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Introduction to Clinical Medicine III - Propedeutics in Medicine - CVSE3P0030
Title: Úvod do klinické medicíny III - Interní propedeutika
Guaranteed by: Department of Internal Medicine 3FM CU and UHKV (12-2INK)
Faculty: Third Faculty of Medicine
Actual: from 2019
Semester: winter
Points: 2
E-Credits: 2
Examination process: winter s.:
summer s.:
Hours per week, examination: winter s.:16/30, C [HS]
summer s.:0/10, C+Ex [HS]
Capacity: winter:unknown / unknown (unknown)
summer:unknown / unknown (unknown)
Min. number of students: unlimited
4EU+: no
Virtual mobility / capacity: no
Key competences:  
State of the course: taught
Language: Czech, English
Teaching methods: full-time
Teaching methods: full-time
Level:  
Guarantor: doc. MUDr. Jan Gojda, Ph.D.
Examination dates   Schedule   
Annotation -
Last update: Pavla Ježková (26.03.2020)
Dear colleagues, following the adoption of a crisis measure restricting any form of presence teaching, including examinations, the examination in propaedeutics is also canceled until further notice. The new schedule with dates will be announced after the crisis measures have been released, sufficient ammount fo slots will be opened. You will be informed about this in due time. Existing dates remain, although it is likely that they will not be able to be implemented given the duration of the crisis measures. I understand that the situation is difficult for you, but believe that it is our priority that all those who have the credit are able to take the exam this academic year. We will keep you informed about the situation. Sincerely, Jan Gojdaa !!! Notice !!! Teaching and examinations during the course of frontal study interruption (MH 10.3.). The remaining practices will be replaced by self-study. For this purpose, presentations from last topics (general laboratory examinations, basic clinical evaluation of findings on heart, lung and abdomen X-ray, ECG) will be uploaded to the vyuka portal in the near future. Each assistant, after consultation with his or her group, can provide an online consultation at the time of the last planned practice. Students will arrange these individually with their assistants. Credit (originally intended to be a patient examination and a medical record writing) will be replaced by a case report. The scope and assignment will be provided to students by their assistant in the near future. After granting the credit it is possible to apply for the exam, the dates will be scheduled from the second week of April. The examination will take place as planned and scheduled in SIS. Students will come to the secretariat of the 2nd dept. of Medicine, after checking all documents will be divided into individual clinics to the examiners. The practical part, which consists of demonstrating the skills of physical examination, will be carried out by students examining each other (originally students should demonstrate skills on patients). This is subject to their oral consent. In case of disagreement or other worthy consideration, it will be up to each examiner to verify the practical skills. Theoretical exam will be standard. Jan Gojda, 11.3.2020 Annotation: Internal propaedeutics is an introductory subject for further study into internal medicine. Within its framework students will acquire the basic knowledge and skills necessary for the examination of the patient. These include approach to the patient, taking of medical history, physical examination and basics of complementary examinations. The student will become familiar with the main symptoms and syndromes so that he / she is able to make a working diagnosis of the patient.
Aim of the course -
Last update: doc. MUDr. Jan Gojda, Ph.D. (13.12.2019)

Learning outcomes of the course ICM-III is to acquire knowledge, skills and attitudes needed for further study of internal medicine. These are mainly:

1. Correct and systematic taking of complete patient's medical history.

2. Physical examination of all body areas, organs and systems. To know physiological finding, its description and basic interpretation of pathological findings.

3. Introduction to basic complementary examination methods used in internal medicine and its sub-disciplines (laboratory examination, ecg, imaging, etc.). To know essential examinations, their indications and general interpretative results (eg. normal finding and basic underlying pathology that may be detected). Integral part is also a knowledge of patient preparation for instrumental examination, its basic indications and contraindications.

4. Acquisition of knowledge and skills for data analysis from medical history, physical examinations and complementary examinations - from symptom to syndrome, working and definitive diagnosis.
Literature -
Last update: doc. MUDr. Jan Gojda, Ph.D. (12.12.2019)

Ladislav Chrobák et al.: Physical examination in internal medicine. Grada, Praha, 2003, 240 p.

