Ateneo - UPO

Doctor-patient relationship. Signs and symptoms: general description and investigative techniques. Diagnostic value of a test. The medical record oriented to problem solving. Medical history: chief complaint, history of present illness, past medical history, current medications, social history, family history. Review of systems. Physical examination: 1) General physical examination, constitutional symptoms, assessment of the nutrition state; 2) skin examination and description of elementary lesions; 3) head and neck examination, headaches, facies description, signs and symptoms of thyroid dysfunction; 4) thorax examination, symptoms of respiratory diseases; 5) abdomen examination, abdominal pain, nausea and vomiting, diarrhea and constipation, GI bleeding, signs and symptoms of liver disease, rectal examination; 6) genito-urinary tract examination (in male and female) and relevant symptoms; 7) musculoskeletal examination (at screening and focused), stretch tests. Other topics: timing and execution mode of a complete physical examination; problem list; troubleshooting plan; progress notes of course; epicrisis.

1) G. Fradà. Semeiotica Medica nell'adulto e nell'anziano (language: Italian) – 6th edition. Copyright by Piccin, 2018.
2) Dioguardi N, Sanna G. Moderni aspetti di semeiotica medica (language: Italian). 6th edition. Copyright by Editrice Universo, 2011.
3) Douglas Graham, Nicol Fiona, Robertson Colin. Macleod. Manuale di semeiotica e metodologia medica (language: Italian). 13rd edition. Copyright by Edra. 2014.
4) Barbara Bates. Esame obiettivo ed anamnesi (language: Italian). 18th edition. Copyright by Piccin, 2018.

The course aims to enable the student at least to know and understand the tools both for a correct clinical approach to the patient (both in terms of collecting the clinical history and performing a correct physical examination) and for correctly using instrumental and laboratory investigations according to the diagnostic value of the tests. A more advanced objective is to provide the student with the necessary elements to correctly set up the compilation of a problem-oriented medical record, autonomously using methodological tools to set up a rational problem-solving in the medical field.

The student must be in possession of the necessary knowledge of Anatomy, Physiology and General Pathology. Students need to have sustained all propedeutic exams, according to the current local academic regulations, before being admitted to this exam.

During the course different teaching methodologies will be alternated, according to convenience In detail:
- Lectures supported by presentations in MS-Powerpoint format (available on University Intranet) and on hard copy;
- Simulation of heart and lung sounds via dedicated software (purchasable under license);
- Practical exercises on the main imaging techniques (radiography of the chest and abdomen) and arterial blood gas analysis;
- Seminars regarding cardiology (with particular reference to ECG) and pulmonology;
- Integrative distance teaching regarding internal medicine and neurology;
- Practical training and rotations in 5 wards at Novara and/or Vercelli Hospitals (i.e., internal medicine/gastroenterology/nephrology; cardiology, neurology, general surgery, pulmonology) during which -in addition to tutoring students at the bedside with regard to the collection of medical history and physical examination- clinical case simulations and discussion regarding the cases under study with direct participation of the students are also planned;
- Self-compilation and correction of at least two medical records compiled by students during their rotations in the internal medicine department.

To attend the departments are needed: white coat, badge, stethoscope, gavel and torch.

The exam (to which are admitted the students who have both regularly completed their internship program in the various departments and distance learning activities where required) consists in a written test with 80 multiple choice questions on topics covered in the course and during the internship (minimum threshold: 54 correct answers). The latter examination consists among other things in the practical demonstration of the clinical skills acquired at the end of the module (analysis and interpretation of the main diagnostic tests: chest and abdomen x-ray, electrocardiogram, arterial blood gas analysis, peripheral blood smear, urine sediment; explanation of the main semeiologic maneuvers). The final vote is derived from the above two tests, which must both be fully overcome.
Regardless of passing the exam, it will be possible to immediately register the internship relating to the activities carried out in the various departments (see “Teaching methods”).

Doctor-patient relationship. Signs and symptoms: general description and investigative techniques. Diagnostic value of a test. The medical record oriented to problem solving. Medical history: chief complaint, history of present illness, past medical history, current medications, social history, family history. Review of systems. Physical examination: 1) General physical examination, constitutional symptoms, assessment of the nutrition state; 2) skin examination and description of elementary lesions; 3) head and neck examination, headaches, facies description, signs and symptoms of thyroid dysfunction; 4) thorax examination, symptoms of respiratory diseases; 5) abdomen examination, abdominal pain, nausea and vomiting, diarrhea and constipation, GI bleeding, signs and symptoms of liver disease, rectal examination; 6) genito-urinary tract examination (in male and female) and relevant symptoms; 7) musculoskeletal examination (at screening and focused), stretch tests. Other topics: timing and execution mode of a complete physical examination; problem list; troubleshooting plan; progress notes of course; epicrisis.

In order to achieve the knowledge and the skills corresponding to the minimum level of sufficiency, the student is asked to demonstrate to:
- know the main physiological and pathophysiological mechanisms of the major organs and systems of the body;
- know how to collect a medical history, interpreting the changes in biological functions and the main symptoms of disease distinguished by system;
- know how to perform a thorough physical examination;
- know how to set up the compilation of a problem-oriented medical record;
- be able to correctly interpret an arterial blood gas;
- be able to correctly use instrumental and laboratory investigations according to the diagnostic value of the tests;
- be able to handle the basic concepts of clinical reasoning.
For the achievement of an advanced level, the student must demonstrate to:
- be able to establish a proper physician-patient relationship;
- be able to perfect the style of compiling a medical record;
- have the initial ability to apply the correct methodological tools to set up a rational problem-solving in the medical field;
- know how to collect, process and, where possible, interpret the multiplicity of complex and/or fragmentary information derived from the analysis of the main signs and symptoms complained of by patients, then transcribing them in an orderly form in a medical record;
- knowing and applying a correct technical language.