PRE-EDUCATION PATHOLOGY
December 13, 2023 2024-09-16 12:20PRE-EDUCATION PATHOLOGY
PRE-EDUCATION PATHOLOGY
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| Type|Type of Course: | YP | SCIENTIFIC AREA | |||||||||||||
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| Teaching Semester: | 5th Semester | |||||||||||||
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| Hours per week: | 6 hours | |||||||||||||
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| Total Time (Teaching Hours + Student Workload) | 161 Hours | |||||||||||||
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| Prerequisites: |
The student must have successfully attended and been examined in at least two (2) of the following courses: i. Anatomy of the Musculoskeletal System ii. Viscera and Vascular Anatomy iii. Anatomy of Nervous System and Sensory Organs iv. Systems Physiology v. Neurophysiology and Endocrine Physiology vi. Pharmacology I |
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| Language of Instruction: | Greek (However, the possibility of teaching in the English language is offered, as this happens repeatedly to foreign students who are taught the course in the context of student exchange in the ERASMUS Program and student exchanges in the HELMSIC program). | |||||||||||||
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| Available for Erasmus: | YES | |||||||||||||
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| Semester Lectures: | Details/Lectures | |||||||||||||
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| Teaching Method: | Lectures either from an auditorium or online through a special platform are not mandatory. Clinical tutorials (clinical exercise) are carried out at the patient's bedside and are mandatory.
Microsoft software (PowerPoint) is used to deliver the lessons. |
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| Evaluation Method: | – The evaluation of the students is done on the one hand with oral questions on the problems of the patients during the clinical exercises and on the other hand with written questions at the end of the semester. Students are assessed in the tutorial course by the instructors at the end of the semester on their ability to perform the basic objective examination and history taking. During the examination periods, the course is examined according to the system of written examinations. The students' performance in the tutoring course is also taken into account for the semester's grade. Written questions include Short Answer Questions as well as Multiple Choice Questions. From the above, it can be concluded that the workload of the students for the Pre-educational Pathology course is extremely high and the requirements are particularly high. The evaluation criteria can be accessed by students on the course website: http://83.212.32.147/internalmedicine/index.php/el/propaideftiki In order to evaluate the course and the teachers, a special questionnaire is available to the students at the end of the teaching semester of the course, with which each of the teachers is evaluated, both for the lectures from the auditorium (twice a week) and for the clinical tutorials (twice a week per week). Students are also encouraged to express their opinion on the overall educational process of the course and any proposed changes. The results of the above questionnaire responses are used appropriately with the aim of improving the educational process for the specific course. |
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| Objective Objectives/Desired Results: | The course is one of the basic core courses of the Medical Schools and has significant demands on the part of the students. Students are required to spend many hours learning how to take and write a medical history, the methods of examination to assess the patient's physical condition and learning the main symptoms with which various diseases manifest. The course includes lectures from an amphitheater 3 hours per week (not mandatory) as well as 3 hours per week of clinical practice in the wards of the University Pathology Clinic (obligatory attendance) with a multitude of patients suffering from diseases originating from various systems and requiring the adoption of the so-called holistic diagnosis and treatment. The aim of teaching is to assess the patient's physical condition and to learn different diagnosis of pathological findings.
Target Upon successful completion of the course, the student will be able to use the acquired knowledge in order to: Conditions Structure of the knowledge that the student must acquire in the Pre-Education course Pathology Skills – gaining experience The selection of patients by the instructor is based on the schedule of lectures that goes hand in hand with the schedule of tutorial exercises. The knowledge to be acquired is described below (see course content). |
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| Course URL : | http://83.212.32.147/internalmedicine/index.php/el/propaideftiki | |||||||||||||
