Universitat Internacional de Catalunya
Appropriate Use of Diagnostic Tests
Teaching staff
Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email:
Dr. Esteve Largués ellargues@uic.es
Dra Elena Vargas Vilardosa: evargas@uic.es
Dr Juan José Sánchez Fernández: jjsanchez@uic.es
Dra María Dolores Cocho Calderón: dcocho@uic.es
Dra Paloma Puyalto De Pablo: ppuyalto@uic.es
Dr Emilio Miguel Gené Tous: emgene@uic.es
Introduction
The course will provide the student with the knowledge for the correct indication and use of diagnostic tests (DT) in clinical practice.
The DT have contributed to great advances in medicine by making available to the physician sensitive and specific information of great help in the diagnosis. The imaging tests provide a very precise degree of anatomical detail, fundamental for clinical and therapeutic decisions.
The indication of the DT should be made based on the clinical reasoning generated by the careful study of the patient, observation and physical examination. The doctor must know how to use the DT with criteria and moderation and assess whether the results will modify the treatment or benefit the patient.
You have to know the information provided by each of the DT, as well as their limitations and possible harm to the patient.
Pre-course requirements
The student must have knowledge of the pathological processes of the different organs and systems, as well as know the repercussion on the organism.
The student must know the basic physical and biochemical foundations of the different types of DT.
It is essential that the student has completed and approved the subjects:
Semiology and Physiopathogeny
Biochemistry
Objectives
To learn the indication and assessment of DT in clinical practice.
Specific objectives:
1. To know the theoretical foundations of the tests / complementary explorations.
2. To know the indications of the DT. Place the DT as a support tool in the diagnostic and therapeutic aspects of the clinical history and patient care.
- To know the indications of the different DT.
- To know the information that can contribute and the limitations of the exploration.
- To evaluate the efficiency of each exploration.
- To recognize the importance of searching for the best evidence.
- To know sensitivity and specificity of each exploration.
- To know how to interpret the results of the tests and the correlation with the clinic.
3. To know how to inform the patient.
- To offer information to patients about the explorations to be performed.
- To obtain written informed consent.
4. To know the conditions of the tests.
- To assess the suitability of the treatment according to the patient's situation.
- To assess the limitation of the diagnostic - therapeutic effort.
- To know the limitations and contraindications of the DT.
- To know adverse and secondary effects of DT.
Learning outcomes of the subject
The student plans the study of DT (indication, priority and staging by complexity) based on clinical reasoning and differential diagnosis.
The student knows the DT, informs the patient of the risk - benefit that they entail, and asks for informed consent.
The student values the information provided by the test and makes a critical contrast with the clinic.
Syllabus
The focus of the subject will be directed to the following areas of knowledge:
- The study and therapeutic approach of systems
Cardiovascular
Respiratory
Digestive - hepatobiliary
Neurological
Nephro - urological
Endocrinology - metabolism
Haematological and coagulation disorders
Infections
Locomotor
- The study of symptoms and syndromes
Sdr. Febrile. Fever of unknown origin
Chest pain
Abdominal pain
Headache
Dorsal and neck pain. Low back pain
Arthralgia and arthritis
Sdr. Constitutional
Sdr. Polyadenopathic
Sdr. Confusional
|
Modalitat |
Tema |
Professor/a |
|
CM |
El procés diagnòstic i l’elecció de PD- I. |
E. Llargués |
|
CM |
El procés diagnòstic i l’elecció de PD - II. |
E. Llargués |
|
CM |
Estudi en infeccions i de l’aparell locomotor: aportació de les PD |
E. Vargas |
|
MC |
Sdr. Febril. Febre d’origen desconegut. Sdr. Constitucional. |
E. Vargas |
|
MC |
Lumbàlgia. Artràlgies. Artritis. |
E. Vargas |
|
CM |
Estudi de l’aparell cardiovascular: aportació de les PD. |
E. Llargués |
|
CM |
Estudi de l’aparell respiratori: aportació de les PD |
E. Llargués |
|
MC |
Diagnòstic per la imatge en el tòrax.R. Cambra |
L. Esteba |
|
LH |
Estudi de dolor toràcic. |
E. Llargués |
|
MC |
Hipòxia i cianosi. Tos. Hemoptisi. Dolor en punta de costat. |
E. Llargués |
|
ABP |
Dolor toràcic. Dispnea. |
E. Llargués |
|
CM |
Estudi de trastorns hematològics i de coagulació: aportació de les PD. |
E. Llargués |
|
MC |
Sdr. Anèmica. Policitèmia. Adenopaties. |
E. Llargués |
|
