1: Patient Care
5 Topics
2: Normal Obstetrics
7 Topics
3: Abnormal Obstetrics
13 Topics
4: General Gynecology
8 Topics
7: Neoplasia
6 Topics
Preventive Care and Health Maintenance
Duration = 9:49
00:00
APGO educational topic number seven
00:02
preventive care and health means
00:05
obstetrician/gynecologist develop
00:06
substantial relationships with their
00:08
patients through the lifespan often
00:10
taking care of women through their
00:11
pregnancy or pregnancies and with
00:13
gynecologic issues throughout their
00:15
reproductive years and beyond the annual
00:18
health maintenance visit provides a
00:19
great opportunity to counsel patients
00:21
about maintaining a healthy lifestyle
00:23
and minimizing health risks the
00:26
objectives of this video are to be able
00:28
to counsel patients regarding the
00:29
following and suggest appropriate
00:31
referrals if necessary contraception
00:33
intimate partner violence prevention of
00:35
sexually transmitted infections
00:36
immunizations diet and nutrition
00:39
exercise seatbelt use stress management
00:41
sun exposure depression tobacco use and
00:44
alcohol substance use to explain
00:46
prevention guidelines including
00:48
screening procedures for diseases of the
00:50
following organ systems breast cervix
00:53
colon cardiovascular skin and bone and
00:56
to identify risk factors in a patient’s
00:59
personal and family history for diseases
01:00
of the following organ systems breast
01:02
cervix colon cardiovascular skin and
01:06
bone there are many important aspects of
01:09
maintaining a healthy lifestyle that are
01:10
important to emphasize at an annual
01:12
health maintenance visit diet and
01:15
nutrition exercise seatbelt use sun
01:21
exposure alcohol and substance use
01:24
tobacco and depression as women’s health
01:28
providers we also need to think about
01:29
contraception for any sexually active
01:31
women of reproductive age as well as
01:33
screening for sexually transmitted
01:35
infections all healthcare providers need
01:37
to also be more cognizant and deliberate
01:39
and screening for intimate partner
01:40
violence many of our reproductive age
01:43
patients primarily see their
01:45
gynecologist and develop substantive
01:46
bonds with their providers the
01:48
obstetrician gynecologist can help
01:50
provide resources such as nutritionists
01:52
for obesity and diet counseling and
01:54
social workers and support networks for
01:56
women at high risk environments we will
01:58
discuss risk factors and prevention
02:00
guidelines in this video for the
02:01
following organ systems breast cervix
02:04
colon
02:05
cardiovascular skin and bone breast
02:08
cancer is the second most common
02:10
malignancy and women and the second most
02:12
common cause of
02:13
two related death and women age is the
02:16
most significant risk factor at the age
02:18
of 20 a woman’s risk of breast cancer is
02:20
one out of 17 60 at age 38 is one out of
02:24
two 29 at 40 it’s 169 at 50 it’s one out
02:28
of 42 at sixty it’s one out of 29 and at
02:31
70 it’s one out of 27 a woman’s lifetime
02:34
risk of developing breast cancer is one
02:36
out of eight the second risk factor is
02:39
family history and genetics having a
02:41
first-degree relative with breast cancer
02:43
puts a woman at higher risk as well as
02:45
being a carrier for brca1 or 2
02:47
components of the reproductive and
02:50
menstrual history can also be risk
02:51
factors including early menarchy before
02:53
age 12 late menopause after 55 delayed
02:57
childbearing her first child after 30
02:59
and Nullah parity radiation exposure is
03:02
an additional risk factor women who
03:04
received significant radiation for
03:05
Hodgkin’s disease or an enlarged thymus
03:07
gland are at increased risk of
03:09
developing breast cancer and women with
03:11
dense breasts also are an increased risk
03:13
of developing breast cancer for breast
03:16
cancer prevention guidelines the
03:17
American College of Obstetricians and
03:19
Gynecologists recommend starting
03:21
mammograms at age 40 and continuing to
03:23
have them annually the American Cancer
03:25
Society has the same recommendations of
03:27
age 40 and annually the National Cancer
03:30
Institute recommends starting at age 40
03:32
and having mammograms performed every
03:33
one to two years the US Preventive
03:36
Services Task Force recommends biannual
03:39
mammograms starting at age 50 through
03:41
age 74 women should be informed of the
03:44
benefits of mammography and the risks of
03:46
additional imaging or biopsies that may
03:48
be recommended based on screening
03:50
results we will now discuss colorectal
03:52
cancer it is the third leading cause of
03:55
cancer death in women it is diagnosed
03:57
more in women than any individual
03:59
gynecologic cancer screening tests are
04:02
underused in many segments of the
04:04
population risk factors include
04:06
inflammatory bowel diseases such as
04:08
Crohn’s disease or ulcerative colitis
04:10
family history of colorectal cancer or
04:13
colorectal polyps genetic syndromes such
04:15
as familial adenomatous polyposis or
04:17
hereditary nonpolyposis colorectal
04:19
cancer other risk factors include
04:22
lifestyle factors such as lack of
04:24
regular physical activity low fruit and
04:26
vege too
04:26
intake low-fiber high-fat diet
04:29
overweight and obesity alcohol
04:31
consumption and tobacco use ACOG
04:34
recommends colorectal cancer screening
04:36
for average age risk women beginning at
04:38
age 50 and for African American women
04:40
beginning at age 45 and recommends
