NR 602 FINAL EXAM STUDY GUIDE
American Cancer Society recommendations
Recommendations and Conclusions
The American College of Obstetricians and Gynecologists (ACOG) makes the following
recommendations and conclusions regarding the use of and indications for the pelvic
examination: Pelvic examinations should be performed when indicated by medical
history or symptoms. Based on the current limited data on potential benefits and harms
and expert opinion, the decision to perform a pelvic examination should be a shared
decision between the patient and her obstetrician–gynecologist or other gynecologic care
provider.. A limited number of studies have evaluated the benefits and harms of a
screening pelvic examination for detection of ovarian cancer, bacterial vaginosis,
trichomoniasis, and genital herpes. Data from these studies are inadequate to support a
recommendation for or against performing a routine screening pelvic examination among
asymptomatic, nonpregnant women who are not at increased risk of any specific
gynecologic condition. Data on its effectiveness for screening for other gynecologic
conditions are lacking. Women with current or a history of cervical dysplasia, gynecologic
malignancy, or in utero diethylstilbestrol exposure should be screened and managed
according to
, NR 602 FINAL EXAM STUDY GUIDE
guidelines specific to those gynecologic conditions. After reviewing risks and benefits, the pelvic
examination also may be performed if a woman expresses a preference for the examination.
Regardless of whether a pelvic examination is performed, a woman should see her
obstetrician–gynecologist at least once a year for well-woman care. A pelvic
examination is not necessary before initiating or prescribing contraception, other than
an intrauterine device, or to screen for sexually transmitted infections.
ACOG Pap smear guidelines
AMERICAN CANCER SOCIETY GUIDLINE ON BREAST EXAM: These guidelines are
for women at average risk for breast cancer. For screening purposes, a woman is
considered to be at average risk if she doesn’t have a personal history of breast
cancer, a strong family history of breast cancer, or a genetic mutation known to
increase risk of breast cancer (such as in
a BRCA gene), and has not had chest radiation therapy before the age of 30. Women
between 40 and 44 have the option to start screening with a mammogram every
year. Women 45 to 54 should get mammograms every year. Women 55 and older
can switch to a mammogram every other year, or they can choose to continue yearly
mammograms. Screening should
continue as long as a woman is in good health and is expected to live at least 10 more
years. All women should understand what to expect when getting a mammogram for
breast cancer screening – what the test can and cannot do. Clinical breast exams are
not recommended for breast cancer screening among average-risk women at any age.
Women should be familiar with how their breasts normally look and feel and should
report any changes to a health care provider right away. Women who are at high risk
for breast cancer based on certain factors should get a breast MRI and a mammogram
every year, typically starting at age 30. This includes women who: Have a lifetime risk of
breast cancer of about 20% to 25% or greater, according to risk assessment tools that
are based mainly on family history. Have a known BRCA1 or BRCA2
gene mutation (based on having had genetic testing). Have a first-degree relative (parent,
brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic
testing themselves. Had radiation therapy to the chest when they were between the ages
of 10 and 30 years. Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-
, NR 602 FINAL EXAM STUDY GUIDE
Ruvalcaba
syndrome, or have first-degree relatives with one of these syndromes. The American Cancer
Society recommends against MRI screening for women whose lifetime risk of breast
cancer is less than 15%.
Dysmenorrhea
Dysmenorrhea: painful menstruation. Reserved for women whose pain prevents normal
activity and requires medication. There are 3 types of dysmenorrhea: (1) primary (no organic
cause), (2) secondary (pathologic cause), and (3) membranous (cast of endometrial cavity shed
as a single entity). The most common misdiagnosis of primary dysmenorrhea is secondary
dysmenorrhea due to endometriosis.
Typically, pain occurs on the first day of the menses, usually about the time the flow begins, but
it may not be present until the second day. Nausea and vomiting, diarrhea, and headache may
occur. NSAIDs or acetaminophen may relieve mild discomfort. For severe pain, codeine or other
stronger analgesics may be needed, and bed rest may be desirable. Antiprostaglandins are now
used for treatment of dysmenorrhea. Cyclic administration of oral contraceptives, usually in the
lowest dosage but occasionally with increased estrogen, prevents pain in most patients who do
not obtain relief from antiprostaglandins or cannot tolerate them. Surgical therapy eventually
may require hysterectomy with or without ovarian removal in extreme cases.
1. Cystocele Anterior Vaginal Wall Defects
Essentials of Diagnosis: Anterior vaginal prolapse describes an anterior vaginal wall defect in
which the bladder is associated with the prolapse. It is also known as a cystocele
2. Rectocele Posterior Vaginal Wall Prolapse
Essentials of Diagnosis : Posterior vaginal wall prolapse describes a posterior vaginal wall
defect. It is also known as a rectocele
3. Uterine Prolapse
Essentials of Diagnosis: Vaginal vault prolapse (posthysterectomy)
Enterocele describes an apical vaginal wall defect in which bowel is contained within the prolapsed Two
general classifications are used to describe and document the severity of pelvic organ prolapse. The Pelvic
Organ Prolapse Quantification (POP-Q) system standardizes terminology of female pelvic organ prolapse.
, NR 602 FINAL EXAM STUDY GUIDE
This is accepted as the most objective method for quantifying prolapse as it provides a more precise
description of the anatomy. This descriptive system contains a series of site-specific measurements of vaginal
and perineal anatomy. Prolapse in each segment is evaluated and measured relative to the hymen. The
anatomic position of the 6 defined points for measurement should be in centimeters above the hymen
(negative number) or centimeters beyond the hymen (positive number). The plane at the level of the hymen
is defined as 0.
