An Insider's Guide to Clinical Medicine
An Insider's Guide to Clinical Medicine
As per the Competency Based Medical Education Curriculum (NMC)
Second Edition
Archith Boloor MBBS MD (Internal Medicine)
Additional Professor Department of Medicine Kasturba Medical College, Mangalore Manipal Academy of Higher Education Karnataka, India archithb@gmail.com
Anudeep Padakanti MBBS MD (Internal Medicine)
Senior Resident Department of Medical Oncology MNJ Institute of Oncology and Regional Cancer Centre Hyderabad, Telangana, India anudeeppadakanti.aigcm@gmail.com
Foreword
Chakrapani M
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An Insider's Guide to Clinical Medicine
First Edition: 2020
Second Edition: 2022
9789354654459
Printed at India
All the young budding doctors who shall be the future caretakers of our society
- Sheetal Raj M
- Associate Professor
- Department of Internal Medicine and
- Program Director, Geriatric Medicine Fellowship
- Kasturba Medical College, Mangalore
- Manipal Academy of Higher Education
- Karnataka, India
- Athulya G Asokan
- Associate Professor
- Department of Internal Medicine
- Pusphpagiri Medical College and
- Research Centre
- Thiruvalla, Kerala, India
- Sriraksha R Nayak
- Consultant Psychiatrist
- District Mental Health Programme
- Uttara Kannada, Karnataka, India
- Abu Thajudeen
- Department of Internal Medicine
- Kasturba Medical College, Mangalore
- Manipal Academy of Higher Education
- Karnataka, India
- Mohammed Shaheen
- Department of Internal Medicine
- Kasturba Medical College, Mangalore
- Manipal Academy of Higher Education
- Karnataka, India
- Ashwini MV
- Senior Resident
- Department of Internal Medicine
- Kasturba Medical College, Mangalore
- Manipal Academy of Higher Education
- Karnataka, India
- Mohammad Azizur Rahman
- Professor
- Department of Respiratory Medicine and Medicine
- Under Faculty of Medicine
- Dhaka University
- Dhaka, Bangladesh
- Nikhil Kenny Thomas
- Senior Resident
- Department of Gastroenterology
- PSG Institute of Medical Sciences and Research
- Coimbatore, Tamil Nadu, India
- Vivek K Koushik
- Senior Resident
- Department of Nephrology
- Apollo Hospital
- Chennai, Tamil Nadu, India
- Madhav H Hande
- Senior Resident
- Department of Nephrology
- Manipal Hospital
- Bengaluru, Karnataka, India
- GG Akshay Prabhu
- Resident
- Department of Internal Medicine
- Kasturba Medical College, Mangalore
- Manipal Academy of Higher Education
- Karnataka, India
- Pradeep Krishna Chowdary
- Senior Resident
- Department of Cardiology
- Government Medical College
- Kozhikode, Kerala, India
- Mohamed Faizan Thouseef
- Resident
- Department of Internal Medicine
- JN Medical College
- KLE Academy of Higher Education and Research
- Belagavi, Karnataka, India
- Manju Rose Sebastian
- Senior Resident
- Department of Internal Medicine
- Kasturba Medical College, Mangalore
- Manipal Academy of Higher Education
- Karnataka, India
- Vaddi Rohith
- Consultant Psychiatrist
- Srinivasa Neuro Mind Care
- Visakhapatnam, Andhra Pradesh, India
Medicine is a science and an art. Clinical examination is fast becoming a forgotten art in the face of technological onslaught. This book is an important step in bringing the students back to the basics of clinical medicine. This book will be valuable for examination preparations. It is a comprehensive compilation of clinical signs for students of internal medicine—both undergraduates and postgraduates. Illustrations are self-explanatory and help in understanding difficult concepts.
Dr Archith has been actively and extensively involved in the clinical teaching of undergraduate and postgraduate students for many years. He has been a popular teacher among medical students and has received “best teacher award” many times at Kasturba Medical College, Mangalore, Karnataka, India. He has understood the limitations of the present clinical examination books and also identified the knowledge gap that needs to be cleared for undergraduate and postgraduate students. His student Dr Anudeep, an enthusiastic learner and teacher has initiated the process of compiling this wonderful book.
Many common concepts which are very pertinent and relevant for university clinical examinations are discussed in detail in this book. Coverage of the topics are comprehensive, contemporary, and clear.
The authors have done extensive research while compiling the details in the book and has presented it in a very convenient to understand format by giving the details of many of these concepts in the form of tables and bullet notes. This will help the student in remembering the important points. They have explained the basic concepts, and this will help the student in understanding and then performing the clinical examinations.
Information compiled in the book is evidence-based and experience enhanced by an eminent teacher. They have taken the feedback from all the stakeholders including teachers and students before finalizing the final version of this book. This book can be strongly recommended for students, teachers and practising physicians.
