Catedra Medicină Internă nr.3

Disciplina - Internal Medicine

Şef studii/responsabil de instruirea în limba engleză -Bugai Rodica univ. assistant

Data evaluării - 11.03.2013

Subiectele predate – Internal Medicine, Internal Medicine-Semiology

1. Cadrele- MD., PhD.m, professor Minodora Mazur

univ. assist. Rodica Bugai

ANALYTIC PROGRAM

,,Internal Medicine- Semiology” (for the students of the II year, Faculty of Dentistry)

Total hours -51, course-17, practical classes-34, evaluation form – undifferentiated colloquium

Course code: S.04.O.045

Type of course: Compulsory

Number of credits allocated to the course unit: 2

The basic content of the course:

A. Lectures:

No. Theme Hours

1 Introductory course in Semiology of internal diseases. Medical Ethics.

Examination of the patient.

2

2 Exploration of patients with respiratory diseases: complaints, anamnesis,

inspection. Palpation of the chest. Comparative percussion of the lungs.

2

3 Lung auscultation. Main respiratory noise and superadded noises. 2

4 Examination of patients with cardiovascular disease: complains and history,

inspection, palpation of the heart and blood vessels. Relative percussion of the

heart.

2

5 Listening of the heart. Examination of peripheral vessels. Peripheral arterial

pulse appreciation and blood pressure. Complementary methods for the

examination of the cardiovascular system.

2

6 Methods of examination of the patients with diseases of the digestive tract,

liver, gallbladder and spleen: complaints and history, inspection, palpation of

the abdomen. Percussion and palpation of the liver.

2

7 Clinical and laboratory methods of examination of patients with kidney and

urinary tract diseases.

2

8 Methods of examination of patients with disorders of the endocrine system:

complaints and history; inspection.

2

9 Methods of examination of patients with diseases of the hematologic system. 1

T O T A L 17 h

B. Practical skills:

No. Theme Hours

1 Introduction. Medical ethics. Medical documentation. Plan review of the

patient. Interrogation. Primary and general complaints. Disease history and

current life history.

2

2 General inspection. Exploration of patients with respiratory diseases:

complaints, anamnesis, inspection. Palpation of the chest.

2

3 Comparative and topographic percussion of the lungs. 2

4 Auscultation of the lung. Main respiratory noise. Superadded respiratory noises 2

5 Testing the professional skills of the respiratory system. 2

6 Examination of the patients with cardiovascular disease: complaints and

history, inspection, palpation of the heart and blood vessels larger region.

2

7 Relative percussion of the heart. 2

8 Listening of the heart. Examination of peripheral vessels. Peripheral arterial

pulse appreciation and blood pressure.

2

9 Complementary methods for examining the cardiovascular system. Method of

recording and deciphering of the ECG. ECG in hypertrophy of the heart

compartments.

2

10 Testing the professional skills of the cardiovascular system. 2

11 Methods of examination of the patients with severe digestive tract diseases:

complaints and history, inspection, palpation of the abdomen.

2

12 Methods of examination of the patients with liver and gallbladder diseases:

complaints and history, inspection, percussion and palpation of the liver,

gallbladder and spleen.

2

13 Testing the professional skills of the digestive system. 2

14 Clinical and laboratory methods of examination of patients with kidney and

urinary tract diseases. Examination of patients with clinical observation

performance tabulation sheet.

2

15 Methods of examination of the patients with diseases of the hematologic

system: complaints and anamnesis, inspection.

2

16 Methods of examination of the patients with endocrine disorders: complaints

and anamnesis, inspection.

2

17 Testing of practical skills. Presentation summarizing clinical observation sheet. 2

T O T A L 34h

Recommended References:

A.

Obligatory:

1. Lectures

2.. A Guide to Physical Examination and History Taking. Barbara Bates. J. B. Lippincot

Company. Phyladelphia, USA

B.

Inaddition:

1. Clinical Medicine. Kumar & Clark. VII-th edition. London 2009

ANALYTIC PROGRAM

,,Internal Medicine” (for the students of the III, IV years, Faculty of Dentistry)

Total hours -99, course-29, practical classes-70, evaluation form –exam.

