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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.
Last update: Ježková Pavla (26.03.2020)
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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. Last update: Gojda Jan, doc. MUDr., Ph.D. (13.12.2019)
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Michal Anděl, Jan Gojda et al.: Propedeutics in Internal Medicine. Online 2023-2024 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. Last update: Gojda Jan, doc. MUDr., Ph.D. (30.09.2023)
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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. Last update: Gojda Jan, doc. MUDr., Ph.D. (12.12.2019)
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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. After the credit os granted in the SIS the student is allowed to enrol for the exam. The exam comprises of four circles. Three of them are theoretical (per one question from A, C, D) and one is a practical demonstration of skills (per two questions from B) A. Symptoms and syndromes Note: This is one question focused on the patient's subjective complaints, their 1/ definition 2/ objective correlate (e.g. shortness of breath - tachypnea; vertigo - vestibular syndrome etc.), 3/ associated symptoms (e.g. shortness of breath - febrile cough; vertigo - nausea and vomiting etc.) and symptom interpretation (very basic differential diagnosis: shortness of breath - cardiac, pulmonary, anaemic syndrome etc.).
1. Fever, chills 2. Hypovolemia, dehydration, hypotension 3. Hypervolemia, hypertension. 4. Skin exanthema 5. Unwanted weight loss, cachexia 6. Disorders of consciousness 7. Cramps, spasms 8. Sleep disturbances and fatigue 9. Cephalea 10. Vertigo 11. Syncope and collapse 12. Dyspnea 13. Chest pain 14. Palpitations 15. Edema 16. Lymph node enlargement/pain 17. Cough, hemoptysis, sputum and its changes. 18. Cyanosis. 19. Symptoms in oesophageal disease (odynophagia, dysphagia, rumination, pyrosis, singultus) 20. Anorexia, nausea and vomitus 21. Abdominal pain, approach to the patient with abdominal pain. 22. Haematemesis, melena, enterorrhagia. 23. Icterus 24. Biliary colic. 25. Constipation. 26. Diarrhoea. 27. Urinary frequency disorders, polyuria, oligo-anuria, polakisuria, nycturia and enuresis. 28. Dysuria, haematuria. 29. Renal colic. 30. Death, sudden death
B. Physical examination and history taking (2 questions for the exam) Note: These are two questions that will be tested at the patient's bedside or on the simulator. These questions are not randomized but are assigned based on patient availability (willingness to be examined, etc.) or simulator availability. For each, the assessment is 1/ the approach to the patient (introduction, hand disinfection, etc.), 2/ the actual performance of the skill, 3/ the definition of a normal finding (how the student would record the finding in the documentation). Conversely, whether the student discovers a pathology is not assessed. If this is present, then the student is alerted to it in advance (e.g. patient has a heart murmur, examine the heart by listening and interpreting the finding - question 21)
1. Taking the history of current illness, exploration of subjective complaints, targeted questioning 2. Collection of personal, family, pharmacological, gynecological, additive, epidemiological, occupational and social history. 3. Examination of the state of consciousness 4. Assessment of vital signs. Definition of vital signs: Measurement of blood pressure and heart rate 5. Respiratory rate examination. 6. Examination of posture and gait. Examination for suspected vestibular syndrome. 7. Examination of the condition of the skin covering, examination of the scrotum and cutaneous adnexa. Presence of efflorescences and their basic semiology. 8. Examination of the cranial nerves (n. trigeminus, oculomotorius, facialis, glossopharyngeus, hypoglossus) 9. Examination of the eyes, mobility of the eyeballs, condition and reactivity of the pupils. Examination of the conjunctiva. 10. Examination of lips, tongue, pharynx, tonsils, gums and teeth 11. Motility of the cervical spine, signs of meningeal irritation. 12. Examination of the cervical nodes, arteries and veins. 13. Examination of the thyroid gland. 14. Examination of the chest by sight. Formation and development of the chest. Auxiliary lines on the chest. 15. Examination of the chest by palpation - fremitus pectoralis, palpation of the cardiac spike. 16. Tapping examination of the chest, systematic and topographical examination. 17. Listening examination of the lungs, systematic and topographical examination. 18. Examination of the type of breathing and collateral pulmonary phenomena. 19. Listening examination of the heart, basic listening sites, heart sounds 20. Additional sounds and murmurs when listening to the heart. Characteristics of murmurs. Pericardial friction murmur. 21. Examination of the breast, examination of the axillary nodes, resistance in the mammary gland. 22. Inspection of the abdomen, pathology of the skin and subcutaneous tissue, respiratory articulations of the abdominal wall, abdominal distension. 23. Examination of suspected hernias and their typical localizations. 24. Superficial palpation, condition of the abdominal wall, defense musculaire. 25. Deep abdominal palpation, characteristics of abdominal masses. 26. Abdominal auscultation, normal and basic pathological findings. 27. Abdominal tapping, normal and basic pathological findings. 28. Examination of signs of peritoneal irritation. 29. Gallbladder examination 30. Examination of the liver: looking, tapping, palpation, listening. Normal liver size 31. Ascites. examination and its interpretation 32. Examination of the spleen 33. Bimanual palpation of the kidney and tapotement. 34. Rectal tap: Approach to the patient, positioning. Inspection of the anus. Technique of indagation 35. Rectal tap: Basic pathology, resistance within reach, prostate enlargement, tenderness and bowing of the Douglas space. 36. Examination of skin condition, trophic changes, adnexal pathology, signs of chronic venous insufficiency. 37. Examination when oedema is suspected. 38. Examination of arteries, palpation, auscultation 39. Examination of the venous system, signs of chronic venous insufficiency, varicose complex, signs of deep vein thrombosis 40. Examination of the lymphatic system and lymph nodes 41. Examination of joints, palpation, range of motion, passive and active mobility; examination of muscle strength 42. Spinal examination 43. Examination of meningeal irritation symptoms 44. Examination of the body of the deceased
