Table of Contents
Health, patient history, examination and diagnostics ........................................................ 2
Cancer .............................................................................................................................. 5
Neurology ...................................................................................................................... 13
Tropical medicine ........................................................................................................... 22
Malaria ........................................................................................................................................................ 24
Tuberculosis ................................................................................................................................................ 25
HIV and AIDS ............................................................................................................................................... 27
Cardiovascular diseases .................................................................................................. 34
Risk factors .................................................................................................................................................. 35
Atherosclerosis ............................................................................................................................................ 35
Hypertension ............................................................................................................................................... 38
Trombosis .................................................................................................................................................... 41
Pulmonary embolism .................................................................................................................................. 42
Heart failure ................................................................................................................................................ 42
Symptoms ................................................................................................................................................... 52
Insulin .......................................................................................................................................................... 52
Risk factors .................................................................................................................................................. 53
Complications .............................................................................................................................................. 54
Diagnosis and treatment ............................................................................................................................. 54
Learning outcomes: ..................................................................................................................................... 55
Obesity ........................................................................................................................... 56
Assessment of obesity................................................................................................................................. 56
Obesity in children ...................................................................................................................................... 57
Common health consequences ................................................................................................................... 57
Learning outcomes ...................................................................................................................................... 58
Treatment of obesity: bariatric surgery ...................................................................................................... 59
Respiratory disease ........................................................................................................ 61
Smoking and asbestos: causes of respiratory diseases ............................................................................... 63
COPD ........................................................................................................................................................... 64
Asthma ........................................................................................................................................................ 65
Pneumonia .................................................................................................................................................. 67
Gastrointestinal (GI) diseases ......................................................................................... 74
Coeliac disease ............................................................................................................................................ 75
Inflammatory Bowel Disease (IBD): Crohn’s Disease (CD) and Ulcerative colitis (UC) ................................ 76
Irritable bowel syndrome (IBS) ................................................................................................................... 79
Diarrhoeal disease....................................................................................................................................... 81
,Health, patient history, examination and diagnostics
Health
The WHO definition of health, formulated in 1948, describes health as “a state of complete
physical, mental and social well-being and not merely the absence of disease or infirmity.”
At that time this formulation was ground-breaking because of its breadth and ambition. It
overcame the negative definition of health as “absence of disease” and included the
physical, mental, and social domains.
The definition is no longer fitting given to rise of chronic disease. The first problem is that it
unintentionally contributes to the medicalization of society. Because of the absoluteness of
the word complete in relation to well-being. Meaning most people are unhealthy most of
the time, which would contribute to over-medicalisation. Second problem is that the
demography of populations and the nature of disease have changed considerably. The
definition becomes counterproductive as it declares people with chronic diseases and
disabilities definitively ill. The number of people living with a chronic disease is increasing.
New definition: the ability to adapt and self-manage in the face of social, physical, and
emotional changes (2011).
Causes of death can be grouped into three categories: communicable (infectious and
parasitic diseases and maternal, perinatal and nutritional conditions), noncommunicable
(chronic) and injuries. The contribution of these categories to mortality is different between
low-income and high- income populations.
7 of 10 leading causes of deaths in 2019 were non-communicable. All noncommunicable
diseases together accounted for 74% of deaths globally in 2019. Leading causes are ischemic
heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections,
neonatal conditions, lung cancers, Alzheimer’s disease, diarrheal diseases, diabetes, and
kidney diseases. Are communicable. Diabetes and kidney disease are increasing rapidly.
All communicable diseases have been declining since 2000.
Low-income group
There is a large variation depending on income. They are more likely to die of a
communicable disease than a noncommunicable disease. In high-income group there have
been decreasing numbers of deaths for heart disease and stroke but are still in the top 3.
Facts about the GP (general practitioner) practice in the Netherlands
A GP is a healthcare specialist. He or she has received 3 years of specialist training after a
general 6- year medical education. The GP is part of primary care. In the Netherlands, the
three most common conditions in the GP practice are hypertension, urinary tract infections,
and diabetes. About 75% of all registered patients visits their GP at least once a year. You
cannot visit a medical specialist in the hospital without a referral from your GP. The GP may
prescribe medication but often use the wait- and-see approach.
