Universitat Internacional de Catalunya

Clinical Semiology and Physiopathogenia

Clinical Semiology and Physiopathogenia
11
12066
3
First semester
OB
Main language of instruction: Spanish

Teaching staff


Ms. HERRANZ PÉREZ, Javier César - jcherranz@uic.es

Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email with teachers

 

Dr. Xavier Herranz : jcherranz@uic.es my phone number is 645565560 please use whattsap 

 

Introduction

We would like to highlight the importance of this subject, a bridge between basic and medical subjects, which allows us to understand the mechanism of the disease (and therefore the possibility of helping the patient) as well as to recognize the signs and symptoms in order to establish an orientation diagnostic. (Pathophysiology and Semiology). The study of these subjects lasts throughout the undergraduate degree, but especially throughout the professional career. A doctor must recognize the signs of the disease, must understand the mechanisms that lead to the disease.

In patient care, the physician’s intent is to establish the diagnosis, plan for the patient’s possible evolution (prognosis) and to indicate the most appropriate regimen (treatment). This medical activity, known as clinical medicine, requires the development of clinical judgment, which allows us, by logical reasoning and assisted explorations, to contextualize the particular clinical situation of each patient.

The medical student, before going into detailed learning of the different pathologies that may affect the individual, must acquire a solid base of knowledge about the process of different diseases, studying their potential causes (etiology), the mechanisms by which they act harmfully (pathogeny), the alterations that occur in the structure and function of organs and systems (pathophysiology) and symptoms reported by the patient and signs identified during physical examination (semiology).

The Physiopathogeny and the Semiology establish all the scientific and practical knowledge necessary to recognize the developmental mechanisms of disease processes and provide the best medical care through the art of history taking and physical examination.

This course is the first student contact with patients and implies the acquisition of the knowledge, skills and attitudes necessary for learning medical pathology, to be developed more extensively in specific subjects.

"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all ". 

Sir William Osler, 1849-1919

Pre-course requirements

For the proper achievement of the competencies of this subject the student must have a basic knowledge of human structure and function to understand the various pathological conditions that occur in the body.

Objectives

The overall objective of this field is get to know, through a systematic overview of the patient, the disease, the presentation and the pathophysiological mechanisms of the diseases.

Specific objectives:

  1. To acquire a comprehensive and integrated vision of the mechanisms that alter the normal functioning of different organs and systems that constitute the human body.
  2. Understand the importance of clinical history with emphasis on semiology and propaedeutic.
  3. Identify and interpret the main clinical manifestations indicative of disease.
  4. Differentiate signs of normal and abnormal organ function in the study areas.
  5. Understand the principles of complementary tests used to study and differentiate the normal and pathological functioning and precise indications in medical pathology.

Competences/Learning outcomes of the degree programme

  • 06 - Develop professional practice with other health professionals, acquiring teamwork skills.
  • 09 - Understand and recognize the effects, mechanisms and manifestations of disease on the structure and function of the human body.
  • 10 - To understand and recognise the agents and risk factors which determine health status, and learn how they determine the symptoms and natural development of acute or chronic diseases in individuals and populations.
  • 14 - Perform a physical examination and a mental assessment.
  • 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
  • 21 - Listen carefully, obtain and synthesize relevant information about the problems affecting the patient and understand the contents of this information.
  • 22 - To write and maintain medical records and other medical documents which can be understood by third parties and are adapted to the protocols and information that is required.
  • 36 - Be able to formulate hypotheses, collect and critically evaluate information for problem solving using the scientific method.

Learning outcomes of the subject

After completing the course the student should be able to: 

