Internal diseases – general diagnostics
Lectures are delivered by Internal Medicine Departments chiefs with the object of presenting the
principles of diagnosis rules in particular fields of internal medicine. Training classes are dedicated to
developing students skills in describing symptoms of different systems and organs diseases,
evaluation of the patient with defined symptoms, physical examination rules, interpretation of
laboratory, radiologic and functional tests. Students are competent to choose a proper approach to
the patient with different symptoms, collect a history data, conduct physical examination, put the
proper interpretation of diagnostic procedures. Students fill in medical documentation, order forms
and case reports, present case reports. Before entering internal medicine classes students are aware
of principal knowledge in the field of anatomy, physiology, biology, biophysics and biochemistry.
Teachers:
Dr hab. med. Jacek Budzyński
Contact: kikgast@cm.umk.pl, budz@cps.pl
Syllabus
I. Chair and Clinic of Gastroenterology, Vascular Diseases and Internal Diseases
II. Head of the Unit: prof. dr hab. Maciej Świątkowski
III. Faculty of Medicine, Medical Program, third year
IV. Course coordinator: prof. dr hab. Maciej Świątkowski
V. Form of classes: lectures, tutorials
VI. Form of crediting: credit with grade, 3 p. ECTS
VII. Number of hours: 22 hours of lectures, 48 hours of tutorials , total: 70 hours
VIII. Aim of the course:
Lectures are delivered by Chiefs of Internal Medicine Departments, where students attend a course
of internal medicine during five half-year periods. The object is to present the principal rules of
diagnosis procedures in the field of cardiology (five hours), allergology and clinical immunology (five
hours), nephrology (four hours), endocrinology ( four hours) and gastroenterology (four hours).
Training classes in internal medicine clinics are dedicated to improve student’s knowledge and skills
in approach to the patient with different diseases symptoms.
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Student becomes acquainted with medical staff, consulting, office and laboratory rooms.
Students are aware of the rules of proper communication with the patient, especially appropriate
appearance, behavior, confidentiality, obtaining the conscious agreement for all medical procedures,
complying with orders and principal hygienic rules. Students describe the proper anamnesis
collection, are aware of the first-look diagnosis
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Students describe signs and symptoms of cardiovascular and respiratory systems diseases,
like chest pain, dyspnoea, palpitation, vertigo, loss of consciousness, edema, cough, haemoptysis,
apnea. Students obtain a history of cardiovascular and respiratory system diseases.
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Students define and describe symptoms of digestive tract diseases, like abdominal pain,
dysphagia, heartburn, nausea, vomiting, bloating, dyspeptic symptoms, distension, diarrhea,
constipation, weight loss, gastrointestinal bleeding, jaundice, abdominal swelling and ascites,
disorders of defecation, anorectal complaints. Students obtain a history of cardiovascular, respiratory
and digestive systems diseases.
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Students define and describe symptoms of urogenital tract, hematopoietic, endocrinology,
musculoskeletal and neurologic systems abnormalities, like lumbar region pain, dysuria, poliuria,
anuria, incontinentia of urinae, hematuria, menstruation, pregnancy, childbirth, leucorrhea, scrotal
enlargement and pain, weakness, diaphoresis, polydipsia, arthralgia, arthrophyma, convulsions,
disturbances in eyesight, hearing, memory, concentration. Students obtain medical history.
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Clinical practicals are dedicated to improve the ability of the proper use of medical
documentation forms, case report description, hospital discharge cards. Student estimate and
describe general appearance: consciousness, body position, walking, speech, body building, body
weight abnormalities, face expression and perform basic measurements like height, body weight,
temperature, pulse rate, breathing rate, blood pressure. Student improves technical skills to obtain
medical history.
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Students present and discuss medical history of the patient’s disease on a teaching round.
The principal rules of physical examination are discussed and applied, like observation, palpation,
percussion, auscultation. Student examines skin, thyroid gland, lymph nodes, arterial and vein vessels
of the neck.
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Next practicals are dedicated to develop technical skills in thorax physical examination.
