PRINCIPLES OF CLINICAL MEDICINE
The principles of clinical medicine constitutes the first clinical subject for medical students that
bridges basic science with clinical disciplines. It aims to provide students with a solid background for
clinical medicine. During the course of “The principles of clinical medicine” students are familiarized
with the process of clinical decision making. In details, student are taught: how to properly take
medical history, how to appropriately examine a patient, when to implement a particular diagnostic
test as well as how to critically appraise its value in order to establish a correct diagnosis. A
comprehensive overview of signs and symptoms of various cardiovascular, respiratory,
gastrointestinal, urogenital, and haematological disorders is given to students during lectures,
seminars and tutorials. Much attention is paid to the issue of differential diagnosis. Furthermore,
numerous diagnostic and therapeutic procedures are demonstrated to students. To make the
education process complete, students apply their theoretical knowledge on history taking and
physical examination gained at lectures and seminars during practical classes with patients. They also
prepare a teaching case in a written form. Additionally, several common life-threatening conditions
requiring immediate adequate management (acute coronary syndromes, pulmonary embolism,
aortic dissection, shock, pneumothorax) as well as major threats for global public health
(hypertension, diabetes mellitus, lipid disorders, atherosclerosis and the most frequent malignancies)
are discussed with students. Finally, we provide medical students with an updated, guidelines-based
course on cardiopulmonary resuscitation. After this introduction to clinical medicine, students are
well-trained to continue their education in internal medicine, paediatrics, neurology, oncology,
surgery, otorynolaryngology etc.
TEACHERS:

lek. med. Piotr Adamski

dr hab. n. med. Marek Koziński

lek. med. Ewa Laskowska

lek. med. Małgorzata Ostrowska
CONTACT: kikkardiol@cm.umk.pl
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SYLABUS
I. Name of the unit offering the course: Department of Principles of Clinical Medicine
II. Head of the Unit/Course coordinator: dr hab. n. med. Marek Koziński
III. 2nd year, number of hours: 115
IV. Form of classes: lectures: 55, tutorials: 60
VI. Form of crediting: credit with grade,
VII. Number of ECTS points: 8
VIII. Aim of the course: to provide medical students with a solid background for clinical medicine.
IX. List of practical skills that will be obtained upon completion of the course of the principles of
clinical medicine:
- proper taking of medical history
- skillful physical examination
- selection of adequate, basic diagnostic tests to facilitate the diagnosis-making process
- ability to critically appraise values of basic diagnostic tests
- knowledge of signs and symptoms of various cardiovascular, respiratory, gastrointestinal,
urogenital, and haematological disorders
- ability of differential diagnosis making
- preparation of a teaching case
- knowledge of symptomatology, pathophysiology, diagnostics and management of selected lifethreatening conditions requiring immediate adequate treatment (acute coronary syndromes,
pulmonary embolism, aortic dissection, shock, pneumothorax) as well as major threats for global
public health (hypertension, diabetes mellitus, lipid disorders, atherosclerosis and the most frequent
malignancies)
- ability to perform cardiopulmonary resuscitation
X. Topics of lectures
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1. Clinical decision making – part 1.
2. Clinical decision making – part 2.
3. Approach to the patient with hydrothorax/pneumothorax. Clinical presentations of bronchitis
and pneumonia.
4. History, physical examination and diagnostic tests in patients with asthma or chronic obstructive
pulmonary disease.
5. Pulmonary embolism.
6. Obstructive sleep apnoea. Smoking and smoking cessation.
7. Physical examination of the heart and central vessels.
8. Approach to the patient with heart murmur. Valvular heart disease.
9. Physical examination of the peripheral vessels. Measurement of blood pressure. Arterial
puncture for blood gas analysis. Arterial access for interventional procedures.
10. Principles of electrocardiography.
11. Stable coronary syndromes: stable angina pectoris, cardiological syndrome X, myocardial
bridging.
