Download The Principles of Clinical Medicine

PRINCIPLES OF CLINICAL MEDICINE
I. Name of the unit offering the course: Department of Principles of Clinical Medicine
II. Head of the Unit/Course coordinator: dr hab. n. med. Marek Koziński
III. 2nd year, number of hours: 115
IV. Form of classes: lectures: 55, tutorials: 60
VI. Form of crediting: credit with grade,
VII. Number of ECTS points: 8
VIII. Aim of the course: to provide medical students with a solid background for clinical medicine.
IX. List of practical skills that will be obtained upon completion of the course of the principles of clinical
medicine:
- proper taking of medical history
- skilful physical examination
- selection of adequate, basic diagnostic tests to facilitate the diagnosis-making process
- ability to critically appraise values of basic diagnostic tests
- knowledge of signs and symptoms of various cardiovascular, respiratory, gastrointestinal, urogenital, and
haematological disorders
- ability of differential diagnosis making
- preparation of a teaching case
- knowledge of symptomatology, pathophysiology, diagnostics and management of selected lifethreatening conditions requiring immediate adequate treatment (acute coronary syndromes, pulmonary
embolism, aortic dissection, shock, pneumothorax) as well as major threats for global public health
(hypertension, diabetes mellitus, lipid disorders, atherosclerosis and the most frequent malignancies)
- ability to perform cardiopulmonary resuscitation
X. Topics of lectures
1. Clinical decision making – part 1.
2. Clinical decision making – part 2.
3. Approach to the patient with hydrothorax/pneumothorax. Clinical presentations of bronchitis and
pneumonia.
4. History, physical examination and diagnostic tests in patients with asthma or chronic obstructive
pulmonary disease.
5. Pulmonary embolism.
6. Obstructive sleep apnoea. Smoking and smoking cessation.
7. Physical examination of the heart and central vessels.
8. Approach to the patient with heart murmur. Valvular heart disease.
9. Physical examination of the peripheral vessels. Measurement of blood pressure. Arterial puncture for
blood gas analysis. Arterial access for interventional procedures.
10. Principles of electrocardiography.
11. Stable coronary syndromes: stable angina pectoris, cardiological syndrome X, myocardial bridging.
12. Non-ST-segment elevation acute coronary syndromes and variant angina.
13. ST-segment elevation myocardial infarction.
14. Approach to the patient with palpitations. Focus on atrial fibrillation.
15. Approach to the patient with syncope. Focus on brady- and tachyarrhytmias.
16. Symptoms, signs and diagnostics of heart failure.
17. Cardiac noninvasive testing (exercise electrocardiography, echocardiography, radionuclide imaging,
computed tomography, cardiac magnetic resonance)
18. Cardiac invasive testing (coronary angiography, fractional flow reserve measurement, intravascular
ultrasound, cardiac catheterisation) and myocardial revascularization.
19. Approach to the patient with abdominal pain. Focus on acute pancreatitis.
20. Approach to the patient with ascites. Approach to the patient with hepatomegaly/splenomegaly.
21. Approach to the patient with weight loss. Inflammatory bowel disease.
22. Acute kidney injury and chronic kidney disease.
23. Lipid disorders.
24. Hypertension: risk factors, diagnosis, secondary causes, resistant hypertension and complications.
25. Thyroid and parathyroid disorders.
26. Diabetes mellitus: pathophysiology, classification, risk factors, symptoms, diagnosis, complications
27. Shock: aetiology, pathophysiology, diagnosis and management.
XI. Topics of tutorials
1.
Topic of the tutorial: Professional secrecy. Main rules of history taking. Development of a relationship
with the patient. Examination techniques and equipment. Behavior and mental status. Level of
consciousness. Vital signs.
a.
Seminars for students: 1. Professional secrecy. Main rules of history taking. Development of a
relationship with the patient. 2. Coma: definition, causes and diagnostics.
b.
Practical classes with patients.
2.
Topic of the tutorial: Physical examination of the skin, hair and nails.
a.
Seminar for students: Diagnostics of jaundice.
b.
Presentation to be prepared by students: Cyanosis and paleness.
c.
Practical classes with patients.
3.
Topic of the tutorial: Physical examination of the head and neck. Fever.
a.