MC |
Edema. Rash cutani. Sdr confusional, deliri. |
E. Vargas |
|
CM |
Estudi del sistema neurològic: aportació de les PD. |
D. Cocho |
|
MC |
Cefalea. Meningisme. Alteracions motores i sensitives. Mareig. Vertigen. |
D. Cocho |
|
MC |
Diagnòstic per la imatge en el crani.-- |
L. Esteba |
|
CM |
Estudi de l’aparell digestiu - hepatobiliar: aportació de les PD |
E. Gené |
|
MC |
Dolor abdominal. Sdr. Ictèrica. Ascites. Hemorràgia digestiva baixa i alta |
E. Gené |
|
MC |
Disfàgia. Dispèpsia. Nàusea – vòmits. Sdr. Diarreica. Restrenyiment. |
E. Gené |
|
MC |
Diagnòstic per la imatge en l’abdomen- |
L. Esteba |
|
CM |
Estudi de l’aparell nefro – urològic i reproductor: aportació de les PD. |
E. Vargas |
|
CM |
Estudi de endocrinològic: aportació de les PD |
E. Llargués |
- Laboratory of skills
- Study of chest pain
Dr. Esteve Llargués
- Virtual Lesson
Dr. Esteve Llargués, Dra. Paloma Puyalto
Teaching and learning activities
In person
The master class is the scenario in which a teacher transmits knowledge in a classroom to the whole group of students. The format, however, allows the introduction of activities in small groups within the classroom and the development of strategies that encourage the active participation of students.
Script:
Approach to the major clinical syndromes of the system (reason for study)
• List of complementary tests that are used for the study of the organ / system
- Structural study tests - Structure of the apparatus - system
- Functional study tests - Function of the device - system
- Structural and functional study tests
- Other diagnostic tests.
• List of the main syndromes that are presented for study and that will be presented in the class, is part of the script of the class.
• Study process based on the differential diagnosis of a specific clinical / syndromic situation.
• What tests do we use and in what order / priority ?. Argumentation, to what the priority obeys.
• Expected results of the tests. Contrast results of complementary tests with the patient's clinic: interpretation of results in the clinical context, false positives, false negatives, ...
The case method consists of the process of solving clinical cases or those specific to the profession. They are activities in groups that are resolved with the active participation of the teacher after the students' deliberation.
The teacher defines the learning objectives he wants the students to achieve.
Clinical cases. Process of analysis of the clinical information of the case. Development of the differential diagnosis. Development of the study process of a specific clinical - syndromic situation through diagnostic tests
Problem-based learning has similarities to the case method but differs in that students are held responsible for finding the solution to the problem. The teacher acts as a tutor that facilitates the learning process based on their metacognitive abilities. It is developed in small groups.
The skills laboratory is an area in which the student can basically develop communication and physical examination skills based on mannequins and clinical cases. They are developed with small groups.
Evaluation systems and criteria
In person
Final note of the Course
To pass the subject:
FIRST CALL (MAY / JUNE)
To pass the subject, Exam must be passed, grade ≥ 5 and also
in Formative Activities * (LH, PBL, Partial Exams, Lesson) you must have a grade ≥ 5.
MIR test type Exam.
4 options to choose
Correct, add 1 point
Incorrect, rest 0.33 point
Qualification of the Formative Activities weighting of the notes of:
|
Skills Lab - PBL and teacher evaluation Note of partial exams Lesson Not presented / No assistance = 0 Attending the PBL or SL, having changed the group of PBL and / or SL without exchange for another student penalizes, supposes a maximum qualification of 5. The change of group must have been communicated and accepted by the coordinator of the subject. |
Pass the subject if the qualification (exam + formative activities) are ≥ 5, they will do the following weighting:
|
Evaluation and weighting |
|
|
Test exam 1st call |
65% |
|
Skill Laboratory - PBL and teacher appraisal |
20% |
|
Partial exams |
10% |
|
Lesson |
5% |
|
Total |
100% |
|
Add qualification: VOLUNTEER
See corresponding section, below This score will be obtained only in 1st call, if the qualification of the exam and formative activities, both separately are = or > 5 |
+ 10% |
Any other situation (exam
Special situations:
DO NOT pass Exam or Formative Activities in the 1st. call:
1- EXAM First Call (May / June)
If the qualification of the exam of the 1st call is between 4.5 and 4.99, it will average with the qualification of Formative Activities if the qualification of Formative Activities ≥ 7.5.
