Summary of all lectures from General Medicine HNH-27806 WUR. Contains lectures on: general practitioner, internal medicine, bariatric surgery, pulmonology, neurology, oncology, cardiology and gastroenterology. Contains many images to support studying.
General practitioner
Medical doctor: specialist completed higher medical education, which is professionally engaged in supporting
or restoring human health through prevention, recognition (diagnosis) and treatment of diseases and injuries.
Health: the ability to adapt and to self-manage
Primary process
▪ Anamnesis: medical history
• Presenting complaint
• Past medical history
• Medication
• Family history
• Social history
→ differential diagnosis; what diseases could the patient have based on the information from the
anamnesis
▪ Physical examination always in this order!
• Inspection looking
• Auscultation listening; with a stethoscope
• Percussion tapping; for consistency of organs
• Palpation feeling; if anything is painful
→ differential diagnosis
▪ Further investigation; laboratory (blood or urine), X-rays, ultrasound, MRI
General practitioner
▪ Diagnosis
▪ Patient population
▪ Urgency; time to investigate the complaint
▪ Referral to specialist
▪ To treat or not to treat
Most frequent health problems during contact with the GP (2017)
Hypertension Cystitis Diabetes mellitus Coughing Upper Respiratory Tract Infections
Health problems for elderly
▪ Cataract (staar)
• Prevalence 40% 52-64 years old
60% > 65 years old
90% > 90 years old
▪ Hearing loss
• Prevalence 33% 65-74 years old
50% > 85 years old
▪ Heart failure
• Prevalence 25% > 80 years old
• 50% die within one year of diagnosis
▪ Hypertension
▪ Stroke
▪ Cancers
▪ Renal diseases
▪ Falls
18-2-2020 21:13 1 - 43
, • Osteoporosis increases risk of fracture
• Falls lead to anxiety, loneliness, dependence and social isolation
• 50% of people who break a hip after falling are dead within one year
• Prevention of falls/fractures from falling
- Vitamin D
- Strengthening exercises
- Balance training
▪ Polypharmacy > 5 medications taken simultaneously
• 7 times more side effects
• 25% experience side effects daily
• 50% are caused by medications that are contraindicated or no longer indicated
▪ Dementia
• Impaired memory, forgetfulness, inability to retain new information
• Loss of the ability to speak and be understood by others and the ability to understand written or spoken
language
• Loss of the ability to plan and carry-out multistep tasks
• Loss of the ability to process and understand visual information
Internal medicine
Hormones: produced in glands, secreted in the blood
The action is elsewhere in the body through receptors
Thyroid diseases
Prevalence: 5-8%
Hyperthyroidism causes
▪ Tumor
• In the pituitary: oversynthesizing TSH
• In the thyroid gland itself: oversynthesizing T3 and T4
18-2-2020 21:13 2 - 43
,▪ Acute destruction
• Acute cell damage → thyroid hormon within the gland leaks into bloodstream
• Thyrotoxicosis; excess of thyroid hormone
- Due thyroiditis (inflammation of the thyroid gland)
▪ TSH-receptor stimulating auto-antibodies
• Auto-antibodies stimulate TSH receptors on thyroid gland → stimulation of thyroid hormone synthesis
without TSH signal
• Grave’s disease
▪ Pills
• Thyroid hormones in pills to lose weight
Hyperthyroidism treatment
▪ Downregulate hormone synthesis with medication (thiamazol)
▪ Destruction of the thyroid with surgery or chemicals (radioactive iodine)
Hypothyroidism causes
▪ Destruction
• Due to trauma, operation, inflammation
▪ Higher need of thyroid hormones
• During pregnancy
▪ Receptor blocking antibodies
• Hashimoto’s disease
Hypothyroidism symptoms
▪ Puffy face
→ accumulation of glycoproteins in subcutis
▪ Slow heartbeat
▪ Weight gain
▪ Fatigue
▪ Depression
Goitre: growth of the thyroid gland without function (benign tumor, stroma)
▪ Iodine deficiency
▪ Only treated when patients get troubles swallowing or breathing
18-2-2020 21:13 3 - 43
, Diabetes mellitus
Prevalence: 10-40%
Elevated glucose concentration
▪ High glucose diagnosis: diabetes mellitus
▪ Normal glucose diagnosis: no diabetes mellitus
▪ In between pre-diabetes; often leading to diabetes but no organ damage on the short term
Pathophysiology
▪ Islets of Langerhans in pancreas: insulin production by β-cells
▪ Fasting decreases insulin secretion
▪ Eating increases insulin secretion
▪ Insulin functions very anabolic hormone
• Glycogen synthesis
• Glycolysis and carbohydrate oxidation
• Synthesis and storage of fat (adipose tissue)
→ absolute insulin deficiency leads to uncontrolled breakdown of lipids →
ketoacidosis
• Protein synthesis
Insulin production healthy subject
Insulin production diabetes type 1
Insulin production diabetes type 2
18-2-2020 21:13 4 - 43
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller maryse5. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $4.29. You're not tied to anything after your purchase.
