General medicine | lectures
HNH-27806
General practitioner
Medical doctor: specialist completed higher medical education, which is professionally engaged in supporting
or restoring human health through prevention, recognition (diagnosis) and treatment of diseases and injuries.
Health: the ability to adapt and to self-manage
Primary process
▪ Anamnesis: medical history
• Presenting complaint
• Past medical history
• Medication
• Family history
• Social history
→ differential diagnosis; what diseases could the patient have based on the information from the
anamnesis
▪ Physical examination always in this order!
• Inspection looking
• Auscultation listening; with a stethoscope
• Percussion tapping; for consistency of organs
• Palpation feeling; if anything is painful
→ differential diagnosis
▪ Further investigation; laboratory (blood or urine), X-rays, ultrasound, MRI
General practitioner
▪ Diagnosis
▪ Patient population
▪ Urgency; time to investigate the complaint
▪ Referral to specialist
▪ To treat or not to treat
Most frequent health problems during contact with the GP (2017)
Hypertension Cystitis Diabetes mellitus Coughing Upper Respiratory Tract Infections
Health problems for elderly
▪ Cataract (staar)
• Prevalence 40% 52-64 years old
60% > 65 years old
90% > 90 years old
▪ Hearing loss
• Prevalence 33% 65-74 years old
50% > 85 years old
▪ Heart failure
• Prevalence 25% > 80 years old
• 50% die within one year of diagnosis
▪ Hypertension
▪ Stroke
▪ Cancers
▪ Renal diseases
▪ Falls
18-2-2020 21:13 1 - 43
, • Osteoporosis increases risk of fracture
• Falls lead to anxiety, loneliness, dependence and social isolation
• 50% of people who break a hip after falling are dead within one year
• Prevention of falls/fractures from falling
- Vitamin D
- Strengthening exercises
- Balance training
▪ Polypharmacy > 5 medications taken simultaneously
• 7 times more side effects
• 25% experience side effects daily
• 50% are caused by medications that are contraindicated or no longer indicated
▪ Dementia
• Impaired memory, forgetfulness, inability to retain new information
• Loss of the ability to speak and be understood by others and the ability to understand written or spoken
language
• Loss of the ability to plan and carry-out multistep tasks
• Loss of the ability to process and understand visual information
Internal medicine
Hormones: produced in glands, secreted in the blood
The action is elsewhere in the body through receptors
Thyroid diseases
Prevalence: 5-8%
Hyperthyroidism causes
▪ Tumor
• In the pituitary: oversynthesizing TSH
• In the thyroid gland itself: oversynthesizing T3 and T4
18-2-2020 21:13 2 - 43
,▪ Acute destruction
• Acute cell damage → thyroid hormon within the gland leaks into bloodstream
• Thyrotoxicosis; excess of thyroid hormone
- Due thyroiditis (inflammation of the thyroid gland)
▪ TSH-receptor stimulating auto-antibodies
• Auto-antibodies stimulate TSH receptors on thyroid gland → stimulation of thyroid hormone synthesis
without TSH signal
• Grave’s disease
▪ Pills
• Thyroid hormones in pills to lose weight
Hyperthyroidism symptoms
▪ Bulging eyes
• Eyes contain TSH receptors → auto-antibodies against TSH-R → inflammation → bulging eyes
▪ Sweating
▪ Rapid heartbeat
▪ Weight loss
▪ Irritability, nervousness
Hyperthyroidism treatment
▪ Downregulate hormone synthesis with medication (thiamazol)
▪ Destruction of the thyroid with surgery or chemicals (radioactive iodine)
Hypothyroidism causes
▪ Destruction
• Due to trauma, operation, inflammation
▪ Higher need of thyroid hormones
• During pregnancy
▪ Receptor blocking antibodies
• Hashimoto’s disease
Hypothyroidism symptoms
▪ Puffy face
→ accumulation of glycoproteins in subcutis
▪ Slow heartbeat
▪ Weight gain
▪ Fatigue
▪ Depression
Hypothyroidism treatment
▪ Lifelong suppletion thyroid hormone
Goitre: growth of the thyroid gland without function (benign tumor, stroma)
▪ Iodine deficiency
▪ Only treated when patients get troubles swallowing or breathing
18-2-2020 21:13 3 - 43
, Diabetes mellitus
Prevalence: 10-40%
Elevated glucose concentration
▪ High glucose diagnosis: diabetes mellitus
▪ Normal glucose diagnosis: no diabetes mellitus
▪ In between pre-diabetes; often leading to diabetes but no organ damage on the short term
Pathophysiology
▪ Islets of Langerhans in pancreas: insulin production by β-cells
▪ Fasting decreases insulin secretion
▪ Eating increases insulin secretion
▪ Insulin functions very anabolic hormone
• Glycogen synthesis
• Glycolysis and carbohydrate oxidation
• Synthesis and storage of fat (adipose tissue)
→ absolute insulin deficiency leads to uncontrolled breakdown of lipids →
ketoacidosis
• Protein synthesis
Insulin production healthy subject
Insulin production diabetes type 1
Insulin production diabetes type 2
18-2-2020 21:13 4 - 43
HNH-27806
General practitioner
Medical doctor: specialist completed higher medical education, which is professionally engaged in supporting
or restoring human health through prevention, recognition (diagnosis) and treatment of diseases and injuries.
