SEMEIOTICS AND CLINICAL METHODOLOGY (B)
Learning outcomes of the course unit
Educational objectives of the course
1. To know how to do general and specific anamnesis.
2. To know how to make a general medical examination.
3. To be able to measure blood pressure, perform venipuncture, do and interpret a standard electrocardiogram.
4. To know the meaning and the general physiopathology of the most frequent signs and symptoms of disease.
5. To know the normal levels of principal laboratory tests of general medical surgical interest.
6. To know how to detect symptoms of pathological objectives, to know the most important changes in laboratory parameters and the instrumental examinations most common for the study of the principal organs and systems of general medical surgery competence.
7. To know the general aspects of epidemiology and of prophylaxis of infectious diseases.
8. To know the simplest rudiments of medical statistics and the methodology of clinical research.
Practical internship (Nursing), 2nd year
The practical internship (nursing) that is held in the 1st and 2nd semester of the 2nd year of the degree course in Medicine and Surgery has as its primary initial goal knowledge of the organizational and welfare aspects that characterize the area of medical, surgical, specialist and emergency wards. This internship is a first opportunity for interaction between students and nursing staff and with clinical and organizational issues. Students are assigned to nursing tutors, under the supervision of lecturers and coordinators, to enable the development and understanding of relationships with other professionals, the initial approach to the competences needed for the observation of underlying and ethical clinical aspects that characterize the hospital health organizational area.
Interactive Didactic Activity (ADI), 3rd year
The Interactive Didactic Activity (ADI) is an integral part of the Course of Clinical Methodology and Semiotics. This is a practical activity in small groups of students conducted by lecturers of the course in the medical or surgical wards. The key objectives of the ADI is the first approach with the patient, the medical history, the general physical examination and learning - the performance of simple semiologic manoeuvres that the student must be able to do before sitting the exam. ADI will normally take place during the months of December and January of each year. Each year, the course coordinator assigns a number of students to a lecturer (15 - 20) which will be divided into small groups of 3 - 4 by the lecturer. It is the responsibility of students to contact their ADI lecturer to agree on the when and how for the realisation of: the lists of students with their relative ADI lecturers are displayed on the noticeboard of the Department of Clinical Sciences (Barbieri Hall) around the 15th of November of each year and are found on the site.
To sit the examination of Semiotics and Clinical Methodology it is necessary to have passed the examinations of:
Normal Human Anatomy, Physiology, General Pathology.
Course contents summary
General medical history: family, physiological, employment, remote pathology, recent pathology, pharmacological.
General medical examination: nutritional status, skin and subcutaneous, lymph nodes, head and neck, eyes, oropharynx, chest, breast, wrists, abdomen, rectal examination, apparatus urinary-genital, limbs, joints, muscular system, nervous system, walking.
General clinical methodology in surgery: medical history, physical examination, diagnostic hypotheses, instrumental diagnostic elements.
Signs and symptoms of illness: fever, cough, dyspnea, cyanosis, anorexia, vomiting, diarrhea, constipation, bloating, intestinal obstruction, jaundice, edema, ascites, palpitations and heart palpitations, chest pain, abdominal pain, headache, dizziness, faintness and syncope, stress and shock, coma, brain haemorrhage, haemorrhage dysuria, oliguria, anuria, polyuria, hematuria, pruritus and dermatitis of internal medical interest, malnutrition, hypertension and hypotension.
Metabolisms: glucides, lipids, proteins, bile salts, uric acid, iron, water, sodium, potassium, calcium, phosphorus, magnesium, acid balance - base.
Blood and hemopoetic organs: red cells, white cells, platelets, blood-sedimentation rate, hemostasis, blood culture, objective pathological findings and study methods of spleen and lymph nodes, bone marrow needle biopsy. Immune system: blood groups, immunoglobulins, autoantibodies, lymphocyte subpopulations, allergic shock, principal allergy tests.