Student estimates the type of breathing, thorax building, breast and localizes abnormalities using
topographic points and lines. Student applies different methods of physical examination, especially
percussion, auscultation and voice tremor comparison. Student improves a logical approach to the
diagnosis and the technical skills to obtain a history and perform a physical examination. During the
next practicals students describe the main abnormalities in percussion and auscultation in different
respiratory tract diseases. Student applies suitable diagnostic tests, like laboratory tests, spirometry
and spirography, X-ray examination, CT and angio-CT tests, bronchoscopy and explains their
usefulness and results.
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Next practicals are dedicated to heart and vascular system physical examination. Student
applies the methods of topographic anatomy in palpation and percussion. Student defines heart
tones and murmurs, especially systolic and diastolic. Students discuss diagnostic tests interpretation,
like ecg, treadmill tests and laboratory tests which can assist in proper diagnosis. Student describes
medical history and results of physical examination.
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Next two practicals are dedicated to improve the technical skills of abdomen examination.
Student applies different methods of physical examination like observation, palpation, percussion
and auscultation. Student estimates abdomen skin abnormalities, like enlargement of blood vessels,
enlargement of abdomen organs, pain reactions during palpation. Student conducts the differential
diagnosis of abdomen circumstance enlargement in the case of tumor or ascites. Student use the
method of auscultation to describe normal or pathological peristalsis. Student performs anorectal
region examination. Student improves his skills in obtaining medical history and physical
examination.
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During the next workshop student mentions tools to patient evaluation, like laboratory,
radiographic and functional tests which can assist in diagnosis of suspected gastrointestinal disease.
Students discuss the common indications for upper endoscopy, colonoscopy, endoscopic retrograde
cholangiopancreatography, endoscopic ultrasound, contrast radiography, ultrasound examination,
CT, CT and MR colonography, MR cholangiography, hepatic biopsy. Students comments the role of
histopathology in evaluating correct diagnosis and the usefulness of functional testing of upper and
lower gastrointestinal tract.
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Next practicals concerns vascular system examination, observation, palpation and
auscultation of arterial and venous vessels. Students also describes abnormalities connected with
lymphatic vessels pathology. Students estimate blood pressure and pulse, discuss application of
ultrasound and radiographic tests in vascular diseases diagnosis.
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Consecutive practicals are dedicated to principal methods of musculoskeletal and neurologic
system examination. Students improve all methods of physical examination.
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During the last practicals student present the case report. The presentation includes medical
history, results of physical examination and planning of specific diagnostic procedures. The technical
skills in performing a physical examination will be also checked
Literature
1.Macleod's Clinical Examination Edited by Graham Douglas, Fiona Nicol, Colin Robertson,12th
Edition ELSEVIER 2009
2.Harrison’s Principles of Internal Medicune - 18th Edition, editors Dan L. Longo et al., Mc Graw Hill
Medical
Rules and regulations
After completing the course of Principal Diagnostic Procedures in Internal Medicine student:
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Defines symptoms connected with particular systems and organs diseases
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Applies the methods of physical examination in diagnostic process
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Plans additional diagnostic tests which can assist in proper diagnosis
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Makes the analysis and interpretation of the abnormalities coming from medical history,
physical examination and additional tests
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Defines the organ or system involved with the disease
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Describes medical history of examined patient
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Presents the oral summary of detected abnormalities
Develops practical and technical skills which enable:
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Presentation of case report in paper, oral and electronic form
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Estimation of medical history at its proper value
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Connection of knowledge and skills from different basic sciences and application all of them
into clinical practice
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Conducting the discussion in differential diagnosis process
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Application of physical examination pattern in clinical practice
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Choosing of proper diagnostic tests which can assist in proper diagnosis
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Application of proper medical documentation forms in clinical practice
Student is obliged to:
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Pass the initial test checking the knowledge from basic science, mainly anatomy, biology,
physiology, biochemistry and biophysics before starting the course
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Wear medical gown, shoes and have stethoscope during clinical trainings
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Pass the partial test after the 5 and 10 class
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Work out and present one medical case
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Attend every lecture, class and workshops during entire course and show adequate activity
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Absence with the written excuse will be executed by additional activity
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Pass the exam of physical examination
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Pass final test
The final credit (credit with grade) depends on all above mentioned components.