,In the Netherlands, doctors are less likely to prescribe antibiotics and other medication
compared to other countries, because it does not work for all infections. It works with
infections caused by bacteria; they do not work against infections caused by viruses. So, a
doctor won’t prescribe antibiotics for a common cold or flu (caused by a virus).
78% of registered patients visited the GP in 2019. Average visits are 5. Most common
reasons for GP to visit are hypertension, urinary tract infections, diabetes, coughing, fatigue,
and acute upper airway infections.
The diagnostic process
History (anamnesis): duration of complaints, severity, smoking habits, occupation,
medication use, living situation, height, and weight
Ideally, GPs should also ask their patient about their Ideas, Concerns, and Expectations
(acronym ICE). You should listen well and empathize, keep questions to a minimum.
Summarize and ICE (ideas, concerns, and expectations).
Diagnostic process in four steps:
Examination
1. Inspection (use your eyes): is the patient pale or feverish, can you see discoloration
of the skin, problems with posture, tremors.
2. Auscultation (what can you hear): heart sounds, breathing sounds, gurgling sounds
3. Percussion (use your hands): tapping the abdomen or chest
4. Palpation (feel): feel for lumps, firmness, nodules
Further investigation can be laboratory (blood, urine), tissue biopsy, spirometry (lung
function), ECG and imaging techniques. Urine sampling for glucose, protein, and infections.
Blood is used for glucose, blood lipids and inflammation markers.
A highly sensitive test will correctly identify a high proportion of patients with a given
disease (true positives). A highly specific test will correctly identify a high proportion of
those who do not have the disease (true negatives).
Imaging techniques
Medical imaging is the technique of producing visual representations of areas inside the
human body to diagnose medical problems and monitor treatment. It is important to know
which types are useful for imaging bones, soft tissues, and metabolic activity.
, Radiography
Radiography means the use of ionizing radiation to produce an image of the body. The most
common type are x-rays. X-rays and other radiography use high energy beams. Some tissues
absorb the high energy beams (e.g. the bones) while others don't (soft tissues). The
structures that absorb the high energy beams will appear in white on an x-ray and the other
ones will appear to be black.
Another common type of radiography is the CT scan, or computed tomography scan. This is
when several cross-sectional images are taken to create a more 3-D view of the body parts
being viewed.
MRI
MRI stands for magnetic resonance imaging. This technology uses magnets and radio waves
to produce an image of the soft tissues of the body. An MRI machine sends an electric
current through the body temporarily. After the electric current is sent through the body,
then radio waves are sent through the body and received back in the machine to help create
the digital images of the soft tissues. The MRI machine causes movement of protons in the
body. They align themselves when the magnetic field is applied, then the protons move back
to their original position after the magnetic field is turned off and the radio waves are sent
through the body. The image is produced from the position of the protons after the
transmission of radio waves through the body. An example of using an MRI is looking for
tumors or other foreign tissue in the brain. MRI does not use radiation.
Ultrasound
Ultrasounds use a machine that sends sound waves through a part of the body to produce
an image. The high energy sound waves are sent through the body where they will bounce
off surfaces to create an image of the structure. Ultrasounds can be used to view all types of
tissues in the body. Hard tissues and soft tissues alike can be viewed using an ultrasound
machine. An ultrasound can be used to diagnose diseases, but also monitor a fetus during
fetal development, viewing blood flow through the body, and viewing the movements of the
heart. Ultrasound does not use radiation.
PET-scans
A positron emission tomography (PET) scan is an imaging test that can help reveal the
metabolic or biochemical function of tissues and organs. The PET scan uses a radioactive
drug called a tracer to show both typical and atypical metabolic activity. A PET scan can
often detect the atypical metabolism of the tracer in diseases before the disease shows up
on other imaging tests, such as computerized tomography (CT) and magnetic resonance
imaging (MRI). Thus, it can be used in early diagnostics. The tracer is most often injected
into a vein of the hand or arm. The tracer will then collect into areas of the body that have
higher levels of metabolic or biochemical activity. This often pinpoints the location of the
disease. Nuclear medicine = tracers.