  • Explain the role of Propaedeutic Clinic, semiotechnique and semiology as a fundamental clinic methodology to the search for signs and symptoms of the sick man and the establishment of diagnostic judgments.
  • Being able to perform a clinic history integrating the content and communication skills (process).
  • Know the contents of a history: Reason for consultation; History of actual illness; Patient's perspective on his illness; Personal medical history; Medication history and allergies; Family history; Personal history and socio-professional context; Functional and organ systems review.
  • Complete history in a targeted manner in the relevant aspects of each section.
  • Develop a clinic history of a case assigned recognizing the symptoms manifested by the patient.
  • Recognize and describe the importance of the physical examination in the diagnosis process.
  • Develop a physical examination of a case recognizing pathological signs.
  • Arguing the importance of history and examination data to assigned cases.
  • Understand and interpret the pathophysiological mechanisms that produce the most frequent clinical manifestations in clinical practice.
  • Lump together symptoms and signs that a patient expresses with the intention to recognize the clinical syndromes.
  • Interpreting the clustering of signs and symptoms in order to establish a diagnostic orientation.
  • Interpreting the clustering of signs and symptoms to perform a differential diagnosis.
  • Arguing the justification for additional diagnostic tests.
  • Interpret studies gases, complete blood count (CBC), biochemistry, urine and other biological fluids.
  • Interpret simple chest RX studies.
  • Describe and interpret basic lesions found on cranial CT or MRI.
  • Knowing the arterial puncture technique.
  • Knowing the indications, contraindications and technique of lumbar puncture.
  • Knowing the indications, contraindications and technique to perform a thoracentesis.
  • Knowing the indications, contraindications and technique to perform a paracentesis.

Syllabus

○    MC: Master Class                                             

○    CM: Case Method                                                                   

○    PBL: Problem Based Learning

○    LS: Laboratory Skills

-     OTS: Online Training Sessions

 The following will detail the contents included subjects in this stream:

 Item 1. Concept of etiology, pathophysiology, symptomatology and clinical propaedeutic. Health and disease. (MC)

  • Concept of General Pathology
  • Concept of etiology
  • Concept of pathophysiology
  • Concept of pathogenesis
  • The evolution of the disease. Patocronia
  • Concept and content of Semiology. Signs and symptoms
  • The Propaedeutic Clinic
  • Diagnosis: types
  • Forecast
  • The therapeutic act. Clinical trial
  • A brief reminder of health and disease


Item 2. The history and the doctor-patient relationship. General exploration of the patient. General principles. (MC)

  • The history. Technical (systems)
  • Elements of history
  • Type of history
  • Clinical Diagnosis

Item 3. Pathophysiology of thermoregulation. Febril syndrome. (MC)

§ General principles of thermoregulation

  • Heat Balance
  • Body temperature normal and recording methods
  • Concept of hypothermia, hyperthermia and fever
  • Etiology of fever
  • Pathophysiology of fever
  • Types of Fever
  • Other manifestations of febrile syndromes


Item 4. Pathophysiology of infection. (MC)

  • Natural and acquired immunity
  • Basic concepts of epidemiology
  • Major pathogens and virulence mechanisms
  • Basic concepts of antimicrobial therapy


Item 5. Pathophysiology of pain. (MC)

  • Pain as a symptom
  • Types of pain

- Primary pain (acute)
- Pain secondary (chronic)
- Sore skin
- Deep pain
- Visceral pain

  • Clinical characteristics of pain (location, quality, intensity)
  • Basic Nomenclature algology
  • Assessment of pain intensity


Item 6. Major signs and symptoms of respiratory tract. (MC)

  • Reason for consultation

- Dyspnea: Definition, Etiology, Clinical assessment
- Cough. Characteristics and types of cough
- Coughing. Clinical evaluation of sputum
- Hemoptysis: Etiology and clinical assessment
- Chest pain of respiratory origin: Etiology and common types
- Cyanosis and clubbing. Chest pain of respiratory origin


  • Directed anamnesis

- Personal History
- Habitat
- Work history, infectious and pharmacologic
- Hereditary Processes
- Toxic habits

Item 7. Physical examination of the respiratory apparatus 1 (LS)

Item 8. Imaging tests in respiratory disease (Rx thorax) (LS)

Item 9. Syndromes and diseases of the respiratory system. (MC)

  • Syndromes of acute and chronic obstruction. Pulmonary function tests and Respiratory failure.


Item 10. Syndromes and diseases of the respiratory system. (MC)

  • Atelectasis and pulmonary cavitation
  • Pulmonary hypertension syndromes
  • Restrictive lung disease
  • Pneumonic syndrome
  • Syndromes of the pulmonary interstitium
  • Pleural syndromes: pleural effusion, and pneumothorax fibrothorax
  • Mediastinal syndrome


Item 11. Thoracocentesis (LS)

Item 12. Syndromes Pleural: pleural effusion, pneumothorax and fibrotórax; Mediastinal syndrome (CM)

Item 13. Dyspnea and cough (CM)

Item 14. Major signs and symptoms of circulatory system. (MC)