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| Course Description: | The set of knowledge described constitutes the taught and examined material. Knowledge 1. Background 1.1. Understanding the importance of the history in the diagnosis and treatment of the patient. Awareness of the fact that a complete and accurate history is a prerequisite for the correct diagnosis and consequently the treatment of the patient. 1.2. Structure of the history (main complaint, present disease, individual and family memory, personal and social history and review of systems). 1.3. Understanding the importance of age, gender, geography, ethnicity and social background. 1.4. Awareness of the difficulties and pitfalls that may arise in the correct assessment of the information they receive. 1.5. Understanding that history is an active process that requires knowledge and experience. Understanding that initial knowledge and experience is gained in Year 3, but history taking technique requires continued effort and is refined in Year 4 Pathology course and Year 6 clinical practice. 2. Description of main symptoms 2.1. Classification of headaches and description of the clinical features of the most common of them. 2.2. Chest pain: Anatomical elements that cause chest pain. Main clinical features of pleural pain, myocardial ischemia, pericarditis, pain due to esophageal disorders, aortic dissection pain, etc. 2.3. Abdominal pain: Clinical features of pain due to peritoneal irritation, obstructive pain of the hollow viscera, vascular occlusion pain, abdominal pain of metabolic disorders. 2.4. Back pain and neck pain: Description of the clinical features of pain of the most common causes. 2.5. Pathophysiology and clinical types of cough. 2.6. Description of the different types of dyspnea. Differentiate paroxysmal dyspnea from continuous dyspnea. Shortness of breath from respiratory causes (inspiratory, expiratory). Dyspnea of cardiac etiology (dyspnea on exertion, forms of dyspnea at rest). Other types of shortness of breath. 2.7. What are atrial fibrillations and how are they described by the patient. How syncope attacks and fainting are defined. What are the main types of seizures and what are their clinical characteristics. 2.8. How are nausea, vomiting, constipation and diarrhea defined and what is the pathophysiology. Differentiation of acute and chronic inflammatory discharges. 3. Evaluation of certain objective examination findings 3.1. Growth disorders: Description of gigantism and different types of dwarfism. 3.2. Nutritional disorders: Definitions and clinical features of wasting and cachexia. Definition, method of objective measurement and grading of the severity of obesity. 3.3. Pathophysiology of body temperature regulation, description of fever types and accompanying symptoms. 3.4. Characteristic faces. 3.5. Description of primary and secondary skin lesions. Clinical description of common and characteristic skin rashes. 3.6. Bleeding manifestations of the skin: Definitions of petechiae, ecchymoses, hematomas and purpura. Common porphyric lesions. 3.7. Definition and pathophysiology of cyanosis. Distinction of peripheral central cyanosis. 3.8. Definition and pathophysiology of edema, topography of edema according to etiology. 3.9. Objective findings of congestive heart failure. 3.10. Objective findings of valvular diseases. 3.11. Objective findings of pulmonary thickening, pulmonary emphysema, atelectasis, pleural effusion and pneumothorax. 3.12. How is jaundice defined and what are the pathophysiological types of jaundice. 3.13. Objective findings of ascitic collection. 3.14. Lymphadenopathy: Topography of lymph node swellings. Evaluation of lymphadenopathy in terms of size, tenderness, consistency, formation of confluent masses and its duration. Main conditions causing lymphadenopathy. 3.15. Splenomegaly: Significance of size, texture, tenderness to palpation, and presence of friction sound. Main causes of spleen enlargement. 3.16. Objective signs of arthritis. Description of clinical characteristics of arthritic syndromes: Monoarthritis, oligarthritis, polyarthritis, arthritis of small joints, or large joints, migratory arthritis, cumulative arthritis, symmetrical arthritis, erosive or non-erosive arthritis. 3.17. How the level of consciousness is examined and how related disorders are classified. Definitions of confusion and delirium. Memory disorders and dementia. 3.18. Speech disorders. What is dysarthria and what is aphasia. Clinical forms of aphasia and ways to control them. Definition of agnostic and pragmatic disorders. 3.19. Manifestations of lesions of the extrapyramidal system and the peripheral central neuron. Gait disorders and clinical gait types. 3.20. Common involuntary pathological movements: Tremor, chorea, athetosis, myoclonus, etc. 3.21. Muscle disorders: Muscle strength and muscle atrophy. Disorders of muscle tone. 4. Paraclinical semiology and basic laboratory investigation of excreta and body fluids 4.1. Evaluation of sputum based on color, consistency, quantity and odor of sputum. Clinical significance and evaluation of bloody sputum. 