INTERNSHIP OF SEMEIOTICS AND CLINICAL METHODOLOGY
Learning outcomes of the course unit
- To be able to collect the medical history from patients autonomously
- To be able to perform autonomously a physical examination, distinguishing normal from the most frequent pathological findings
- To be able to measure vital signs
- To be able to register an ECG, recognizing the most frequent ECG alterations
- To be able to comprehensively approach patients and their health problems
Please see the modules of frontal teaching for the general objectives of the Semeiotics and Clinical Methodology Intergrated course.
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
The Semeiotics and Clinical Methodology internship will allow students to learn the basics of approach to patients and clinical reasoning, witnessing the organization of clinical activity in a hospital ward. In this practical module, students will learn how to collect anamnesis from patients, how to perform a physical examination, how to measure vital signs and to register and interpret an ECG trace.
Please see the modules of frontal teaching for the general outline of the Semeiotics and Clinical Methodology Intergrated course.
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 practical internship 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.
In case of restrictions due to the COVID-19 pandemic, the practical internship will be substituted with online live seminars, with active discussion of clinical cases between professors and small groups of students.
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.