Course code: S.05.O.053, S.07.O.071

Type of course: Compulsory

Number of credits allocated to the course unit: 6

The purpose of discipline Internal Medicine:

• Study of the etiology, pathogenesis, clinical manifestations of the most common internal

diseases, principles of treatment and prophylaxis of these diseases;

• Enrichment and deepening of the fundamental knowledge and its implementation in clinical

practice;

• Enhancing and enriching the patient examination practical skills, clinical reasoning

development: assessment of the results of clinical examination of the patient’s treatment, presumptive

diagnosis reasoning, reasoning program preparation and laboratory investigations and consultations from

other medical specialists, making differential diagnosis within the limits of the studied conditions,

formulation of positive diagnosis (clinical) practice, and presentation of appropriate arguments to an

individual treatment, predicting the evolution of pathology established for the patient concerned.

• Enhancement, enrichment and implementation of the clinical practical knowledge in the field of

ethics and medical ethics;

Training objectives in the Internal Medicine discipline: Knowledge and understanding:

For different diseases:

• The definition, incidence, epidemiology, etiology and modern pathogenesis aspects;

• Clinical manifestations, including atypical variants, modern classification, particularities of the clinical

examination, modern methods of instrumental and laboratory investigations ;

• Early diagnosis, premorbid states, diagnostic criteria, diagnostic formulation, differential diagnosis;

• Developments, complications, prognosis;

• Medical treatment (if surgery - general principles, indications and contraindications), complications of treatment;

• The criteria for hospitalization;

• Particularities of clinical manifestations and treatment of adolescents, women during pregnancy and nursing,

during the climacteric period of the senile and presenile patients, of the patients with multiple concomitant diseases;

• Diagnostic and treatment algorithm in any state of emergency;

• Primary prevention and secondary prevention of acute worsening, medical expertise of vitality, recovery, medical

surveillance;

Application:

• To undertake data collection history and appreciation of physical exploration of patients with

pathologies of internal organs;

• To formulate and argue the presumptive diagnosis;

• To prepare and argue the paraclinical laboratory investigation program;

• To make the differential diagnosis within the studied disease;

• To formulate and argue the positive diagnosis (clinical);

• Individual treatment appropriate to argue;

• To be able to predict the evolution of established pathologies.

Integration:

• To appreciate the importance of Internal Medicine in the context of general medical and its

integration with related medical disciplines

•To apply basic medical knowledge creatively in the clinical examination of the patient;

• To deduct the interrelations between Internal Medicine other fundamental and clinical

disciplines

• To take optimal decisions in emergency aid in critical situations;

• To formulate the principles of ethics in healthcare to patients with diseases of internal organs;

• To be able to objectively evaluate and self-assess knowledge in the field;

• To be able to assimilate new developments in the clinical disciplines.

Preparation and preliminary requirements:

Internal Medicine is one of the basic clinical disciplines in academic training of doctors, regardless of

specialty that one will choose later, is the widest field of integration and implementation of fundamental

knowledge (anatomy, Human Physiology, pathophysiology, etc..) clinical practice. In this discipline,

along with studying the etiology, pathogenesis, clinical manifestations, evolution, treatment and

prevention of the most common internal diseases , the future specialist builds practical investigation

skills and the assessment of patient results, the basis of clinical reasoning is accumulated , which ensures

a correct diagnosis and appropriate treatment.

Internal Medicine course for college students studying dentistry clinic includes contemporary nosological

forms of particular internal organ diseases, with particular emphasis on diseases that have some

manifestations of the mouth, the disease may be a consequence of dental pathology or may cause damage

to the mouth.

The basic object of study is the patient. All topics will be discussed with clinical examples. Some of the

topics will be studied independently under the guidance of the teacher.

The current program provides Internal Medicine discipline teaching to the students learning in the

dentistry faculty, years of study III and IV.

To acquire good knowledge of the discipline, skills in the field of chemistry, human anatomy, human

histology and embryology and molecular biology genetics, human physiology, pathophysiology,

Morphopathology, pharmacology, medical semiology, all of which are obtained in university studies .