4.2. Evaluation of ememas based on the color and composition (food, bile and bloody) the amount and smell of ememas. Clinical significance of hematemesis. 4.3. Assessment of 24-hour urine output: Definition and clinical significance of oliguria and polyuria. Clinical evaluation of the appearance, color and odor of urine. Clinical significance of urine specific gravity (hyposthenuria, isosthenuria, hypersthenuria) of urine pH reaction. 4.4. Evaluation of urine biochemical parameters such as albumin, sugar, ketone bodies, pigments and urinary hemoglobin. 4.5. Evaluation of urine sediment: Hematuria and its forms, pyuria, cylindruria. 4.6. Clinical assessment of stool quantity and color. Definition and clinical significance of black stools and stool discoloration. 4.7. Pathological components of feces: Mucus, pus, bloody impurities, intestinal parasites, etc. 4.8. Method of distinguishing the pleural fluid, into interstitial and exudative. Clinical significance of hemorrhagic, purulent, and purulent pleural fluid. 4.9. Macroscopic and microscopic characteristics of pericardial fluid. 4.10. Differentiation of ascitic fluid into portal hypertension fluid and fluid without portal hypertension. Clinical significance of hemorrhagic, purulent and purulent peritoneal fluid. 4.11. Indications and contraindications for lumbar puncture. Clinical significance of the tension, appearance and presence of blood in the cerebrospinal fluid and normal biochemical and cellular findings. 4.12. The concept of hematocrit and hemoglobin of blood, definition of anemia and erythrocytosis. Definition and evaluation of erythrocyte markers and resulting classification of anemias. 4.13. Quantitative disorders of leukocytes. Gaining experience and skills 1. History download 1.1. Exercise in taking history on clinic patients 1.2. Gain experience in recording history 2. Basic and directed objective examination 2.1. The student must learn to perform the basic systematic objective examination of the patient. This examination is carried out on every patient regardless of the history and projected symptoms. This exam must slowly become the property of the student and it acts in a consistent and automatic manner. 2.2. The exam is done in a specific sequence. In our clinic we teach a sequence which includes: – General overview of the patient – Examination of the head and neck – Upper extremity examination – Chest and trunk examination – Abdominal examination – Lower extremity examination 2.3. A standardized basic objective examination is described in the table. This sequence must become the absolute property of the student. 2.4. If the symptoms and general history or physical examination reveal system-specific symptoms, this should be examined in detail (directed physical examination). 2.5. Proper objective examination requires basic equipment that must always be available (see table) 3. General overview and assessment of the patient 3.1. Position the patient in bed 3.2. Observation of general growth and nutrition 3.3. Body temperature measurement 3.4. General overview of the skin (complexion, rashes, varicose veins, etc.). Palpation of the skin and any lesions to determine the temperature of its composition and elasticity. 3.5. Examination of extremities and nails. – complexion (pallor, cyanosis, redness, Raynaud's syndrome) – deformities (scleroderma, muscle atrophy, joint deformities, Dupuytren palm, arachnodactyly) – hand size – terror – examination of nails (colonychia, keyboardactyly, gram-like bleedings. 4. Head and neck examination 4.1. Shape, size of skull, presence of alopecia, facial features, skin lesions, sensitivity, facial swelling. 4.2. General eye examination: extraocular. 4.3. Eyelid examination (eyelid ptosis, upper eyelid twitching, eyelid swelling, xanthelasma, etc.). 4.4. Examination of the conjunctiva (complexion, etc.) and cornea. Pupil examination: size, shape, symmetry, pupillary and accommodation reflexes. Identifying Horner's syndrome. 4.5. Eyeball motility test and hemianopsia test. 4.6. Examination of the nose and salivary glands 4.7. Examination of lips and oral cavity: (cyanosis, pallor, pigmentation, etc.). Examination of gums, tongue (smear, atrophy of nipples, etc.), palate, pharynx, tonsils. 4.8. Cervical examination: Examination for neck stiffness, examination of thyroid gland, trachea, vessels (jugular pulse, arterial pulse and palpation of cervical lymph nodes). 5. Respiratory System 5.1. Topographic orientation on the chest 5.2. Overview of the thorax – Abnormalities of the shape of the chest (pithoid, bird-like, etc.) – Local chest wall abnormalities – Control of breathing movements (breathing rhythm disorders, frequency, depth). 