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Practical skill exam.
1. Internal medicine. Definition. Objectives. Different parts of internal medicine (propeudeutic, faculty and
hospital therapy).
2. Professional medical ethics and medical deontology.
3. Methods of the patient's clinical examination (questioning, inspection, palpation, percussion, auscultation).
4. Questioning of the patient. Grigory Zakharyin and his anamnestic method of diagnosis. Case history. Main
parts.
5. General methods of the patient's clinical examination. Subjective and objective symptoms.
6. Taking temperature. Types of fever.
7. General inspection of the patient. Inspection technique. Investigation of consciousness, posture,
constitution. Anthropometry.
8. Inspection of the skin (colour, elasticity, moistness, eruption, scars).
9. Investigation of head and neck.
10. Investigation of the lymph nodes, the muscular system, joints and extremities.
11. Percussion. The kinds of percussion. Types of percussion sounds.
12. Auscultation. Laennec, Russian physicians and their role in the development of this method. The rules and
technique of auscultation.
13. The questioning of the patient with respiratory diseases. The main complaints: dyspnoea, cough, pain in the
chest, bloody expectorations.
14. Inspection of the patient with respiratory diseases. Normal form of the chest.
15. Pathological form of the chest (emphysematous , paralytic, rachitic, funnel, foveated chest).
16. Inspection of the patient with respiratory diseases. The type, frequency, depth and rhythm of respiration.
17. Pathological respiration: Grocco’s respiration, Cheyne-Stokes’ respiration, Biot’s respiration, Kussmaul’s
respiration.
18. Palpation of the chest: the shape of the chest, respiratory movements, local or profuse tenderness, elasticity,
vocal fremitus.
19. Percussion of the lungs. The rules and methods. Comparative percussion.
20. Comparative percussion of the lungs. Normal percussion sounds.
21. Comparative percussion of the lungs. Pathological changes of percussion sounds.
22. Topographic percussion of the lungs. Determination of the upper borders of the lungs, Kroenig's area, the
lower borders of the lungs.
23. Determination of respiratory mobility of the lower border of the lungs.
24. Auscultation of the lungs. The rules and methods. Vesicular and bronchial breathing.
25. Auscultation of the lungs. Pathological changes of vesicular breathing.
26. Auscultation of the lungs. Pathological bronchial breathing. Bronchovesicular breathing.
27. Auscultation of the lungs. Adventitious sound (rales, crepitation and pleural friction). Mechanism of
appearance, characteristic, diagnostic value.
28. Bronchophony, vocal fremitus. The diagnostic value of their intensity and weakness. Pleural friction.
29. Brochoscopy. Indication, contraindication, diagnostic value.
30. The functional studies of external respiratory system. Spirography, pneumotachometry,
pneumotachography. Study of arterial blood gases. Tiffno test.
31. The puncture of the pleural cavity. The purpose, method, indication and contraindication. Physicochemical,
cytological and bacteriological analyses.
32. The study of the sputum. General and special investigations of the sputum, microscopic studies.
33. Haemoptysis (causes, clinical features, investigation of the patient, first aid).
34. Pulmonary bleeding (etiology, clinical picture, investigation of the patient, main principles of the
treatment).
35. Bronchial asthma. Severe attack (etiology, clinical features, main principles of the treatment).
36. Status asthmaticus (causes, clinical features, investigation of the patient, main principles of the treatment).
37. The questioning of the patient with heart diseases. The main complaints: dyspnoea, chest pain, palpitations,
syncope, oedema.
38. Inspection of the patient with the heart diseases. The patient's posture, colour of the skin and visible
mucosa, cyanosis, oedema, drum-stick fingers. The difference between cyanosis in patients with heart and lung
diseases.
39. Study of the peripheral vessels. Inspection, palpation, auscultation of the arteries. Inspection and palpation
of the veins. Clinical significance.
40. Study of arterial pulse. Palpation of the pulse. Properties of the arterial pulse.
41. Inspection of the neck vessels: swollen veins, positive and negative venous pulse. Difference between
arterial and venous pulsation. Main mechanisms of their appearance. Diagnostic significance. Visual
determination of central venous pressure.
42. Inspection of the heart region: cardiac "humpback", the apex beat, the cardiac beat, epigastric
pulsation.
43. Palpation of the heart region. Determination of the apex beat, the cardiac beat, systolic and diastolic
thrill (cat's purr). Diagnostic significance.
44. Palpation of the heart region. Characteristic of the apex beat ( width, height, strength, resistance).
45. Percussion of the heart. Determination of the relative and absolute cardiac dullness, the borders of the
vascular bundle, the configuration of the heart. Diagnostic significance of the heart borders displacement.