12. Non-ST-segment elevation acute coronary syndromes and variant angina.
13. ST-segment elevation myocardial infarction.
14. Approach to the patient with palpitations. Focus on atrial fibrillation.
15. Approach to the patient with syncope. Focus on brady- and tachyarrhytmias.
16. Symptoms, signs and diagnostics of heart failure.
17. Cardiac noninvasive testing (exercise electrocardiography, echocardiography, radionuclide
imaging, computed tomography, cardiac magnetic resonance)
18. Cardiac invasive testing (coronary angiography, fractional flow reserve measurement,
intravascular ultrasound, cardiac catheterisation) and myocardial revascularization.
19. Approach to the patient with abdominal pain. Focus on acute pancreatitis.
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20. Approach to the patient with ascites. Approach to the patient with hepatomegaly/splenomegaly.
21. Approach to the patient with weight loss. Inflammatory bowel disease.
22. Acute kidney injury and chronic kidney disease.
23. Lipid disorders.
24. Hypertension: risk factors, diagnosis, secondary causes, resistant hypertension and
complications.
25. Thyroid and parathyroid disorders.
26. Diabetes
mellitus:
pathophysiology,
classification,
risk
factors,
symptoms,
diagnosis,
complications
27. Shock: aetiology, pathophysiology, diagnosis and management.
XI. Topics of tutorials
1.
Topic of the tutorial: Professional secrecy. Main rules of history taking. Development of a
relationship with the patient. Examination techniques and equipment. Behavior and mental
status. Level of consciousness. Vital signs.
a.
Seminars for students: 1. Professional secrecy. Main rules of history taking. Development of a
relationship with the patient. 2. Coma: definition, causes and diagnostics.
b.
Practical classes with patients.
2.
Topic of the tutorial: Physical examination of the skin, hair and nails.
a.
Seminar for students: Diagnostics of jaundice.
b.
Presentation to be prepared by students: Cyanosis and paleness.
c.
Practical classes with patients.
3.
Topic of the tutorial: Physical examination of the head and neck. Fever.
a.
Seminars for students: 1. Physical examination of the head and neck. 2. Fever.
b.
Practical classes with patients.
4.
Topic of the tutorial: Symptoms of respiratory tract disorders.
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a.
Seminars for students: 1. Approach to the patient with dyspnoea. 2. Basics of chest X-ray
interpretation.
b.
Presentations to be prepared by students: 1. Diagnostics of haemoptysis. 2. Cough:
pathophysiology and diagnostics. 3. Diagnostic value of D-dimers.
5.
Topic of the tutorial: physical examination of the chest and lungs.
a.
Seminar for students: Physical examination of the chest and lungs.
b.
Practical classes with patients.
6.
Topic of the tutorial: Diagnostic examinations of the respiratory tract (pulse oximetry, blood gas
analysis, computed tomography, bronchoscopy, transthoracic lung biopsy, spirometry).
a.
Seminars for students: 1. Indications for bronchoscopy 2. Indications and interpretation of
spirometry.
b.
Practical classes: presentation of pulse oximetry, interpretation of blood gas analysis,
animations on puncture of pleural effusion and needle aspiration of pneumothorax.
7.
Test 1
8.
Topic of the tutorial: Physical examination of the heart and central vessels. Atherosclerosis.
a.
Seminar for students: Atherosclerosis - a brief overview on its pathophysiology, manifestations
and risk factors.
b.
Practical classes with patients
9.
Topic of the tutorial: Diagnostics of chest pain - Part 1.
a.
Seminar for students: Approach to the patient with chest pain.
b.
Presentations to be prepared by students: 1. Biomarkers of myocardial ischaemia: cardiac
troponins and creatine kinase. 2. Diagnostic value of natriuretic peptides (BNP and NT-proBNP).
3. Clinical presentation of Takotsubo cardiomyopathy (apical ballooning syndrome).
10. Topic of the tutorial: Diagnostics of chest pain - Part 2.
a.
Practical classes with patients including history taking, physical examination and ECG
interpretation.
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11. Topic of the tutorial: Diagnostics of oedema. Cardiac tamponade. Acute aortic syndromes.
a.
Seminar for students: Approach to the patient with oedema.
b.
Presentation to be prepared by students: Aortic dissection - clinical presentation, diagnostics
and management.
c.
