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Internal Medicine II. - C6VL003
Title: Vnitřní lékařství - II.
Guaranteed by: Department of Internal Medicine 3FM CU and UHKV (12-2INK)
Faculty: Third Faculty of Medicine
Actual: from 2024
Semester: both
Points: 23
E-Credits: 23
Examination process:
Hours per week, examination: 0/520, C [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
Level:  
Note: you can enroll for the course in winter and in summer semester
Guarantor: prof. MUDr. Petr Widimský, DrSc.
Examination dates   Schedule   
Annotation -
Training in clinical internal medicine for students in 6th year. Training has a practical and a theoretical part. In the practical part, students participate in the routine medical care of the patient under the supervision of qualified physicians. The students are also obliged to take part in the patients admission and assist by some of the diagnostic and invasive procedures. During the rotating training scheme, students work at the admission of internal patients and at the departments of internal medicine (department of cardiology, pneumology, gastroenterology, hepatology, nefrology, diabetology and endocrinology, hematology and intensive care unit). This practice can be done in any hospital with the entire spectrum of internal medicine and with unselectited acute admission from the service area. In the seminars, held by senior teachers or professors, lectured subspecialties of internal medicine are discussed. Final state exam: multiple-choice test, practical and oral examination.
Last update: Widimský Petr, prof. MUDr., DrSc. (05.09.2022)
Aim of the course -

The aim of this course is summarization of basic diagnostical and therapeutical tools in internal medicine. The course exposes students to physician´s role by daily bedside activities. The objective is to expand student´s knowledge and clinical skills in internal medicine.

Last update: Widimský Petr, prof. MUDr., DrSc. (05.09.2022)
Literature -

Harrison`s Principles of Internal Medicine

Additional literature:  Kumar and Clark´s Clinical Medicine, Harrison´s Principles of Internal Medicine (handbook)

Last update: Widimský Petr, prof. MUDr., DrSc. (05.09.2022)
Teaching methods -

The prerequisite for participation in the Internal Medicine pre-study block is passing all examinations from the 3rd, 4th and 5th year. The control will be conducted at the study department prior to enrolment in the module.

 

Knowledge of propedeutics and previous years' examined material is required for entry to the course. A strong emphasis will be placed on practical knowledge. In the practical part, clinical practice in hospitals outside Prague is preferred.

 

1. teaching schedule:

The course lasts 12 weeks with the following schedule: the first two weeks of compulsory seminars in internal medicine; eight weeks of clinical practice (internship); one week for exam preparation and credit with the practical part of state exam; the last week is reserved for the oral state exam in internal medicine.

 

2. Compulsory seminars:

The compulsory seminars will be conducted in attendance form from 9:00 to 11:45 a.m. and from 12:30 to 3.15 p.m. each day (a total of 6 teaching hours per day) throughout the first two weeks of the Internal Medicine block, according to a schedule designed to cover the basic problems of the specialty. Topics not covered in the face-to-face seminars may be available online for self-study. During the seminars, students may request clarification from the lecturers on specific Internal Medicine exam questions that are not sufficiently clear to them. At the introduction seminar, students will receive information and documents including a seminar schedule, a logbook (a syllabus of skills to be learned during the internship) and letters to the heads or chiefs of the internal medicine departments where the internship will take place.

 

3. Clinical practice (internship):

The practical part of the training (3rd-10th week of the block) should be arranged by each student on his/her own in the hospital according to his/her interest. Each student will report the chosen hospital (where he/she has arranged the internship) to the Secretary, Chair of Internal Medicine. Internships in hospitals outside Czech Republic (i.e. in any country, where the students are able to fluently communicate with patients – e.g. students home country) are preferred. When students of the English curriculum plan to arrange the 8-weeks internship in the Czech Republic, such students should be able to speak at least basic Czech with the patients.