The basic content of the course:

A. Lectures: Nr. Topic Nr. of

hours

INTERNAL MEDICINE, III YEAR , 5 SEMESTER

1 Chronic bronchitis.

Pneumonias.

1

1

2 Bronchial asthma.

Pulmonary emphysema. Cor pulmonale.

1

1

3 Alergies (Anaphylactic shock,Quinke edema , urticaria).

Acute rheumatic fever.

1

1

4 Heart mitral, aortic, tricuspid valvulopathy.

Endocardtis.

1

1

5 Atherosclerosis.

Ischemic cardiomyopathy.Angina pectoris.

1

1

6 Myocardial infarction.

Rythm and conduction disorders.

1

1

7 Acute and chronic heart failiure.

Acute vascular insufficiency.

1

1

8 Arterial hypertension (essential and symptomatic).

Diabetes mellitus.

1

1

9 Vitamin defficiencies and hypovitaminosis. 1

Total number of hours 17

INTERNAL MEDICINE WITH PNEUMOLOGY, IV YEAR , 7 SEMESTER

10 Gastric and duodenal ulcers.

Actue and chronic gastritis.

1

1

11 Chronic hepatitis.

Hepatic cirrhosis.

1

1

12 Ulcerative colitis. Crohn's disease.

Chronic pancreatitis.

1

1

13 Acute and chronic glomerulonephritis 2

14 Acute and chronic pyelonephritis.

Kidney stones (medical aspects).

1,5

0,5

15 Rheumatoid arthritis. Systemic lupus erythematosus.

Osteoarthrosis

1,5

0,5

Total number of hours 12

OVERALL TOTAL HOURS 29

B. Practical lessons:

Nr. Topic Ore

INTERNAL MEDICINE, III YEAR , 5 SEMESTER

1 Patient’s investigation. Repeating the semiology. 2

2 Acute tracheobronchitis.

Chronic bronchitis.

1

1

3 Pneumonias.Pleurisy.

Bronchopulmonary cancer.

1

1

4 Bronchial asthma.

Pulmonary emphysema. Cor pulmonale.

1

1

5 Pulmonary suppurations (bronchiectasis and lung abscess).

Alergies (Anaphylactic shock,Quinke edema , urticaria).

1

1

6 Acute rheumatic fever.

Myocarditis. Pericarditis.

1

1

7 Heart mitral, aortic, tricuspid valvulopathy.

Congenital heart disease.

1

1

8 Infectious endocarditis 2

9 Atherosclerosis.

Ischemic cardiomyopathy.Angina pectoris.

1

1

10 Myocardial infarction. 2

11 Rythm and conduction disorders. 2

12 Arterial hypertension (essential and symptomatic). 2

13 Secondary cardiomyopathies.

Idiopathic cardiomyopathy.

1

1

14 Acute and chronic heart failure.

Acute vascular insufficiency.

1

1

15 Diabetes mellitus.

Hyperthyroidism. Hypoparathyroidism.

1

1

16 Vitamin deficiencies and hypovitaminosis.

Low nutrition. Obesity.

1

1

17 Undifferentiated colloquium. 2

Total number of hours 34

INTERNAL MEDICINE WITH PNEUMONOLOGY, IV YEAR , 7 SEMESTER

1. Patient’s investigation. Aute and chronic gastritis.

Duodenal and gastric ulcer.

2

2

2. Chronic hepatitis.

Hepatic cirrhosis.

2

2

3. Chronic cholecystitis. Cholelithiasis (medical aspects)

Chronic pancreatitis.

2

2

4. Ulcerative colitis. Crohn's disease.

Tumors of the organs of the digestive system (gastric cancer, colorectal

cancer, liver, biliary tract and gallbladder tumors,).

2

2

5. Acute and chronic glomerulonephritis.

Acute and chronic pyelonephritis.

2

1

Kidney stones (medical aspects). 1

6. Rheumatoid arthritis.

Systemic lupus erythematosus.

Osteoarthrosis.

Presentation of clinical teaching observation sheet.

1

1

1

1

Total number of hours 24

TOTAL OVERALL HOURS 58

Note: Last two days of placement in the fourth year (day 7 and 8 to 12 hours) are scheduled for the

tuberculosis department.

