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Course, academic year 2024/2025
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Introduction to Clinical Medicine - DA0105454
Title: Introduction to Clinical Medicine
Guaranteed by: Department of Internal Medicine (13-341)
Faculty: Second Faculty of Medicine
Actual: from 2024
Semester: winter
Points: 11
E-Credits: 11
Examination process: winter s.:
summer s.:
Hours per week, examination: winter s.:2/3, C [HT]
summer s.:2/4, C+Ex [HT]
Extent per academic year: 14 [weeks]
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: English
Teaching methods: full-time
Teaching methods: full-time
Level:  
Is provided by: DA1105454
Guarantor: prof. MUDr. Radan Keil, Ph.D.
Teacher(s): prof. MUDr. Radan Keil, Ph.D.
Classification: Medicine > Practical Training
Co-requisite : DA0104104, DA0105341, DA0105439
Pre-requisite : DA0103007, DA0103337, DA0104103
Is co-requisite for: DA0105341, DA1106424, DA1105424, DA0105439, DA0104104
Is pre-requisite for: DA0108104, DA0108107, DA0108006, DA0108004, DA0108067, DA0108435, DA0108358, DA0108369, DA0108368, DA0108370, DA0110105, DA0108371
Annotation - Czech
Jde o povinný studijní předmět, který patří mezi základní teoretické předměty profilujícího základu. Cílem předmětu je získání klinických znalostí a dovedností v klinické propedeutice a jejich fixace, které vytvářejí základní předpoklady nezbytné pro úspěšný výkon zdravotnického povolání lékaře. V rámci předmětu student získá především následující znalosti, dovednosti a kompetence: - Odebrat kompletní a přesnou anamnézu ve standardizované formě, s ohledem na pacientova očekávání, priority, hodnoty a duchovní potřeby, orientovat se v obtížích pacientů všech věkových kategorií, přizpůsobit se jazykovým schopnostem a zdravotní gramotnosti pacienta, respektovat lékařské tajemství. - Zjistit očekávání a priority pacienta. - Vést cílený rozhovor založený na diferenciální diagnostice; být pozorní k verbální i nonverbální komunikaci pacienta, jeho návykům, resp. návykům jeho rodiny, k povaze onemocnění; ověřit, zda je třeba zajistit překladatele; přistupovat k pacientům celostně (holisticky), empaticky a bez předsudků. - Identifikovat a používat i jiné zdroje informací při získávání kompletní anamnézy, včetně rodinných příslušníků, praktických lékařů, případně personálu ubytovacího zařízení, lékárny, sociálních služeb a jiných zdravotnických organizací. - Zjistit, jaká byla dosavadní léčba pacienta, včetně doplňkových nebo alternativních postupů léčby. - Zjistit, zda a případně jaké psychoaktivní látky pacient užívá. - Použít klinickou rozvahu při získávání informací významných pro pacientovu léčbu. - Identifikovat problémy, které pacient nezmínil spontánně. - Rozpoznat sebepoškozování nebo násilí páchané na pacientovi, včetně napadení. - Odebrat pediatrickou anamnézu v závislosti na věku pacienta (včetně matky/otce a dítěte nebo adolescenta). - Získat sociálně-pracovní anamnézu s ohledem na ergonomickou a hygienickou situaci na pracovišti. - Odebrat anamnézu užívání nebo zneužívání psychoaktivních látek a dalšího chování ohrožujícího zdravotní stav pacienta. - Odebrat gynekologickou anamnézu, zmapovat sexuální aktivitu pacienta a odebrat reprodukční anamnézu. - Odebrat anamnézu u těžce nemocného nebo umírajícího pacienta. - Provést přesné a klinicky relevantní fyzikální vyšetření v logickém a plynulém pořadí, zaměřit se na účel vyšetření a brát v úvahu očekávání, obtíže a symptomy u pacientů všech věkových kategorií. - Posoudit kognitivní a mentální stav pacienta včetně paměti, vnímání, porozumění, vyjadřování a emočního stavu. - Provést fyzikální vyšetření v obtížných situacích, jako je například obezita pacienta, vykonávání potřeby, pacient nespolupracující, pacient s poruchou vědomí nebo s kognitivní poruchou, pacient s jazykovou barierou. - Identifikovat, popsat, zapsat a vyhodnotit abnormální nález fyzikálního vyšetření. Zhodnotit životní funkce (tělesná teplota, pulz, dech, krevní tlak). - Zvládnout a osvojit si vyšetřovací techniky zaměřené na pacienta (patient-centred), být schopen používat nástroje (např. fonendoskop, otoskop, oftalmoskop aj.), respektovat soukromí pacienta, jeho pohodlí a bezpečnost. - Provést následující: o Celkové zhodnocení statusu praesens a životních funkcí pacienta. o Zhodnocení stavu výživy pacienta. o Zhodnocení úrovně pozornosti, myšlení, vnímání, řeči, emočního stavu a psychomotorických schopností. o Posouzení stavu pacientovy kůže a kožních adnex (zejm. vlasy, nehty) a popis jejich poškození (lézí). o Palpace lymfatických uzlin. o Vyšetření nosu, obličeje, úst, slinných žláz a hrtanu pohledem. o Vyšetření všech částí (struktur) krku pohledem, pohmatem a poslechem. o Vyšetření štítné žlázy a karotid pohledem a pohmatem. o Vyšetření kostry a kloubů pohledem a pohmatem. o Vyšetření kloubní pohyblivosti ramen, loktů, zápěstí, prstů, kyčlí, kolen a kotníků. o Vyšetření páteře pohledem, poslechem a poklepem, včetně vyšetření její pohyblivosti. o Vyšetření hrudi pohledem a pohmatem, poklep a poslech plic. o Palpace (úder srdečního hrotu/fremitus) a poslech srdce, popis ozev a šelestů. o Palpace pulsu, zhodnocení případné arteriální insuficience nebo tvorby modřin. o Zhodnocení žilního systému. o Vyšetření břicha pohmatem, poklepem a poslechem a následný popis nálezů. o Vyšetření třísel a kýlních otvorů pohledem a pohmatem. o Palpace prsu o Základní neurologické vyšetření o Zhodnocení stupně poruchy vědomí (škála). o Zhodnocení antropometrických charakteristik u kojence/dítěte/adolescenta v závislosti na věku pacienta. o Zhodnocení stupně puberty u pacienta o Zhodnocení psychomotorického vývoje u pediatrického pacienta (neurologický a kognitivní vývoj). o Zhodnocení základních a instrumentálních aktivit denního života pacienta. - Být přítomen u: o Vyšetření mužského genitálu o Vyšetření rekta u muže (anus, rectum, prostata, sakrum) a u ženy o Vyšetření novorozence (Apgar skóre, obličejový dysmorfismus, malformace). - Rozpoznat abnormální vitální funkce. - Rozpoznat obtíže a patologické nálezy jako například bolest, dyspnoe, srdeční šelesty, žloutenka a další změny na kůži, abnormality výsledky biochemického a hematologického vyšetření, poruchy nervového systému, změny příjmu potravy a denního rytmu a dal. - Identifikovat obtíže pacienta a posoudit jejich prioritu, odebrat od pacienta relevantní, souvislou a přesnou osobní a rodinnou anamnézu nebo ji případně získat z jiných zdrojů.
Last update: Strnadová Dita (10.01.2024)
Course completion requirements