The chosen hospital should be a large or medium-sized hospital with major internal medicine specialties and with unselected acute admission of patients from the catchment area, the hospital must also have an internally oriented intensive care unit or coronary care unit. Practice is not permitted in small hospitals that do not have a non-selected acute admission and have no intensive care unit. The period of 8 weeks may be spent in different institutions, provided that no period of less than two weeks is spent in any of them.

 

During this internship, the student will work under supervision on the ward in a similar way to a junior doctor preparing for the internal medicine examination, i.e. an average of 8 hours per day (including possible attendance at emergency services in the outpatient department). He/she will participate in morning report, grand rounds, X-ray rounds or other seminars. Under supervision, performs rounds in assigned room, actively reports on patients during rounds. All entries made by the student in the medical record must be legibly signed by the student and must always be seen by the attending or supervising physician. The student does not prescribe therapy or examinations himself/herself, but only suggests them to the attending physician. He or she participates in diagnostic and therapeutic considerations and also takes part in autopsies.

 

Last update: Widimský Petr, prof. MUDr., DrSc. (12.10.2022)
Requirements to the exam -

Credit

Confirmation of participation in individual forms of teaching will be recorded in the above documents by the teacher's signature and name tag. Credit will be awarded after completion of the initial 2-week course and the 8-week hospital placement, subject to a minimum of 80% participation in each activity (both course and placement). In case of less than 80% participation, a written apology with justification is required to the Chair of Internal Medicine who will decide whether to accept the apology.

The credit is recorded (after checking the participation according to the documents brought by the student) in the SIS by the academic staff member who tested the student's practical knowledge of internal medicine on a specific case (including testing knowledge of physical examination at the patient's bedside and including testing knowledge of ECG). The award of credit is a prerequisite for access to the oral examination part of the State Exam Internal Medicine. Therefore, the credit must be entered by the examiner into the SIS on the same day that the student is examined.

The course of the practical examination for credit is recorded in a standard protocol. The protocol shall indicate which parts of the practical examination for credit must include.

Part of the state examination - internal medicine

The actual oral State Examination (SZk) can only be taken after successful completion of the practical examination and after credit has been awarded. The list of questions is below. The examination shall take place before a committee of at least three members, the chairman of which shall be an associate professor or a professor with a habilitation in one of the disciplines which are part of internal medicine. The oral examination shall begin with a description of at least one ECG curve, followed by a randomly drawn question which has three parts. At least one part is practically (case) oriented and one is usually oriented to an acute disease or emergency.

Registering for the SZk: The student registers electronically for a specific date. It is not possible to register for a specific examiner. Students do not need to have credit at the time of registration for the SZk date, but may only take the actual oral SZk with credit awarded in SIS (see above).

Cancellation of registration for an examination:

A student may cancel their registration in the electronic enrolment system one week before the date of the examination at the latest. If a student wants to cancel their registration less than one week before the examination,they must present a doctor´s confirmation of illness as an excuse. In the event of other serious reasons students must excuse themselves to the Chair of Internal Medicine prof. Widimský od his deputy doc. Brunerova.

Questions for oral part of exam from internal medicine

of the state exam of general medicine

Valid from academic year 2022/2023

 

