General medicine
Topic 1: Examination and diagnostics
Current definition of health
The ability to adapt and self-manage in the face of social, physical and, emotional
challenges
Most important causes of death, and disparities between low- and high
income
Noncommunicable diseases cause 74% of deaths > CVD, stroke, lower
respiratory infections
Low-income: more communicable diseases
Know which diseases are on the rise and declining
Diabetes and CKD are rising, neonatal conditions, diarrheal diseases and lower
respiratory tract infections are decreasing
Role of GP in the Netherlands
Primary care; hypertension, UTI, diabetes. Need referral from GP to see medical
specialist. May prescribe medication but often wait and see
Four steps of diagnostic process
1. Anamnesis (history)
2. Examination
a. Inspection
b. Auscultation (what you hear)
c. Percussion (use your hands)
d. Palpation (feel)
3. Investigation (Imaging techniques, blood sampling, urine, spirometry)
4. Arrive at diagnosis
Describe sensitivity vs specificity
Sensitivity: correctly identify a high proportion of patients (true positives)
Specificity: correctly identify a high proportion of patients who do not have the
disease (true -)
Main types of imaging techniques and their use
1. Radiography: radiation > some tissues absorb, other don’t, tissues that
absorb will show, X-ray, CT-scan
2. MRI: magnets and radio waves to show soft tissues, movement of protons
> tumours
3. Ultrasound: sound waves, hard and soft tissues
4. PET scan: radioactive drug as tracer, shows typical and atypical metabolic
activity used in early diagnostics. Image through detection of photons
Topic 2: CVD:
Name 4 risk factors for CVD
, Unhealthy diet, physical inactivity, smoking and alcohol abuse
Explain how CVD can be prevented
Keep healthy weight, stay active
Explain arteriosclerosis, atherosclerosis and, arteriolosclerosis
Arteriosclerosis: thickening and hardening of arterial walls (not due to plaques)
Atherosclerosis: plaque buildup
Arteriolosclerosis: hardening of small vessels due to hypertension and diabetes
Process of atherosclerosis
1. Damaged endothelium > dysfunction
2. Oxidized lipoproteins accumulate in the vessel wall > taken up by
macrophages > foam cells
3. Fatty streaks > plaques (soft interior + fibrous caps: can rupture>
thrombosis)
Difference between LDL and HDL cholesterol
LDL: carrier in plasma, can accumulate into plaques, statins lower LDL levels
HDL: reverse cholesterol transport
Similarities and differences between angina and myocardial infarction
MI: coronary arteries blocked, part of the heart can die off
A: MI but mild, only when active, no permanent damage to the heart
Both: chest pain, not enough oxygen in muscles
Congenital heart disease: birth defects
Definition of thrombosis
Formation of blood clot deep in the body
Virchow’s triad (risk for thrombosis)
Stasis of flow, hypercoagulation, vessel wall damage, symptoms: pain and
oedema
Difference between thrombus and embolus
Thrombus is a stationary blood clot, embolus is a blood clot that travels
Deep vein thrombosis with pulmonary embolism
Blood clot gets loose and sits in pulmonary artery > difficulty breathing and
increased heart rate
2 reasons why pregnancy may lead to thrombosis
1. Stasis of flow due to pressure on interior vena cava
2. Increase in clotting factors during pregnancy
Angiogram
Topic 1: Examination and diagnostics
Current definition of health
The ability to adapt and self-manage in the face of social, physical and, emotional
challenges
Most important causes of death, and disparities between low- and high
income
Noncommunicable diseases cause 74% of deaths > CVD, stroke, lower
respiratory infections
Low-income: more communicable diseases
Know which diseases are on the rise and declining
Diabetes and CKD are rising, neonatal conditions, diarrheal diseases and lower
respiratory tract infections are decreasing
Role of GP in the Netherlands
Primary care; hypertension, UTI, diabetes. Need referral from GP to see medical
specialist. May prescribe medication but often wait and see
Four steps of diagnostic process
1. Anamnesis (history)
2. Examination
a. Inspection
b. Auscultation (what you hear)
c. Percussion (use your hands)
d. Palpation (feel)
3. Investigation (Imaging techniques, blood sampling, urine, spirometry)
4. Arrive at diagnosis
Describe sensitivity vs specificity
Sensitivity: correctly identify a high proportion of patients (true positives)
Specificity: correctly identify a high proportion of patients who do not have the
disease (true -)
Main types of imaging techniques and their use
1. Radiography: radiation > some tissues absorb, other don’t, tissues that
absorb will show, X-ray, CT-scan
2. MRI: magnets and radio waves to show soft tissues, movement of protons
> tumours
3. Ultrasound: sound waves, hard and soft tissues
4. PET scan: radioactive drug as tracer, shows typical and atypical metabolic
activity used in early diagnostics. Image through detection of photons
Topic 2: CVD:
Name 4 risk factors for CVD
, Unhealthy diet, physical inactivity, smoking and alcohol abuse
Explain how CVD can be prevented
Keep healthy weight, stay active
Explain arteriosclerosis, atherosclerosis and, arteriolosclerosis
Arteriosclerosis: thickening and hardening of arterial walls (not due to plaques)
Atherosclerosis: plaque buildup
Arteriolosclerosis: hardening of small vessels due to hypertension and diabetes
Process of atherosclerosis
1. Damaged endothelium > dysfunction
2. Oxidized lipoproteins accumulate in the vessel wall > taken up by
macrophages > foam cells
3. Fatty streaks > plaques (soft interior + fibrous caps: can rupture>
thrombosis)
Difference between LDL and HDL cholesterol
LDL: carrier in plasma, can accumulate into plaques, statins lower LDL levels
HDL: reverse cholesterol transport
Similarities and differences between angina and myocardial infarction
MI: coronary arteries blocked, part of the heart can die off
A: MI but mild, only when active, no permanent damage to the heart
Both: chest pain, not enough oxygen in muscles
Congenital heart disease: birth defects
Definition of thrombosis
Formation of blood clot deep in the body
Virchow’s triad (risk for thrombosis)
Stasis of flow, hypercoagulation, vessel wall damage, symptoms: pain and
oedema
Difference between thrombus and embolus
Thrombus is a stationary blood clot, embolus is a blood clot that travels
Deep vein thrombosis with pulmonary embolism
Blood clot gets loose and sits in pulmonary artery > difficulty breathing and
increased heart rate
2 reasons why pregnancy may lead to thrombosis
1. Stasis of flow due to pressure on interior vena cava
2. Increase in clotting factors during pregnancy
Angiogram