Lynn S Bickley et al.: Bates‘ guide to physical examination and history taking. 11th Edition, Wolters Kluwer, Lippincott Williams and Wilkins, Philadephia, USA, 2013, 967 s.
Teaching methods -
Last update: doc. MUDr. Jan Gojda, Ph.D. (12.12.2019) 
Teaching comprises of seminars and practicals in small groups at the clinical wards of faculty medicine departments. Teaching is both theoretical and practical. Theoretical one consists of acquiring the knowledge needed to examine patients. It is realized in the form of  interactive seminars and students' own theoretical work with patient data.
Practical training consists of training of skills, especially taking medical history, physical examination and interpretation of findings. It consists of independent examination of patients, demonstrations of pathological findings and use of simulation technologies.
Requirements to the exam -
Last update: doc. MUDr. Jan Gojda, Ph.D. (12.12.2019) 
The credit is given in the summer semestra after completion of the course. Criteria are: attendance at seminars and clinical internships, elaboration of a theoretical clinical case and demonstration of individual examination of the patient. The theoretical clinical case will be assigned to the students at the end of the winter block by their respective teachers, the students will elaborate it and present it during the summer internship block. Demonstration of the individual examination will take place during the summer semestra after consultation with the teacher.

The exam will consist of two parts

1st part: Practical examination at a patient. Students have to demonstrate their skills how to perform physical examination of one particular region (e.g. abdomen, neck etc.). Students do not need necessarily to recognise detailed pathology, however have to proceed technically and methodically correctly. In case of not proving skills to correctly perform physical examination, students will be asked to examine different region and if students don’t fulfil requirements, the exam will be terminated with classification „failed“, and second theoretical part will not be executed.

2nd part-theoretical part: Theoretical question will be focused on basic signs and symptoms of pathological states, basic examination methods and their principles, indications, contraindications, and basics of evaluation. List of questions is published.

If student is classified as failed of any part of examination, the whole examination will be classified as failed. In such a case student has to repeat both parts of exam (thus, even if during first attempt he/she passed practical part of the exam)

 

Questions for theoretical part of the exam

  1. Examination of consciousness disorders

  2. Measurement of body temperature, physiological and pathological findings

  3. Assessment of nutritional status, BMI

  4. Examination of skin and skin adnexa, basic pathological changes

  5. Medical history in patient with chest pain.

  6. Medical history and physical examination in patient with shortness of breath

  7. Medical history and physical examination in patient with syncope

  8. Medical history and physical examination in patient with palpitation

  9. Systolic murmurs

  10.  Diastolic murmurs

  11.  Pathological heart sounds, accessory clicks, pericardiac friction rub

  12.  Signs and symptoms in patient with arterial stenosis and obstruction

  13.  Signs and symptoms in patient with venous thrombosis and phlebitis

  14.  Cyanosis (central vs. peripheral)

  15.  Measurement of heart rate and blood pressure

  16.  Principles of ECG and how to correctly register ECG curve

  17.  Description of ECG curve, physiological curve

  18.  Basic pathological ECG findings: extrasystoles (ventricular vs. supraventricular), atrial fibrillation vs. ventricular fibrillation, tachycardia (supraventricular vs. ventricular), ECG signs of myocardial infarction 

