SEMEIOTICS AND CLINICAL METHODOLOGY
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;
7. be acquainted with general aspects of epidemiology and prevention of infectious diseases;
8. be familiar with essential notions of medical statistics and of clinical research methodology.
Practical Training Programme (Nursing), 2nd year
The main aim of the practical training programme (nursing) that takes place during the 1st and 2nd terms of the 2nd year of the degree course in Medicine and Surgery is to acquaint students with organisational and care aspects that characterise hospital departments in the medical, surgical, specialist and emergency areas. This training programme provides an initial opportunity for students to interact with nursing staff and clinical and organisational issues. Students are assigned to nursing tutors, under the supervision of teachers and coordinators, enabling them to learn about and develop relationships with other professional figures and to familiarise themselves for the first time with the necessary skills for observing and understanding the fundamental clinical and ethical issues that characterise hospital healthcare organisation.
Interactive Learning Activity (ADI, Attività Didattica Interattiva), 3rd year
The Interactive Learning Activity (ADI) forms an integral part of the Course in Semeiotics and Clinical Methodology. It consists of practical activity in small groups of students conducted by the course teachers in the relevant medical or surgical departments. The fundamental aims of the ADI are to teach students about initial contact with the patient, conducting a medical history, the general physical examination and the most basic semeiological manoeuvres that they must know before taking the exam. The ADI usually takes place during December and January every year. Every year the course coordinator assigns a certain number of students (15-20) to a teacher. They are split into small groups of 3-4 by the teacher him/herself. Students must contact their ADI teacher to arrange times and methods for completing the ADI: the lists of students and their assigned ADI teachers are displayed on the noticeboard of the Department of Clinical Science (Barbieri building) around November 15 every year and can be viewed on the website.
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.
Heart: specific anamnesis and physical examination of the heart, changes in heart sounds, cardiac murmurs, pericardial murmurs, heart x-ray and great vessels, laboratory examination for myocardial infarction, characteristics of pulse, normal electrocardiogram and most common changes (atrial fibrillation and Flutter, ischaemia, infarct), diagnostic procedures in cardiology: significance and utility of echocardiogram, cardiac catheterism, coronarography, myocardial scintigraphy, echo-Doppler of supraortic trunks, cardiovascular risk factors.
Pulse: points and characteristics.
Lungs and bronchi: physical findings during thoracic effusion, pneumatothorax, atelectasis, pneumonia, emphysemia, acute and chronic bronchitis, bronchial asthma, acute pulmonary edema, pulmonary embolism and pleurisy, respiratory functional exploration, examination of expectorate, thoracentesis and examination of pleuric liquid, Standard chest x-ray, meanings and utility of computerised axial tomography, pulmonary scintigraphy, bronchoscopy.
Digestive tube: common methods of study and endoscopic semeiotics for oesophagus, stomach, jejunum, ileum, colon and rectum; intestinal malabsorption, examination of the faeces and coproculture; rectal exploration.
Liver, biliary ducts and pancreas: physical findings, hepatic, biliary and pancreatic function tests, serological markers of viral hepatitis, ecography and computerised axial tomography, paracentesis, pathophysiology of hepatic circulation and of portal hypertension.
Kidneys and urinary ducts: physical findings, complete urine test and urine culture, assessment of renal function, radiological and endoscopic examinations.
Thyroid and parathyroids: principal physical alterations and function tests.
Arteries and veins: peripheral arterial ischemia, physical signs of obstruction of superior and inferior vena cava, phlebothrombosis and thrombophlebitis.
Peritoneum: anatomical and pathophysiological bases.
Breast: semeiotics of the breast.
Medical statistics and medical research methodology: significance and basic elements of medical statistics, methodological foundations of clinical research.
General epidemiology: importance of infectious diseases today, host/parasite relationship, reservoirs of infection, chains of infection, how infectious diseases appear in population.
General preventive medicine: notification, isolation measures, diagnostic test for infectious diseases, sterilisation, disinfection, disinfestation, vaccine prophylaxis, types of vaccine, vaccination strategies and schedules, passive immunoprophylaxis and chemoprophylaxis.
Recommended texts and reading list
1. Course material on website.
2. Semeiotica Medica e Metodologia Clinica. Edizioni Minerva Medica, 2010, author: Ranuccio Nuti.
3. Manuale di Semeiotica Medica. Edizioni McGraw-Hill, 1998, authors: J.L. Wills, H. Schneiderman, edizione italiana a cura di Giorgio Lambertenghi.
4. Semeiotica e Metodologia Chirurgica. Edizioni Goliardiche, 2005, author: Mariano Cherubini.
5. Dottore ... mi posso fidare? Manuale di medicina comprensibile. Edizioni Avverbi, 2007, author: Giorgio Dobrilla.
6. Igiene e Medicina Preventiva, Vols. I -4. Edizioni Moruzzi, authors: Barbuti & Bellelli.
7. Medici umani, pazienti guerrieri. Editore Baldini Castoldi Dalai, 2008, author: Gianni Bonadonna.
8. Diagnosi infermieristiche. Casa Editrice Ambrosiana, 2006, author: L.J. Carpenito-Moyet, Italian edition edited by Carlo Calamandrei & Laura Rasero.
The learning activities relating to the teaching of Semeiotics and Clinical Methodology as a whole are structured and developed during the 2nd and 3rd year of the degree course in Medicine and Surgery as follows:
- 2nd year, 1st term: practical training programme in “preparatory medical-surgical clinical methodology” with medical and surgical nursing and emergency treatment, concluding with a certificate of attendance. Coordinator: Prof. Aderville Cabassi.
- 2nd year, 2nd term: practical training programme in “preparatory specialised clinical methodology” with pediatric, obstetric/gynaecological and neuropsychiatric rehabilitation nursing, concluding with a certificate of attendance. Coordinator: Prof. Aldo Agnetti.
- 3rd year, 1st and 2nd terms: “lectures in semeiotics and clinical methodology” (coordinator: Prof. Loris Borghi) and Interactive Learning Activity (ADI, Attività Didattica Interattiva) in small groups at the patient’s bedside (coordinator: Prof. Loris Borghi), concluding with a certificate of attendance and exam.
The course activities overall are worth 23 learning credits which are gained upon passing the exam in Semeiotics and Clinical methodology held during the 3rd year.
The exam is oral.
Teachers: Prof. Loris Borghi (coordinator), Prof. Aldo Agnetti, Prof. Almerina Biggi, Prof. Aderville Cabassi, Prof. Paolo Coruzzi, Prof. Chiara De Panfilis, Prof. Marcello Maggio, Prof. Tiziana Meschi, Prof. Enzo Molina, Prof. Luisa Musiari, Prof. Giovanna Pelà, Prof. Erminia Ridolo, Prof. Nicoletta Ronda, Prof. Leopoldo Sarli, Prof. Roberto Sivelli, Prof. Maria Luisa Tanzi, Prof. Vincenzo Violi.
The Integrated Course covers the following scientific subject areas:
MED/09 – Internal Medicine, MED/18 – General Surgery, MED/38 – General and Specialist Paediatrics, MED/40 – Obstetrics and Gynaecology, MED/26 – Neurology, MED/42 – General and Applied Hygiene, MED/01 – Medical Statistics