37223 - Internal Medicine I (A)

Learning outcomes

At the end of the course, the student will learn the general principles of physiopathology needed for the future clinical activity. In particular, the knowledge of these principles will allow the understanding of the altered functioning of organs and systems from which both semeiological and clinical aspects derive. The student will also be able to perform correctly the clinical approach to the patient, integrating history, physical examination, and procedures following the several steps of clinical methodology. The integration between the knowledge of pathophysiology and semeiotics makes the student able to understand and face the elementary bases of diseases required by the future development of the course of study.

Course contents

1. Approach to physical examination of the heart.
- Inspection, palpation, percussion and auscultation
- Locations for auscultation of the heart
- Heart tones: physiology and pathological aspects
- Heart murmurs: physiology and pathological aspects
- General information on heart disease signs and symptoms

2. Approach to physical examination of the peripheral vascular system.
- Inspection, palpation and auscultation
- Signs and symptoms of arterial ischemia AAII
- Signs and symptoms of chronic venous insufficiency AAII

3. Approach to the physical examination of the respiratory system.
- Inspection, palpation, percussion and auscultation
- Tactile vocal fremitus
- Vesicular murmur and added noises (wet and dry)
- Semeiological notes on the main respiratory diseases (asthma, pulmonary emphysema, lobar pneumonia, pleural effusion, pneumothorax)

4. Approach to physical examination of the liver and biliary tract.
- Natural history of chronic liver disease (hepatitis, compensated cirrhosis, decompensated cirrhosis)
- Inspection, percussion and palpation of the liver
- Pathophysiological aspects of cirrhosis
- Signs and symptoms of the patient with cirrhosis
- Laboratory tests and instrumental tests in liver disease

5. Approach to physical examination of the articular system
- Outline of pathophysiology of joint diseases
- Inspection, percussion and palpation of the joints
- Signs and symptoms of joint disease (inflammation and degenerative damage)

6. Approach to physical examination of the nervous system
- Generalities on the examination of higher nervous functions: state of alertness and consciousness, orientation, attention, perception, intellectual functions, symbolic functions, activity and behavior
- Generalities on the examination of motor function: tone, trophism and muscle strength, reflexes, coordination, standing, walking
- Generalities on the examination of the sensory function: subjective sensitivity, objective sensitivity and combined sensitivity

Readings/Bibliography

• G Fradà e G. Fradà. Semeiotica medica nell’adulto e nell’anziano.VI edizione. Piccin editore. 2018
• A Amoroso e F Rossi Fanelli. Semeiotica Medica e Metodologia Clinica. II edizione. Delfino editore. 2018
• GE Gerunda. Metodologia Medica e Chirurgica. I edizione. Idselson Gnocchi editore. 2020
• G Sesti. Metodologia Medica e Chirurgica. La Semeiotica Medica. Il metodo clinico passo dopo passo. I edizione. EDRA editore. 2022
• MacLeod’s Clinical Examination. XV edizione. Elesevier editore. 2023
• eBook: Bates’ guide to physical examination and history taking. Lynn S Bikley. 12th Edition. Wolter Kluwers Edition. 2018. Available also on Amazon in the version for Kindle.

Teaching methods

Lectures with support of teaching material on Power point files and videos accessible to all students via the Jove digital platform.

Assessment methods

The exam of the integrated course consists of an oral exam divided into the 5 teaching modules. The final grade will result from the weighted average obtained in the 5 individual parts.

Teaching tools

The teaching material presented in class (Power Point file) is made available to students. Such material should be brought to class by students when given in advance. Access to the videos of the Clinical Skills Section of the Jove platform (www.jove.com) is free for all teachers and students of the University of Bologna. Instructions for access will be provided to students at the beginning of the course.

Office hours

See the website of Paolo Caraceni