04:43
colonoscopy every 10 years as the most
04:45
effective screening modality moving now
04:48
in a cervical cancer the incidence of
04:50
cervical cancer has decreased more than
04:52
50 percent in the past 30 years because
04:54
of widespread screening it continues to
04:56
be more common worldwide particularly in
04:58
countries without screening programs
05:00
we’ll begin by discussing cervical
05:02
cancer risk factors most cervical cancer
05:05
occurs in women who were either never
05:07
screened or were inadequately screened
05:11
50% of women diagnosed with cervical
05:13
cancer have never had cervical cytology
05:15
testing an additional 10% of women had
05:18
not been screed within 10 years of
05:19
diagnosis other risk factors for
05:21
cervical cancer include
05:23
immunosuppression there is a higher
05:24
incidence of HPV infection and
05:26
progression in HIV organ transplant and
05:29
other immunosuppressed women smoking and
05:32
early cor turkey the screening
05:34
guidelines are that Pap test should
05:36
begin at age 21 and from age 21 to 30
05:39
cytology alone should be performed every
05:41
three years and from age 30 to 65
05:43
cytology plus HPV every five years is
05:46
the preferred screening screening can
05:49
stop after the age of 65 if she has not
05:51
had any high-grade dysplasia for 20
05:53
years and the HPV vaccine should be
05:55
given if females from age 9 to 26 moving
05:58
now to bone health
06:00
osteoporosis has a 5 times greater
06:02
prevalence in women than in men and
06:04
women’s sustained 80% of hip fractures
06:07
in the United States hip fractures are a
06:10
significant source of morbidity and
06:11
mortality of women older than 80 years
06:14
old with a hip fracture only 56% could
06:16
walk independently after one year and
06:18
approximately 3 to 6 / 7 a woman died of
06:21
complications while hospitalized for a
06:23
hip fracture 4 risk factors for
06:26
osteoporosis Caucasian women have the
06:28
highest rates of hip fracture and
06:30
african-american women have the lowest
06:32
rates increasing age and low body weight
06:35
personal history of fracture family
06:37
history of osteoporosis
06:39
alcohol and tobacco use for prevention
06:43
it is important to address bone health
06:44
in all age groups including puberty and
06:47
adolescence poor nutrition including
06:49
anorexia nervosa inactive lifestyle and
06:52
smoking may prevent girls from reaching
06:54
their peak bone mass screening for
06:56
osteoporosis is with a DEXA scan of the
06:58
lumbar spine and hip it should begin at
07:00
age 65 DEXA scans can be selectively
07:04
used for women less than 65 if they have
07:06
a medical history of aphrodite fracture
07:08
if they weigh less than 127 pounds
07:10
they’ve a medical cause of bone loss of
07:13
parental history of a hip fracture if
07:15
they are a current smoker if there is
07:17
alcoholism or if they have rheumatoid
07:18
arthritis osteoporosis is diagnosed by
07:21
the t-score which is the number of
07:23
standard deviations above or below the
07:25
mean average bone density of young adult
07:27
women a normal T score is greater than
07:30
or equal to minus one low bone mass or
07:33
osteopenia is between minus 1 and minus
07:35
2.5 and osteoporosis is when it’s less
07:38
than minus 2.5 let’s switch gears now
07:41
and discuss skin cancer the incidence of
07:44
melanoma is increasing faster than any
07:46
other potentially preventable cancer in
07:48
the United States risk factors are
07:50
familial having a typical Niva having a
07:52
high nevis count sun or UV exposure and
07:55
phenotypic traits of light skin
07:57
pigmentation having a red or blond hair
07:59
color high density freckling and a light
08:02
eye color
08:02
when performing a skin examination of a
08:05
lesion look at the a for asymmetry B for
08:08
border irregularities C for color
08:10
variation D for a diameter greater than
08:13
six millimeters and E for enlargement or
08:15
evolution of color change shape or
08:17
symptoms our final topic is coronary
08:20
heart disease one out of five Americans
08:22
have a high total cholesterol level
08:24
abnormal cholesterol levels have been
08:27
found to be associated with
08:28
atherosclerosis and cardiovascular
08:30
disease cholesterol levels that are
08:32
checked are low-density lipoproteins or
08:34
LDL high density lipoproteins or HDL
08:37
triglycerides and total cholesterol
08:39
levels dis lipedema is diagnosed if
08:41
there is a high LDL triglyceride or
08:44
total cholesterol level or a low HDL
08:46
level initial screening for women should
08:49
begin at age 45 and occur every five
08:51
years unless she has risk factors for
08:53
cardio
08:53
vascular disease and these risk factors
08:55
include family history of familial
08:58
hyperlipidemia family history of
09:00
premature cardiovascular disease less
09:02
than 54 men and less than 64 women
09:04
personal or family history of peripheral
09:06
vascular disease obesity diabetes
09:08
mellitus or multiple cardiovascular risk
09:11
factors for example tobacco use and
09:12
hypertension the US Preventive Services
09:15
Task Force recommends starting
09:17
cholesterol screening at age 45 for
09:19
women who are at increased risk for
09:20
coronary heart disease this concludes
09:22
the aapko video on preventive care and
09:25
health maintenance we have discussed the
09:26
importance of the health maintenance
09:28
visit as well as talked about prevention
09:30
guidelines and identified risk factors
09:32
for breast cervix colon cardiovascular
09:35
skin and bone disorders