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Summary Learning outcomes General Medicine
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Learning outcomes General Medicine
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Learning outcomesLearning outcomes Introduction
Recognize the current definition of health
The ability to adapt and self manage in the face of social, physical and emotional challenges.
Know the most important causes of death globally and the disparities between the four
income groups & Know which disease are on the rise and which ones are declining
Most important cause of death globally is ischeamic heart disease (⅙ deaths). Diabetes and
kidney disease are on the rise, due to rising obesity.
Top 10 causes of death per income status:
- Low-income countries: 6 communicable diseases and neonatal condition is the
leading cause of death.
- Lower-middle-income countries: 5 communicable diseases, 4 noncommunicable
diseases, 1 injury. Ischeamic heart disease is nr. 1 and rising, as is diabetes.
Diarrhoeal disease remains a challenge. HIV is out of the top 10.
- Upper-middle-income countries: 1 communicable disease, only top 10 with stomach
cancer, biggest increase in ischaemic heart disease, biggest decrease in COPD.
- High-income countries: 1 communicable disease, ischaemic heart disease is nr. 1 but
is decreasing, Alzheimer's is nr. 2 and took over from; stroke is nr. 3 but is
decreasing, the rest of top 10 is increasing, and hypertensive heart disease is on the
rise.
Discuss the four elements of the physical examination
1. Inspection: look if you see visible symptoms on the patient.
2. Auscultation: hear heart sounds, breathing sounds, gurgling sounds.
3. Percussion: tapping on the abdomen or chest.
4. Palpation: feeling for abnormalities.
Know the steps of the general diagnostic process
- Anamnesis: Duration of complaints, severity, smoking habits, occupation, medication
use, living situation, height and weight.
- Physical examination: inspection, auscultation, percussion and palpation.
- Investigation: Imaging techniques, blood sampling, urine sampling, spirometry
Explain the main types of imaging techniques and provide examples of their use in clinical
practice
- X-ray: bone (fractures), protheses, and solid tumours.
- CT-scan: bone structures, organs, tumours, and blood clots.
- PET-scan: Active metabolism, functionality (e.g. tumours).
, - MRI: Best for soft tissue (brain, organs, tumours).
- Ultrasound: Boundaries of different tissues and organs. Fluids black, bones white.
Learning outcomes Diabetes
Molecular structure of insulin, its origin and its function & How blood glucose is regulated in
the body
Insulin is a hormone made by beta cells in the center of the Islets of Langerhans in the
pancreas. It is secreted from the pancreas when blood glucose rises. Insulin activates the
insulin receptors of cell membranes (of liver-, muscle- or adipose tissue) and causes
vesicles containing glucose transporter that are inside the cell to fuse with the cell
membrane, allowing glucose to be transported into the cell. Blood glucose drops.
Normal values for blood glucose
- Fasting = <5.5 mmol/l.
- Non-fasting = <7.8 mmol/l.
- HbA1C = <5.7%
Definition of hypoglycaemia, and its relation with insulin
Too low blood glucose is called hypoglycemia. Insulin injections lower blood glucose levels
in type 1 diabetes. It should be injected with a meal, otherwise blood glucose will drop too
low and you will become hypoglycaemia.
Cause and consequence of diabetic ketoacidosis + effect on respiration
In extreme cases, hyperglycemia causes ketoacidosis: a potentially fatal condition in which
the body breaks down fat tissue (because it cannot use glucose), the liver makes ketone
bodies from the free fatty acids. Releasing ketone bodies at a high rate in the blood leads to
a sharp drop in blood pH (<7.35). Because of acid build up in blood, your respiratory system
is triggered to start breathing faster to reduce carbon dioxide.
Involvement of the liver, skeletal muscles, fat tissue, intestines and pancreas
After eating, glucose enters the blood via the intestine. This will trigger the pancreas to
secrete insuline. Insuline will stimulate the uptake of glucose in skeletal muscles, adipose
tissue and the liver. And insulin suppresses glucose output from the liver.
The difference between type 1-, type 2-, and gestational diabetes
In type 1 diabetes there is not enough insuline produced by the beta cells in the pancreas,
due to an autoimmune response that attacks the beta cells. Cells can still use insulin to get
glucose in the cells, so insulin injections are the treatment.
In type 2 diabetes there is still insuline produced, but the cells won't respond to insulin to get
the glucose in. This is called insulin resistance. Anti-diabetic medication or lifestyle changes
are the treatment.
With gestational diabetes there is hypoglycemia during pregnancy due to hormones that
cause insulin resistance.
Prevalence and possible causes for type 1 diabetes
10% of the global population has diabetes mellitus.
,Prevalence type 1: 10% of people with diabetes have type 1 diabetes.
Causes/risk factors type 1: family history (genes), diet (low vitamin D intake), and
infections/illnesses which can damage the pancreas.
Prevalence, proportion and risk factors for type 2 diabetes
10% of the global population has diabetes mellitus.
Prevalence type 2: 90% of people with diabetes have type 1 diabetes.
Causes/risk factors type 2: aging, obesity (80-85%), diet and physical inactivity.
Based on the risk factors, you can conclude that type 2 diabetes is largely preventable.
Trend in diabetes numbers and 3 reasons why the number of diabetes is increasing
worldwide
Currently there are 463 million people diagnosed with diabetes. That is more than was
estimated. Globally 50% is undiagnosed. In 2045 it is estimated that there will be 700 million
diabetes patients. Reasons:
1. Increasing population
2. Global increase in obesity
3. Populations are aging
Differences in prevalence between ethnic groups: possible causes
There is less diabetes in Asian and Caucasian people, compared to Hispanic and black
people. This is partly because of
- genes,
- but also because of socia-economic status.
The sighs of (pre)diabetes
Polyuria, polydipsia, polyphagia, weight loss, vision changes, and fatigue.
The complications of diabetes
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb
amputation. Adults with diabetes have a 2-3 x increased risk of heart attack and strokes.
Neuropathy (nerve damage) in the feet, combined with reduced blood flow, increases the
chance of foot ulcers, infection and ulceration (diabetic foot); and eventual need for limb
amputation. Diabetes is among the leading causes of kidney failure/nephropathy.
Prevalence of diabetes retinopathy
Diabetic retinopathy is an important cause of blindness = 2.6% of global blindness.
How diabetes is a risk factor for cardiovascular disease
Overtime high glucose levels can cause damage to tiny blood vessels (the
microvasculature). Hyaline arteriolosclerosis, is where the walls of arterioles
develop hyaline (protein) deposits. These deposits of proteins make arterioles
hard and inflexible. In capillaries, the basement membrane can thicken and this
makes it hard for oxygen to easily move from the capillary to the tissues, causing
hypoxia. Diabetes increases the risk of medium and large arterial wall damage
and subsequent atherosclerosis → heart attack and stroke.
Purpose of the 75-g oral glucose tolerance test
, Drinking glucose and measuring blood glucose every 30-60 minutes to see how it is
dropping. Two hours after drinking, blood glucose should be <7.8 mmol/L.
How diabetes is diagnosed, and the role of diet in the management of diabetes
Diabetes is diagnosed at blood glucose levels of
- >7 mmol/l fasting,
- >11.1 mmol/l non-fasting,
- or >6.5% HbA1c
Eating healthy and getting/maintaining a healthy weight can prevent/manage diabetes.
Why diabetes reduces life expectancy
Overall LE with diabetes is reduced by 4-6 years, because diabetes has a lot of
complications that can be fatal. This includes nephropathy, cardiovascular disease and
neuropathy.
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