Ex. Tests:

Simple choice:

1. s.c. In acute glomerulonephritis the following factors contribute to the developpement of

hypertension, except:

A. increased capillary permeability

B. dicrease of glomerular filtration

C. fluid retension

D. renin hypersecretion

E. aldosteron hypersecretion

.c.m. For chronic bronchitis is typical:

A. expiratory dyspnoea

B. muco-purulent cough with sputum

C. abdominal pain

D. vomiting

E. arthralgia

Recommended bibliography:

A. Mandatory: 1. Lectures

2. Harison. The principles of the internal medicine.The I and II Vol.1995

3. Oxford Book of Internal Medicine / R. A. Hope 1995.

4. Clinical electrocardiography, 7th

edition, 2006

5. Current diagnosis & treatment in gastroenterology, hepatology, & endoscopy - 3rd ed. (2009)

6. Firestein kelley's textbook of rheumatology, 8th ed,2008

7. Libby Braunwald's heart disease a textbook of cardiovascular medicine, 8th ed, 2008

8. Andreoli and Carpenter's Cecil essentials of medicine. Philadelphia, PA : Saunders/Elsevier,

©2010.

9. Clinical medicine: a textbook for médical students and doctors. / Ed.by P. Kumar. M. Clark.

Edinburgh. 1998.

Methods of teaching and learning:

Internal Medicine discipline is taught classically: through lectures and practical work. The theoretical

lectures will be read by current holders. The practical consists of the students making visits to patients for

an independent clinical examination under the guidance of the teacher, will present clinical cases, will

prepare a clinical observation sheet according to the set scheme (fourth year), will participate in the

instrumental examination and will perform curative procedures for the examined patient. The basic object

of study is the patient. Each subject provided in the syllabus will be achieved only through the

presentation (by one of the students) and discussion of the patient (or patients) with that nosological

form, with the active participation of all students in the group. In the practical work, informational

technologies will also be used (clinical cases at the simulator).

Department reserves the right to spend some practical work lessons interactively.

Suggestions for individual activities:

In terms of teaching, one of the least effective methods of learning is passively listening lessons, even with very

careful structuring and illustrating them, including the use of multimedia technologies. Even if the material is

interesting, and the student - motivated enough, so that he remembers something, many ways of processing the

studied materials are needed. Fulfilling a practice is more effective than reading about how to do it, but better is to

teach others to do the same. Based on the above, if you want to have success in acquiring Internal Medicine, is to

work actively with the material. Below we offer some suggestions:

1. Initially read the material, but not just simply overseeing it. Take notes. Try to formulate your own

highlights. Study the diagrams and pictures in the manual and notebook. Reply to tests made in the books

2. Attend the courses and practical lessons, but not just by being there! If you do otherwise, than you probably

won’t meet the requirements. Abstract carefully. Try to assimilate the information, asking yourself: Do I

agree with the teacher? Do I understand what we’re talking about? Does it correspond with the material

taught in the manual?

3. Ask questions! To the teacher, each other, yourself. Do this in the auditorium, the study hall, corridors,

teachers’ offices. Asking questions means you’re trying to understand and process the material taught and

that can only be welcomed. Each student has the right to appeal to his teacher for individual consultations

at teacher working hours or hours, expected for the recovering of arrears (from 14:00 hours until 17:00).

4. Organize your students into groups of 2-3 to meet with you regularly for discussions on course material and

preparing for tabulation. Usually in small groups, each student gets a much better understanding and the

material clearer than when working individually. In addition, the ability to explain the learned material to

the other colleagues will be very helpful in the future.

5. A thorough way training effectively is to have students prepare scientific reports on certain topics.

6. Use time rationally. Internal Medicine Discipline forwards high requirements to the process of acquiring

more material. The same is true of many disciplines, taught in this school year. Therefore, you have to

rationally manage your time and find the perfect balance of effort to obtain knowledge, other

responsibilities and personal life. According to the requirements that were mentioned, for each hour of work

in direct contact with the teacher, the student must work individually 1-2 hours. In other words, to acquire

sufficient knowledge in this discipline means you have to work individually at least 5 hours a week.