Information about Introduction to Clinical Medicine – Internal part. The subject is composed from theoretical lectures organized together with pediatric department and clinical practical training.

Clinical practical trainings start every week with short seminar held mostly in library of Internal Clinic (Floor 4D). Practicals are run on wards of Internal Clinic.

The exam period will take place from 15th of January till 11th February when dates for credit tests for all students will be posted in SIS. The test has 20 questions, the answers are in the form of a choice and more than 75% of the answers must be correct, i.e. there must be more than 15 points from the test for the test to be evaluated as correct.The summer semester will be closed with oral exam, dates will be posted in SIS as well. To the exam, the student will bring with him/her: the attendance record from the pediatric part of the class, a prepared sample medical record from the internal and pediatric part. Without supporting these documents, the student will not be admitted to the exam (they are a condition for credit, so you cannot take the exam without a credit).

Start of lectures and practicals is specified in time schedule. Students may check which meeting room/ward is assigned to their class: SIS on a noticeboard on the floor 4D (in front of the secretariat of Internal Clinic) 

All practical classes and seminars are compulsory and the attendance is checked. The lectures are optional but you are requested to attend them if possible. The student is allowed to miss up to 4 practical classes and seminars during the semester, but there is necessary to replace them (about substitution talk to your teacher during practicals).