Presentation of pericardiocentesis.
d.
Practical classes with patients.
12. Topic of the tutorial: Prevention of cardiovascular disease.
a.
Seminar for students: Primary and secondary prevention of cardiovascular disease.
b.
Presentations to be prepared by students: 1. Clinical implications of abdominal obesity. 2.
Prevention of cardiovascular disease with a Mediterranean diet. 3. Does wine drinking protect
against cardiovascular disease?
13. Topic of the tutorial: Practical classes on ECG interpretation.*
14. Topic of the tutorial: Interventional treatment of coronary artery disease - practical classes in
the cardiac catheterization laboratory.*
*Each group will be divided into two subgroups for Tutorials No 13 and 14. The first subgroup will
start with Tutorial No 13 and will continue with Tutorial No 14 next week while the second subgroup
will follow the opposite sequence of tutorials.
15. Test 2
16. Topic of the tutorial: Symptoms of gastrointestinal disorders.
a.
Seminar for students: Bleeding in the digestive tract.
b.
Presentations to be prepared by students: 1. Dysphagia. 2. Constipation. 3. Diarrhea. 4. Nausea
and vomiting.
17. Topic of the tutorial: Physical examination of the abdomen.
a.
Seminar for students: Physical examination of the abdomen.
b.
Practical classes with patients
18. Topic of the tutorial: Viral hepatitis. Hepatocirrhosis
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a.
Seminars for students: 1. Viral hepatitis. 2. Hepatocirrhosis - aetiology, pathophysiology, signs
and symptoms.
b.
Practical classes with patients
19. Topic of the tutorial: Diagnostic examinations of the gastrointestinal tract (ultrasound, X-ray,
computed tomography, cholangiography, gastrointestinal endoscopy, endosonography).
a.
Seminar for students: Gastrointestinal endoscopy.
b.
Practical classes with patients.
20. Topic of the tutorial: Physical examination of the breasts and axillae. Lymphadenopathy.
a.
Seminars for students: 1. Lymphadenopathy. 2. Indications for mammography.
b.
Practical classes with patients.
21. Topic of the tutorial: Signs and symptoms of genitourinary disorders.
a.
Seminar for students: Dysuria.
b.
Presentation of male and female urethral catheterization.
c.
Presentations to be prepared by students: 1. Anuria, oliguria, polyuria and nocturia definitions
and causes. 2. Haematuria: definition and diagnostics. 3. Proteinuria: definition and basic
diagnostics.
22. Test 3
23. Topic of the tutorial: Simplified physical examination of the nervous system.
a.
Seminar for students: Simplified physical examination of the nervous system.
b.
Practical classes with patients.
24. Topic of the tutorial: Signs and symptoms of haematological disorders.
a.
Seminar for students: Signs and symptoms of haematological disorders.
b.
Presentation of bone marrow aspiration and biopsy.
c.
Presentation of cases of patients with haematological disorders.
25. Topic of the tutorial: Symptoms and signs endocrinological disorders.
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a.
Seminar for students: Symptoms and signs of pituitary disorders.
b.
Presentations to be prepared by students: 1. Cushing syndrome. 2. Pheochromocytoma. 3.
Adrenocortical insufficiency. 4. Primary aldosteronism.
26. Topic of the tutorial: The most common neoplastic diseases - Sign, symptoms, risk factors,
diagnostics and screening tests (Part 1).
a.
Seminars for students: 1. Lung cancer. 2. Colon cancer.
b.
Presentation to be prepared by students: 1. Stomach cancer.
27. Topic of the tutorial: The most common neoplastic diseases - Sign, symptoms, risk factors,
diagnostics and screening tests (Part 2).
a.
Seminar for students: 1. Breast cancer. 2. Prostate cancer.
b.
Presentation to be prepared by students: 1. Cervical cancer.
28. Putting it all together: physical examination and history taking
a.
Practical classes with patients.
b.
Practical test.
c.
Preparation in writing a patient teaching case.
29. Topic of the tutorial: Cardiopulmonary resuscitation.
a.
Seminar for students: Cardiopulmonary resuscitation.
b.