46. Taking of blood pressure. Korotkoff`s method. Blood pressure monitoring, diagnostic significance.
47. Auscultation of the heart. Main rules. Normal heart sounds, mechanisms of their appearance,
characteristics. The three-sound rhythm.
48. Auscultation of the heart. The sites of projection of the valves on the anterior chest and main auscultatory
areas. Normal heart sounds.
49. Auscultation of the heart. Changes of the heart sounds (changes of intensity, reduplication of the heart
sounds). The additional heart sounds. The triple rhythm, gallop rhythm, pendulum rhythm.
50. Auscultation of the arteries and veins. Nun's murmur. Traube's doubled tone. Vinogradov- Durozie's
doubled murmur.
51. Auscultation of the heart. Cardiac murmurs. Mechanisms of their appearance. Differentiation of functional
and organic murmurs.
52. Cardiac murmurs. Classification of murmurs. Properties of murmurs. Diagnostic value.
53. Electrocardiography. Taking ECG. Lead placement( standard leads, augmented limb leads, chest leads).
Reading and interpreting ECG.
54. Electrocardiography. Reading and interpreting ECG. Normal ECG. Characteristics of the main elements
(waves, intervals, complexes).
55. Determination electrical axis of the heart (Einthoven`s triangle, hexaxial reference system). ECG
characteristics of the left and right atria hypertrophy. Left and right ventricular hypertrophy. ECG sings.
56. Exercise electrocardiography (treadmill exercise, bicycle testing). Indications, methods, contraindications.
Interpretation of results (positive exercise test).
57. Echocardiography. Methods (general description). Clinical significance.
58. X-ray study of the cardiovascular system. Diagnostic significance. Coronary angiography.
59. Sinus arrhythmias. Etiology, mechanisms of production, clinical symptoms, ECG characteristics.
60. Ectopic beats. Causes, mechanisms of production, types of ectopic beats, clinical features. ECG pattern.
61. Atrial fibrillation and atrial flutter. Etiology, pathogenesis, clinical features. ECG sings.
62. Paroxysmal supraventricular tachycardia. Etiology, mechanisms of production, clinical symptoms. ECG
pattern. Fist aid.
63. Paroxysmal ventricular tachycardia. Etiology, mechanisms of production, clinical symptoms. ECG pattern.
Fist aid.
64. Atrioventricular block (first-degree, second-degree, complete atrioventricular block). ECG sings.
Morgagni- Adams- Stokes syndrome. Fist aid.
65. Acute left-ventricular failure (cardiac asthma, oedema of the lungs). Etiology, pathophysiology, clinical
symptoms, main principles of the treatment.
66. Acute right- ventricular failure. Etiology, pathophysiology, clinical manifestation, investigation of the
patient, main principles of the treatment.
67. Acute vascular insufficiency (syncope, collapse, shock). Main causes, mechanisms of the development,
clinical features. Fist aid.
68. Acute pain in the heart, region. Differential diagnostics between acute attack of angina pectoris and
cardialgia. Fist aid.
69. Acute coronary syndrome. Etiology, pathophysiology, clinical manifestation, investigation of the patient,
main principles of the treatment.
70. Hypertensive crisis. Etiology, mechanisms of the development, clinical features, investigation of the patient,
main principles of management.
71. Sudden death. Cardiopulmonary resuscitation (CPR).
72. Inquiry of the patients with stomach diseases.
73. Inspection of the abdomen. (shape, mobility of the abdominal wall, visible peristalsis, distension).
74. Superficial palpation of the abdomen. Technique. Determination of tenderness of the abdomen, the presence
of muscular defence, irritation of the peritoneum (Shchetkin-Blumberg symptom).
75. Deep sliding palpation by Obraztsov and Strazhesko. Diagnostic significance. The role of Russian clinicists
Obraztsov, Strazhesko, Vasilinko in the development of this methods for patients examination. Palpation of the
caecum, sigmoid, ascending and descending colon, transverse colon.
76. Percussion of the abdomen. Determination of ascite (main methods).
77. Study of gastric secretion. Estimation of the acid-secreting function (basal, submaximal, maximal acid
output). Determination of PH. Diagnostic significance.
78. Methods of Helicobacter pylory revealing.
79. Inquiry and physical examination of the patients with intestinal diseases.
80. Inadequate digestion syndrome. Etiology, pathogenesis, a clinical picture,
methods of investigation.