Chakrapani M md
Professor
Department of Medicine
Formerly, Head and Associate Dean
Kasturba Medical College, Mangalore
Manipal Academy of Higher Education
Karnataka, India
Preface to the Second Edition
The beauty of life is in its infinite tendency to give you time. To learn, to heal and to get better: in whatever capacity that may be. As students of medicine, we are very often pressured to get things right on the first try. To be perfect and to not leave any stone unturned; yes, we agree that the stakes are a lot different for us than it is for a chef or an actor. But understand that as 20-somethings learning medicine in an environment that is very service-centric, you are not helping anyone by adding an extra layer of troubles to your existing mountain of troubles. Give yourself some breathing space, take it easy and relish that second chance.
The more mistakes you make, the more chances you get to correct them. Every senior doctor that you have met will have innumerable stories of how they have made fools of themselves in medical school. We too have several anecdotes of our own, with which we could regale our students to several hours of mirth. But let's digress. What we really want to shine light on is the importance of chances and taking them when they are thrown at you. With the pandemic having pushed admissions and examinations and opportunities by several years, it is important for you students to reflect on the progress you have made in your journey as a doctor and it is imperative that you accept second chances, with open arms. It is even more important to accept with open, lab-coat laden arms, these second chances.
We have received a second chance with this book. The crux of this book largely remains the same, along with some finer adjustments. Font sizes, color and page breaks have been adjusted to make reading easier. We have added a more detailed section on history-taking with some much-needed adjustments, especially with respect to patients that are different from the masses. The highlights from the previous book, the positive points which most of you gave very good feedback about have been left as it is—complete case sheets on all organ systems, with added emphasis on the common examination cases. A plethora of pictures make the visual experience of this book what it is, it also gave many of my interns a very interesting past time activity to run around the wards with a camera and a consent form. While we worked on the different case sheets, both short and spot cases, we have included model cases and classical presentations to help you to arrive at a diagnosis earlier than most. X-rays, Spotters, Common Drugs, and Instruments take up their own spot in this book, deservedly so.
As students of medicine, you may very often find yourself, lost in a maze of facts and clinical experiences. This book is designed to help you to best navigate the maze, that is the world of medicine, while keeping an astute eye on the requirements for passing your clinical examination. We hope you enjoy reading and comprehending the finer concepts and learn to love this book as much as we enjoyed bringing to you this second edition. We welcome your suggestions, criticisms and feedback, wholeheartedly and look forward to enriching your learning in the times to come.
Archith Boloor
Anudeep Padakant
Preface to the First Edition
The clock had struck a solid 1:30 PM. The examiner was hungry, the last student was jittery and in between them lay a central nervous system (CNS) case that was going to determine whether a four-and-half-year ripe child of medicine would be prefixed with a “Dr” or not.
The examiner was more bored than he could care to admit. Lakshman, aged 32, hailing from Shivamogga, Karnataka with chief complaints of bilateral lower limb weakness was being presented for the 14th time that day. The same boring questions had been asked in the same uninspired fashion.
“List the causes of neck pain”, the examiner asked.
A little taken aback but the student realized that the question was within the realm of a CNS case. After gathering his thoughts for a moment, he began listing out, “Meningitis causing neck muscle spasm, cervical spondylosis, cervical spondylolisthesis…” his voice trailing off in response to the examiner's unimpressed face.
”Go ahead, what else?”
Not to lose face in front of the examiner, the student once again reset his thoughts, and a few umms and ahhs later continues:
”Sir, other cervical causes like cervical intraepithelial neoplasia, cervical cancer, etc. can also cause neck pain”.
Jokes apart, getting psyched for an examination is an absolutely normal and foreseeable predicament. We often notice the most brilliant students fumbling to show off years’ worth of hard work simply because the psyche overpowers their preparation. As the saying goes “For most diagnoses, all that is needed is an ounce of knowledge, an ounce of intelligence, and a pound of thoroughness.” With that very thought in mind, it is our pleasure to present to you a simple, comprehensive and exam-oriented clinical manual—a compass to guide you through the art of clinical medicine.
The practical examinations pose a real challenge to the medical student—he has to finish writing an entire case sheet, elicit the expected clinical findings and finally arrive at a proper diagnosis. All this to be done before the examiner has even made eye-contact with the student. The catch here being the limited availability of what we all take for granted—time. One asks the wrong questions, examines the wrong systems, latches on to the wrong points and before we realize, we are knee-deep in heaps of unorganized information that has no head or tail. Having been in the same shoes at some point in the past, this book was made to solve those problems: complete case sheets on all organ systems, with added emphasis on the common examination cases have been incorporated. We hope it will teach the reader to anticipate questions that are asked in different contexts. The book is as visually charged as we could possibly make it because we believe that seeing is learning. We have dealt with spot and short cases which are meant to test a student's take on the bigger picture of diseases. The diagnostic clues given in this book will help the student to arrive at a definitive decision sooner. X-rays, spotters and instruments are dealt with extensively and in exquisite detail.
