenta previa
  • Abruptio plantae
  • Molar pregnancy
  • Trophoblastic disease
  • Premature rupture of the membranes
  • Rh incompatibility
  • Dystocia
  • Post partum hemorrhage
• For each of the above conditions, outline the relevant signs and symptoms, diagnostic considerations, and treatment protocols.

By the end of this Review Concept you should be able to:

• Explain how ectopic pregnancy develops.
• Cite incidence and mortality rates associated with ectopic pregnancy
• List factors that increase the risk of ectopic pregnancy.
• Describe common anatomical locations for ectopic pregnancy.
• List differential diagnoses that are often associated with ectopic pregnancy.
• Describe the clinical signs and symptoms that characterize ectopic pregnancy.
• Describe key diagnostic tests used to differentially diagnose ectopic pregnancy.
• Explain how ectopic pregnancy affects the subsequent fertility of the patient

By the end of this Review Concept you should be able to:

• Describe the various causes of abnormal uterine bleeding, including ovulatory and anovulatory processes.
• Define the terms commonly applied to abnormal bleeding patterns
• Differentiate between normal and abnormal bleeding
• Explain the pathophysiological mechanism responsible for dysfunctional uterine bleeding

By the end of this Review Concept you should be able to:

• Describe the epidemiology of dysmenorrhea
• Explain the pathogenesis and pathophysiology of dysmenorrhea
• Differentiate primary and secondary dysmenorrhea and state the causes of each
• Outline procedures and protocols in the diagnostic workup of the patient with dysmenorrhea
• List differential diagnoses for dysmenorrhea
• Outline procedures and protocols in the clinical management of primary and secondary dysmenorrhea
• Define premenstrual syndrome and discuss possible causes
• Discuss the clinical presentation of PMS
• Describe the therapeutic options for women with symptomatic PMS

By the end of this Review Concept you should be able to:

• Compare and contrast the various manifestations of premalignant cervical disease.
• Describe the primary method of transmission and associated risk factors for cervical carcinoma.
• Describe remission rates and progression for mild, moderate and severe cervical dysplasia.
• Explain the role of Pap smears and colposcopic-directed biopsy in the screening and diagnosis of cervical carcinoma.
• Explain why colposcopy is technically difficult during pregnancy.
• Describe the importance of the pelvic exam in diagnosing diseases of the ovaries
• Describe the etiology and clinical presentation of the following types of benign tumors:
  • Follicular cyst
  • Corpus luteum cyst
• Classify pre-malignant and malignant tumors of the ovaries
• Describe the diagnostic workup and clinical management of malignant ovarian tumors
• Describe the epidemiology of vulva carcinoma and vulva dystrophies
• Describe the epidemiology, clinical presentation, and common complications of fibromyomas and endometriosis

By the end of this Review Concept you should be able to:

• Describe the epidemiology and risks associated with the following conditions:
  • Incompetent cervix
  • Cervicitis
  • Cystolece, rectocele
  • Uterine prolapse, metritis
  • Condyloma
  • Salpingitis,
  • Gonorrhea
  • Trichomoniasis
  • Chlamydia infection
  • Pubic lice
  • Scabies
• For each of the above conditions, outline the relevant signs and symptoms, diagnostic considerations, and treatment protocols.

By the end of this Review Concept you should be able to:

• Describe the epidemiology and pathogenesis of vaginitis
• Differentiate the normal vaginal environment from the environment characteristic of vaginitis
• Describe the clinical presentation of vaginitis
• List differential diagnoses for vaginitis
• Outline procedures and protocols in the diagnostic workup of the patient with vaginitis
• Differentiate the epidemiology of the following 3 primary causes of vaginitis:
  • Bacterial vaginosis
  • Candidiasis
  • Trichomonas
• List relevant laboratory studies and criteria for diagnosing the type of vaginitis caused by each of the pathogens listed above
• Differentiate the clinical management of patients infected by each of the pathogens listed above

By the end of this Review Concept you should be able to:

• Describe the epidemiology and pathogenesis of vaginitis
• List types of benign and malignant breast disorders
• Describe the epidemiology of breast cancer
• Outline procedures and protocols in the routine evaluation of the breast
• Explain the role of mammography and other diagnostic techniques in the detection and evaluation of palpable breast lesions
• Describe the clinical management of breast cancer
• Describe the epidemiology, clinical presentation and clinical management of benign breast disorders such as fibrocystic disease and fibroadenomas
• Describe the epidemiology, clinical presentation and clinical management of infectious and inflammatory breast disorders such as galactocele and duct ectasia
• Differentiate between elicited and spontaneous nipple discharge

By the end of this Review Concept you should be able to:

• Define the terms menopause, perimenopause, and postmenopause.
• Describe the key physiologic changes that characterize the menopausal syndrome
• Describe the clinical signs and symptoms typically associated with menopause
• List differential diagnoses that are often associated with the menopause syndrome
• Compare and contrast key diagnostic tests used to differentially diagnose menopausal patients
• Describe complications that may arise if the menopausal patient is untreated
• State the primary focus of managing the menopause patient
• Describe general measures the patient can take to reduce the risk of osteoporosis
• Explain why estrogen replacement therapy (ERT) is the mainstay of treatment for menopause
• Describe the benefits of supplementing ERT with testosterone or progesterone
• List the indications and contraindications for ERT

Return to the List of Module Titles