  • Chest pain of cardiovascular origin: characteristics and causes
  • Palpitations: Definition and causes
  • Dyspnea: Definition, Causes and Types
  • Edema: Causes and Types
  • Syncope / fainting: definition and causes


Item 15. Syndromes and diseases of the circulatory system. (MC)

  • Heart failure

Item 16. Physical examination of the respiratory apparatus 2 (LS)

Item 17. Physical examination of the circulatory system; heart sounds and their alterations (LS)

Item 18. Arterial pulse. Venous pulse. Blood pressure. Venous pressure. (LS)

Item 19. Chest pain of cardiac origin (CM)

Item 20. Hypertension and Syndromes arterial and venous (MC)

  • Hypertension
  • Syndromes arterial and venous


Item 21. General semiology of the digestive system. (MC)

  • Major signs and symptoms of the digestive
  • Colic pain, peritoneal irritation, pain, gastrointestinal mucosa and other types of abdominal pain
  • Drooling, asialia, dysphagia
  • GERD. Pyrosis
  • Gastrointestinal bleeding

- Hematemesis
- Manes
- Causes of gastrointestinal bleeding

Item 22. Syndromes and diseases of the digestive system.  (MC)

  • Jaundice syndrome. Portal hypertension syndrome. Liver failure. Hepatic encephalopathy
  • Cirrhotic patient


Item 23. Syndromes and diseases of the digestive system.  (MC)

  • Esophageal syndrome. Vomiting
  • Disorders of gastric motility
  • Disorders of gastric secretion
  • Maldigestion and malabsorption syndromes. Diarrhea and constipation

Item 24. Sediment study (CM)

Item 25. Cirrhotic patient (CM)

Item 26. Esophageal syndrome. Vomiting. Dysphagia. (CM)

Item 27. Disorders of acid-base balance and hydric (CM)

Item 28. Physical examination of the digestive system. Exploration of the abdomen. ano-rectal examination (including genitourinary). (LS)

Item 29. Arrhythmias (LS)

Item 30. Semiology and general exploration of the urinary tract. (MC)

  • Major signs and symptoms

- Pain nephrourological. Characteristic patterns
- Disorders of micturition
- Alterations in appearance and composition of urine

  • Physical examination of the urinary

- Conditions and equipment
- Techniques and maneuvers of the physical exploration
- General semiological findings

Item 31. Syndromes and diseases of the urinary tract. (MC)

  • Nephrotic syndrome and nephritic
  • Tubulo-interstitial syndromes
  • Renal Failure

Item 32. Semiology of the musculoskeletal system. (MC)

  • Major signs and symptoms of musculoskeletal

- Osteoarticular pain. Type
- Joint stiffness

  • Joint swelling
  • Functional impotence

Item 33. General semiology of the nervous system. Major signs and symptoms. (MC)

  • Major signs and symptoms of nervous system.
  • Headache. Type
  • Motor Deficits
  • Sensory disorders

- Neuropathic pain
- Paresthesias

  • Dizziness
  • Visual Disorders
  • Dyskinesias
  • Loss of intellectual faculties
  • Speech Disorders

- Aphasia
- Dysarthria

Item 34. Syndromes and diseases of the nervous system. (MC)

  • Pyramidal syndrome, and extrapyramidal motor unit and its disorders.
  • Hypokinesia syndromes. Hyperkinesias. Disorders of muscle tone

Item 35. Paracentesis. Technique and interpretation (LS)

Item 36. Syndromes and diseases of the nervous system. (MC)

  • Medullary and periphereals syndromes.

Item 37. Sº meningeal (CM)

Item 38. Syndromes and diseases of the nervous system. (MC)

  • Brainstem syndromes, vestibular and cerebellar dysfunction syndromes.

