Summary of all the material of General Medicine

Respiratory Tract Diseases
COPD (Chronic Obstructive Pulmonary Disease):
Causes: long term exposure to toxic particles and smoking
Symptoms:
- Breathlessness = dyspnoe
- Productive coughing
- Fatigue
Findings on examination:
- Dyspnoe
- Wheeze
- Decreased breath sounds
Investigations:
- Spirometry (decreased Forced Expiratory Volume 1 (FEV1))
- Blood gasses (decreased O2, increased CO2)
- X-ray (enlarged lung volume, low flattened diaphragm)

Upper Respiratory tract Infection (URI) common cold, hay fever, sinusitis, etc.
Causes: virusses (rhinovirus!), bacteria or fungi
Symptoms:
 Cough/Sneezing
 Sore throat
 Runny nose
 Headache
Findings on examination:
 Symptoms which lead to the diagnosis (investigations often not necessary).
Investigations:
 Hay fever: skin prick test or measuring of IgE antibodies
 Blood test for virus, bactium or fungus

Pneumonia
Causes: virusses, bacteria or fungi
Symptoms:
 Cough
 Fever
 Chest pain
 Breathlessness
Findings on examination:
 Rapid breathing
 Increased temperature
 Changed skin colour (due to lack of oxygen)
Investigations:
 X-ray (white areas)
 Blood test (WBC high)
 Bronchoscopy

,Pulmonary Embolism
Causes: often a deep venous thrombosis (DVT) in the leg
Symptoms:
 Breathlessness
 Chest pain
 Coughing (with blood = hemoptysis)
Findings on examination:
 Rapid breathing
 Arrhythmia
 Cyanosis, increased heart rate, sweating  collapse
 (Swollen, painful, red, warm leg in case of DVT)
Investigations:
 Ventilation/perfusion scan, VQ scan (to localize)
 Pulmonary angiography (look for blood cloth)
 CT-scan (look for blood cloth)
 Blood test (high D-dimer)
 ECG (dysfunction of the right side of the heart)

Pneumothorax
Causes: COPD, asthma, cyctic fibrosis, lung infections, lung cancer, trauma to chest/lung
Symptoms:
 Unilateral chest pain
 (increasing) dyspnoe (leading to severe oxygen shortage and cardiac arrest)
Findings on examination:
 Breathlessness
 Pale
 Tachycardia
Investigations:
 X-ray (black lung)
 CT-scan
 Ultrasound

Asthma
Causes: allergens (e.g. dust), chemicals, drugs, etc.
Symptoms:
 Wheezing attacks of shortness of breath
 Cough
 Chest tightness
Findings on examination:
 Decreased breathing sounds
 Wheezing
 Eczema
Investigations:
 Spirometry
 Skin test for allergies
 Blood gasses (decreased O2, increased CO2)

, Gastrointestinal Diseases
Cystitis (inflammation of the bladder)
Causes: bacteria (E. coli!), virusses, fungi, chemotherapy/radiotherapy
Symptoms:
 Painful voiding
 Frequent urination
 Heamaturia
 Abdominal pain
Findings on examination:
 Constant urination impulse
 Smelly urine (with blood)
 Increased temperature
Investigations:
 Urine culture
 Cytoscopy (+ biopsy to look for inflammation)
 Less common: imaging with X-ray/CT/Ultrasound/MRI

Cholelithiasis = gallstones, mostly in gallbladder
Causes: Obesity, fat diet, diabetes mellitus,
Symptoms:
 Abdominal colic pain
 Nausea and vomiting
 Dark urine and clay-colored stools (when stones block the billary tract)
Findings on examination:
 Right upper quadrant abdominal tenderness
 Jaundice (when stones block the billary tract)
 Increased temperarture (when stones block the billary tract)
Investigations:
 Blood tests (inflammatory markers  cholecystitis?)
 ERCP (Endoscopic Retrograde CholangioPancreaticography) to localize and remove
 CT-scan

Cholecystitis (inflammation of the gallbladder)
Causes: cholelithiasis  stasis of the gall  infection by E.coli
Symptoms:
 Severe pain in the right upper quadrant of the abdomen or in the epigastric region
 Nausea (with vomiting)
 Diarrhea
Findings on examination:
 Emphyema (extended gallbladder by pus)
 Increased temperature
 Jaundice (normally not in cholecystitis, so this indicates complications!)
Investigations:
 X-ray (to look for gallstones and inflammation)
 Ultrasound (to look for gallstones and inflammation)
 Blood test (to look for inflammatory markers)