The winter semester will be closed by credit, the summer semester by credit and oral examination.

For obtaining credit of winter semester the student must fulfil following criteria:

to complete attendance at practicals and seminars, replace all missed

group teachers check the student´s ability of providing the physical examination

group teachers / their tutors check the knowledge of theory

For obtaining the credit of summer semester the student must fulfil following criteria:

to complete attendance at practicals and seminars, replace all missed

bring attendance sheet from pediatric part

group teachers check the student´s ability of providing the physical examination

to complete 1 case study report from internal and 1 from pediatric part

Examination: the terms for examination will be available in SIS during first weeks of the summer semester and the examination will take place after finishing the practicals

Last update: Strnadová Dita (22.01.2024)
Literature

INTRODUCTION TO CLINICAL MEDICINE:

Chrobák, L.: Physical examination in internal medicine : Grada, 2003 (B)
Zelenková, J.: Internal propaedeutic workbook : Triton, 2009 (A)

+ Douglas G. Macleod´s Clinical Examination

Last update: Polanecká Daniela, Ing. (08.07.2020)
Requirements to the exam

The winter semester will be closed by credit, the summer semester by credit and oral examination.

For obtaining credit of winter semester the student must fulfil following criteria:

  • to complete attendance at practicals and seminars, replace all missed ones
  • group teachers check the student´s ability of providing the physical examination
  • group teachers/their tutors check the knowledge of theory

For obtaining the credit of summer semester the student must fulfil following criteria:

  • to complete attendance at practicals and seminars, replace all missed ones
  • bring attendance sheet from pediatric part
  • group teachers check the student´s ability of providing the physical examination
  • to complete 1 case study report from internal and 1 from pediatric part

Examination: the terms for examination will be available in SIS during the summer semester and the examination will take place after finishing the practicals