Seminars for students: 1. Physical examination of the head and neck. 2. Fever.
b.
Practical classes with patients.
4.
Topic of the tutorial: Symptoms of respiratory tract disorders.
a.
Seminars for students: 1. Approach to the patient with dyspnoea. 2. Basics of chest X-ray
interpretation.
b.
Presentations to be prepared by students: 1. Diagnostics of haemoptysis. 2. Cough: pathophysiology
and diagnostics. 3. Diagnostic value of D-dimers.
5.
Topic of the tutorial: physical examination of the chest and lungs.
a.
Seminar for students: Physical examination of the chest and lungs.
b.
Practical classes with patients.
6.
Topic of the tutorial: Diagnostic examinations of the respiratory tract (pulse oximetry, blood gas
analysis, computed tomography, bronchoscopy, transthoracic lung biopsy, spirometry).
a.
Seminars for students: 1. Indications for bronchoscopy 2. Indications and interpretation of
spirometry.
b.
Practical classes: presentation of pulse oximetry, interpretation of blood gas analysis, animations on
puncture of pleural effusion and needle aspiration of pneumothorax.
7.
Test 1
8.
Topic of the tutorial: Physical examination of the heart and central vessels. Atherosclerosis.
a.
Seminar for students: Atherosclerosis - a brief overview on its pathophysiology, manifestations and
risk factors.
b.
Practical classes with patients
9.
Topic of the tutorial: Diagnostics of chest pain - Part 1.
a.
Seminar for students: Approach to the patient with chest pain.
b.
Presentations to be prepared by students: 1. Biomarkers of myocardial ischaemia: cardiac troponins
and creatine kinase. 2. Diagnostic value of natriuretic peptides (BNP and NT-proBNP). 3. Clinical
presentation of Takotsubo cardiomyopathy (apical ballooning syndrome).
10. Topic of the tutorial: Diagnostics of chest pain - Part 2.
a.
Practical classes with patients including history taking, physical examination and ECG interpretation.
11. Topic of the tutorial: Diagnostics of oedema. Cardiac tamponade. Acute aortic syndromes.
a.
Seminar for students: Approach to the patient with oedema.
b.
Presentation to be prepared by students: Aortic dissection - clinical presentation, diagnostics and
management.
c.
Presentation of pericardiocentesis.
d.
Practical classes with patients.
12. Topic of the tutorial: Prevention of cardiovascular disease.
a.
Seminar for students: Primary and secondary prevention of cardiovascular disease.
b.
Presentations to be prepared by students: 1. Clinical implications of abdominal obesity. 2. Prevention
of cardiovascular disease with a Mediterranean diet. 3. Does wine drinking protect against
cardiovascular disease?
13. Topic of the tutorial: Practical classes on ECG interpretation.*
14. Topic of the tutorial: Interventional treatment of coronary artery disease - practical classes in the
cardiac catheterization laboratory.*
*Each group will be divided into two subgroups for Tutorials No 13 and 14. The first subgroup will start
with Tutorial No 13 and will continue with Tutorial No 14 next week while the second subgroup will follow
the opposite sequence of tutorials.
15. Test 2
16. Topic of the tutorial: Symptoms of gastrointestinal disorders.
a.
Seminar for students: Bleeding in the digestive tract.
b.
Presentations to be prepared by students: 1. Dysphagia. 2. Constipation. 3. Diarrhea. 4. Nausea and
vomiting.
17. Topic of the tutorial: Physical examination of the abdomen.
a.
Seminar for students: Physical examination of the abdomen.
b.
Practical classes with patients
18. Topic of the tutorial: Viral hepatitis. Hepatocirrhosis
a.
Seminars for students: 1. Viral hepatitis. 2. Hepatocirrhosis - aetiology, pathophysiology, signs and
symptoms.
b.
Practical classes with patients
19. Topic of the tutorial: Diagnostic examinations of the gastrointestinal tract (ultrasound, X-ray,
computed tomography, cholangiography, gastrointestinal endoscopy, endosonography).
a.
Seminar for students: Gastrointestinal endoscopy.
b.
Practical classes with patients.
20. Topic of the tutorial: Physical examination of the breasts and axillae. Lymphadenopathy.
a.