Health, patient history, examination and diagnostics ........................................................ 2
Cancer .............................................................................................................................. 5
Neurology ...................................................................................................................... 13
Tropical medicine ........................................................................................................... 22
Malaria ........................................................................................................................................................ 24
Tuberculosis ................................................................................................................................................ 25
HIV and AIDS ............................................................................................................................................... 27
Cardiovascular diseases .................................................................................................. 34
Risk factors .................................................................................................................................................. 35
Atherosclerosis ............................................................................................................................................ 35
Hypertension ............................................................................................................................................... 38
Trombosis .................................................................................................................................................... 41
Pulmonary embolism .................................................................................................................................. 42
Heart failure ................................................................................................................................................ 42
Symptoms ................................................................................................................................................... 52
Insulin .......................................................................................................................................................... 52
Risk factors .................................................................................................................................................. 53
Complications .............................................................................................................................................. 54
Diagnosis and treatment ............................................................................................................................. 54
Learning outcomes: ..................................................................................................................................... 55
Obesity ........................................................................................................................... 56
Assessment of obesity................................................................................................................................. 56
Obesity in children ...................................................................................................................................... 57
Common health consequences ................................................................................................................... 57
Learning outcomes ...................................................................................................................................... 58
Treatment of obesity: bariatric surgery ...................................................................................................... 59
Respiratory disease ........................................................................................................ 61
Smoking and asbestos: causes of respiratory diseases ............................................................................... 63
COPD ........................................................................................................................................................... 64
Asthma ........................................................................................................................................................ 65
Pneumonia .................................................................................................................................................. 67
Gastrointestinal (GI) diseases ......................................................................................... 74
Coeliac disease ............................................................................................................................................ 75
Inflammatory Bowel Disease (IBD): Crohn’s Disease (CD) and Ulcerative colitis (UC) ................................ 76
Irritable bowel syndrome (IBS) ................................................................................................................... 79
Diarrhoeal disease....................................................................................................................................... 81
,Health, patient history, examination and diagnostics
Health
The WHO definition of health, formulated in 1948, describes health as “a state of complete
physical, mental and social well-being and not merely the absence of disease or infirmity.”
At that time this formulation was ground-breaking because of its breadth and ambition. It
overcame the negative definition of health as “absence of disease” and included the
physical, mental, and social domains.
The definition is no longer fitting given to rise of chronic disease. The first problem is that it
unintentionally contributes to the medicalization of society. Because of the absoluteness of
the word complete in relation to well-being. Meaning most people are unhealthy most of
the time, which would contribute to over-medicalisation. Second problem is that the
demography of populations and the nature of disease have changed considerably. The
definition becomes counterproductive as it declares people with chronic diseases and
disabilities definitively ill. The number of people living with a chronic disease is increasing.
New definition: the ability to adapt and self-manage in the face of social, physical, and
emotional changes (2011).
Causes of death can be grouped into three categories: communicable (infectious and
parasitic diseases and maternal, perinatal and nutritional conditions), noncommunicable
(chronic) and injuries. The contribution of these categories to mortality is different between
low-income and high- income populations.
7 of 10 leading causes of deaths in 2019 were non-communicable. All noncommunicable
diseases together accounted for 74% of deaths globally in 2019. Leading causes are ischemic
heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections,
neonatal conditions, lung cancers, Alzheimer’s disease, diarrheal diseases, diabetes, and
kidney diseases. Are communicable. Diabetes and kidney disease are increasing rapidly.
All communicable diseases have been declining since 2000.
Low-income group
There is a large variation depending on income. They are more likely to die of a
communicable disease than a noncommunicable disease. In high-income group there have
been decreasing numbers of deaths for heart disease and stroke but are still in the top 3.
Facts about the GP (general practitioner) practice in the Netherlands
A GP is a healthcare specialist. He or she has received 3 years of specialist training after a
general 6- year medical education. The GP is part of primary care. In the Netherlands, the
three most common conditions in the GP practice are hypertension, urinary tract infections,
and diabetes. About 75% of all registered patients visits their GP at least once a year. You
cannot visit a medical specialist in the hospital without a referral from your GP. The GP may
prescribe medication but often use the wait- and-see approach.