Clinical propedeutics winter semester – credit examination 2018

1. Evaluation of consciousness

2. Disturbances of consciousness

3. Gait and abnormal movements

4. Changes of the voice and speech

5. Body temperature, subfebrility, fever, hyperpyrexia

6. Most frequently observed changes of the skin and skin adnexes (color, circulation, hydration, eflorescences)

7. Cyanosis

8. Chest pain

9. Tachypnea, hyperpnea, cough, hemoptysis

10. Dyspnea, stridor

11. Breathing and added breathing sounds

12. Heart sounds and their changes

13. Changes of heart rhytm

14. Heart murmurs

15. Physical examination of the head; physiological and pathological findings

16. Physical examination of the neck; physiological and pathological findings

1. Physical examination: Findings in bronchial asthma

2. Physical examination: Findings in acute bronchitis

3. Physical examination: Findings in chronic bronchitis

4. Physical examination: Findings in emphysema

5. Physical examination: Findings in pneumonia

6. Physical examination: Findings in pleural effusion

7. Physical examination: Findings in pneumothorax

8. Physical examination: Findings in pulmonary collaps

9. Physical examination: Findings in mitral stenosis and mitral regurgitation

10. Physical examination: Findings in aortic stenosis and aortic regurgitation

11. Physical examination: Findings in tricuspidal regurgitation

12. Physical examination: Findings in congenital heart defects

13. Physical examination: Findings in combined valve disorders

14. Physical examination: Findings in pericarditis

Introduction to clinical medicine – examination questions, 3rd year, 2018-19

Box I. – Symptoms

1. Evaluation of consciousness

2. Disturbances of consciousness

3. Gait and abnormal movements

4. Changes of the voice and speech

5. Body temperature, subfebrility, fever, hyperpyrexia

6. Growth disorders, evaluation of somatic development, percentile graphs

7. Disorders of nutrition, hypotrophy, dystrophy, obesity

8. Most frequently observed changes of the skin and skin adnexes (color, circulation, hydration, eflorescences)

9. Cyanosis

10. Chest pain

11. Tachypnea, hyperpnea, cough, hemoptysis

12. Dyspnea, stridor

13. Breathing and added breathing sounds

14. Heart sounds and their changes, added sounds

15. Changes of heart rhythm

16. Heart murmurs

17. Edemas

18. Vomitus, hematemesis

19. Abdominal pain

20. Icterus

21. Ascites

22. Changes of defecation / bowel movements

23. Dysuria, polakisuria, polyuria, oliguria, anuria, polydipsia

24. Principles of healthy nutrition, dietary system

25. Natural nutrition of the baby - breastfeeding

26. Artificial nutrition of the infant

27. Symptomatology of malignant diseases

28. Growth and sexual development of the child – auxology – basic growth and developmental data

29. Major disorders of the neuropsychological development

30. Bleeding disorders – symptomatology

Box II. – Physical examination

1. Physical examination: Findings in bronchial asthma

2. Physical examination: Findings in acute and chronic bronchitis

3. Physical examination: Findings in emphysema

4. Physical examination: Findings in pneumonia

5. Physical examination: Findings in pleural effusion

6. Physical examination: Findings in pneumothorax

7. Physical examination: Findings in pulmonary collaps

8. Physical examination: Findings in mitral stenosis and mitral regurgitation

9. Physical examination: Findings in aortic stenosis and aortic regurgitation

10. Physical examination: Findings in tricuspidal regurgitation

11. Physical examination: Findings in congenital heart defects

12. Physical examination: Findings in combined valve disorders

13. Physical examination: Findings in pericarditis

14. Principles of physical examination of the abdomen and physiological findings

15. Major patological findings in physical examination of the abdomen

16. Physical examination: typical findings in patient with acute abdominal pain

17. Physical examination: typical findings in patient with peritonitis

18. Physical examination: typical findings in patient with ileus

19. Physical examination: typical findings in patient with ascites

20. Physical examination: typical findings in patient with ischemic disease of lower extremities

21. Physical examination: typical findings in patient with venous thrombosis (deep and superficial)

22. Physical examination of joints and locomotor system

23. Symptoms of endocrine diseases

24. Basic neurological examination

25. Meningeal syndrome and intracranial hypertension – symptoms, clinical examination

26. Evaluation of psycho-motorical development of the child

27. Physiological new-born baby – first examination after delivery

28. New-born baby of a low birth body weight, immaturity and hypotrophy

29. Physical examination of the head; physiological and pathological findings

30. Physical examination of the neck; physiological and pathological findings

Box III. – Laboratory and imaging methods

1. Blood count – examination, specific features of different age periods; differences in childhood

2. Urine collection for chemical, microscopic and bacteriological examination in children and adults

3. Examination of the faeces in children and adults

4. Examination of the cerebrospinal fluid

5. Laboratory methods in diseases of the uropoetic system

6. Laboratory methods in diseases of the respiratory system

7. Laboratory methods in circulatory diseases

8. Laboratory methods in endocrine diseases

9. Laboratory methods in diabetology

10. Laboratory methods in diseases of the gastrointestinal tract

11. Laboratory methods in blood disorders

12. Laboratory methods in diseases of the liver and gallbladder

13. Laboratory methods in diseases of the locomotor system

14. Basic immunoassays in children and adults

15. Basic examination of coagulation in children and adults

16. Injection technique – in children and adults

17. Puncture and biopsy – in children and adults

18. Infusion and transfusion – in children and adults

19. Vaccination and tuberculine (Sterneedle) tests

20. Disturbances of the acid-base balance – examination

21. Changes in osmolality of the homeostasis – examination methods and interpretation

22. Technique of blood pressure measurement, hypertension, hypotension, percentile graphs

23. Dehydration – clinical and laboratory examination

24. Basic allergological laboratory tests

25. Non-invasive and invasive imaging methods in cardiology

26. Imaging and examination methods in pulmology

27. Imaging and examination methods in gastroenterology nad hepatology

28. Non-invasive and invasive imaging methods in angiology

29. Examination methods in nephrology

30. Imaging and examination methods in endocrinology

Last update: PALACKAJ (30.07.2019)
Syllabus

Syllabus of Introduction to Clinical Medicine – Internal part

1. Summary of the main symptoms of internal diseases.

An introductory lecture to the course of propaedeutic of internal diseases. Importance of history taking for making correct diagnosis. Segments of patient´s history. Main symptoms and signs of internal diseases. Pain. Dyspnea. Cough. Palpitations. Nausea and vomiting. Constipation. Diarrhea.

Required knowledge: anatomy, physiology

2. Overall condition of the patient, the state of consciousness.

Mental state of the patient, consciousness, growth, nutrition, standing and walking and their disturbances, voice and speech and their disturbances, body temperature - measurement and different types of temperature curves.

