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During the Clinical examination in internal medicine course students will learn the basics of history taking and physical examination with a focus on internal diseases.
Last update: Bartáková Tereza, Bc. (27.08.2024)
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Expected outcomes (knowledge and clinical skills):
Last update: Bartáková Tereza, Bc. (13.09.2023)
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Recommended source: James Thomas and Tanya Monaghan, Oxford Handbook of Clinical Examination and Practical Skills, 2017
Innes et al.: Macleod's Clinical Examination, 2024 https://www-clinicalkey-com.ezproxy.is.cuni.cz/student/content/toc/3-s2.0-C20200036698 Moodle LFHK https://moodle.lfhk.cuni.cz/moodle2/course/index.php?categoryid=671
Interesting additional source: O'Neill,Paul: Macleod's Clinical OSCEs, 2016 https://www-clinicalkey-com.ezproxy.is.cuni.cz/student/content/toc/3-s2.0-C2012006509X
Last update: Bartáková Tereza, Bc. (28.08.2024)
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Requirements for credit
Participation in seminars and practicals A maximum of two excused absences are allowed, one for practicals and one for seminars. Excused absences must be sent only in advance in the excuse form. In case of a higher number of absences, the situation will be resolved individually with the Head of the Department of Internal Medicine.
Credit Credit will be awarded based on successful completion of all the tests before the seminars (History taking in patients with respiratory diseases, History taking in patients with cardiac disorders, History taking in hepatogastroenterology, Rheumatology: case presentation, Physical examination in cardiology, Physical examination in pneumology, General assessment of the patient) - required success rate 70 %. Not completing all the tests before the seminar will be a reason for not receiving a credit.
Exam Theoretical part: The theoretical part of the exam will assess knowledge of the symptoms of internal diseases, principles of physical examination and clinical cases of the most common internal diseases. First and second attempt: Test in Moodle, grade: ≥ 90 % excellent, ≥ 80 % very good, ≥ 70 % good. Third attempt: commissional oral exam Practical part: Clinical examination of the patient. - Evaluation by OSCE method, required success rate > 70%. Last update: Bartáková Tereza, Bc. (28.08.2024)
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Lectures The lectures are aimed at introducing the basic principles of clinical examination of the patient.
Lecturers: Assoc. Prof. Miroslav Solař, M.D., Ph.D. Róbert Bánszky, M.D. Assoc. Prof. Petr Bradna, M.D., Ph.D. Assoc. Prof. Jiří Ceral, M.D., Ph.D. Tomáš Fejfar, M.D., Ph.D. Assoc. Prof. Vladimír Koblížek, M.D., Ph.D. Vratislav Sedlák, M.D., Ph.D. Assoc. Prof. Roman Šafránek, M.D., Ph.D. Štěpán Šembera, M.D., Ph.D. Prof. Pavel Žák, M.D., Ph.D.
Topics: Introduction into Clinical Medicine Introduction into cardiac exam (briefing before practising with cardiac aucultation simulator) Introduction into lung exam (briefing before practising with lung aucultation simulator) Clinical Examination in Pneumology I-IV Clinical Examination in Cardiology I-V Clinical Examination in Hepatogastroenterology I-IV Clinical Examination in Rheumatology I-II Clinical Examination in Hematology Clinical Examination in Nephrology I Clinical Examination in Angiology I-II A wrap up of clinical examination in cardiology A wrap up of clinical examination in pneumology A wrap up of clinical examination in hepatogastroenterology . Seminars The seminars focus on the practical aspects of the clinical examination of the patient.