American Cancer Society recommendations
Recommendations and Conclusions
The American College of Obstetricians and Gynecologists (ACOG) makes the following
recommendations and conclusions regarding the use of and indications for the pelvic
examination: Pelvic examinations should be performed when indicated by medical
history or symptoms. Based on the current limited data on potential benefits and harms
and expert opinion, the decision to perform a pelvic examination should be a shared
decision between the patient and her obstetrician–gynecologist or other gynecologic care
provider.. A limited number of studies have evaluated the benefits and harms of a
screening pelvic examination for detection of ovarian cancer, bacterial vaginosis,
trichomoniasis, and genital herpes. Data from these studies are inadequate to support a
recommendation for or against performing a routine screening pelvic examination among
asymptomatic, nonpregnant women who are not at increased risk of any specific
gynecologic condition. Data on its effectiveness for screening for other gynecologic
conditions are lacking. Women with current or a history of cervical dysplasia, gynecologic
malignancy, or in utero diethylstilbestrol exposure should be screened and managed
according to
, NR 602 FINAL EXAM STUDY GUIDE
guidelines specific to those gynecologic conditions. After reviewing risks and benefits, the pelvic
examination also may be performed if a woman expresses a preference for the examination.
Regardless of whether a pelvic examination is performed, a woman should see her
obstetrician–gynecologist at least once a year for well-woman care. A pelvic
examination is not necessary before initiating or prescribing contraception, other than
an intrauterine device, or to screen for sexually transmitted infections.
ACOG Pap smear guidelines
AMERICAN CANCER SOCIETY GUIDLINE ON BREAST EXAM: These guidelines are
for women at average risk for breast cancer. For screening purposes, a woman is
considered to be at average risk if she doesn’t have a personal history of breast
cancer, a strong family history of breast cancer, or a genetic mutation known to
increase risk of breast cancer (such as in
a BRCA gene), and has not had chest radiation therapy before the age of 30. Women
between 40 and 44 have the option to start screening with a mammogram every
year. Women 45 to 54 should get mammograms every year. Women 55 and older
can switch to a mammogram every other year, or they can choose to continue yearly
mammograms. Screening should
continue as long as a woman is in good health and is expected to live at least 10 more
years. All women should understand what to expect when getting a mammogram for
breast cancer screening – what the test can and cannot do. Clinical breast exams are
not recommended for breast cancer screening among average-risk women at any age.
Women should be familiar with how their breasts normally look and feel and should
report any changes to a health care provider right away. Women who are at high risk
for breast cancer based on certain factors should get a breast MRI and a mammogram
every year, typically starting at age 30. This includes women who: Have a lifetime risk of
breast cancer of about 20% to 25% or greater, according to risk assessment tools that
are based mainly on family history. Have a known BRCA1 or BRCA2
gene mutation (based on having had genetic testing). Have a first-degree relative (parent,
brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic
testing themselves. Had radiation therapy to the chest when they were between the ages
of 10 and 30 years. Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-
, NR 602 FINAL EXAM STUDY GUIDE
Ruvalcaba
syndrome, or have first-degree relatives with one of these syndromes. The American Cancer
Society recommends against MRI screening for women whose lifetime risk of breast
cancer is less than 15%.
Dysmenorrhea
Dysmenorrhea: painful menstruation. Reserved for women whose pain prevents normal
activity and requires medication. There are 3 types of dysmenorrhea: (1) primary (no organic
cause), (2) secondary (pathologic cause), and (3) membranous (cast of endometrial cavity shed
as a single entity). The most common misdiagnosis of primary dysmenorrhea is secondary
dysmenorrhea due to endometriosis.
Typically, pain occurs on the first day of the menses, usually about the time the flow begins, but
it may not be present until the second day. Nausea and vomiting, diarrhea, and headache may
occur. NSAIDs or acetaminophen may relieve mild discomfort. For severe pain, codeine or other
stronger analgesics may be needed, and bed rest may be desirable. Antiprostaglandins are now
used for treatment of dysmenorrhea. Cyclic administration of oral contraceptives, usually in the
lowest dosage but occasionally with increased estrogen, prevents pain in most patients who do
not obtain relief from antiprostaglandins or cannot tolerate them. Surgical therapy eventually
may require hysterectomy with or without ovarian removal in extreme cases.
1. Cystocele Anterior Vaginal Wall Defects
Essentials of Diagnosis: Anterior vaginal prolapse describes an anterior vaginal wall defect in
which the bladder is associated with the prolapse. It is also known as a cystocele
2. Rectocele Posterior Vaginal Wall Prolapse
Essentials of Diagnosis : Posterior vaginal wall prolapse describes a posterior vaginal wall
defect. It is also known as a rectocele
3. Uterine Prolapse
Essentials of Diagnosis: Vaginal vault prolapse (posthysterectomy)
Enterocele describes an apical vaginal wall defect in which bowel is contained within the prolapsed Two
general classifications are used to describe and document the severity of pelvic organ prolapse. The Pelvic
Organ Prolapse Quantification (POP-Q) system standardizes terminology of female pelvic organ prolapse.
, NR 602 FINAL EXAM STUDY GUIDE
This is accepted as the most objective method for quantifying prolapse as it provides a more precise
description of the anatomy. This descriptive system contains a series of site-specific measurements of vaginal
and perineal anatomy. Prolapse in each segment is evaluated and measured relative to the hymen. The
anatomic position of the 6 defined points for measurement should be in centimeters above the hymen
(negative number) or centimeters beyond the hymen (positive number). The plane at the level of the hymen
is defined as 0.