Item 39. Exploration locomotor and nervous system (LS)

Item 40. Syndromes and diseases of the nervous system. (MC)

  • Topographic brain syndromes

- Frontal syndrome
- Parietal syndrome
- Temporary Syndrome
- Syndrome occipital

  • Meningueos Syndromes
  • Dementia syndromes

 Item 41. Semiology and general exploration of the hematic system. (MC)

  • Reason for inquiry: cutaneous-mucosal pallor, bleeding, and lymphadenopathy
  • Physical examination: diagnostic value of the findings in skin and mucous membranes, head, neck nodal areas, thorax, abdomen and extremities
  • Investigations

Item 42. Syncope, seizures and sedoanalgesia (CM)

Item 43. Lumbar puncture. Technique and interpretation (LS)

Item 44. Muscular weakness (CM)

Item 45. Syndromes and hematic system diseases. (MC)

  • Anemic syndromes
  • Poliglobulycs Syndromes

Item 46. Syndromes and hematic system diseases. (MC)

  • Leucocitocycs and leukopenic syndromes
  • Adenopathic syndrome and syndromes esplenomegalycs
  • Hemorrhagic diathesis syndromes

Item 47. Gasometry. Technique and interpretation (LS)

Item 48. Semiology and general exploration of the endocrine system and metabolism. (MC)

  • Reason for inquiry: loss and weight gain, abnormal skin color, polyphagia, polydipsia, polyuria, fatigue and debility
  • Physical examination of the endocrine system
  • Investigations of endocrine function

Item 49. Anemia and adenopathic (CM)

Item 50. Neurology Image (LS)

Item 51. Syndromes and diseases of the endocrine system and metabolism. (MC)

  • Hypothalamic-pituitary-adrenal

Item 52. Syndromes and diseases of the endocrine system and metabolism. (MC)

  • Disorders of the thyroid and parathyroid

Item 53. Syndromes and diseases of the endocrine system and metabolism. (MC)

  • Disorders of carbohydrate metabolism. Hypoglycaemia. Hyperglycemia. Diabetes. Syndromes of lipid metabolism. Hypo-and hyperlipoproteinemia
  • Disorders of water balance and acid-baseeight disorders and asthenia
  • Constitutional syndrome

Item 54. Weight changes and asthenia. Sº constitutional (CM)

Item 55. Evaluation of specific patients: the geriatric patient. (MC)

  • Influence of aging on the patient. Organic and functional changes
  • The disease in the elderly
  • Comprehensive geriatric assessment
  • Major geriatric syndromes

- Cognitive Disorders
- Incontinence
- Immobility
- Pressure Sores
- Instability and falls
- Malnutrition
- Depression, confusion and insomnia

Item 56. ABP-1

Item 57. ABP-2

Item 58. ABP-3

Item 59. ABP-4

Item 60. Interdisciplinary (LS)

 

Teaching and learning activities

In person



The master class is the stage in which a teacher transmits knowledge to a whole group of students in a classroom. It will be on line with differents activities. 

If the situation allows it, we will do face-to-face classes again.

The case method is the process of solving clinical or own profession cases. They are group activities that are solved with the active participation of the professor after the deliberation of the students. Usually presential but it s possible there are blended activities.

Problem based learning has similarities to the case method but differs in that students are responsible to find a solution to the problem. The teacher acts as a tutor facilitating the learning process through his metacognitive abilities. It is also done in groups. PBL will be on line activities.

The laboratory skills is done with groups of 20 or 40 students according to the practice and it consists in the practical observation of different cases that has been sent to the student /student groups before. They discuss all together to find set of findings that arise each one of the students in relation to the proposed cases.

The online training sessions is an activity that will be done to reinforce concepts in both basic electrocardiography and pericardial pathology.

There will be 30 Master Classes, 12 Case Methods and 4 activities of Problem Based Learning. This academic course 2017/2018 incorporates the online training sessions (SFO



In the laboratory skills environement a total of 13 workshops will be performed (two hours each):

  1. Physical examination of the respiratory apparatus 1
  2. Imaging tests in respiratory disease (Rx thorax)
  3. Thoracocentesis
  4. Physical examination of the respiratory apparatus 2
  5. Physical examination of the circulatory system; heart sounds and their alterations
  6. Arterial pulse. Venous pulse. Blood pressure. Venous pressure.
  7. Physical examination of the digestive system. Exploration of the abdomen. ano-rectal examination (including genitourinary).
  8. Arrhythmias
  9. Paracentesis. Technique and interpretation
  10. Exploration locomotor and nervous system
  11. Lumbar puncture. Technique and interpretation
  12. Gasometry. Technique and interpretation
  13. Neurology Image

 

Evaluation systems and criteria

In person



Assessment is the system by which we will try to measure the degree of acquisition of the subject's competences. For this we will use different evaluation tools; questions type test, ECOE type examination and evaluation of ABPs. Not only the contents developed in the classes will be evaluated but the learning objectives of the subject. The skills of the skills laboratories will be assessed using the ECOE format but the knowledge contents of the skills laboratories can be assessed in the exams, for example.
This course, the evaluation system will be subject to the modifications that the global situation allows, especially in the ECOE exam.
The test exams can be done either in person or via online with online surveillance systems depending on the situation, for example.