  19.  Signs and symptoms of cardiac failure (acute and chronic) and shock  

  20.  Oedemas

  21.  Difficulties and complaints localized in abdominal region. Medical history in gastroenterology

  22.  Analysis of abdominal pain: localization, character, irradiation, course.

  23.  Symptoms in oesophageal disorders

  24.  Physical examination of abdomen (abdominal regions, quadrants, per rectum examination)

  25.  Typical irradiation of pain in diseases of abdominal organs

  26.  Examination and general signs in disorders of liver, gall bladder and gall ducts. Jaundice.

  27.  Examination and general signs in disorders of pancreas. and endoscopic  gastroenterology

  28.  Medical history and physical examination in patients with cough

  29.  Skiagram of the chest

  30.  Signs and symptoms in patient with pneumonia

  31.  Pathological auscultation findings at thorax

  32.  Spirometry, physiological and pathological findings

  33.  Symptoms and findings in patients with pleural effusion

  34. Medical history and common sings in patients with disorders of kidney and urinary tract

  35.  Physical examination in patients with disorders of kidney and urinary tract

  36. Examination of urine and basic kidney syndromes

  37.  Medical history and common signs in patients with locomotor apparatus

  38. Examination of vertebral column

  39.  Examination of muscles, ligaments, joints  and related extraarticular structures

  40. Examination of structure and function in patients with hypothalamic and pituitary dysfunction

  41.  Examination of structure and function in patients with thyroid and parathyroid disorders

  42.  Examination of structure and function in patients with adrenal and gonadal disorders

  43.  Examination of OGTT and its interpretation: normal values, prediabetes and diabetes

  44.  Recommended target levels of total, LDL-, HDL-cholesterol and triglycerides in healthy subjects and patients at risk (with obesity, diabetes, hypertension) and patients with proved coronary heart disease

  45.  Basic examination of lower extremities

  46.  Basic neurologic examination and examination of skin sensitivity

  47.  Recommended levels of arterial blood pressure in healthy subjects and diabetic patients

  48.  Lymphadenopathy: basic examination procedures

  49.  Splenomegaly: basic examination procedures

  50.  Disorders of red blood count: physical, laboratory and other procedures for determining of aetiology

  51.  Disorders of white blood count: physical, laboratory and other procedures for determining of aetiology

  52. Trombophilia: physical, laboratory and other procedures for determining of aetiology
Syllabus -
Last update: doc. MUDr. Jan Gojda, Ph.D. (12.12.2019)

Teaching comprises of mandatory seminars and clinical training.

Seminars.  Eight seminars covering propaedeutic of internal medicine and its basic subspecialties will take place. Attendance, which is mandatory, will be registered by teachers in attendance sheets that will be distributed to students during the first seminar.

Propedeutics in cardiology. Medical history and examination in cardiovascular diseases

Ecg, principles, normal curve, basic pathological changes

Propaedeutics in gastroenterology. History and examination in diseases of the gastrointestinal tract

Propedeutics in pneumology. History and examination in respiratory diseases

Propedeutics in Nephrology. History and examination in diseases of uropoietic apparatus

Propaedeutics in rheumatology. History and examination in rheumatological diseases

Propedeutics in Endocrinology and Diabetology. History and examination in diseases of endocrine glands

Propedeutics in hematology. History and examination in diseases of hematopoietic apparatus

Clinical training will take place at clinical wards of the Medicine departments. Students will be distributed to particular wards and teachers during first day of clinical classes. The aim of clinical classes is to learn and practice history taking and physical examination of patients. Second aim will be also to learn basics of laboratory, imaging and other methods used in internal medicine with the stress on their principles, basic indications and contraindications, basal findings and preparation of patients. Attendance will be registered by teachers (stamp and signature) in attendance sheets that will be distributed to students during the first class.

Introduction to propedeutics, documentation, patient access, communication with patients and professionals, clinical cases reporting

Anamnesis

Basics of physical examination, examination of general condition and vital functions

Examination of head and neck

Examination of the chest and breast, including the heart and lungs

Examination of the abdomen, including per rectum and examination of the kidneys

Examination of limbs, vascular system, spine

Symptoms and syndromes in diseases of the cardiovascular apparatus

Symptoms and syndromes in diseases of the respiratory system

Symptoms and syndromes in diseases of digestive and uropoietic tract

Symptoms and syndromes in diseases of endocrine glands
Entry requirements -
Last update: doc. MUDr. Jan Gojda, Ph.D. (12.12.2019)

Basic requirement is the registration for 3rd year.

Essential condition for clinical training is having of white coat, stethoscope, ID batch, overshoes and vaccination against hepatitis B.

Students are requested not to attend clinical training when having signs and symptoms of respiratory or gastrointestinal infection. Substitute practice is possible based on deal with a teacher.

 
 
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