Presentations of defibrillation, orotracheal intubation, central venous catheterization, peripheral
intravenous cannulation.
30. Test 4
XII.Literature
Basic literature in English
1. Harrison's Principles of Internal Medicine: Volumes 1 and 2, 18th Edition. Ed. Longo D.L., Kasper
D.L., Jameson J.L., Fauci A.S., Hauser S.L., Loscalzo J. McGraw-Hill Professional, 2011.
2. Macleod's Clinical Examination. 13th Edition. Ed. Douglas G., Nicol F., Robertson C. Elsevier,
2013.
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3. Macleod's Clinical Diagnosis. 1st Edition. Japp A., Robertson C., Hennessey I. Churchill
Livingstone, 2012.
Supplementary literature in English
1. Bates’ Guide to Physical Examination and History Taking. Ed. Bickley L.S. Lippincott Williams and
Wilkins, 2013.
2. Mosby's Guide to Physical Examination. Ed. Rosalyn W. Stewart, Henry M. Seidel, Joyce E. Dains,
John A. Flynn, Jane W. Ball, Barry S. Solomon. Mosby Elsevier, 2011.
Basic literature in Polish
1. Badanie kliniczne Macleod. Red. Douglas G., Nicol F., Robertson C. Elsevier Urban & Partner,
2010.
2. Diagnostyka różnicowa objawów chorobowych. Red. Kokot F. Wydawnictwo Lekarskie PZWL,
2007.
3. Interna Szczeklika 2013. Red. Gajewski P., Szczeklik A. Medycyna Praktyczna, 2013.
Supplementary literature in Polish
1. Diagnostyka internistyczna. Tatoń J. Czech A. Wydawnictwo Lekarskie PZWL, 2005.
2. Podstawy ogólnej diagnostyki klinicznej. Bolechowski F. Wydawnictwo Lekarskie PZWL, 1985.
3. Badanie kliniczne. Epstein O., Perkin G.D., de Bono D.P., Cookson J. Wydanie polskie pod
redakcją Sikorski M., Sikorska A. Czelej, 2001.
RULES AND REGULATIONS
1.
The knowledge of basic science is essential to start the course of the principles of clinical
medicine.
2.
Attendance at every lecture, seminar and tutorial is mandatory.
3.
Students must be punctual.
4.
Students are obligated to be prepared for every lecture, seminar or tutorial.
5.
Academic teachers may evaluate students' preparation for all forms of classes mentioned above
by organizing an entry test or asking oral questions.
6.
Each change between the groups must be approved by the teacher.
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7.
Each case of absence requires presenting a legitimate excuse, preferably a sick leave.
8.
For each absence students have to make up by doing extra hours (specific timeframe to be
accepted by the course director or the academic teacher designated by him).
9.
The course of “The principles of clinical medicine” is divided into four parts (1st part - lectures,
seminars and tutorials up to Test 1 including Test 1, 2nd part - lectures, seminars and tutorials
between Test 1 and Test 2 including Test 2, 3rd part - lectures, seminars and tutorials between
Test 2 and Test 3 including Test 3, 4th part - lectures, seminars and tutorials between Test 3 and
Test 4 including Test 4).
10. For the practical classes the students come with their own white coats, protective shoes and
stethoscopes.
11. The knowledge covering “The course of the principles of clinical medicine” includes lectures,
seminars, tutorials, presentations prepared by students and recommended literature. All tests
will be prepared based on these sources.
12. Students are obligated to:
-
Pass all Tests 1-4. Non-passers are allowed to take one resit test that will take place within two
weeks of the initial one. Detailed timeframes are to be discussed with the course director or the
academic teacher designated by him.
-
Deliver a PowerPoint presentation on a topic relevant to the subject.
-
Pass the final test practical test (medical history taking and physical examination). Non-passers
are allowed to take one resit test. Detailed timeframes are to be discussed with the course
director or the academic teacher designated by him.
13. The final grade depends on a combination of all above-mentioned components.
14. Students, who failed twice 1 or 2 tests in the semester, may apply for the conditional status and
in case of the Dean’s agreement they will be given an additional (only one) chance to pass failed
test/tests.
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