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Ministry of health protection of Ukraine

Bukovinian State Medical University


“Ratify”

Vice-rector on educational work

Professor ________M.Yu.Kolomoiets’

“______”_____________2008


Reference book for student on study of propedeutics of internal diseases discipline

(structure, goals, content of the subject, principles of rating, control questions)


Student’s reference book is composed on the basis of actual educational plan and program on educational subject of propedeutics of internal diseases for students of higher medical educational institutions of III-IVth accreditation levels (MHP of Ukraine, K., 2006), appendix according to order MHP of Ukraine on 23th July 2007 № 414 to program of educational subject.


Approved on the methodical council of the department of propedeutics of internal diseases, clinical immunology and allergology on the 25d of Мау 2008 (record №18) and on the session of subject methodical commission on therapeutic disciplines on the 25th of June (record №13)


Head of the department of

propedeutics of internal diseases,

clinical immunology and allergology,

professor O.I.Voloshyn


Head of the subject methodical commission

on therapeutic disciplines,

Head of the department of cardiology, functional

diagnostics, TPC and sport medicine,

professor V.K.Tashchuk


Chernivtsy, 2008


Course of study

Propedeutics of Internal Medicine

1. Introduction

Definition of the subject

Quantity of educational hours: 210 (7 ECTS credits), including: lectures – 40 hours.

Practical tutorials: 90 hours.

Independent work of students – 80 hours.

Contents of the subject is structured into 2 modules and 9 contents modules.


^ 2. The structure of “Propedeutics of internal diseases” discipline and calculation of balls for current learning activity (convertation of traditional marks into balls; rating in balls for completion of individual tasks, if suggested by working educational program).

Module number, quantity of educational hours /quantity of ECTS credits

Quantity of contents modules, their numbers

Quantity of practical tutorials

Convertation of traditional marks into balls

Minimal balls quantity

Traditional marks

Balls for completion of individual task as a way of SIW

5

4

3

2

Module 1 120/4,0

5

№1-5

23

5

4

3

0

10

70

Module 2 

75/2,5

4

№6-9

15

8

6

5

0

8

70


* - minimal balls quantity that has to be gained by a student for current learning activity while studying of exact module to be admitted to passing of final module control.


^ 3. Final aims of learning of educational discipline according to Educational-professional program (EPP)*:

- to conduct questioning and physical examination of patients, and analyse their results in the clinics of internal diseases

- to analyse results of principal laboratory and instrumental methods of investigation

- to detect leading syndromes and symptoms in the clinics of internal diseases


^ 4.1. Thematic plan of lectures



Topic

Hours quantity

1.

Propedeutics of internal diseases as introduction into clinics of internal diseases. Principal methods of patient examination. Anamnestic part of a case history. Inspection of a patient and its role in the diagnostic process.

2

2.

Symptoms in pulmonary diseases on the basis of patient interviewing, palpation ad percussion of the chest.

2

3.

Symptoms in pulmonary diseases on the basis of lungs auscultation

2

4.

Instrumental and laboratory methods of investigation in diseases of bronchopulmonary apparatus

2

5.

Symptoms and syndromes on the basis of pulse and arterial pressure investigation

2

6.

Heart auscultation. Normal heart sounds. Chief symptoms and syndromes in auscultation of pathological heart sounds.

2

7.

Symptoms and syndromes on the basis of heart murmurs auscultation.

2

8.

Instrumental methods of cardiovascular system investigation

2

Total

16

^ 4.2. Thematic plan of practical tutorials (seminars)



Topic

Hours quantity

1

Schedule of case history. Conduction of patient questioning.

2

2

General inspection of a patient. Diagnostic meaning of symptoms explored during patient examination.

2

3

Inspection of the separate body parts: head, neck, trunk, extremities.

2

4

Principal complains of patients with diseases of the respiratory organs. Static and dynamic inspection of the chest. Palpation of the chest.

2

5

Percussion of the lungs. Method and technique of comparative percussion conduction.

2

6

Percussion of the lungs. Method and technique of topographic percussion conduction.

2

7

Auscultation of the lungs: principal respiratory sounds (vesicular and bronchial respiration)

2

8

Auscultation of the lungs: additional respiratory sounds (crepitation, rales, pleural friction noise)

2

9

Instrumental methods of respiratory organs examination.

2

10

Clinical interpretation of sputum and pleural punctate investigation in respiratory organs’ diseases

2

11

Questioning and general inspection of patients with cardiovascular pathology. Pulse (arterial, venous, pseudocapillary) and arterial pressure investigation.

4

12

Inspection and palpation of precardiac area. Detection of relative and absolute heart dullness borders by percussion. Percussion of the heart in pathological states. Changes of heart borders caused by heart diseases and extracardiac reasons. Demonstration of roentgenograms with different configurations of the heart.

