Clinical Methodology
Academic/Subject Sector
Year
Semester
Total number of credits
Integrated Course coordinator
Integrated Course lecturers
MED/09-Internal Medicine;
MED/18-General Surgery
III
2
11
Prof. Giuseppe Pisano (gpisano@unica.it)
Even student numbers:
Prof. Calò PG (pgcalo@unica.it)
Zorcolo L. (zorcolo@pacs.unica.it)
Farci MG (amgfa@tiscali.it)
Erdas E. (erdasenrico@libero.it)
Loddo M. (mloddo@pacs.unica.it).
Odd student numbers:
Prof. Pisano G. (gpisano@unica.it)
Pisanu A. (adolfo.pisanu@tin.it)
Mandas A. (amandas@pacs.unica.it)
Multineddu R.
Aims of the course
Aims of the Integrated/Joined Course of Clinical Methodology
This course aims at providing students with internal medicine and surgical skills. Course
content includes teaching how to take clinical history and how to perform physical
examinations.
From the appraisal of General Clinical Examination, students will be taught how to perform
physical examination of the head and neck, cardiovascular, respiratory and gastro enteric
systems as well as the kidney, urinary tract and skin apparatus.
Clinical evaluation will be integrated with the main methods of functional and instrumental
study of the following organs and apparatus: cardiovascular, respiratory, thyroid, breast,
oesophagus, stomach, small and large bowel, liver and biliary tract, pancreas, kidney and
urinary tract, arteries and veins.
Main physiopathologic mechanisms of the following diseases will be analysed: portal
hypertension, acid-base and hydroelettrolitic imbalances, coagulation disorders as well as
disturbances of sodium, potassium, calcium and phosphorous metabolism. Clinical
consequences following infections, injuries, shocks, burns, digestive bleeding, bowel
obstruction, peritonitis and organ transplantations will be examined. Course content also
includes: Somatic and visceral pain, bronchial asthma, chronic obstructive pulmonary
disease, pulmonary emphysema, pulmonary oedema, acute and chronic heart failure and
respiratory failure.
Professional training
Professional training will take place at the departments of Medicine and Surgery of the
Hospital “San Giovanni di Dio” in Cagliari and at the Policlinico in Monserrato. The aim of
the training is to enable students to perform:
- Clinical history
- General physical examination
- Arterial pulse evaluation
- Blood pressure examination
- Conscience status appraisal
- Neck examination
- Chest wall and respiratory examination
- Cardiovascular system examination
- Cardiovascular system examination
- Kidney and urinary tract examination
- Osteoarticular system examination
- Main skin diseases examination
- Oedema evaluation
The training will also provide students with a basic knowledge of the following
instrumental diagnostic tools:
 EKG
 Ultrasonography
 Doppler ultrasound
 Traditional radiology and computerized tomography
 Spirometry
 Gastrointestinal endoscopy and Laparoscopy
Syllabus
Medical Semeiotics (Prof. AMG Farci and Prof. A. Mandas)
1. Familial anamnesis, personal anamnesis, past pathological anamnesis, immediate
past pathological anamnesis
2. General examination
3. Respiratory system: examination, palpation
4. Respiratory system: percussion, auscultation
5. Coughing, pneumonias, bronchopneumonias, chronic obstructive bronchopathy,
pulmonary emphysema, bronchial asthma, pleuritis, pneumothorax
6. Cardiovascular system: anamnesis, risk factors
7. Dyspnoea
8. Thoracic pain (angina, myocardial infarction, aortic dissection, pulmonary embolism,
esophagitis, muscle/tendon pain, pneumothorax, pleuritis, ganglion radiculitis, etc)
9. Cardiovascular system: examination, palpation (heartbeats, fremiti)
10. Cardiovascular system: percussion, auscultation (auscultation areas)
11. Heart tones, murmurs, clicks
12. Valvular diseases: aortic stenosis, aortic insufficiency, mitral stenosis, mitral
insufficiency, pulmonary stenosis, pulmonary insufficiency, tricuspid stenosis,
tricuspid insufficiency, interatrial defect, interventricular defect, permeability of
Botallo's duct
13. Acute pericarditis, cardiac tamponade
14. Arterial pulse: features. Venous pulse
15. Arterial pressure measurement
16. Abdomen: examination, palpation, percussion, auscultation
17. Hepatomegalies: acute and chronic hepatitis, cirrhosis of the liver,
hemochromatosis, Wilson's disease
18. Portal hypertension, ascites
19. Skin colour variation: icterus, cyanosis, purpura
20. Spleen: examination, palpation, percussion; Splenomegaly
21. Kidney: physical semiology
22. Micturition troubles, urine examination
23. An outline of the osteoarticular semiology
Functional semeiotics Lecturer: Prof. M Loddo e R Multineddu
1. Electrocardiogram (ECG): sinus rhythm interpretation
2. Cardiac frequency and QRS axis measurement
3. An outline of P-wave pathology, AV conduction and QRS
4. Premature ventricular contractions (PVCs)
5. Fibrillation and atrial flutter
6. Necrosis wave
7. Holter's dynamic ECG
8. Respiratory system: An outline of physiology
9. Ventilation insufficiency
10. Spirometry
11. Asthma
12. COPD
13. Emphysema
14. Pulmonary oedema
15. Acute and chronic pulmonary heart
16. Respiratory insufficiency
17. Hemogasanalysis
18. Cyanosis
19. Thorax X-ray
Surgical semeiotics Lecturer: Prof. PG Calò e G Pisano
1. Diagnostic procedure: doctor-patient relationship. Familial anamnesis, personal
anamnesis, past pathological anamnesis, immediate past pathological anamnesis
case history.