C. Basics of complementary examinations and instrumental procedures Note: This is a question that is structured as follows: 1/ definition, 2/ basic indications (e.g. peripheral vein cannulation - need for IV treatment, 3/ basic performance (access to the patient, approaches - e.g. antecubital veins, tourniquet, IV cannula with introducer, verification of correct position by aspiration, checking for paravasation)
1. Peripheral venous cannulation and blood sampling 2. Central venous cannulation 3. Arterial cannulation and puncture 4. Urinary catheter insertion 5. Nasogastric probe insertion and gastric lavage 6. Oxygen therapy 7. Indication, preparation of the patient and electrocardiogram 8. ECG: description of the physiological curve 9. ECG: cardiac rhythm disturbances 10. ECG: waveform abnormalities 11. Indication, preparation and performance of abdominal ultrasound 12. Indication, preparation and performance of echocardiography 13. Astrup blood gas examination, indications 14. Biochemical blood examination 15. Urinary sediment examination and biochemical urinalysis 16. Stool examination 17. laboratory indicators of inflammation 18. Laboratory indicators of myocardial lesions 19. laboratory indicators of hepatic lesion 20. Laboratory indicators of renal impairment 21 Blood count and coagulation. 22. Basic microbiological examination, culture and sensitivity in antibiogram. 23. Haemoculture 24. Chest X-ray, basics of examination. 25. X-ray of the abdomen, basics of examination. 26. Endoscopy of upper GIT, basic indications, and patient preparation. 27. Endoscopy of the lower GIT, basic indications, and patient preparation. 28. Bronchoscopy, basic indications, patient preparation 29. Spirometry and spiroergometry, basic indications 30. Functional examination in endocrinology and diabetes: OGTT
D. Symptoms of selected serious conditions. Note: This is a complex question that mainly targets the basic theory needed to identify the underlying pathologies based on history and physical examination. On the other hand, it is not the aim that the student knows the etiopathogenesis of each disease. 1/ basic definitions, 2/ subjective symptoms, 3/ objective symptoms, 4/ suggest further investigations, 5/ identify potentially life-threatening conditions and know the basic approach (ABCDE).
1. General symptoms of cancer. 2. General symptoms of acute bacterial inflammation 3. Meningeal irritation syndrome 4. Life-threatening conditions associated with severe headache 5. Basic symptoms of shock, skin changes 6. Basic symptoms of sepsis and septic shock 7. Basic symptoms of allergic reaction and anaphylactic shock 8. Basic symptoms of obesity and malnutrition 9. Basic symptoms of acute coronary artery occlusion 10. Basic symptoms of acute limb arterial occlusion 11. Basic symptoms of acute closure of the abdominal arteries 12. Basic symptoms of acute occlusion of the cerebral arteries 13. Basic symptoms of right-sided heart failure 14. Basic symptoms of left-sided heart failure 15. Basic signs and symptoms of pulmonary oedema 16. Basic symptoms of aortic valve defects 17. Basic symptoms of mitral valve defects 18. Basic symptoms of coarctation and dissection of the aorta 19. Basic symptoms of deep vein thrombosis 20. Basic symptoms of pulmonary embolism 21. Basic symptoms accompanying thrombophlebitis 22. Basic symptoms accompanying lymphadenitis and lymphangitis 23. Basic symptoms of thoracic effusion 24. Basic symptoms of pneumothorax 25. Basic symptoms of airway inflammation and pneumonia 26. Basic symptoms of bronchial obstruction 27. Basic symptoms of an asthma attack 28. Basic symptoms of pulmonary infarction and atelectasis 29. Basic symptoms of pulmonary emphysema 30. Basic symptoms of interstitial lung disease (interstitial pneumonia, pulmonary fibrosis) 31. Basic symptoms of urinary tract inflammation (haematuria, dysuria, pyuria) 32. Basic symptoms accompanying pyelonephritis 33. Basic symptoms of renal failure/uraemia 34. Typical renal colic and its radiation 35. Basic symptoms accompanying liver failure 36. Symptoms of upper GIT bleeding 37. Symptoms of lower GIT bleeding 38. Anemic syndrome 39. Typical biliary colic and its radiation 40. Localized and generalized symptoms of peritoneal irritation 41. Ileus 42. Basic symptoms in portal hypertension 43. Symptoms of inflammatory and non-inflammatory joint affection. 44. Basic symptoms in thyrotoxicosis 45. Basic symptoms in hypothyroidism 46. Basic symptoms of Cushing's syndrome 47. Basic symptoms of acromegaly 48. Signs of death Last update: Gojda Jan, doc. MUDr., Ph.D. (30.09.2023)
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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 Last update: Gojda Jan, doc. MUDr., Ph.D. (12.12.2019)
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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.
Last update: Gojda Jan, doc. MUDr., Ph.D. (12.12.2019)
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