Summary Class notes - General Medicine

Course
- General Medicine
- Nicole de Roos
- 2020 - 2021
- Wageningen University (Wageningen University, Wageningen)
- Voeding en Gezondheid
414 Flashcards & Notes
1 Students
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Summary - Class notes - General Medicine

  • 1613343600 Examination and diagnosis

  • What is the current definition of health (and who made it)
    The ability to adapt and self manage in the face of social, physical, and emotional challenges (BMJ, 2011)
  • How does the current definition of health differ from the 1946-definition of health by the WHO?
    Acceptance that health is not static

    Definition: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1946)

    Differ: The Who definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease. Machteld Huber and colleageus propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical and emotional challenges.
  • What are the most common reasons for GP visits?
    1. Hypertension
    2. Urinary tract infections
    3. Diabetes
    4. Coughing
    5. Fatigue
    6. Acute upper airway infections
  • The GP is part of primary care
  • What does the acronym ICE stand for?


    As a doctor, you ask about the Ideas, Concerns, and
    Expectations of the patient (and share your own)


    Idea
    Concerns Expectations

    Voorbeeld met jongetje met leukemie, dokter maakt zich zorgen over het process en de chemo etc maar het jongetje maakt zich zorgen over of hij nog wel kan zwemmen in de zomer en lekker naar het strand kan gaan. Door naar ICE te vragen kun je meer betekenen voor de patiënt.
  • Which 3 steps are made in the diagnostic process?
    1. History/Anamnesis - everything the patient can tell you (GP)
      1. Duration of complaints, severity, smoking habits, occupation, medication use, living situation, height and weight (best to measure these)
    2. Examination - what you can see, hear, feel, smell (GP)
      1. Inspection - kijken 
        1. is the patient pale or feverish, can you see discolouration of the skin, problems with posture, tremors
      2. Auscultation - horen
        1. heart sounds, breathing sounds, gurgling sounds
      3. Percussion - kloppen + luisteren naar de geluiden
        1. tapping the abdomen or chest
      4. Palpation - voelen en soms druk uitoefenen 
        1. feel for lumps, firmness, nodules
    3. Investigation - imaging or sampling (hospital)
      1. imaging techniques, blood sampling, urine sampling, spirometry (lung function) etc. 
  • Where do you need to think about when taking the anamnesis?
    • Duration and severity of symptoms
    • Localisation of pain, situation 
    • Family history, smoking, occupation 
    • Medication 
    • Past medical history 
  • What is the mechanics of patient history?
    • Chief complaint 
    • History of present illness
    • Past medical history 
    • Medications & allergies
    • Family history 
    • Social history 
  • 3 strategies to taking a good patient history
    1. Listen well and empathise 
      1. listen with your whole body 
      2. keep questions to a minimum 
    2. Summarize 
      1. go over data with the patient 
    3. ICE
      1. ideas
      2. concerns 
      3. expectations
  • Out of which parts does a physical examination consists
    • Inspection
      • kijken 
    • Auscultation
      • luisteren 
    • Percussion
      • tapping on the patient and listening to the sounds 
    • Palpation
      • voelen 
  • What can be further investigations after taking a GP (usually in hospital setting)
    • Laboratory (blood, urine)
    • Tissue biopsy 
    • Imaging techniques
      • X-ray or CT-scan 
      • PET scan 
      • MRI 
    • Spirometry 
    • ECG
  • X-rays
    • Principle
    • Used for imaging what?
    • Resolution ( + or +/- or -)
    • Risk (+ or -)
    • Electromagnetic radiation; dense areas or high atomic numbers show white. 2D image
    • fractures (bone), soft tissue, organs 
    • + (bone) - (soft tissue)
    • +/- (radiation)
  • CT-scan
    • Principle
    • Used for imaging what?
    • Resolution ( + or +/- or -)
    • Risk (+ or -)
    • Multiple x-rays divide patient in 'coupes' --> 3D image
    • organs, bone 
    • + (bone) - (soft tissue)
    • +/- (radiation)
  • PET-scan
    • Principle
    • Used for imaging what?
    • Resolution ( + or +/- or -)
    • Risk (+ or -)
    • Radioactive contrast material ('tracer') is infused
    • function at a cellular level (blood flow, oxygen use, glucose use)
    • + (radiation)
  • MRI
    • Principle
    • Used for imaging what?
    • Resolution ( + or +/- or -)
    • Risk (+ or -)
    • Magnets produce strong magnetic field that forces protons in the body (e.g. In water) to align with that field. When a radiowave is then pulsed through the patient, the protons spin out of equilibrium, which is visible on screen. Dense areas show darl. 3D image 
    • soft tissue (organs)
    •      .
    • -
  • Ultrasound 
    • Principle
    • Used for imaging what?
    • Resolution ( + or +/- or -)
    • Risk (+ or -)
    • Ultrasound waves (2 to approximately 15 MHz) propagate through different tissues, and then return to the transducer as reflected echoes. Ultrasound waves are reflected at the surfaces between the tissue of different density. 2D image
    • organs, blood vessels, fetus 
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After bariatric surgery, patients may experience dumping syndrome. What is this?Weakness, dizziness, and diarrhea after a mealVomiting within 10-30 minutes after a mealFatty stools (steatorrhoea) due to impaired fat absorptionDelayed emptying of the gastric pouch after a meal

  1. Weakness, dizziness, and diarrhea after a meal
Which nutrient deficiency is most likely after a gastric bypass procedure?Vitamin B12 deficiencyFolate deficiencyVitamin C deficiencyMagnesium deficiency

  1. Vitamin B12 deficiency
John is a 30-year old man with a BMI of 38 kg/m2. He has been overweight since he was a child and has tried several weight-loss diets which were not effective. Would he be eligible for bariatric surgery?Yes, if the weight-loss diets were under the supervision of a dietitianYes, if he has comorbidities such as type 2 diabetesNo, he is too young for bariatric surgeryNo, because it is unlikely he will be able to stick to a diet after his surgery

  1. Yes, if he has comorbidities such as type 2 diabetes
Which of the following statements about bariatric surgery is false?It is the most effective long-term therapy for treating obesityIt is sometimes called metabolic surgery as it improves insulin metabolismIs more effective in men than in womenIs recommended for obese people with a BMI of at least 40 kg/m2

  1. Is more effective in men than in women
Which of the following conditions is not a typical consequence of obesity?HypertensionType 1 diabetes mellitusHeart failureObstructive sleep apnoea

  1. Type 1 diabetes mellitus
What can be a comorbidity of obesity?Reflux diseaseOsteoporosisLumbagoHyperventilation

  1. Reflux disease
The most common cause for obesity isOvereating and a sedentary lifestyleGeneticsMedicationMetabolic disease

  1. Overeating and a sedentary lifestyle
Headache, stiff neck, vomiting and fever could be signs of...Subarachnoid bleedingAutonomic neuropathyMeningitisTinnitus
  1. Meningitis
Paralysis of the right arm and leg indicates problems in theleft brain hemisphereright brain hemispherespinal cordbrain stem

  1. left brain hemisphere
Which terms are used to distinguish between different types of strokes?Haemorrhagic and ischaemic strokeVascular and neurological strokeCentral and peripheral strokeType I and type II stroke

  1. Haemorrhagic and ischaemic stroke