Lecturers: Prof. Petr Dulíček, M.D., Ph.D. Assoc. Prof. Vladimír Koblížek, M.D., Ph.D. Michal Kopecký, M.D. Prof. Radek Pudil, M.D., Ph.D. Assoc. Prof. Miroslav Solař, M.D., Ph.D. Šembera Štěpán, M.D., Ph.D. Tomš Jan, M.D., Ph.D. Topics: Communication with the patient General Assessment of the Patient History taking in patients with cardiac disorders History taking in hepatogastroenterology Physical examination of the cardiovascular system Physical examination of the respiratory tract Rheumatology: case presentations History taking in patients with respiratory diseases A wrap up of physical examinationhistory taking, QA A wrap up of history taking, QA . Practicals During practical classes of physical examination the students will master the following knowledge and skills. Medical history Family history: occupational history and social background, allergy, atopy, smoking history, alcohol and illicit drug abuse, previous medical history (assessment of individua organ systems, surgery, major injury), gynaecological history, pharmacotherapy (n. of drugs and indications) Current complaints (detailed assessment of the most frequent symptoms): Pain assessment (SOCRATES), Chest pain (cardiac and non-cardiac chest pain, angina pectoris, chest pain in acute myocardial infarction), Dyspnoea (NYHA a mMRC scoring, typical features of of dyspnoea in heart failure, pulmonary disease, anemia), Short lasting unconsciousness (clinical picture of cardiogenic, ortostatic and reflex syncope, epilepsy), Palpitace (to know the accompanying symptoms that may correspond to serious arrhythmias: chest pain, dyspnoea, weakness, syncope), Leg pain (to know the symptom related to the peripheral artery disease), Leg oedema (to know the characteristics of oedema in deep vein thrombosis, heart failure, chronic venous insufficiency, hypoproteinemia), Cough, Dysphagia , Upper dyspepsia, Lower dyspepsia, Sing of gastrointestinal bleeding, Acute abdominal pain (to know the signs of peritonitis), Arthalgia (inflammatory and non-inflammatory), Signs of infection, Signs of malignant disorders, Signs associated with kidney and urinary tract disease. Physical exam General assessment Vital signs: State of consciousness and cooperation (AVPU, GCS), Respiration (respiratory rate, abnormal respiratory patterns), Capillary refill time, Heart rate, Blood pressure, SpO2 measurement, Other: Skin (colour, and major abnormalities), Hydration (signs of dehydration and hyperhydration), Position and mobility, Head exam Common pathologies of the face (eg. uremic face), Nose and ears, N. V a n. VII Eye exam: Position and movement of eyeballs, Pupils, Scleras and irises, Conjuctivas Mouth exam: Oral mucosa, Dentice, Tongue Neck exam: Neck spine mobility, Neck (jugular) vein filling (normal, increase, decreased, not accessible for examination), Carotid arteries, Lymph nodes, Thyroid gland. Chest exam Shape, Brest exam (on a model), Skin abnormalities, Scars. Cardiac exam Inspection, Palpation, Auscultation: heart rate, sounds and murmurs (systolic murmur in a patient must be heard by every student) Pulmonary exam Inspection (to know signs of respiratory distress, paradoxical breathing, normal and pathological breathing patterns), Percussion, Palpation and bronchophony Auscultation (every student must examine a patient with abnormal breathing sounds: crackles, wheezing, prolonged expiration) Abdominal exam Inspection (Constitution, respiration, hernias, scars, caput medusae, skin abnormalities), Auscultation (peristalsis, vascular murmurs), Percussion, Palpation, Liver exam (every student must examine patient with hepatomegaly), Splenic exam, Per rectum exam (on a model), Examination of a patient with ascites. Examination of the kidney exam and urinary tract Tapotement, Bimanual palpation Examination of the extremities Examination of arteries, Examination of the veins (varices, signs of dep vein thrombosis), Oedema, Examination of typical patients with Acute coronary syndrome, Heart failure, Chronic obstructive pulmonary disease, Pneumonia, Liver cirrhosis
Necessary equipement: stethoscope Required clothing: white coat
Last update: Bartáková Tereza, Bc. (09.07.2024)
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Entry requirements: successful completion of Physiology II Last update: Bartáková Tereza, Bc. (13.09.2023)
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