Seminars for students: 1. Lymphadenopathy. 2. Indications for mammography.
b.
Practical classes with patients.
21. Topic of the tutorial: Signs and symptoms of genitourinary disorders.
a.
Seminar for students: Dysuria.
b.
Presentation of male and female urethral catheterization.
c.
Presentations to be prepared by students: 1. Anuria, oliguria, polyuria and nocturia definitions and
causes. 2. Haematuria: definition and diagnostics. 3. Proteinuria: definition and basic diagnostics.
22. Test 3
23. Topic of the tutorial: Simplified physical examination of the nervous system.
a.
Seminar for students: Simplified physical examination of the nervous system.
b.
Practical classes with patients.
24. Topic of the tutorial: Signs and symptoms of haematological disorders.
a.
Seminar for students: Signs and symptoms of haematological disorders.
b.
Presentation of bone marrow aspiration and biopsy.
c.
Presentation of cases of patients with haematological disorders.
25. Topic of the tutorial: Symptoms and signs endocrinological disorders.
a.
Seminar for students: Symptoms and signs of pituitary disorders.
b.
Presentations to be prepared by students: 1. Cushing syndrome. 2. Pheochromocytoma. 3.
Adrenocortical insufficiency. 4. Primary aldosteronism.
26. Topic of the tutorial: The most common neoplastic diseases - Sign, symptoms, risk factors, diagnostics
and screening tests (Part 1).
a.
Seminars for students: 1. Lung cancer. 2. Colon cancer.
b.
Presentation to be prepared by students: 1. Stomach cancer.
27. Topic of the tutorial: The most common neoplastic diseases - Sign, symptoms, risk factors, diagnostics
and screening tests (Part 2).
a.
Seminar for students: 1. Breast cancer. 2. Prostate cancer.
b.
Presentation to be prepared by students: 1. Cervical cancer.
28. Putting it all together: physical examination and history taking
a.
Practical classes with patients.
b.
Practical test.
c.
Preparation in writing a patient teaching case.
29. Topic of the tutorial: Cardiopulmonary resuscitation.
a.
Seminar for students: Cardiopulmonary resuscitation.
b.
Presentations of defibrillation, orotracheal intubation, central venous catheterization, peripheral
intravenous cannulation.
30. Test 4
XII.Literature
Basic literature in English
1. Harrison's Principles of Internal Medicine: Volumes 1 and 2, 18th Edition. Ed. Longo D.L., Kasper D.L.,
Jameson J.L., Fauci A.S., Hauser S.L., Loscalzo J. McGraw-Hill Professional, 2011.
2. Macleod's Clinical Examination. 13th Edition. Ed. Douglas G., Nicol F., Robertson C. Elsevier, 2013.
3. Macleod's Clinical Diagnosis. 1st Edition. Japp A., Robertson C., Hennessey I. Churchill Livingstone,
2012.
Supplementary literature in English
1. Bates’ Guide to Physical Examination and History Taking. Ed. Bickley L.S. Lippincott Williams and
Wilkins, 2013.
2. Mosby's Guide to Physical Examination. Ed. Rosalyn W. Stewart, Henry M. Seidel, Joyce E. Dains,
John A. Flynn, Jane W. Ball, Barry S. Solomon. Mosby Elsevier, 2011.
Basic literature in Polish
1. Badanie kliniczne Macleod. Red. Douglas G., Nicol F., Robertson C. Elsevier Urban & Partner, 2010.
2. Diagnostyka różnicowa objawów chorobowych. Red. Kokot F. Wydawnictwo Lekarskie PZWL, 2007.
3. Interna Szczeklika 2013. Red. Gajewski P., Szczeklik A. Medycyna Praktyczna, 2013.
Supplementary literature in Polish
1. Diagnostyka internistyczna. Tatoń J. Czech A. Wydawnictwo Lekarskie PZWL, 2005.
2. Podstawy ogólnej diagnostyki klinicznej. Bolechowski F. Wydawnictwo Lekarskie PZWL, 1985.
3. Badanie kliniczne. Epstein O., Perkin G.D., de Bono D.P., Cookson J. Wydanie polskie pod redakcją
Sikorski M., Sikorska A. Czelej, 2001.