2. General examination and objective examination: physical examination of the patient
by inspection, palpation, percussion and auscultation.
3. Physical examination of the tumefactions and injuries (an outline of equipments
methods).
4. Clinical neck examination in relation to the congenital pathology, thyroid, salivary
glands, lymph node stations.
5. Clinical thorax examination in relation to surgical pathologies: Thoracic traumas,
bronchial carcinoma, pleuric effusion, pulmonary embolism, mediastinic syndromes.
6. Clinical breast examination
7. Clinical abdomen examination in selection conditions: clinical evaluation of the
abdominal tumefactions; symptoms and signs of the most frequent abdominal
pathologies. Rectal examination. Abdominal traumas.
8. Clinical examination of the liver and gall ducts; cholestatic icterus; portal
hypertension
9. Clinical examination of hernias and external genitalia
10. Acute abdominal syndromes: physical examination of intestinal occlusions,
peritonitis, acute pancreatitis, hemoperitoneum. An outline of instrumental
semeiotics.
11. Clinical evaluation of digestive haemorrhages, shock semeiotics.
12. Clinical history and physical examination of chronic obstructive arteriopathies and
venous insufficiency. Acute limb ischemia. An outline of equipments methods.
13. Diuresis and micturition troubles; hematuria
Functional surgical semeiotics Lecturers: Prof. A Pisanu e
L Zorcolo
1. Equipments methods
a. Echography
b. Radiological methods
2. Angiography
a. CAT
b. Endoscopy
c. Laparoscopy
3. Functional and instrumental semeiotics of the thyroid
4. Instrumental semeiotics of the breast
a. Radiology
b. Ecography
c. Cytology
d. Biopsy
5. Instrumental semeiotics of the thorax
a. Radiology
b. Endoscopy
c. Hemogasanalysis
6. Instrumental semeiotics of the mediastinum
7. Instrumental semeiotics of the oesophagus
8. Instrumental semeiotics of the stomach
9. Instrumental semeiotics of the small intestine
10. Instrumental semeiotics of the colon
11. Functional and instrumental semeiotics of the liver and gall ducts
a. Ecography
b. CT
c. Agobiopsy
d. Oral holecystography, endovenous cholangiography
e. ERCP
12. Functional and instrumental semeiotics of the portal hypertension
13. Instrumental semeiotics of the pancreas
14. Functional and instrumental semeiotics of the del kidney and urinary tract
a. Clearance
b. Urinanalysis
c. Urography e ascending pyelography
d. Kidney scintigraphy and RNG
e. Cystoscopy
f. Urodynamic examinations
15. Instrumental semeiotics of arteries and veins
a. Doppler ultrasound
b. Ecography
c. Angiography
Surgical physiopathology Lecturers: Prof. E Erdas e A Pisanu
1. Physiopathology of the hydroelectrolytic balance and sodium homeostasis
2. Potassium, calcium, phosphorus, magnesium homeostasis and alterations
3. Acid-base balance: respiratory acidosis and alkalosis
4. Acid-base balance: metabolic acidosis and alkalosis
5. Shock: general principles
6. Shock: classification, systematics, clinical correlations
7. Burns I
8. Burns II
9. Intestinal occlusions physiopathology
10. Peritonitis physiopathology
11. Digestive haemorrhage physiopathology
12. General principles on grafts
Reference texts
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Il nuovo Rasario - Semeiotica e Metodologia Clinica
B. Tarquini - Idelson editore
Metodologia clinica
Nuti e Caniggia
Moderni aspetti di Semeiotica Medica
Sanna e Dioguardi
Metodologia Chirurgica
W. Montorsi, A. Pernacchia, P. Pietri - Ed Minerva Medica.
Semeiotica e Metodologia Chirurgica
E. Berti Riboli, M. Gipponi - ECIG
Semeiotica Chirurgica e Metodologia Clinica
L. Gallone - Casa Editrice Ambrosiana
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