General Medicine HNH-27806 Summary
Week 1
Week 1 – Patient health, Examination and Diagnostics
Fact sheet Health, Patient history, Examination and Diagnostics
Health
The WHO definition of health, formulated in 1948, describes health as “a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity.” At that time this
formulation was ground-breaking because of its breadth and ambition. It overcame the negative
definition of health as absence of disease and included the physical, mental, and social domains. The
current definition of health as proposed by the British Medical Journal is “the ability to adapt and
self manage in the face of social, physical, and emotional challenges”.
Globally, ischeamic heart disease are the number one cause of death: 1 in every 6 deaths is
attributable to this disease. Diabetes and kidney disease are on the rise, due to the growing number
of people with obesity, which is a common risk factor of many non-communicable diseases. The top
10 is different for low-income countries: six of the top 10 causes of death in low-income countries
are communicable diseases (e.g. malaria, diarrheal diseases, HIV).
Facts about the GP practice
• The GP is part of primary care
• In the Netherlands, the three most common conditions are hypertension, urinary tract
infections, diabetes
• About 75% of all registered patients visits their GP at least once a year
• GP’s should ask their patient about ICE, which stands for: Ideas, Concerns, Expectations.
The diagnostic process
Step Examples
duration of complaints, severity, smoking habits, occupation, medication use, living
Anamnesis
situation, height and weight
Examination
inspection (use your eyes): is the patient pale or feverish, can you see discoloration of
1
the skin, problems with posture, tremors.
2 ausculation (what can you hear): heart sounds, breathing sounds, gurgling sounds
3 percussion (use your hands): tapping the abdomen or chest
4 palpation (feel): feel for lumps, firmness, nodules
Imaging techniques
Investigatio Blood sampling (e.g glucose, blood lipids, inflammation markers) Urine sampling (e.g.
n glucose, protein, infection)
Spirometry (lung function)
Imaging techniques
Medical imaging is the technique of producing visual representations of areas inside the human body
to diagnose medical problems and monitor treatment. It is important to know which types are useful
for imaging bones, soft tissues, metabolic activity.
Non-communible diseases are on the rise
Kidney diseases and diabeters are rapidly increasing
Large variation depending on income
The diagnostic process
History: everythins the patient can tell you => GP
Examination: what you can see, hear, feel, smell => GP
Investigation: imaging or sampling
Taking the anamnesis
- Duration and severity of symptoms
- Localization of pain, situation
- Family history, smoking, occupation
- Medication
- Past medical history
- ICE: ideas, concers, expectations
The differential diagnosis: list of possible diagnosis or diseases that present similar signs of
symptoms
Further investigation (usually in hospital setting)
- Laboratory (blood, urine)
- Tissue biopsy
- Spirometry
- ECG
- Imaging techniques
2
,Radiography (x-rays, CT-scans)
- Most common form of medical imaging (x-rays)
- Uses electromagnetic (ionizing) radation
- Structures that absorb the high energy beams will appear in white: bones and
prosthetics (dense structures and high atomic number)
- Relatively inexpensive
- CT-scan (or CAT-scan) = computed tomography: several high resolution cross-
sectional images are taken to create a more 3D view of the body parts (position and
shape) -> tumors, blood clots, infections
MRI (magnetic resonance imaging)
- Magnetics and radio waves to produce image of soft tissue of the body: tumors,
organ damage
- No radiation (less risk than CT-scan)
- High-resolution images
- Based on movement of protons in the body
Nuclear medicine (e.g. PET-scan)
- Uses radioactive tracers (isotopes) bonded to a carrier molecule (e.g. modified
glucose)
- Administration: intravenous, oral, inhalation
- Produces 3D image through detection of photons
- Can view all types of tissues
- Usually for digestive or circulatory system, also for lungs (e.g. pulmonary embolism)
Ultrasound (echography)
- High-frequency sound waves
- Does not use radiation: safe!
- Hard tissues (white) and soft tissues (grey tones) can be viewed using ultrasound
machine: diagnose disease, monitor foetus during fetal development, viewing blood
flow through the body, and viewing the heart
- Can capture movement (live images)
- Small portable machines
3
, Video 1 – X-rays and CT-scans
x-rays: type of electromagnetic radiation, with higher energy than visible light, and lower
energy than gamma rays
- Collisions are more likely if a material is dense or if it is made of elements with higher
atomic numbers which means more electrons
- Bones are dense and full of calcium which has a high atomic number -> absorb x-rays
- Soft tissue is not as dense; mostly lower atomic numbered elements C,H,O
Spiral CT-scans: produce data that can be processed into cross sections
Video 2 – MRI scans
- Soft tissues
- Magnet, radio waves, gradient, computer
Water = magnetic
- Magnetic field (B0)
o H2O molecules at same frequency as B0
o Molecules that not move around = low-energy water molecules
- Machine produces 3D image
Video 3 – Ultrasound
- Evaluate organ damage, measure tissue thickness, and detect gall-bladder stones,
tumors, and blood clots
Bones: reflect most waves, appearing as tightly packed dots forming bright white shapes
Less dense objects: appear in fainter shades of grey
Multiple frequencies used together and composited into a life-like image; 2 – 10 mill. Hz
- No known negative side effects when used properly
Video 4 – PET scan
- 3D image
- Radio active tracers -> intravenous injection
o Carrier molecules tightly bonded to radioactive atom = isotope
Bind to specific proteins / sugars in the body
o Tissues absorb a lot of glucose -> may indicate a cancerous tumor
- Isotope produces small particles called positrons, which can interact with
surrounding electrons
Video 5 – Difference between an MRI and CT-scan
CT = x-ray machine + computer
- Patient flat on table
- Cross sectional images
- Takes +- 5 min
MRI = images water molecules in the body
- Coils placed over body part
- At least 30 min
- No radiation, soft tissue
Video 6 – MRI, PET, CT scans
Pregnant women, pacemaker, metal implant cannot do MRI
4
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