Evaluation methods: Assessment of students' knowledge is made through the appreciation of theoretical knowledge (oral, written test), at

the practical lessons, by considering the practical skills shown at the examination of the patient , the argument for

the diagnosis, by evaluating the clinical observation sheets the to fourth year of teaching (VII semester),

Through solving situational problems and at the promotional exam after the VII semester. The Internal Medicine

discipline , during the third year concludes with a tabulation (undifferentiated colloquium).

Students with an average that’s lower that 5 will not be admitted at the promotional exam, and also the students who

haven’t recovered their unattended practical lessons.

The exam for the Internal Medicine discipline is a combined one, made up of a multiple-choice test (option "Test

Editor" USMF "Nicolae Testemitanu") the oral test, certification and practical skills will be done in two stages:

Stage I. The practical part in the therapy section (end placement in semester VII) Practical skills list is approved at

the department and presented to the students at the beginning of the study. Each student will have to examine a

patient for 30 min. You will appreciate: the establishment and reasoning to patient clinical data based on

presumptive diagnosis (at bedside), the composition of paraclinical investigation plan, interpretation of laboratory

data, differential diagnosis of pathology in question and therapeutic assistance in emergencies. An appropriate mark

will be fixed in the examiner’s record sheet. If the mark is negative, the student will be allowed to request a

reexamination by the committee.

Stage II. 1. The multiple-choice test consists of variants, each having 100 tests consisting of all the studied topics

of the course, from which 40 tests are of simple complement, 60 being of multiple complement. The student is

provided a total of 2 hours to respond to the test. The test is then evaluated with grades from 0 to 10.

2. The oral test consists of offering the student a choice of one of the 40 random tickets, each containing 3

questions drom all the topics of the internal medicine, according to the analytical program. The student then has 30

minutes to get ready to answer. He is then evaluated with grades from 0 to 10.

Topics for the exam (tests, questions "oral") approved at the chair meeting and made for the students at least one

month before the session.

Assessment of knowledge is assessed with a mark 10-1 with no decimals, as follows:

- Note 10 or "excellent" (equivalent to ECTS - A) will be granted for acquiring the 91 -

100% of the material;

- Note 9 or "very good" (equivalent ECTS - B) will be granted for the acquisition of 81 -90% of the material;

- Note 8 or "good" (equivalent ECTS - C) will be granted for the acquisition of 71-80% of the material;

- Notes 6 and 7 or "satisfactory" (equivalent to ECTS - D) will be awarded for the acquisition of respectively 61-

65% and 66-70% of the material;

- Rating 5 or "weak" (equivalent to ECTS - E) will be granted for the acquisition of 51-60% of the material;

- Notes 3 and 4 (equivalent ECTS - FX) will be granted for the acquisition of 31-40% and of 41-50% of the

material;

- Notes 1 and 2 or "unsatisfactory" (equivalent to ECTS - F) will be awarded for the appropriation of 0-30% of the

material.

Failure of being present to examination without a good reason shall be recorded as "absent" and is equivalent to

grade 0 (zero). The student has the right to 2 repeated examinations.

Assessment of knowledge must be assessed with marks from 10 to 1 and decimals 0.5. Marks

from "5" up to "10", obtained as a result of evaluation of the course unit, allow the students to obtain

appropriations, according to the curriculum. The final grade results from the weighted sum of current

assessments and notes from the final examination, being rounded to the students’ benefit or decimal

number 0.5. Students who’s mark for the current assessment is less than "5" will not be admitted to the

final evaluation. The final grade consists of four components: annual average mark consisting of the

average marks in internal medicine at the year III, IV and clinical teaching observation sheet (coefficient

0.3), the practical test (coefficient 0.2) ,oral test (coefficient 0, 3), multiple-choice test (coefficient 0.2).

The method of rounding of the grades

The weighted sum of mark at the current assessments and final examination

Final mark

5-5,0 5

5,1-5,5 5,5

5,6-6,0 6

6,1-6,5 6,5

6,6-7,0 7

7,1-7,5 7,5

7,6-8,0 8

8,1-8,5 8,5

8,6-9,0 9

9,1-9,5 9,5

9,6-10 10

Language of instruction:

English.