Samenvatting - 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 
  • - 
  • -