Required knowledge: anatomy, physiology

3. Findings on the skin. Physical examination of the head and the neck (part I).

Examination of the skin – color, tonus, moisture, temperature, affections. Hair and nails. Shapes of head, hair cover, face, eyes, nose, mouth, and throat. Physical examination, normal findings.

Required knowledge: anatomy, physiology of skin, head, and neck

4. Physical examination of the head and the neck (part II). Physical examination of the eyes and the throat.

Examination of eyes, eyelids, nose, mouth, throat. Inspection, percussion, palpation, auscultation. Mobility of the neck, vessels, lymphatic nodes, thyroid gland. Pathological findings.

Required knowledge: anatomy, physiology of head and neck

5. Symptomatology of the cardiovascular diseases. Physical examination of the heart (physiological findings).

History, important complaints. Changes in chest shape, inspection, percussion. Finding the heart borders. Palpation, auscultation – physiological findings.

Required knowledge: anatomy, physiology of circulation

6. Physical examination of the heart (physiological findings – part II), pathological findings.

Auscultation of the heart, basic heart sounds, extra sounds, murmurs. Physiological and pathological findings. Blood pressure measurement.

Required knowledge: anatomy, physiology of circulation

7. Acquired and congenital heart diseases in the adults.

Heart valve disease – mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation - clinical presentation, physical examination. Congenital heart defects – septal defects, Fallot´s tetralogy, Ebstein´s anomaly, ductus arteriosus persistent, coarctation of the aorta. Clinical presentation, physical examination.

Required knowledge: anatomy, physiology of circulation

8. Symptomatology of the pulmonary diseases. Physical examination of the lungs (physiological findings).

Physical examination of the lungs – observation (changes in chest shape), palpation, percussion, auscultation.

Required knowledge: anatomy, physiology of ventilation

9. Physical examination of the lungs (physiological findings – part II), pathological findings.

Pathological findings during physical examination. Effusions, inflammation, edema.

Required knowledge: anatomy, physiology of ventilation

10. Symptomatology of the gastrointestinal diseases. Physical examination of the abdomen (physiological findings)

Inspection, percussion, auscultation, palpation and per rectum examination. Superficial and deep palpation. Importance of excellent knowledge of normal findings to be able to recognize pathology. Importance of history.

Required knowledge: anatomy, physiology of gastrointestinal tract

11. Physical examination of the abdomen (physiological findings – part II), pathological findings.

Inspection, percussion, auscultation, palpation and per rectum examination. Superficial and deep palpation. Importance of excellent knowledge of normal findings to be able to recognize pathology. Importance of history.

Required knowledge: anatomy, physiology of gastrointestinal tract

12. Physical examination of the abdomen (pathological findings).

Physical examination, pathological findings. Important complaints: pain, dyspepsia, dysphagia, pyrosis, bowel movement disorders.

Required knowledge: anatomy, physiology of gastrointestinal tract

13. Symptomatology and affections of the limbs. Physical examination of the limbs.

Common complaints. Edemas, claudication, rest pain, trophical changes. Inspection, palpation, auscultation. Examination of joints and mobility. Upper and lower extremities.

Required knowledge: anatomy, physiology of limbs

14. Examination methods in cardiology.

History, common complaints. Physical examination. ECG, echocardiography, stress examination. CT and MR imaging. Biochemical markers.

Required knowledge: anatomy, physiology of circulation

15. Basics of electrocardiography

Recording the ECG. Reading and interpretation of ECG records. Basic dysrhythmias, disturbances of conduction, acute and chronic ischemic changes.

Required knowledge: anatomy, physiology of circulation

16. Examination methods in gastroenterology and hepatology.

History, common complaints. Physical examination. Ultrasound, X-ray, CT, and MR imaging. Endoscopic and biochemical methods.

Required knowledge: anatomy, physiology of gastrointestinal tract

17. Examination methods in endocrinology – clinical presentation, basic examination, differences in adult patients.

History, common complaints. Clinical presentation and examination of basic disturbances. Ultrasound, CT, and MR imaging. Biochemical markers and tests. Differences in children and adult patients.

Required knowledge: anatomy, physiology of glands

18. Basic laboratory examination. Blood cell count, biochemistry, examination of urine and feces.

Head supervisor of teaching of internal part of clinical propaedeutic is:

prof. MUDr. Keil Radan, Ph. D.

Responsible person: MUDr. Pavlína Piťhová, Ph.D., tel. 22443 4014, 4067

Last update: Strnadová Dita (10.01.2024)
 
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