Learning objectives
First Dublin descriptor: knowledge and understanding
At the end of the course, students must be aware of the technique of taking medical history in different clinical settings (outpatient clinic, medical or surgical ward, emergency), and must be able to describe the technique of physical examination of different body districts (head, neck, chest, abdomen, limbs, joints, nervous system). Students must also know the pathophysiological features of the main signs and symptoms of illness and of the alterations of the main clinical laboratory tests, being aware of the lines of reasoning leading to the formulation of a differential diagnosis. Finally, students must know the principles guiding the appropriateness of prescription of the main instrumental examinations (radiological, endoscopic, functional) in different clinical scenarios.
Second Dublin descriptor: applied knowledge and understanding
Students must prove to be able to conduct anamnestic interviews in some basic clinical scenarios, basing on the presence of specific signs or symptoms. They must also be able to perform a general physical examination of head, neck, chest, abdomen, joints or nervous system autonomously or with minimal supervision, identifying the commonest alterations that can be found in everyday clinical practice. They must also be able to interpret the main alterations of first-level lab tests (blood cell count, renal function profile, liver function profile, inflammation markers, electrolytes, standard urine exam). They must finally be able to draft a plan of prescription of the main instrumental examinations in some simple clinical scenarios that can be found in everyday medical or surgical practice.
Third Dublin descriptor: making judgements
Students must be able to formulate and support a clinical reasoning, making diagnostic hypotheses and a plan of prescription of laboratory tests and instrumental examinations, in the main clinical scenarios that can be found in everyday medical and surgical practice (for example, patient with respiratory impairment, patient with acute chest pain, patient with acute abdominal pain).
Fourth Dublin descriptor: communication skills
Students must prove to have acquired a sufficient level of mastery of specific medical jargon. They must also prove to be able to modulate communication style and language according to the characteristics of patients.
Fifth Dublin descriptor: learning skills
At the end of the course, students must prove to have acquired a method of clinical reasoning, allowing them to effectively approach even situations or clinical scenarios not met before.
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. Nuti R. Semeiotica Medica Metodologia Clinica. IX Edizione. Minerva Medica 2009.
3. Fradà G, Fradà G. Semeiotica medica nell'adulto e nell'anziano. V Edizione. Piccin Nuova Libraria 2014.
4. 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.
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.
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
2030 agenda goals for sustainable development
Health and wellbeing
