Introduction to Internal Diseases
The skill of history taking and physical examination are central to the practice of clinical medicine.
This course is 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, other 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 (in the Chair and Clinic of Endocrinology and Diabetology) : prof. dr hab. Roman Junik, dr hab. Agata Bronisz, dr med. Marcin Gierach, dr med. Anna Kamińska, dr
Małgorzata Szafrańska, dr I. Florczyk
Contact : kikendok@cm.umk.pl
Syllabus
I.Chair and Clinic of Allergology , Clinical Immunology and Internal Diseases
Chair and Clinic of Endocrinology and Diabetology
Chair and Clinic of Gastroenterology, Vascular Diseases and Internal Diseases
Department of Hematology and Malignant Diseases of Hematopoietic System
Chair and Clinic of Cardiology and Internal Diseases
Chair and Clinic of Nephrology, Hypertension and Internal Diseases
II. Head of the Unit: prof. dr hab. Zbigniew Bartuzi prof. dr hab. Roman Junik prof. dr hab. Maciej Światkowski

dr hab. Jarosław Czyż prof. dr hab. Jacek Kubica prof. dr hab. Jacek Manitius
III. Faculty of Medicine, Medical Program, third year
IV. Course coordinator: prof. dr hab. Roman Junik
V. Form of classes: lectures, tutorials
VI. Form of crediting: credit with grade, 3 p. ECTS (mark from the final colloquium)
VII. Number of hours: 35 hours of lectures, 50 hours of tutorials (10 days course), total: 85 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, allergology and clinical immunology, nephrology, endocrinology with diabetology and gastroenterology.
Training classes in internal medicine clinics are dedicated to improve student’s knowledge and skills in approach to the patient with different diseases symptoms.
After completing the course student:
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Defines symptoms connected with particular systems and organs diseases
Applies the methods of physical examination in diagnostic process
Plans additional diagnostic tests which can assist in proper diagnosis
Makes the analysis and interpretation of the abnormalities coming from medical history,
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physical examination and additional tests
- Defines the organ or system involved with the disease
Describes medical history of examined patient
Presents the oral summary of detected abnormalities
Student develops practical and technical skills which enable:
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Presentation of case report in paper, oral and electronic form
Estimation of medical history at its proper value
- Connection of knowledge and skills from different basic sciences and application all of them
into clinical practice
- Conducting the discussion in differential diagnosis process

- Application of physical examination pattern in clinical practice
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Choosing of proper diagnostic tests which can assist in proper diagnosis
Application of proper medical documentation forms in clinical practice
IX. Lectures/tutorials topics
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, allergology and clinical immunology, nephrology, endocrinology with diabetology and gastroenterology.
Training classes in internal medicine clinics are dedicated to improve student’s knowledge and skills in approach to the patient with different diseases symptoms.
Day 1
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
Day 2
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.
Day 3
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.
Day 4
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.

Day 5
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. 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.
Day 6
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. 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.
Day 7
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.
Day 8
Next 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.
Day 9
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.
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. Principal methods of musculoskeletal and neurologic system examination are discussed. Students improve all methods of physical examination.
Day 10
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. The final test is performed.
Literature
1.Macleod's Clinical Examination Edited by Graham Douglas, Fiona Nicol, Colin Robertson,13 th
Edition ELSEVIER 2013
2.Harrison’s Principles of Internal Medicine - 18th Edition, editors Dan L. Longo et al., Mc Graw Hill
Medical
X. Rules and regulations:
1. Unit: Department of Endocrinology and Diabetology CM UMK
2. Head of Unit: prof. dr hab. Roman Junik
3. Course: “Introduction to Internal Diseases” Faculty of Medicine, year III
4. The conditions of crediting the exercise:
- active participation in all exercises
- the acquirement of practical skills (as shown in assessment record)
- passing partial colloquia (short oral test) carried by academic teachers during the course)
- obtaining positive mark for description or presentation of case record

- passing final colloquium (obtaining positive mark)
5. Form and conditions of passing final colloquium
The final colloquium is a 20-questioned test and is carried out in the last day of the course. Grades are given according to the scale presented below:
100% of correct answers – 5,0
84% of correct answers – 4,5
76% of correct answers – 4,0
68% of correct answers – 3,5
60% of correct answers – 3,0 less than 60% of correct answers – 2,0 (fail)
Re-sit colloquium takes place in one term for all third year students. The date of re-sit colloquium should be established with the Head of the Unit.
Failing re-sit colloquium results in failing the whole course (that must be repeated)
6. Form of exam
The course ‘Internal Diseases” is ended with the exam at the end of summer semester of 5 th year of studies. The conditions of passing the exam are resolved in separate regulations.
7. Rules of make-up the classes missed
The participation in classes is obligatory. Students who were absent (only justified absence is accepted) should participate in classes with another group. If it is not possible due to organizational reasons, alternative form of make-up the classes missed is the participation in emergency service.
The participation in emergency service should be approved by physician on duty. In case of the absence on lectures, student is obliged to pass the colloquium that covers the material which was presented during the lecture. The colloquium is carried out by Head if Unit or by delegated person.
8. Deadlines to deliver elaborations, reports or different forms required in the Unit
The deadline to deliver the case record is the last day of the course.
9. General and detailed Management of Health and Safety at Work

Regulations required during teaching program in the Unit
Students are obliged to comply with general Management of Health and Safety at Work Regulations.
All procedures carried out during classes by students are supervised by assistants.
Students are obliged to wear white, clean coats, change shoes and wash hands. Eating and drinking in the Department of Endocrinology and Diabetology is prohibited.

Student’s name and surname:
Year: group:
Academic year:
Practical skills date confirmation
(signature)
The general examination
Respiratory system examination (the history and physical examination)
Cardiovascular system examination (the history and physical examination)
Gastrointestinal system examination (the history and physical examination)
Renal system examination (the history and physical examination)
Endocrine system examination (the history and physical examination)
Subjective and objective examination of the hematopoietic system.
The musculoskeletal system examination (the history and physical examination)
Weight, height, temperature, respiratory rate, pulse measurement
The assessment of upper airway permeability
The interpretation of results of spirometry
Blood pressure measurement
The interpretation of chest X-ray
The interpretation of ECG (norm and major abnormalities)
The assessment of clinical manifestations of critical illness
Rectal examination
The interpretation of endoscopic investigations of gastrointestinal system (norm and major abnormalities)
The interpretation of laboratory investigations: blood count, urine examination, glucose concentration, TSH, cholesterol and triglicerides, electrolites, liver enzymes, markers of inflammation comments