5.3. Palpation – Mobility of the pectorals – Voice vibrations – Additional vibration – Pathological palpitations 5.4. Chest percussion – Technique of impingement – Sounds produced on percussion (clear pulmonic, blunt, tympanic) 5.5. Chest auscultation – Technique (the way listening is done in different areas) – Breath sounds (alveolar murmur and its variations, bronchial breathing and subcategories such as tubular murmur, pleural murmur and amphoric sound) – Additional lung sound (musical and non-musical snoring and friction sounds) 5.6. Breast examination – Breast examination (positions of the patient during the examination, nipple insertion, skin examination) – Palpation of the breasts 5.7. How to palpate the armpits 6. Circulation System 6.1. Examination of the vessels – Examination of the venous (jugular) pulse (patient position, assessment of central venous pressure, hepatojugular reflux) – Arterial pulse (carotid pulse examination, aortic pulse examination – frequency, rhythm and rhythm disturbances, types of pulses) – Technique and pitfalls in blood pressure measurement 6.2. Overview – palpation of the heart – Prophecy of cardiac area – Cardiovascular examination – Roizos 6.3. Listening to the heart – Hearing centers of the heart – Physiological heart tones and changes in their intensity – Additional heart tones (3rd, 4th) – Clicks – Heart murmurs (systolic, diastolic, systolic and diastolic). Determination of focus, quality and effect of breathing. – Pericardial friction sound 7. Examination of the Digestive System 7.1. Topographic orientation on the abdomen 7.2. Abdominal overview (skin condition, symmetry, abdominal wall movements) 7.3. Abdominal impaction – Normal impact sound – Liver impaction – Spleen impaction – Abdominal percussion to find free peritoneal fluid 7.4. Abdominal auscultation – Listening to peristaltic bowel movements in a normal state and in various pathological conditions – Splash – Vascular sounds 7.5. Abdominal palpation – Methods of palpation (very light palpation, muscle resistance) – Deep palpation – Palpation of the liver (size of swelling in centimeters, contracture of the lip, texture of the surface, tenderness) – Gallbladder palpation (Murphy point, Courvoisier point, gall bladder) – Spleen palpation (size in cm, sensitivity, texture, surface texture) 7.6. Examination of the anus and rectum – Overview of the ring and finger examination 8. Examination of the genitourinary system 8.1. Inspection and palpation of the lumbar regions (muscle contraction, Giordano's point) – Palpation of the kidneys – Examination of the bladder episcopally and percussively 8.2. Examination of the inguinal regions (femoral artery compressions, swollen lymph nodes, hernias). 8.3 Examination of male external genitalia (penile examination, inspection and palpation of testicle and epididymis) 9. Examination of the musculoskeletal system 9.1. Spine examination – Overview of the spine and identification of changes such as kyphosis, scoliosis, lordosis, etc. – Palpate and gently tap the spine to find local tenderness and muscle spasm – Control of spinal mobility (flexion, extension, lateral movements and rotational movement) – Examination of sacroiliac joints – Lasegue point 9.2. Examination of peripheral joints – Examination of complexion, temperature and texture of the underlying skin – Identification of swelling of the joints (thickening of the synovial membrane, hydroarthrosis, bone swelling) – Sensitivity of joints to pressure – Examination of joint range of motion 9.3. Examination of individual joints – Temporomandibular joint examination – Examination of the shoulder – Examination of the elbow – Examination of the joints of the extremities – Examination of the hip – Examination of the knees – Examination of the ankle joint – Examination of the joints of the foot 10. Nervous System 10.1. Examination of level of consciousness and familiarization with the grading of disorders of consciousness 10.2. Examination of mental functions – Examining memory – Examination of speech (dysarthrias, aphasic disorders and especially the distinction between perceptual aphasia and expressive aphasia and how to control them) – Examination of cognitive and practical functions (agnosias and apraxias) 10.3. Cerebrospinal nerve examination – Examination of the olfactory nerve (anosmia, dysodor) – Optic nerve examination (visual acuity, color perception disorders, visual field testing to identify hemianopsia) – Examination of oculomotor nerves (examination method based on eye movements, nystagmus search) – Examination of the trigeminal nerve (examination of facial skin sensitivity, scalp, release of corneal reflexes) – Examination of the facial nerve (overview of facial symmetry and mobility of facial muscles with demonstration of teeth, attempt to whistle, convergence of eyelids, elevation of nostrils and distinction of supranuclear from peripheral lesion). – Auditory nerve examination (nystagmus search, Romberg point, upper hand extension test, index test) – Examination of the glossopharyngeal and vagus nerve (vocal rock, soft palate mobility, pharyngeal reflexes, autonomic system disorders) – Examination of accessory nerve (examination of sternocleidomastoid and trapezius muscle) – Examination of the sublingual nerve 10.4. Examination of sensibility, familiarization with the concepts hypoesthesia-anesthesia, hypoalgesia-analgesia, hyperalgesia and thermoanesthesia. – Examination of many sensibilities and specifically the touch of pain, hot, cold and critical sensibilities. – Examination of deep sensation (sensation of "deeper" pain, joint sensation, vibration sensation - palaesthesia). 