,In the Netherlands, doctors are less likely to prescribe antibiotics and other medication
compared to other countries, because it does not work for all infections. It works with
infections caused by bacteria; they do not work against infections caused by viruses. So, a
doctor won’t prescribe antibiotics for a common cold or flu (caused by a virus).
78% of registered patients visited the GP in 2019. Average visits are 5. Most common
reasons for GP to visit are hypertension, urinary tract infections, diabetes, coughing, fatigue,
and acute upper airway infections.
The diagnostic process
History (anamnesis): duration of complaints, severity, smoking habits, occupation,
medication use, living situation, height, and weight
Ideally, GPs should also ask their patient about their Ideas, Concerns, and Expectations
(acronym ICE). You should listen well and empathize, keep questions to a minimum.
Summarize and ICE (ideas, concerns, and expectations).
Diagnostic process in four steps:
Examination
1. Inspection (use your eyes): is the patient pale or feverish, can you see discoloration
of the skin, problems with posture, tremors.
2. Auscultation (what can you hear): heart sounds, breathing sounds, gurgling sounds
3. Percussion (use your hands): tapping the abdomen or chest
4. Palpation (feel): feel for lumps, firmness, nodules
Further investigation can be laboratory (blood, urine), tissue biopsy, spirometry (lung
function), ECG and imaging techniques. Urine sampling for glucose, protein, and infections.
Blood is used for glucose, blood lipids and inflammation markers.
A highly sensitive test will correctly identify a high proportion of patients with a given
disease (true positives). A highly specific test will correctly identify a high proportion of
those who do not have the disease (true negatives).
Imaging techniques
Medical imaging is the technique of producing visual representations of areas inside the
human body to diagnose medical problems and monitor treatment. It is important to know
which types are useful for imaging bones, soft tissues, and metabolic activity.
, Radiography
Radiography means the use of ionizing radiation to produce an image of the body. The most
common type are x-rays. X-rays and other radiography use high energy beams. Some tissues
absorb the high energy beams (e.g. the bones) while others don't (soft tissues). The
structures that absorb the high energy beams will appear in white on an x-ray and the other
ones will appear to be black.
Another common type of radiography is the CT scan, or computed tomography scan. This is
when several cross-sectional images are taken to create a more 3-D view of the body parts
being viewed.
MRI
MRI stands for magnetic resonance imaging. This technology uses magnets and radio waves
to produce an image of the soft tissues of the body. An MRI machine sends an electric
current through the body temporarily. After the electric current is sent through the body,
then radio waves are sent through the body and received back in the machine to help create
the digital images of the soft tissues. The MRI machine causes movement of protons in the
body. They align themselves when the magnetic field is applied, then the protons move back
to their original position after the magnetic field is turned off and the radio waves are sent
through the body. The image is produced from the position of the protons after the
transmission of radio waves through the body. An example of using an MRI is looking for
tumors or other foreign tissue in the brain. MRI does not use radiation.
Ultrasound
Ultrasounds use a machine that sends sound waves through a part of the body to produce
an image. The high energy sound waves are sent through the body where they will bounce
off surfaces to create an image of the structure. Ultrasounds can be used to view all types of
tissues in the body. Hard tissues and soft tissues alike can be viewed using an ultrasound
machine. An ultrasound can be used to diagnose diseases, but also monitor a fetus during
fetal development, viewing blood flow through the body, and viewing the movements of the
heart. Ultrasound does not use radiation.
PET-scans
A positron emission tomography (PET) scan is an imaging test that can help reveal the
metabolic or biochemical function of tissues and organs. The PET scan uses a radioactive
drug called a tracer to show both typical and atypical metabolic activity. A PET scan can
often detect the atypical metabolism of the tracer in diseases before the disease shows up
on other imaging tests, such as computerized tomography (CT) and magnetic resonance
imaging (MRI). Thus, it can be used in early diagnostics. The tracer is most often injected
into a vein of the hand or arm. The tracer will then collect into areas of the body that have
higher levels of metabolic or biochemical activity. This often pinpoints the location of the
disease. Nuclear medicine = tracers.
