Learning objectives
The learning objectives of this module are the following:
- To know the methodology of clinical reasoning in the approach to the main signs and symptoms referred to all body’s organs and systems, and to apply this methodology at the bedside
- To be able to formulate a diagnostic suspicion and a differential diagnosis for the main signs and symptoms of medical interest
- To know the main instrumental and laboratory tests exploring the structure and function of the main organs and systems of the human body, and to know the correct indications for prescription of each of them
The learning objectives of the Integrated Course, which the module is part of, are the following:
1. To know the methodology of medical history taking, and to be able to apply it with patients
2. To know how to perform a physical examination, be able to perform it on patients, and be able to distinguish normal findings from the main pathological findings
3. To be able to measure arterial pressure, perform venipuncture, register and interpret an electrocardiogram
4. To know the physio-pathology and clinical meaning of most frequent signs and symptoms of disease
5. To know the normal ranges of the main laboratory tests used in clinical practice, and be able to interpret their alterations
6. To know the main instrumental exams that can be prescribed to study the morphology and function of the human body organs and systems, and to know when the prescription of each one is appropriate
7. To know and be able to recognize the main objective findings in the most frequent medical and surgical syndromes
8. To know the basics of clinical reasoning and be able to apply them in approaching a medical or surgical patient
9. To know the general aspects of epidemiology and prophylaxis of infectious diseases, and the importance of these concepts in clinical activity
10. To know the basics of clinical research methodology.
Prerequisites
In order to take the exam in Clinical Semeiotics and Methodology students must have passed the exams in Human Anatomy, Physiology and General Pathology.
Course unit content
The module is aimed at making students learn the basics of physical examination and the main instrumental, functional and laboratory tests used to approach medical patients and to make differential diagnosis. The main focus will be on clinical methodology and its gradual steps: first medical history and physical examination, then prescription of instrumental or laboratory tests guided by signs, symptoms and diagnostic suspicions. The themes of cost-benefit ratio in medical prescription and appropriateness of prescriptions for diagnosis will be also treated. Students will thus learn a rational approach to diagnostics, distinguishing first and second-level diagnostic resources, and specialist diagnostic resources.
All these concepts will be applied to signs and symptoms referred to all the main body districts (chest, abdomen, pelvis, head and neck, upper and lower limbs, column, joints), with a particular focus on the most frequent clinical syndromes of interest in internal medicine (for example, acute myocardial infarction, heart failure, acute pulmonary edema, atrial fibrillation, heart valvular diseases, pneumonia, pleuric effusion, pulmonary enfisema, pneumothorax, cirrhosis, acute pancreatitis, nephrotic syndrome, nephritic syndrome, renal colic, urinary tract infections, sepsis, shock, thrombosis and acute pulmonary embolism, thyroid diseases, stroke, central nervous system infections).
The content of the module will be strictly integrated with the rest of the course. Some of the module’s specific elements could be recalled also within other modules, to give students a unitary vision of “Semeiotics and Clinical Methodology” as the basics for any clinical activity at the patient’s bedside.
Full programme
Full program of the integrated course:
- Medical anamnesis and its importance in medicine.
- Vital signs and their clinical significance.
- Physical examination of the main body districts: chest, abdomen, head and neck, skin, limbs and peripheral vascular system, joints, nodes, breast. Neurological examination. Nutritional status evaluation and nutritional markers. Main semeiological signs and manoeuvres.
- How to approach the patient with: head pain, back pain, chest pain, abdominal pain, astenia, insomnia, alterations of appetite or thirst, alterations of void or diuresis, hematuria, menorrhagia o metrorrhagia, jaundice, diarrhoea, stipsis, nausea, vomiting, regurgitation, hiccup, dysphagia, digestive haemorrage (hematemesis, melena, hematochetia, rectal bleeding), haemophtisis, cough, dyspnea, palpitations, syncope or lipotimia, arterial hypertension, arterial hypotension, itch, fever, cianosis, edema, acute mental confusion, coma, persistant vegetative state, vertigo, trauma. How to approach a patient with multimorbidity. Overview on the main neurological signs and symptoms.