10.5. Sensory disturbances depending on the point of damage – Peripheral nerve damage – Damage to nerve roots – Spinal cord injury : Complete section, semi-transverse section (Brown Sequard syndrome) – Posterior bundle damage – Damage to spinothalamic bundles – Damage to the central part of the spinal cord – Damage to the stem and optic chambers – Damage to the sensory cortex and subcortical areas 10.6. Sense of mobility – Examination of voluntary mobility: gait, gait disorders and recognition of gait characteristics. – Examination of synergistic movements: walking in a straight line, Romberg test – Toe-nose and heel-knee test, pronation, forearm supination 10.7. Involuntary pathological movements – Familiarity with the different types of horror – Chorea athetosis, myoclonus, muscle spasms 10.8. Examination of the muscles – Test for muscle atrophy – Examination of muscle strength – Examination of muscle tone (hypertonia, hypotonia) 10.9. Examination of reflexes – Examination of many skin reflexes – Reflexes pharynx, soft palate – Plantar reflexes 10.10. Examination of tendon reflexes and pathological reflexes Panel. Objective examination instruments • Stethoscope • Electric flashlight • Neurological hammer • 128 Hz crossover • Measuring tape • Sphygmomanometer • Tongue depressor • Cotton-gauze pads • Elastic gloves • Vaseline • Magnifying glass BASIC MEDICAL EXAMINATION GENERALLY 1. Personality, mental state. 2. Gait and position during the examination. 3. General Overview: Body Build, Muscular Build, Nutrition, Skin Tone, Rashes, hirsutism. 4. Temperature measurement. HEAD 5. Conjunctival examination (anemia, jaundice). 6. Ball motility, nystagmus, pupils (size, shape, reflexes to light and adaptation, visual fields), exophthalmos. 7. Oral cavity (tongue, mucous membranes, paristhmia. NECK 8. Neck stiffness 9. Palpation of cervical, thyroid lymph nodes. 10. Overview of vessels of the neck, central venous pulse. UPPER EXTREMITY 11. Overview – palpation of extremities (temperature, xanthomas, keyboarding, nails). 12. Palpation of the standing pulse. 13. Blood pressure measurement. 14. Hand tremor control, fine movements and synergy of movements, muscle strength, tendon reflexes. 15. Joint control (sensitivity, mobility, swelling). 16. Hair control and armpit lymph node palpation. CHEST 17. Types of breathing at rest, comparison of hemithoracic mobility, chest wall abnormalities. 18. Position, intensity of cardiac effort (overview, palpation). 19. Heart auscultation (tones, murmurs, friction). 20. Chest percussion in symmetrical positions. 21. Chest auscultation (respiratory murmur, additional sounds) in symmetrical positions. 22. Overview – breast palpation. 23. Abnormalities of the spine, tenderness and dullness of the renal region. BELLY 24. Abdominal examination (general or local distension, epivena). 25. Abdominal palpation (tenderness, masses and especially palpation of the liver, kidney spleen). 26. Palpation of inguinal glands and inspection of hernias. 27. Palpation of femoral artery pulse. 28. Examination of genital organs. 29. Rectal examination and (optionally) digital examination. LOWER END 30. Overview for varicose veins, atrophies, swellings. 31. Palpation of lower extremities for temperature, pressure to detect swelling. 32. Palpation of lower limb arteries. 33. Joint control (swelling, mobility). 34. Control of muscle power, reflexes. Subjective symptoms and common clinical syndromes 6.1. Headaches: Classification of headaches and description of the manifestation of the most common of them. 6.2. Chest pain: Forms of chest pain. Special description of angina pain and heart attack pain. 6.3. Abdominal pain: 6.4. Arthralgias, arthritis 6.5. Developmental disorders 6.6. Primary and secondary skin lesions 6.7. Shortness of breath 6.8. Cough and hemoptysis 6.9. Palpitation, fainting, convulsive attacks 6.10. Dysphagia 6.11. Weight loss and obesity 6.12. Nausea and vomiting 6.13. Hematemesis, blacks 6.14. Diarrhea 6.15. Constipation 6.16. Jaundice 6.17. Ascetic 6.18. Lymphadenopathy 6.19. Splenomegaly 6.20. Porphyric lesions 6.21. Dizziness, vertigo 6.22. Coma 6.23. Confusion, delirium 6.24. Automatic movements 6.25. Sensory disturbances 6.26. Movement disorders 6.27. Speech disorders 6.28. Haematuria 6.29. Polyuria |
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RECOMMENDED-BIBLIOGRAPHY
-Suggested Bibliography:
1. Clinical semiology and diagnostics (G.I. Arapakis) ISBN 960-7795-03-2
2. Bate's Guide to Clinical Examination and History Taking (Bickley S. Lynn) ISBN 9789603722069
3. Clinical Diagnosis, History and Physical Examination (Swartz Mark) ISBN 978-960-7875-52-5
4. Chamberlain's Clinical Semiology & Diagnosis (Houghton Andrew, Gray David) ISBN
9789963274574
5. Medical Bibliography on the Internet (PubMed and other bibliographic sources)
-Related scientific journals:
1. The New England Journal of Medicine
2. The Lancet
3. Annals of Internal Medicine
4. JAMA Internal Medicine
English 
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