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Summary - General Medicine (HNH27806)
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General Medicine summaryExamination and diagnostics
Videos
MRI (magnetic resonance imaging): used to examine the soft tissues. The machine uses magnets,
radio waves, a gradient, and a computer to compose images. Water in the body is magnetic, due to
small parts of the hydrogen atoms. Steps:
1. A big magnet is used to create a magnetic field around the patient.
2. The gradient adjusts the magnetic field into smaller sections of different magnetic strengths
to isolate specific body parts.
3. Once inside a magnetic field, the water molecules move in the same frequency as the
magnetic field (normally, they move randomly). The ones that do not move along with the
magnetic field, are the low energy water molecules.
4. Radio waves move at the same frequency as the magnetic field. The low energy water
molecules can absorb the energy from radio waves to move along with the magnetic field
frequency.
5. If radio waves are stopped, the low energy water molecules release the absorbed energy and
go back to their original state.
6. This movement is detected by the MRI machine and the signal is sent to a computer, that
uses imaging software to translate the information into an image of the body.
Ultrasound: sound is created when molecules in the air, water, or another medium vibrate in a
pulsing wave. The distance between each wave determines the frequency (in Hertz). Ultrasound uses
waves with a high frequency. Ultrasound waves can be used for detection (for example as a sonar in
WW1).
Ultrasound in medicine is used to detect organ damage, measure tissue thickness, to detect gall
stones, tumours, and blood clots and to visualize a foetus. First, the skin is covered with a conductive
gel, since sound waves lose speed and clarity when moving through air. The gel produces a barrier
between the body and the device sending the ultrasound waves. The ultrasound waves move easily
through liquids in the body (for example urine), but when it detects a solid mass, the wave beams
back. This beaming back of the wave is seen as a dot on the imaging screen. Objects like bones
produce the most dots. Multiple frequencies are often used together, as lower frequency waves move
further through the tissues. Different frequencies can create an image.
Ultrasound has no negative side-effects. Modern ultrasound machines are also portable.
PET scan: radioactive tracers are used to create 3D images of the body. The radioactive tracers are
usually intravenously administered to a patient. The tracers are made of a carrier molecule that is
tightly bound to a radioactive molecule: the isotope. The carrier molecule can interact with specific
proteins/sugar molecules in the body. The used carrier molecule depends on what the doctor wants
to detect. A modified form of glucose is used to determine if a patient has cancer. When tissues
absorb a lot of glucose, it may indicate a cancerous tumour. The isotope produce small particles,
called the positrons, which can interact with surrounding electrons. This interaction results in the
release of two photons (in opposite directions). The detectors in a PET scanner measure these
photons to create an image of carrier molecule distribution in the body.
, Book
Forming a diagnosis is a complex
process, which always starts with
taking a history. History: up to 80%
of the diagnosis can be made based
on history. History involves talking
about the complaint (time
course/severity), past medical
information (including family
history), medication use (including
drug allergies) and life style habits.
Golden minute: in the beginning of an appointment, where the patient should tell their story for 1
minute without interruption, so they won’t forget key details. If the drug history is not recorded
correctly, medication error can occur, which is a common cause of morbidity and mortality.
Establishing social history is done to determine if there are environmental factors and to determine
the patient’s life style.
Physical examination: the next step. This includes objective observations to confirm of refute the
initial diagnosis made from the history. The examination will also include some formal observations,
such as blood pressure, heart rate, oxygen saturation, respiratory rate, level of consciousness,
capillary blood glucose, and temperature. Examination includes inspection (eyes), auscultation (what
you hear), percussion (tapping abdomen or chest), and palpation (feeling for lumps).
Further tests (=investigation): include imaging and invasive procedures, such as endoscopy or
angiography. For this, you should consider the risks for the patient and the level of certainty you want
to achieve.
‘Hello, my name is..’ campaign: a campaign focused on personal introduction of every medical
specialist/staff members, to help the patient understand where in the busy trajectory they are and
what is going to happen. Introductions can also build trust between a person who is vulnerable and
suffering and a person who wishes to help.
Causes of death can be grouped into three categories: communicable (infectious and parasitic
diseases and maternal, perinatal and nutritional conditions), noncommunicable (chronic) disease and
injuries. The contribution of these categories to mortality is different between low-income and high-
income populations. In low-income countries, more people die from communicable deaths. All
noncommunicable diseases account for 74% of deaths globally.
WHO health definition: a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. Changed because the word ‘complete’ suggests that most people are
unhealthy most of the time (over-medicalisation) and because the number of people with chronic
diseases is increasing. They should not be considered ill.
New definition: the ability to adapt and self-manage in the face of social, physical, and emotional
challenges.
Highly sensitive test: will identify a high proportion of patients with a given disease (true positives).
Highly specific test: will identify a high proportion of this who do not have a disease (true negatives).
Cancer
Videos
Cancer is the growth of cells resulting in a malignant tumour with the ability to metastasise. Mutation
in DNA (either inherited or acquired during life) and clonal selection, based on growth advantages,
has to occur before cancer occurs.
, Each year, 14.1 million people are diagnosed with cancer (=cancer incidence). The most occurring
type of cancer is lung cancer, followed by breast cancer, colorectal cancer, prostate cancer, and
stomach cancer. About 8 million people die from cancer each year (=13% of the worldwide deaths).
Most people die from lung, stomach, and liver cancer.
Cancer prevalence: the number of people who had cancer diagnosed in the previous 5 years (32.6
million). Most of them had breast, colorectal, and prostate cancer.
There is a rise in cancer incidence due to population growth, an increasing age, and an increase in
screening methods (there is also an increase in less-developed countries). Screening is based on age
and risk factors. Cancer risk factors:
Age: accumulation of (epi)genetic mutations over time, causing a cancer to grow. This growth
may taken over 30 to 40 years.
Genetics: 5 to 10% of the cancers is inherited.
Smoking
Unhealthy diet and inactivity: overweight increases the cancer risk. A low intake of
vegetables, fruits, and cereals and a high intake of red meat also increases the risk of cancer.
Finally, the intake of energy-dense foods increases the risk of cancer.
Occupation
Pollution
Chronic infection: particularly in low and middle income countries. This includes HPV,
hepatitis B and D, and Epstein-Barr virus.
Hormones: including age at which you get your first child and the number of children you get.
Cancer is a multifactorial disease, based on genetic susceptibility,
lifestyle, and bad luck. The occurrence of cancer is also based on
where you live. In Japan, the incidence of colorectal cancer is low,
but in the USA, the incidence is
high. When Japanese moved
to Hawaii, the also had a high
colorectal cancer incidence. The opposite occurred for stomach
cancer. This was due to adaptation because of life style and diet.
We could prevent about 25% of the occurring cancers only based
on the foods we eat and the amount of physical activity we do.
Breast cancer can also occur in males. The majority of the people with breast cancer are, however,
women (99.2%). The highest incidence of breast cancer is between the age of 50 and 70.
Risk factors:
Oestrogen exposure: including early menarche (first menstruation), late menopause, later
age of pregnancy, no pregnancy, and hormone replacement therapy.
Hereditary syndromes: such as a BRCA gene mutation
The breast consist of mammary glands, surrounded by
connective tissue and fat. The nipple is surrounded by a dark
region, known as the areola. Most types of breast cancer are
adenocarcinomas, cancers occurring in the epithelial tissue of
the secretory lobules (produce milk) and ducts (transports
milk). The lobules and ducts are part of the mammary glands.
Mammograms aim to detect cancers in the breast. A
mammogram uses X-ray radiography.
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