Course of internal medicine
The first course when the students start to work in clinic with real patients
Teaches the general rules of patient examination and legalization of medical documents, common for all medical specialties;
Forms the idea about ethics and deontology
Basic for many specialties
Necessity of acquiring general medical knowledge
•Common language
•Common understanding of the problem
•Common principles of clinical diagnosis formation
•Determination of prognosis
Main steps in the course of internal medicine
2-3 |
Propaedeutics of internal |
Classical signs and their |
course |
diseases |
academic interpretation |
4 course Therapy |
Typical nosological forms |
5-6 |
Госпитальная терапия Multiple clinical signs |
course |
(«doubt in diagnosis» |
«Department of the propaedeutics of internal diseases – is a very important stage in the development of a doctor that often influences the future»
Е.М. Тареев
Tasks of propaedeutics
•Teaching the principles of physical examination
•Learning the symptoms of the diseases – semiotics;
•Making the diagnosis on the base of examination;
•Learning the classical signs of internal diseases;
•Principles of treatment.
Methods of physical examination
Interview
From simple to complex Downwards
From outside to inside
Contribution of different methods to clinical judgement
•Interview – 70 %
•Physical examination– 20%
•Additional methods10%
«Always look at the patients, see the images of the diseases that can be voluntary or involuntary remembered and make the wealth of the doctor in the future»
Armand Trousseau
«By books and patients, by patients and books every student and every doctor can touch the heights of theory and practice»
Е.М. Tareev
«Studying the signs of the disease without books is like navigation without map,
Studying books without patients – is absence of any navigation».
William Osler
Матвей Яковлевич Мудров (1776-1831). Разработал и внедрил в практику метод систематического и всестороннего исследования больного, методическое ведение истории болезни
Григорий Антонович Захарьин (1829-1897), Внедрил оригинальный метод расспроса, метод анамнестического исследования больного
Василий Парменович Образцов (1851-1921). Внедрил оригинальный метод систематической глубокой скользящей пальпации органов брюшной полости, метод однопальцевой перкуссии, метод непосредственной аускультации ухом, описал клинику острого инфаркта миокарда.
Алексей Александрович Остроумов (1844-1908).. Обоснование необходимости всестороннего, развернутого и индивидуального клинического диагноза.
Николай Дмитриевич Стражеско (1876-1952). Обосновал принципы исследования органов пищеварения, теорию ревматизма, описал соотношение между кардиальной астмой и грудной жабой .