1 Acute myocardial infarction Approach to patient with ascites Acromegaly and gigantism. Hyperprolactinemia.
2 Acute coronary syndromes Approach to patient with abdominal pain Atelektais
3 Acute pericarditis, Cardiac tamponade Approach to paitent with icterus Anaphylaxis: diagnosis and treatment
4 Antithrombotics,: Anticoagulants, antiaggregancia, trombolytics Approach to patient with disordes of swallowing Cushing's disease and Cushing's syndrome
5 Aortic valve disease Approach to patient with constipation Antibiotics: principles of treatment, distribution, side effects
6 Betablockers. Diuretics. Vasodilatancy Approach to patient with heartburn ( pyrosis) Degenerative diseases of the joints and spin
7 Atrial septal defect also.,congenital heart defects in the adult Approach to paitent with constipation Bronchogenic carcinoma
8 Diagnostic cardiac catheterization. Hemodynamics Approach to patient with vomiting Diabetes mellitus type of 1
9 Differential diagnosis shock states Approach to patient with liver and spleen enlargenet Diagnostic and therapeutic bronchoscopy
10 EKG Patient on immunosuppressive therapy Targeted treatment in oncology and hematology
11 Atrial fibrillation Obese patient with fasting glycemia 9 mmol/l Acute and chronics hepatittis
12 Chronic forms of coronary artery disease Tired patient with tachycardia, sweating, more frequent stools and weight loos Diet at liver disease, biliary tract and pankreas
13 Chronical pericardial effusion. Constrictive pericarditis. Approach to patient with vertigo Essential Thrombocythemia (ET)
14 Infective endocarditis Malaise patient with bradycardia, dry skin and constipation Functional examination of lungs
15 Cyanosis: types, causes, treatments. Approach to patients with chronic chest pain Glomerulonephritis (GN)
16 Cardiogenic shock Patient with randomly detected glycemia 5,6 – 7 mmol/l Haemophilia and von Willebrandt disease
17 Cardiomyopathy Approach to patient in corticotherapy Celiac disease and gluten- free diet
18 Cardiac pacing, Defibrillation Patient with BMI 35 Hodgkin's lymphoma
19 Ventricular arrhythmias Approach to patient with the weight loss Chronic lymphocytic leukemia
20 Complications of  myocardial infarction Approach to patient with food intake disorder Hypopituitarism and diabetes insipidus
21 Mitral valve disease Approach patient with incidentalom of endocrine gland Chronic myeloid leukemia (CML)
22 Myocarditis A pale patient with erythrocyte volume 100 fl Chronic obstructive lung disease
23 Sudden cardiac death Patient with resistant hypertesion and hypokalemia Chronic pancreatitis
24 Side effects of medicines in cardiology A pale patient with erythrocyte volume 70 fl Chronic respiratory insificiency
25 Pulmonary edema Approach to patient with liver and spleen enlargenet Chronic complications of diabetes
26 Pulmonary embolism Approach to patient with Lymphadenopathy Immunodeficiency primary ande secondary
27 Pulmonary hypertension. Cor pulmonale Approach to patient with neutrophilia and neutropenia Chronic Kidney Disease ( CKD), Progression of CKD, Uremic Syndrome
28 Long ECG intervals QT or QRS or PQ Approach to patient with indications for bone marrow transplantation Metabolic liver disorders
29 Cardiac failure Patient wit reduced or with increased amound o urine Insulins
30 Stress-induced myocardial stunning ( Tako -Tsubo syndrom) Patient with hypocalcemia and hypercalcemia Liver cirrhosis
31 Supraventricular arrythmias Patient with hyponatremia and hypernatremia Community-acquired pneumonia
32 Heart nad brain relations in various diseases Approach to the patient with Lymphocytosis Crystal arthropathy, Hyperuricaemia, gouty arthritis
33 Acute hemiparesis Approach to patient with acute kidney injury (AKI) Metabolic osteopathy
34 Atherosclerosis Approach to patient with hematuria Extra- pulmonary tuberculosis
35 Dissection and transsection of aorta Approach to patient with chronic kidney disease (CKD – chronic kidney disease) Monoklonální gamapatie a mnohočetný myelom
36 Esential ( primary ) hypertension Approach to patient with chronic exposition of addictive substances Cystic fibrosis
37 Deep venous thrombosis Approach to patient with urinary tract infection Male and Female hypogonadism. Hyperandrogenic conditions
38 Peripheral artery disease (all forms of limb ischemia) Approach to patient with intoxication ( oral, respiratory, intravenosus) Obstructive sleep apnoea
39 Acute limb ischemia. Chronic limb threatening ischemia. Approach to patient with proteinuria Liver tumours
40 Strokes Approach to patient with disiorder of consciosness Tumours of the colon and rectum
41 Secondary hypertension Approach to patient with uremia Tumours of the oesophagus and stomach
42 Transient ischemic attack Patient with hemoptysis Non-Hodgkin's lymphomas
43 Vasculitides affecting the large arteries Approach to patient with chronic dyspnea Idiopathic intestinal inflammation
44