1. Test type examination

a) Partial: Test type. Type A questions Failures discount 1/3 of the question value (MIR Type). Represents 10% of the final grade. This note will count for the final exam of the first and second summons (same academic year).

b) End: Test type. Type A questionsFailures discount 1/3 of the question value (MIR Type). It represents 55% of the final grade. In the event that a student appears for two calls, the final grade will be calculated with the grade obtained in the second test.

Type B questions (they would be identified in the exam) can be asked a number of questions considered basic in order for teachers to require to be passed in a ratio of 6/10 in order to average the exam

2. Practical exam (ECOE), in which the student must demonstrate the skills acquired in the clinical simulation laboratory. Attendance at all laboratory practices is essential to be evaluated. Represents 20% of the final grade. In the event that the student has passed the ECOE but not the subject, the note will be saved for future calls. In principle, it is a face-to-face exam, but if it cannot be done, it can be replaced by an online exam.
3. Problem Based Learning (ABP): Represents 15% of the final grade. This note will count for the final exam of the first and second summons (same academic year).
FINAL SCORE
Weighted sum of the Partial (10%), Final Test (55%), ECOE (20%) and ABP (15%)
It is necessary to pass the final exam (Test) and the practical one, separately, with a grade = or> 5, in order to pass the course. The% will not be applied if both parts are not exceeded separately.
In the case of having obtained a final grade equal to or greater than 5, the student will be able to choose to raise their grade up to one more point, the teaching team will value, among other things: tasks or evidence collected from the individual work carried out by the student prior to the development of MC, LH, etc., as well as carrying out the activities proposed online. In no case will it serve to pass the course.
Second and subsequent students will not be eligible for honors.

 

Bibliography and resources

  • Argente-Álvarez. SEMIOLOGÍA MÉDICA: FISIOPATOLOGÍA, SEMIOTECNIA Y PROPEDÉUTICA. 2ª Edición. Panamericana, 2013. ISBN: 978-950-06-0600-4
  • Rozman y Cardellach F. Farreras: MEDICINA INTERNA. 17º edición. Elsevier, SL. 2012. ISBN 978-84-8086-896-9
  • Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, and Loscalzo, Eds. HARRISON PRINCIPIOS DE MEDICINA INTERNA. 18a edición. McGraw Hill, 2012. ISBN: 9789701067888
  • Goldman and Schafer Ed. Cecil y Goldman. TRATADO DE MEDICINA INTERNA. 24a edición. Elsevier, 2013. ISBN 978-8480869713
  • Garcia-Conde. PATOLOGIA GENERAL: SEMIOLOGIA CLINICA Y FISIOPATOLOGÍA. McGraw Hill, 2003. ISBN: 9788448605506
  • Laso Guzmán. DIAGNOSTICO DIFERENCIAL EN MEDICINA INTERNA. Harcourt S.A., 2005. ISBN: 8481742554
  • Swartz. TRATADO DE SEMIOLOGÍA. Eds Elsevier Saunders, 2010. Sexta Edición. ISBN 978-1-4160-6203-5
  • Steven S. Agabegi y Elizabeth D. Agabegi. INTRODUCCIÓN A LA MEDICINA CLÍNICA. 3ª edición. Wolters Kluwer/Lippincott Williams & Wilkins, 2013. ISBN 978-84-15684-00-8
  • Gutiérrez Isauro. LA FISIOPATOLOGÍA COMO BASE FUNDAMENTAL DEL DIAGNÓSTICO CLÍNICO. Panamericana,  2012. ISBN 978-607-7743-25-5
  • Noguer-Balcells. EXPLORACIÓN CLÍNICA PRÁCTICA. 28ª edición. Elsevier, 2016. ISBN 978-84-458-2641-6

Evaluation period

E: exam date | R: revision date | 1: first session | 2: second session:
  • E1 08/01/2025 I2 14:00h
  • E1 08/01/2025 I1 14:00h
  • E1 08/01/2025 I3 14:00h
  • R1 27/01/2025 A03 14:30h
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