81. Acute abdomen syndrome.
82. Malabsorption syndrome.
83. Coprological studies. Common coprological syndromes.
84. Study of duodenal contents. Diagnostic significance.
85. Inquiry of the patients with liver diseases.
86. General inspection of the patients with liver diseases. Diagnostic significance of such signs as jaundice,
xanthelasma, spider angiomata, liver palms, petechial eruption, gynaecomastia, drum (Hippocratic) fingers.
87. Percussion and palpation of the liver. Diagnostic significance.
88. Main laboratories syndromes in the liver diseases (cytolic, cholestasis, hypersplenism).
89. Investigation of the liver protein, carbohydrate, lipid metabolism. Determination excretory and detoxication
function.
90. Investigation of the liver bilirubin metabolism. Jaundice (hemolytic, parenchymatous, obstructive types).
91. Study of liver enzymes.
92. Serological tests (hepatitis virus antigens and antibodies investigation).
93. Jaundice (hemolytic, parenchymatous, obstructive types). Clinical, laboratory and instrumental methods of
jaundice determination.
94. Ultrasound examination of the liver. Computed tomography. Scintiscanning.
95. Liver biopsy, laparoscopy.
96. X-Ray examination of the gall bladder and bile ducts (cholecystography, cholangiography,
cholangiopancreatography).
97. Portal hypertention syndrome. The mechanism of ascites and peripheral oedema development.
98. Hepatic insufficiency. Clinical signs. Laboratory tests. Hepatic coma. Fist aid.
99. Inquiry and physical examination of the patients with gall bladder diseases. A diagnostic significance of the
findings obtained by palpation of the gall bladder. Main symptoms revealed in gall bladder diseases
(Zakharyn`s, Vasilenko's, Orthner's, de Mussy-Georgievsky`s symptoms).
100. Gastrointestinal bleeding. Fist aid.
101. Inquiry of the patients with kidneys diseases. Main complaints and their pathogenesis.
102. Renal edema (causes, investigation of the patient with renal edema).
103. Examination of the patients with kidneys diseases (inspection, palpation of kidneys, Pastenatsky`s
symptom). Diagnostic significance.
104. The study of urinalysis (specific gravity, colour, urinary pH, chemical testing, microscopy of urine
sediment). Estimation of urine pathological changes.
105. Protein determination in urine. Proteinuria. Diagnostic significance the selective and non-selective
proteinuria.
106. Microscopy of urinary sediment (white cells, red cells, casts). The estimation of urine pathological changes
(Nechiporenko's test, Addis-Kakovsky`s test). Bacteriological studies of urine.
107. Zimnitsky's test. The rules of collection urine for Zimnitsky's test. The Rehberg`s test. Clinical estimation
of the Zimnitsky`s and Rehberg`s tests result.
108. X-Ray examination, ultrasonography of the kidneys, scanning and radioisotope nephrography.
109. Kidney biopsy. Diagnostic significance.
110. Renal colic (causes, clinical features, investigation of the patient, first aid.
111. Renal eclampsia (etiology, clinical picture, main principles of the treatment).
112. Acute renal failure (etiology, clinical features, main principles of the treatment).
113. Nephrotic syndrome. Etiology, pathogenesis, a clinical picture, a laboratory investigation. Amyloidosis of
the kidneys.
114. Renal failure. Clinical and laboratory diagnosis of the renal failure stages (periods). Uremic coma.
115. Thyroid gland disease, methods of examination. Inquiry, inspection, palpation.
116. Thyroid gland diseases. Laboratory and instrumental studies (thyroid hormone level estimation,
ultrasound study, scanning, thyroid gland puncture).
117. Diabetes mellitus. Inguiry, inspection, laboratory and instrumental studies.
118. Glucose level estimation in blood, urine, quality and quantitative methods.
119. Diabetic and hypoglycemic coma. First aid.
120. Adrenal failure. First aid.
121. Acute allergoses: a urticaria, a Quincke's disease, an anaphylactic shock.
122. Inquiries of the patients with haematological diseases.
123. Examination of the patients with blood diseases. Inspection, palpation, percussion of the spleen. Palpation
of lymph nodes, diagnostic value of revealed changes.
124. Laboratory and instrumental methods examination of the patients with blood diseases. Diagnostic value of
sternal puncture, trepanobiopsy.
125. General blood analysis. Diagnostic value.
126. Erythrocyte count. Haemoglobin and blood color index. Erythrocyte sedimentation rate. Diagnostic value.
127. Leukocytic formula and its changes at various internal diseases. Leukopenia, leukocytosis and leukemoid
reaction.
128. The basic methods of research of coagulating and anticoagulative system of blood.
129. Hemorrhagic syndrome. The basic diseases accompanying bleeding. Symptoms of hemorrhagic vasculites
and haemophilia.