Systemic ebolysim ( systemic emabolization)

 Approach to patient with  impaired kidney function from imaging methods view and general principles of  pharmacotherapy Imaging methods in pneumology
45 Resistant hypertension, hypertensive crises Hospitalized patient witn development of fever and with  infiltration of lungs on RTG Renal cell cancer and blandder cancer
46 Acute respiratory distress syndrome ( ARDS) The diabetic patient with  creatinine increase Tumours of the biliary tract and pancreas
47 Acute pancreatitis Patient with coughing Nutritional support
48 Approach to the patient with gastrointestinal bleending Patient with randomly detected bearing on lungs in RTG Myelodysplastic syndromes
49 Approach to patient with ileus Acutely breathless patient with weakened breathing on the one side of the chest Diseases of the adrenal medulla
50 Liver failure Patient with fluid in pleural cavity Pancytopenia
51 Ulcer disease of the stomach and duodenum Approach to patient with back pain Genetic kidney disease
52 Acute cholecystitis and cholangitis Patient with progressive dyspnoea and constant crepitus in the base of lungs Neuroendocrine tumours
53 Primary and secundary adrenal insufficiency 35 old years women with se symetrickým symmetrical joint disability of hand Kidney diseases in the context of systemic vasculitis and systemic inflammatory diseases
54 Meatbolic acidosis and metabolic alkalosis Septic condition of young woman. Septic condition of old man. Diseases of pleura and mediastinum
55 Acute conditions in dialysis patients (cardiology complication) Approach to patient with acute febrile condition Diseases of the parathyroid glands
56 Acute diabetic complications Approach to patient with longer -lasting subfebria Diseases of the small intestine
57 Acute leukemia Patient with nosocomial infection Non-cancerous diseases of the oesophagus
58 Disseminated intravascular coagulation (DIC) Approach to patient after myocardial infarction Paraneoplastic symptoms
59 Immune trombocytopenic purpura  (ITP) Approach to patient after syncope Oral antidiabetics and insulins
60 Haemolyitc anemia Approach to patients with acute chest pain Sarcoidosis
61 Thrombotic microangiopathy Approach to a patient with acute dyspnea Struma, thyroiditis and thyroid tumors
62 Trombosis and trombophilia Approach to patient with pathologic ECG as accidental finding Polyglandular syndromes. Syndromes of multiple endocrine neoplasias.
63 Acute status of patient in wilderness: mushroom poisoning, snake bites, allergies, heatstroke/ sunstroke, lightning strike Approach to patient with arrytmia Polymyalgia rheumatica. Temporary arteritis.
64 Dehydration and hyperhydration, edemas Internal preoperative examination Polymyositis/dermatomyositis, skleroderma
65 Hyperpotasemia and hypopotasemia Approach to patient with prosthetic valves Principles of anti- tumour chemotherapy
66 Intoxication with Ethanol and Methanol, Intoxication with drugs ( Pervitin/ Methamphetamine, Heroin, Marijuana) Approach to the gravidity patient - Cardiac female paitent   Principes of anti-tumour radiotherapy
67 Kidney disease of vascular etiology ( atherosclerosis, renal artery stenosis, renal vasculitis) Approach to patient with rifht heart failure or with anasarca ( generalized edema) Anti-tumour immunotherapy
68 Organophosphate poisoning, Agents in chemical warfare. Suicidal medication poisoning. Approach to patient with palpitations Tubulointerstitials nephritis (TIN)
69 Acid-base balance disorders Approach to patient with high risk of cardiovascular disease  (primary prevention) Rheumatic Fever
70 The Uroseps Approach to patient with precordial murmur Supportive treatment in oncology and haematoncology
71 Relations between kidney diseas and heart disease. Approach to a patient with acute dyspnea Speciphic types of diabetes - endoccrine and pancreatic. Inhereted types of diabetes.
72 Acute Heart Failure Approach to patient with painfully swollen superficial veins Spondylartritidis. Reaktives arthritis.
73 Acute respiratory insuficience Approach to patient with chronic heart failure Polycythaemia vera and primary myelofibrosis
74 Acute airway infections Approach to cardiac patients before/ during/ after/ non- cardiac surgery Systémová zánětlivá onemocnění pojiva (systémový lupus erythematodes)
75 Bronchial asthma, Status asthematicus Approach to patient with aortic dilatation Blood transfusion and blood derivates, indication for their application and its complications
76 Anaphylactic shock Approach to patient with hyperlipidaemias Solid organs transplantation – basic principles of transplantation and managment of the patient for transplantation
77 Acute exacerbation, COPD ( chronic obstructive pulm. diseas) Approach to patient with limb edema Wilsons diseases and  hemochromatosis. Steatosis a steatohepatitis.
78 Influenza Approach to patient with danger of stroke Management of patient for renal replacement therapy ( RRT). Principles and types of dialysis treatment. Principles of transplantation and management of the patient for transplantation.
79 Covid-19 Approach to patient with unilateral lower limb pain Vaskulitis
80 Meatabolic acidosis and metabolic alkalosis Approach to patient with arterial hypertension Pulmonary tuberculosis
Last update: Svobodová Marcela (24.04.2023)
Syllabus -

