How to use this book
Pathology

This section goes through the different diseases in each system. They have been simplified and structured to provide the essence of each disease. Medicine involves a lot of lists which unfortunately have to be learned. Structuring each list allows more to be remembered with less effort; if you understand the disease and can remember the headings of your structure, you can work out the entire list.

Definition

This is ever so important. Know what you are talking about. If asked about any disease, defining it is a good place to start. It also buys you time. Remember, you can be quite general and simplistic yet still sound clever, e.g. "COPD is a chronic, progressive respiratory disorder most commonly seen in smokers characterised by airway obstruction with little reversibility".

Description

It is useful to know a brief summary of the epidemiology of a particular disease. Don’t bother remembering the exact incidence of a disease; it’s much more useful to know whether it is relatively common or incredibly rare. Most diseases can happen in any age group, sex or ethnicity. These are just guides to provide a picture of the typical patient.

Aetiology

This is the cause (or causes) of the pathology, and the risk factors should be screened for in your history if you’re suspecting it.

Pathophysiology

These are the changes in mechanical, physical, and biochemical functions associated with or resulting from disease. This is important as it allows you to understand the concrete changes that are occurring in the body. The causes and the effects of these changes are what you are looking out for in the history, examination, then investigating and subsequently treating. If you understand how the disease behaves, you should be able to work everything else out.

History and Examination

This section is divided into causes and effects. Effects are generally more obvious as they are what the patient presents with. In most cases causes and risk factors have been discussed under “aetiology”. You should remember to screen for them too. Unlike many medical texts, the segregation into signs and symptoms is not always made because this structure is not as helpful for remembering them, neither is it always clear what category they fall into, for example jaundice –who noticed it first, the doctor or the patient? What is important is that they are manifestations of the same pathology.

Investigations

Once again, these are looking for causes and effects of the pathology. Imaging allows the pathology itself to be visualised. The aim is to diagnose the disorder, exclude differentials, assess severity and look for complications. Essential investigations for each disease are highlighted in bold in the text (for example ECG and troponin in suspected MI).

Simple Bedside tests such as PEFR, ECG
Blood Haematology/ Biochemistry/ Microbiology
Imaging X-ray/ US/ CT/ MRI
Invasive e.g. endoscopy, angiogram
Special e.g. lung function tests
   

E.g. for atrial fibrillation

   
Simple ECG
  Effect -irregularly irregular rhythm, no P waves
Bloods FBC, cardiac enzymes, TFT
  Cause -infection, MI, hyperthyroidism
Imaging Echocardiogram
  Cause and effect -heart failure, valve disease

 

Treatment

You should consider the treatment of the pathology including its causes and effects, as well as complications. You can’t go wrong using the buzzword “multidisciplinary team” especially for diseases like cancer.
Conservative e.g. physiotherapy, dietary changes
Medical i.e. drugs
Interventional “Interventional” is used rather than “surgical” due to the increased use of interventional radiology, such as angioplasty


Prognosis

Have some idea of the natural history of the disease, response to treatment and complications.

 

 

 

 

 

 
     
     
 
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Thinking Medicine
2007