FUNCTIONAL MEDICAL INSTRUMENTAL SEMEIOTICS
Learning outcomes of the course unit
By the end of the course students will:
1. be able to conduct a general and specific medical history;
2. be able to conduct a general medical examination;
3. be able to measure arterial pressure, take a blood sample from the vein and carry out and interpret a standard electrocardiogram;
4. understand the meaning and general pathophysiology of the most frequent signs and symptoms of disease;
5. be familiar with the normal levels for the main laboratory tests of general medical-surgical interest;
6. be able to detect physical signs of disease, be familiar with the most important variations from laboratory parameters and be familiar with the most common diagnostic tests for studying the major organs and systems that fall within the scope of general medicine/surgery.
In order to take the exam in Clinical Semeiotics and Methodology students must have passed the exams in Normal Human Anatomy, Physiology and General Pathology.
Course contents summary
General medical history (anamnesis): family, physiological, occupational, past and recent, pharmacological.
General medical examination: nutritional state, skin and appendages, lymph nodes, head and neck, eyes, oropharynx, chest, breast, wrists, abdomen, rectal examination, urogenital system, limbs, joints, muscular system, nervous system, ambulation.
General clinical methodology in surgery: anamnesis, physical clinical examination, diagnostic hypotheses, elements of instrumental diagnostics.
Signs and symptoms of disease: fever, cough, dyspnoea, cyanosis, asthenia, anorexia, vomiting, diarrhoea, constipation, flatulence, intestinal occlusion, jaundice, oedema, ascites, palpitations, chest pain, abdominal pain, migraine, dizziness, fainting and syncope, stress and shock, coma, stroke, bleeding, dysuria, oliguria, anuria, polyuria, haematuria, itching and dermatosis of interest to internal medicine, malnutrition, hypertension and hypotension.
Metabolisms: glucides, lipids, proteins, bile salts, uric acid, iron, water, sodium, potassium, calcium, phosphorus, magnesium, acid – base equilibrium.
Blood and haematopoietic organs: red blood cells, white blood cells, platelets, erythrosedimentation rate, haemostasis, haemoculture, physical findings of signs of disease and methods of study of spleen and lymph nodes, bone marrow needle biopsy. Immune system: blood groups, immunoglobulin, autoantibodies, lymphocyte sub-populations, allergic shock, principal allergy tests.
- 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.
Testi consigliati e bibliografia
1. Borghi, Meschi, Nouvenne, Ticinesi. Lezioni di semeiotica medica e metodologia clinica. (The text will be published during the course).
2. Semeiotica Medica e Metodologia Clinica. Edizioni Minerva Medica, 2010, autore Ranuccio Nuti.
3. Manuale di Semeiotica Medica. Edizioni Mc Graw-Hill, 1998, autori J.L. Wills, H. Schneiderman, edizione italiana a cura di Giorgio Lambertenghi.
4. Semeiotica e Metodologia Chirurgica. Edizioni Goliardiche, 2005, autore Mariano Cherubini.
5. Dottore ... mi posso fidare?. Manuale di medicina comprensibile. Edizioni Avverbi, 2007 autore Giorgio Dobrilla.
6. Igiene e Medicina Preventiva, Vol. I -4. Edizioni Moruzzi, autori Barbuti - Bellelli.
7. Medici umani, pazienti guerrieri. Editore Baldini Castoldi Dalai, 2008, autore Gianni Bonadonna.
8. Diagnosi infermieristiche. Casa Editrice Ambrosiana, 2006, autore L.J. Carpenito - Moyet, edizione italiana a cura di Carlo Calamandrei e Laura Rasero.
- Lectures and seminars
- Didactic resources made available by professors, also in e-learning on the University platform
- Bedside training with simulation activity for little groups of students
Assessment methods and criteria