SEMEIOTICS AND CLINICAL METHODOLOGY (ATT)
Learning outcomes of the course unit
The learning objectives of the Integrated Course, which the module is part of, are the following:
1. To know the methodology of medical history taking, and to be able to apply it with patients
2. To know how to perform a physical examination, be able to perform it on patients, and be able to distinguish normal findings from the main pathological findings
3. To be able to measure arterial pressure, perform venipuncture, register and interpret an electrocardiogram
4. To know the physio-pathology and clinical meaning of most frequent signs and symptoms of disease
5. To know the normal ranges of the main laboratory tests used in clinical practice, and be able to interpret their alterations
6. To know the main instrumental exams that can be prescribed to study the morphology and function of the human body organs and systems, and to know when the prescription of each one is appropriate
7. To know and be able to recognize the main objective findings in the most frequent medical and surgical syndromes
8. To know the basics of clinical reasoning and be able to apply them in approaching a medical or surgical patient
9. To know the general aspects of epidemiology and prophylaxis of infectious diseases, and the importance of these concepts in clinical activity
10. To know the basics of clinical research methodology.
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 contents summary
For the Medicine and Surgery undergraduate students, the Semeiotics and Clinical Methodology course represents a cross-road between basic science and clinical science. Thus, it is the first moment of practical application of the physiological and physio-pathological concepts acquired in the first two years of undergraduate studies. The course will deal with the methodology of approach to patients, either admitted to hospital or visited in a clinic, either with medical or surgical health problems. The physio-pathological interpretation of the main signs and symptoms of disease and of the main alterations of physical examination will be particularly focused. Teachers will thus treat the classical Semeiotics concepts (medical history, physical examination, approach to signs and symptoms) bridging the physio-pathological background with the concepts of Medical Pathology, to make students learn not only the approach to signs, symptoms or diseases, but to patients as persons with disease. Teachers will thus teach students how to take a medical history, how to perform a physical examination, how to approach to the main signs and symptoms of disease – either of medical or surgical interest, how to make a diagnostic reasoning and how to prescribe the main laboratory tests and instrumental examinations. They will also teach the main semeiological alterations (physical, laboratoristic and instrumental) associated with the most frequent diseases or syndromes that can be met in clinical practice, to make students be able to recognize the main pathological scenes.
The course also includes a practical internship, that will be conducted in a simulation lab with dummies and in hospital wards with real patients.
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.
1. Learning material available on the course site (Elly Medicina web platform, that can be accessed by all students)
2. 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.
3. Nuti R. Semeiotica Medica Metodologia Clinica. IX Edizione. Minerva Medica 2009.
4. Fradà G, Fradà G. Semeiotica medica nell'adulto e nell'anziano. V Edizione. Piccin Nuova Libraria 2014.
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.
Around 20% of the internship will be performed at the Simulation Lab of the Department of Medicine and Surgery, under the supervision of an academic teacher. In this part of the internship, which will generally be performed before the activity in hospital wards, students will be taught how to perform the main semeiological manoeuvres on dummies. Active participation from students will be encouraged. By the end of the simulation activity, students must be able to perform the basic semeiological manoeuvres (palpation, percussion, auscultation) on dummies in complete autonomy.
Assessment methods and criteria
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.
Teachers will be available for any requests from students, subject to e-mail contact.