Samenvatting
Summary Exam material General Medicine
- Instelling
- Wageningen University (WUR)
Exam material General Medicine
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Voorbeeld 4 van de 50 pagina's
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Voorbeeld van de inhoud
Study material General MedicineWeek 1
This week we start with defining health and studying the diagnostic process. What does
health mean to people? What are the most important diseases in terms of mortality? What
does a general practitioner do? What is a patient history and how is this combined with the
physical presentation of the patient into a 'differential diagnosis'? We will also discuss
common methods of imaging techniques in clinical practice.
Course introduction
Fact sheet- Health and history taking
In 1948 the WHO definition overcame the negative definition of health as absence of disease
and included physical, mental and social domains. Currently the definition is: ‘The ability
to adapt and self manage in the face of social, physical and emotional challenges.’.
Causes of death:
Globally, ischeamic heart disease is the number one cause of death: 1 in every 6 deaths is.
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 income status of countries:
- Low-income countries: 6 of the top 10 causes of death in low-income countries are
communicable diseases (e.g. malaria, diarrheal diseases, HIV). Neonatal condition is
the leading cause of death.
- Lower-middle-income countries: top 10 causes of death include 5 noncommunicable
diseases, 4 communicable diseases, and 1 injury. Diabetes is rising, the biggest
increase is ischaemic heart disease (nr. 1), diarrhoeal disease remains a challenge,
HIV had the biggest decrease and is now out of top 10.
- Upper-middle-income countries: notable rise in lung cancers, also stomach cancer is
in the top 10 (not in other income groups), largest increase in ischaemic heart
disease, biggest decrease in COPD, 1 communicable disease.
- High-income countries: deaths are increasing for all top 10 diseases, except
ischaemic heart disease and stroke. These are decreasing, but still on the top of the
top 10 with Alzheimer's. Alzheimer’s took place 2 from stroke. Hypertensive heart
disease is on the rise. 1 communicable disease.
Facts about GP:
- 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 patients about ICE: Ideas, Concerns, Expectations
Kumar and Clark: box 1.2 - Good practice for using the medical history to build a
therapeutic relationship
Allow the patient to tell their story, without jumping in prematurely with
questions. → Ask the patient specifically about their ICE:
- Ideas: What do they think might be going on? Have they done any reading about
their symptoms or asked anyone they know?
- Concerns: Are they feeling anxious or worried about their symptoms? What is the
cause then concern? Are there any particular areas where their symptoms might be
making life difficult?
- Expectations: What are they hoping for from this consultation?
Try to develop an understanding of who the patient is as a person. Where, and with whom,
do they live? What is their occupation? What things do they enjoy? Moments of human
connection, such as a shared interest in a place or activity, can be powerful in building a
relationship between clinician and patient.
Try to convey empathy and concern, reinforcing to the patient that you ate their advocate
and will do your best to help them.
Kumar and Clark: box 1.4 - A structured approach to information-gathering in the
medical history
- Present complaint: why has the patient sought medical advice?
- history of the presenting complaint: further information about the patient’s main
problem
- Past medical and surgical history
- Drug history
- Social history: information on the patient’s present living arrangements and relevant
risk factors
The diagnostic process:
Step Examples
Anamnesis Duration of complaints, severity, smoking
habits, occupation, medication use, living
situation, height and weight.
Examination
1 Inspection (eyes): is the patient pale or
feverish, can you see discoloration of the
skin, problems with posture, tremors
2 Auscultation (ears): heart sounds, breathing
sounds, gurgling sounds
3 Percussion (hands): tapping the abdomen
or chest
4 Palpation (feel): feel for lumps, firmness,
, nodules
Investigation Imaging techniques, blood sampling, urine
sampling, spirometry
Imaging techniques:
Podcing visual representations of areas inside the human body to diagnose medical
problems and monitor treatment. It is important which types are useful for imaging bones,
soft tissues, metabolic activity etc.
Name Principle Used for Resoluti Risk Time
imaging on (+ or
what? +/- or -)
X-rays This is a type of Bone + for Very low Quick
electromagnetic radiation, (fractures) bones dose
with higher energy than , radiation
visible light and lower protheses
energy than Gamma rays. , and solid
They are powerful enough tumours.
to go through many types
of matter. The parts of the
body that absorb the
waves will produce an
image. They can make
images of human tissue
without harming them.
CT-scans X-rays from multiple Bone +++ Very Low dose 5 min
angles. You now can see structures detailed radiation,
position and shape. The X- , organs, imaging. but
ray machine rotates tumours, 3D image possible
around the body, making blood and more reaction to
images of slices of the clots. precise contrast
body. location material
PET-scan Creates 3D images of the Active +/- Not Low from 30 min
body by using specific metabolis as radioactive
radioactive tracers bonded m, detailed/c tracers
to an isotope to see functionali lear as
interaction with specific ty (e.g. MRI or
proteins/sugars in the tumours). CT.
body. The isotope Function
produces positrons which al
interact with surrounding informati
electrons, by speeding in on
opposite directions. This is
used by the PET scan to
make an image of the
distribution of the tracer in
the body. When a tissue
, absorbs a lot of glucose
(tracer FDG) it may
indicate a cancerous
tumour.
MRI 60% of our body is H2O. Best for ++ Risk free. 30 min
(magnetic The 2xH of H2O functions soft tissue Radio
resonanc as tiny magnets. A big (brain, waves and
e magnet forms a magnetic organs, magnetic
imaging) field around the patient by tumours). field
revolving around them.
The gradient defines the
magnetic field to isolate
specific body parts. Most
H2O move along with the
magnetic field, but the low-
energy water molecules do
not. By sending radio
waves the low-energy
water molecules absorb
the energy they need so
they can move along with
the magnetic field. When
the radio waves stop, the
low-energy molecules
release the energy and go
back to their position. This
is picked up by the MRI
and sent to a computer
that translates it into an
image.
Ultrasou Sound is created when Boundarie + No risk. Minutes
nd molecules vibrate in a s of Also
pulsing wave. The distance different during
between each wave pregnancy.
tissues
determines the frequency
(cycles per second or and
hertz). Over the same organs.
timespan, a high frequency Fluids
wave has more cycles than show
a low frequency wave. black and
Very high frequency waves bones
are used in ultrasound.
show
They penetrate soft tissue,
and bounce back from white.
dense tissues. This
bouncing visualises
detailed imaging.
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