Health: the ability to adapt and to self-manage
Primary process
▪ Anamnesis: medical history
• Presenting complaint
• Past medical history
• Medication
• Family history
• Social history
→ differential diagnosis; what diseases could the patient have based on the information from the
anamnesis
▪ Physical examination always in this order!
• Inspection looking
• Auscultation listening; with a stethoscope
• Percussion tapping; for consistency of organs
• Palpation feeling; if anything is painful
→ differential diagnosis
▪ Further investigation; laboratory (blood or urine), X-rays, ultrasound, MRI
General practitioner
▪ Diagnosis
▪ Patient population
▪ Urgency; time to investigate the complaint
▪ Referral to specialist
▪ To treat or not to treat
Most frequent health problems during contact with the GP (2017)
Hypertension Cystitis Diabetes mellitus Coughing Upper Respiratory Tract Infections
Health problems for elderly
▪ Cataract (staar)
• Prevalence 40% 52-64 years old
60% > 65 years old
90% > 90 years old
▪ Hearing loss
• Prevalence 33% 65-74 years old
50% > 85 years old
▪ Heart failure
• Prevalence 25% > 80 years old
• 50% die within one year of diagnosis
▪ Hypertension
▪ Stroke
▪ Cancers
▪ Renal diseases
▪ Falls
18-2-2020 21:13 1 - 43
, • Osteoporosis increases risk of fracture
• Falls lead to anxiety, loneliness, dependence and social isolation
• 50% of people who break a hip after falling are dead within one year
• Prevention of falls/fractures from falling
- Vitamin D
- Strengthening exercises
- Balance training
▪ Polypharmacy > 5 medications taken simultaneously
• 7 times more side effects
• 25% experience side effects daily
• 50% are caused by medications that are contraindicated or no longer indicated
▪ Dementia
• Impaired memory, forgetfulness, inability to retain new information
• Loss of the ability to speak and be understood by others and the ability to understand written or spoken
language
• Loss of the ability to plan and carry-out multistep tasks
• Loss of the ability to process and understand visual information
Internal medicine
Hormones: produced in glands, secreted in the blood
The action is elsewhere in the body through receptors
Thyroid diseases
Prevalence: 5-8%
Hyperthyroidism causes
▪ Tumor
• In the pituitary: oversynthesizing TSH
• In the thyroid gland itself: oversynthesizing T3 and T4
18-2-2020 21:13 2 - 43
,▪ Acute destruction
• Acute cell damage → thyroid hormon within the gland leaks into bloodstream
• Thyrotoxicosis; excess of thyroid hormone
- Due thyroiditis (inflammation of the thyroid gland)
▪ TSH-receptor stimulating auto-antibodies
• Auto-antibodies stimulate TSH receptors on thyroid gland → stimulation of thyroid hormone synthesis
without TSH signal
• Grave’s disease
▪ Pills
• Thyroid hormones in pills to lose weight
Hyperthyroidism symptoms
▪ Bulging eyes
• Eyes contain TSH receptors → auto-antibodies against TSH-R → inflammation → bulging eyes
▪ Sweating
▪ Rapid heartbeat
▪ Weight loss
▪ Irritability, nervousness
Hyperthyroidism treatment
▪ Downregulate hormone synthesis with medication (thiamazol)
▪ Destruction of the thyroid with surgery or chemicals (radioactive iodine)
Hypothyroidism causes
▪ Destruction
• Due to trauma, operation, inflammation
▪ Higher need of thyroid hormones
• During pregnancy
▪ Receptor blocking antibodies
• Hashimoto’s disease
Hypothyroidism symptoms
▪ Puffy face
→ accumulation of glycoproteins in subcutis
▪ Slow heartbeat
▪ Weight gain
▪ Fatigue
▪ Depression
Hypothyroidism treatment
▪ Lifelong suppletion thyroid hormone
Goitre: growth of the thyroid gland without function (benign tumor, stroma)
▪ Iodine deficiency
▪ Only treated when patients get troubles swallowing or breathing
18-2-2020 21:13 3 - 43
, Diabetes mellitus
Prevalence: 10-40%
Elevated glucose concentration
▪ High glucose diagnosis: diabetes mellitus
▪ Normal glucose diagnosis: no diabetes mellitus
▪ In between pre-diabetes; often leading to diabetes but no organ damage on the short term
Pathophysiology
▪ Islets of Langerhans in pancreas: insulin production by β-cells
▪ Fasting decreases insulin secretion
▪ Eating increases insulin secretion
▪ Insulin functions very anabolic hormone
• Glycogen synthesis
• Glycolysis and carbohydrate oxidation
• Synthesis and storage of fat (adipose tissue)
→ absolute insulin deficiency leads to uncontrolled breakdown of lipids →
ketoacidosis
• Protein synthesis
Insulin production healthy subject
Insulin production diabetes type 1
Insulin production diabetes type 2
18-2-2020 21:13 4 - 43