- How to interpret the main clinical laboratory tests: blood count, glycemia, uricemia, lipid metabolism, markers of kidney injury and function, sodiemia, potassiemia, calcemia, fosforemia, magnesiemia, arterial blood gas analysis, markers of liver function, markers of myocardial damage, haemostasis and coagulation tests, inflammatory indexes, hormones, autoantibodies, standard urine test, 24-hour urinary collection, proteinuria, tests on effusions, fecal analysis, microbiological analyses, principles of transfusion medicine. Acid-base metabolism alterations: metabolic acidosis and alkalosis, respiratory acidosis and alkalosis.
- Semeiotics of the main clinical syndromes in internal medicine: acute myocardial infarction, heart failure, acute pulmonary edema, atrial fibrillation, cardiac valve diseases, pneumonia, pleural effusion, COPD, pneumothorax, acute abdomen, cirrhosis, acute pancreatitis, mechanic and functional ileus, nephrotic syndrome, nephritic syndrome, renal colic, urinary tract infections, sepsis, shock, deep venous thrombosis and acute pulmonary thromboembolism, hypo- and hyperthyroidism, stroke, meningitis.
- Instrumental semeiotics: clinical imaging and functional tests in heart, vascular, respiratory, kidney, gastroenteric, articular and nervous diseases.
- Normal ranges of the main laboratory tests used in clinical practice.
- Knowledge of the basic characteristics of EKG recordings in: healthy subjects, acute myocardial infarction, pulmonary embolism, atrial fibrillation, atrial flutter, ventricular and atrial tachicardia, extrasystolia, atrioventricular blocks, alterations induced by electrolyte inbalances.
Bibliography
1. Learning material available on the course site (Elly Medicina web platform, that can be accessed by all students)
2. Borghi L, Meschi T, Nouvenne A, Ticinesi A. Semeiotica e metodologia clinica. Per gli studenti del Corso di Laurea in Medicina e Chirurgia. Monte Università Parma Editore 2017.
3. Nuti R. Semeiotica Medica Metodologia Clinica. IX Edizione. Minerva Medica 2009.
4. Fradà G, Fradà G. Semeiotica medica nell'adulto e nell'anziano. V Edizione. Piccin Nuova Libraria 2014.
Teaching methods
The present module includes frontal lessons, some of which will be performed as seminars. In these seminars, expert clinicians will participate with the academic teather, and will discuss simulated clinical cases interactively with students.
The Integrated Course, which this module is part of, will include frontal lessons during the first and second semester of the third undergraduate year course. Around 30% of lessons will be supplied as seminars, with the participation of expert clinicians that will engage with the academic teacher and students interactive discussion of simple clinical cases or practical aspects of the approach to patients.
The Integrated Course will include also a practical internship, that will be carried out in the academic teachers’ hospital wards, under their responsibility and supervision. Students will be divided in small groups, and each group will be assigned to a clinical representative, who will follow students during the whole activity. Students will be refreshed the theoretical basics of patient approach, medical history, physical examination (with particular focus on chest and abdomen), execution of the main semeiological manoeuvres, arterial pressure measurement, ECG registration. Each one of these skills will be then practiced by students directly on patients, under the direct supervision of the clinical representative.
Around 20% of the internship will be performed at the Simulation Lab of the Department of Medicine and Surgery, under the supervision of an academic teacher. In this part of the internship, which will generally be performed before the activity in hospital wards, students will be taught how to perform the main semeiological manoeuvres on dummies. Active participation from students will be encouraged. By the end of the simulation activity, students must be able to perform the basic semeiological manoeuvres (palpation, percussion, auscultation) on dummies in complete autonomy.
Assessment methods and criteria
Oral examination
Students will be asked by the examining commission to outline the practical aspects of the clinical approach to patients with particular signs, symptoms or alterations of the physical examination. They will be also asked to make simple clinical reasoning in simulated clinical cases, using a rational approach to diagnosis and prescription of diagnostic resources.
Other information
Teachers will be available for any requests from students, subject to e-mail contact
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