Heart: specific medical history and physical examination of the heart, abnormal heart sounds, heart murmurs, pericardial friction rub, XR heart and large vessels, myocardium infarction laboratory examination, pulse characteristics, normal electrocardiogram and more common abnormalities (fibrillation and atrial flutter, ischemia, infarction), instrumental cardiology investigations: meaning and utility of echocardiography, cardiac catheterization, coronary radiography, myocardial scintigraphy, echo-doppler of the supra-aortic vessels, cardiovascular risk factors.
Pulse locations and characters.
Lungs and bronchi: objective findings in the course of chest effusion, pneumothorax, atelectasis, pneumonia, pulmonary emphysema, acute and chronic bronchitis, bronchial asthma, acute pulmonary edema, pulmonary and pleuritic embolism, functional exploration of respiration, sputum examination, thoracentesis and pleural fluid examination, standard chest XR, meaning and usefulness of computerized axial tomography, pulmonary scintigraphy, bronchoscopy.
Digestive tract: common methods of study and endoscopic semiotics of the esophagus, stomach, duodenum, stomach, jejunum, colon and rectum, intestinal malabsorption, microbiolgical examination of stool; rectal exploration.
Liver, biliary and pancreas tracts: objective findings, liver function examinations, biliary and pancreatic, serologic markers of viral hepatitis, computerized axial ultrasonography and tomography, paracentisis, pathophysiology of hepatic circulation and of the hypertension portal.
Kidney and urinary tracts: objective findings, complete urinalysis and urocoltura, assessment of renal function, radiological and endoscopic investigations.
Thyroid and parathyroid glands: major objective changes and functionality examinations.
Arteries and veins: peripheral arterial ischemia, objective signs of obstruction of the superior and inferior vena cava, phlebothrombosis and thrombophlebitis.
Peritoneum: anatomical and physiopathological bases.
Breast: breast semiotic.
Medical statistics and methodology of medical research: meaning and basic elements of medical statistics, methodological bases of clinical research.
General epidemiology: the importance of infectious diseases today, host/parasite relationship, reservoirs of infection, mode of transmission, chains of infection, mode of appearance of infectious diseases in the population.
Recommended texts and bibliography
1. Didactic material on the site.
2. Semeiotica Medica e Metodologia Clinica. Edizioni Minerva Medica, 2010, author Ranuccio Nuti.
3. Manuale di Semeiotica Medica. Edizioni Mc Graw-Hill, 1998, authors J.L. Wills, H. Schneiderman, Italian edition edited by 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, Vol. 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 and Laura Rasero.
The overall educational activities related to the teaching of Clinical Semiotics and Methodology is articulated and developed over time in the 2nd and 3rd year of Degree Course in Medicine and Surgery in the following way:
- 2nd year, 1st semester: practical traineeship “propaedeutical medical-surgical clinical methodology” with medical, surgical and emergency room nursing, which concludes with a certificate of attendance; coordinator Prof. Aderville Cabassi.
- 2nd year, 2nd semester: practical traineeship " already propaedeutical clinical specialist methodology” with pediatric nursing, obstetrics - gynecology and neuropsychiatric rehabilitation, concluding with a certificate of attendance; coordinator Prof. Aldo Agnetti.
- 3rd year, 1st and 2nd semesters: “classroom lectures and clinical semiotics and methodology”; coordinator Prof. Loris Borghi and “interactive educational activities (ADI) in small groups at the bedside of patients”, coordinator Prof. Loris Borghi, concluding with a certificate of attendance and examination.
The complex of educational activities for the student provides 23 CFU that are acquired at the time of passing the Clinical Semeiotics and Methodology exam scheduled for the 3rd year.
Methods of examination: oral.
Lecturers: 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 Pela, Prof. Erminia Ridola, Prof. Nicoletta Ronda, Prof. Leopoldo Sarli, Prof. Roberto Sivelli
Prof. Maria Luisa Tanzi, Professor Vincenzo Violi
SSD involved in the Integrated Course
/09 - Internal Medicine, MED/18 - General Surgery, MED/38 - General and Specialized Pediatrics, MED/40 - Gynecology and Obstetrics, MED/26 - Neurology, MED/42 - General and Applied Hygiene, MED/01 -- Medical Statistics