If the exam qualification of the 1st call is between 4.5 and 4.99, and the qualification Formative Activities
If the exam qualification in the 1st. call is < 4.5, you go to the 2nd call.
2 - FORMATIVE ACTIVITIES First Call (May / June)
If the qualification of Formative Activities is less than 5, and the qualification of the examination is ≥ 6.5, the weighting in 1st call will be:
|
Evaluation and weighting |
|
|
Test exam 1st call |
40 % |
|
Training activities |
60 % |
|
Total |
100% |
To pass it is necessary that the "total" is ≥ 5, otherwise it goes to second call.
If qualification of Formative Activities is less than 5, and qualification of the exam is < 6.5, you go to second call.
Any personal situation of any student that prevents the follow-up of classes and formative activities will be taken into account if it is a specific situation and responsible teacher is informed..
SECOND CALL
If Formative Activities (SL, PBL, Partial Exams, Lesson) you must have a qualification ≥ 5, to pass the subject, and a qualification ≥ 5 must be taken in the exam (2n call):
Average:
|
Evaluation and weighting |
|
|
Test exam 1st call |
65 % |
|
Skill Laboratory - PBL and teacher appraisal |
20 % |
|
Partial exams |
10 % |
|
Lesson |
5 % |
|
Total |
100% |
If the qualification of Formative Activities of the 1st. call is < 5, it is necessary to do the work of Add Qualification (if the work answers to all the corresponding sets, the note of formative activities will be of 5) and to pass examination of 2a. call (= ó > 5).
If the qualification of Formative Activities of the 1st. call is < 3, it is necessary to do the work of Add Qualification (if the work answers to all the corresponding sets, the note of formative activities will be of 5) and to pass examination of 2a. call with minimum qualification of 7:
Average when qualification of Formative Activities of the 1st. call is < 5:
|
Evaluation and weighting |
|
|
Test exam 1st call |
50 % |
|
Formative Activities (maximum grade: 5) |
50 % |
|
Total |
100% |
If the exam grade of the 2nd. call is between 4.5 and 4.99, will average with the qualification of Formative Activities, if the qualification of Formative Activities ≥ 7.5.
If the exam grade of the 2nd. call is between 4.5 and 4.99, and the qualification of Formative Activities
Maximum qualification 2nd call: 7
Repeating student, at the beginning of the semester, must go to the professor responsible for the subject to assess possible validation of formative activities from the previous year.
Any personal situation of any student that prevents the follow-up of classes and formative activities will be taken into account if it is a specific situation and responsible teacher is informed..
Add qualification - VOLUNTARY -:
- Review a clinical guide or an article (each one's choices - see 1 sources of articles and clinical guides-) dealing with the indication of diagnostic tests in clinical practice.
- Make a one-page summary of what this guide/article provides, indicating what you have learned.
- Prepare a MIR-type question (with multiple answers, 4 answers, 1 correct) that is related to the guide/reviewed article. The originality of the question and that the answers are reasoned / argued will be valued.
In Moodle you will find the date to upload the work.
You have to deliver:
- Clinical guideline / revised article
- Summary page with what this article provides and indicate what you have learned
- The question with the 4 options, with the reasoning/argumentation of the answers
- 1 - Sources of articles, clinical guidelines:
- PubMed: in the “limits” section, choose type documents: clinical guidelines, consensus documents, ...
- Websites of scientific societies: Catalan, Spanish, European, American, …
Examples:
https://essencialsalut.gencat.cat/ca/inici
www.nice.org.uk/guidance/
Bibliography and resources
Longo, Fauci, Kasper, Hauser, Jameson, and Loscalzo, Eds. HARRISON’S PRINCIPLES OF INTERNAL MEDICINE INTERNA. 18th Ed. McGraw Hill, 2011.
Rozman C., Cardellach F. Farreras: MEDICINA INTERNA 16º edición. ELSEVIER ESPAÑA, S.A. 2008.