Start of the course,. Patient with an increase in blood pressure.

 

Patient with pain in the lower limbs.

 

Vomiting patient

 

PAtient with weight loss or wtih kachexia

 

A pale patient

 

 

Patient with recurrent chest pain.

 

Patient with acute  neurological symptoms.

 

Patient with pain

abdominal pain

Patient with obesity

 

Patient with  hepatosplenomegaly

 

 

Patient with heart murmur

 

Patient with hemoptysis

 

Patient with diarrhoea

 

Patient with thyroid enlargement

Patient with spontaneous bleeding

 

Patient with chronic shortness of breath and swelling.

 

Patient with fever and cough

 

Patient with constipation.

 

Patient with pituitary/adrenal incidentaloma

Patient with lymphocytosis or lymph node enlargement

 

Patient with pathological EKG.

Patient with impaired ventilation parameters

Patient with icterus.

 

Patient with hyperglycaemia

Patient treated with cancer chemotherapy and targeted therapy

 

Patient with hearth palpitation or with cardiac syncope

 

Patient with radiographic findings of lung shadowing or infiltration

Patient with hepatomegaly

 

Patient with complications of diabetes

Patient with skeletal pain and pathological elfo protein

 

Patient with acute anuria/oliguria / ionic imbalance

 

Patient with spontaneous (non-traumatic) fracture

Approved patient with high fever

Patient in shock

Cardiology, angiology

Patient with rapidly deteriorating kidney function

 

Patient with subfebrile and butterfly exanthema

Patient with prolonged subfebrile episodes

Patient with disorder of consciousness

Pneumology

 

Pacient s proteinuria and/or hematuria

Female patient with paintful disability of the joints of both hands

 

Patient with fever and disorder of consciousness

 

Sudden collapse on the street

 

Hematology, oncology

Patient with chronically deteriorating renal function

Patient with painful swelling of the toe joint

 

Patient with fever and patological RTG of lungs

 

Patient with acute chest pain

 

Gastroenterology

 

Patient with leukocyturia (and fever/renal dysfunction)

 

Patient with acute dyspnoe accompanied by exanthema and  a pressure dropp

 

Patient with temperature and dirrhoea

 

Patient with acute dyspnoea

 

Nefrology, clinical biochemistry

 

Patient wih replecement of kidney function

 

Patient with recurren infections

 

Patient with complications of antibiotic treatment

 

Patient with hematemesis or with melena

Rheumatology

 

 

Last update: Widimský Petr, prof. MUDr., DrSc. (12.10.2022)
 
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