4

13

Auscultation of the heart. Normal cardiac tones, additional tones. Auscultation of the heart in pathology, changes of tones strength (intensivity): increase and weakening of both of heart tones and each separately, tones splitting and segregation, quail rhythm, gallop rhythm, pendulum-like rhythm and embriocardia.

4

14

Auscultation of the heart. Organic cardiac murmurs. Functional cardiac murmurs, mechanism of their origin. Differences between organic (valvular) and functional murmurs. Extracardiac murmurs: pericardial friction noise, pleuropericardial, cardiopulmonary murmurs. Analysis of phonocardiograms.

4

15

Methodics of electrocardiogram registration and decoding. ECG-signs of atriums and ventricles hypertrophy.

2

16

ECG-signs of automatism and excitability violations.

2

17

ECG-signs of conductivity violations. Basis for electroimpulse therapy conduction.

2

18

Instrumental methods of cardiovascular system investigation.

2

19

Questioning and inspection of patients with pathology of digestive organs. Inspection and superficial palpation of the abdomen.

2

20

Profound methodical sliding topographic palpation of the gut parts and the stomach. Profound methodical sliding topographic palpation of the liver, spleen, kidneys.

4

21

Instrumental methods of gastroenterological tract investigation. Investigation of the gastric and duodenal content.

2

22

Investigation of the faeces and their clinical interpretation.

2

23

Final module control, incl. test-control of theoretical training. Control of the practical skills. Analysis of the results of instrumental investigations.

2

Total

56



^ 4.3. Kinds of independent work.



Topic

Hours quantity

1.

Preparation to practical tutorials – theoretical and mastering methods of patient physical examination:







- questioning of a patient with internal organs pathology

4




- general inspection of a patient, inspection of the separate body parts (head, neck, trunk, extremities, chest, abdomen)

4




- chest palpation

1




- comparative and topographic percussion of the lungs

2




- lungs auscultation

3




- palpation of precardiac area

1




- determination of pulse properties

1




- percussion of the borders of heart relative and absolute dullness

1




- heart auscultation

3




- superficial palpation of the abdomen, profound methodical sliding topographic palpation of the gut, the stomach, the liver, spleen, kidneys.

2




- determination of borders of the liver and the spleen by percussion

1

2.

Gaining skills of conduction of instrumental investigations:







- spirography and pneumotachometry

1




- ECG and PhCG registration

2

3.

Gaining expertness to analyse:







- results of investigation of external breathing functions

1




- results of electrocardiographic and phonocardiographic investigations

7




- results of investigation of the gastric and duodenal content.

1

4.

Independent working out topics not included to curriculum of class tutorials:

- electrocardiographic investigation in case of combined violations of the heart rhythm


2

5.

Curation of the patients with writing of anamnestic part of the case history

2

6.

Individual work:

Conduction of investigation of external breathing functions in significant model patients, working of obtained data and report at the tutorial

ECG registration, participation in conduction of instrumental investigations in significant model patients with working of obtained data and report at the tutorial

Conduction of investigation of significant model patient and preparation of literature review concerning investigated case


2


2


2

7.

Preparation to final control of module 1 adoption

4

Total

49


^ 5. Module 2. Symptoms and syndromes in internal organs diseases.

5.1 Thematic plan of lectures



Topic

Hours quantity

1.

Mitral and aortal defects of heart. Principal symptoms and syndromes in arterial hypertension and ischemic heart disease

2

2.

Syndrome of cardiac and vascular insufficiency in cardiovascular system pathology

2

3.

Acute and chronic bronchitis, bronchial asthma. Syndrome of increased airiness of the lungs. Emphysema of the lungs. Principal symptoms and syndromes in pneumonias, dry and exudative pleurisies.

2

4.

Principal symptoms and syndromes in diseases of the stomach and the gut. Methods of clinical, laboratory and instrumental investigations in acute and chronic gastritis, stomach and duodenum ulcerative disease.

2

5.

Principal symptoms and syndromes in diseases of the bowel and pancreas. Methods of clinical, laboratory and instrumental investigations in enteritis, colitis, pancreatitis.

2

6.

Principal symptoms and syndromes in hepatobiliary diseases. Methods of clinical, laboratory and instrumental investigations.

2

7.

Principal symptoms and syndromes in diseases of the kidneys. Symptomatology of acute and chronic glomerulonephritis and pyelonephritis.

2

8.

Principal symptoms and syndromes in anemias. Methods of clinical, laboratory and instrumental investigations.

2

9.

Haemorrhagic syndromes. Methods of clinical, laboratory and instrumental investigations.




10.

Methods of clinical, laboratory and instrumental diagnostics of endocrine system diseases and metabolic disorders.

2

11.

Principal symptoms and syndromes in diseases of joints.

2

12.

Symptomatology of acute allergoses and emergent help in their case. Anaphylactic shock and primary help in it.

2

Total

24
  1   2   3

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