We have read several clinical books in an attempt to make this one different. In doing so, we have found that this is one single guide which can be safely relied upon to deal with the practicals of Final MBBS Part II. We hope that the fruit of our labor becomes as close to your bookshelf as it is to our hearts. Any suggestions and/or constructive criticism is always welcome, and we hope you enjoy reading An Insider's Guide to Clinical Medicine.
Archith Boloor
Anudeep Padakanti
Remembering the Father of Modern Medicine
Medicine is a science of uncertainty and an art of probability.
The best preparation for tomorrow is to do today's work superbly well.
Every patient you see is a lesson in much more than the malady from which he suffers. Listen to your patient. He is telling you the diagnosis.
He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.
The good physician treats the disease; the great physician treats the patient who has the disease.
We are here to add what we can to life. Not to get what we can from life. Too many men slip early out of the habit of studious reading and yet that is essential.
One of the duties of the physician is to educate the masses not to take medicine.
The practice of medicine is an art. Not a trade; a calling. Not a business: A calling in which your heart will be exercised equally with your head.
Happiness lies in the absorption in some vocation which satisfies the soul. To have striven. To have made the effort. To have been true to certain ideals------ this alone is worth the struggle.
Acquire the art of detachment, the virtue of method and the quality of thoroughness but above all the grace of humility.
Sir William Osler
(July 12, 1849 – December 29, 1919)
Acknowledgments to the Second Edition
With immense gratitude we place on record our heartfelt thanks for the appreciation our book An Insider's Guide to Clinical Medicine has received from students and teachers all over India. With inputs and feedback from all we set to compile the second edition. The task was not easy. Working as frontline healthcare workers, along with our peers we managed to find time to compile this edition, the experience of which has been infinitely memorable.
Firstly, we would like to thank our families—the unwavering pillars of strength that have supported us throughout every challenge in our life. Our friends, colleagues, and well-wishers who have always supported our work were not an exception this time too. Lastly, we want to thank all my students, each and every one, because without their unrelenting urge to learn, we would not have the drive to compile our teachings in the form of a book.
We are thankful to all our friends whose contributions and knowledge flowed seamlessly at a very short notice. We thank Dr Sheetal Raj M, Dr Mohammed Shaheen, Dr Sriraksha R Nayak, Dr Madhav H Hande, Dr Pradeep Krishna Chowdary, Dr Ashwini MV, Dr Athulya G Asokan, Dr Manju Rose Sebastian, Dr GG Akshay Prabhu, and Professor Dr Mohammad Azizur Rahman, for their contributions.
We are thankful to Dr Nikhil Kenny Thomas, Dr Abu Thajudeen, Dr Vivek K Koushik, Dr Mohamed Faizan Thouseef, and Dr Vaddi Rohit, for their encouragement, their contributions, and motivation they give us every day.
We convey our sincere thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit (Managing Director), and Mr MS Mani (Group President) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for having been the guiding force behind all our works.
We also thank Dr Madhu Choudhary (Publishing Head–Education), Ms Pooja Bhandari (Production Head), Ms Sunita Katla (Executive Assistant to Group Chairman and Publishing Manager), Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Visualizer), Mr Laxmidhar Padhiary (Proofreader), Mr Deep Kumar Dogra (Typesetter), and Mr Nitin Bhardwaj (Graphic Designer) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their help in the formatting and their well-received technical assistance and unwavering support during the process of developing this project.
A very special gratitude goes out to all our teachers, who are solely responsible for what we are today and for having ignited the passion of teaching and writing in us.
Lastly, we thank God Almighty, for what was, what is, and what will be.
Archith Boloor
Anudeep Padakanti
Acknowledgments to the First Edition
It was our long-standing dream to write a clinical book that would encompass all the relevant matter needed for a student with due emphasis on clinical methods. Incorporating many years of clinical teaching and an astute understanding of the actual needs of a medical student, this book has been compiled to cater to their unmet needs. It has been a Herculean task of reading, writing, rewriting and editing this vast amount of information into this concise textbook.
When we began this work, almost a year ago, little did we anticipate the shape our ideas would finally take in the form of this An Insider's Guide to Clinical Medicine. This endeavor of ours would have been impossible without the constant support and encouragement of our well-wishers.
Firstly, we thank all our students—undergraduates, postgraduates for having kindled in us this idea, for compiling our notes and most importantly, for asking the questions whose answers have taken the form of this book.
This book would not have seen the light of day without the constant persuasion of Dr Vivek Koushik, Dr Abu Thajudeen and Dr Nikhil Kenny Thomas. They are and will continue to be the pillars of strength on whom our life and this book would gain sustenance… Thank you.
We profusely thank Dr Chakrapani M, for writing the foreword for this edition. Sir is the embodiment of a true teacher of clinical medicine and we thank him for his constant support and inputs during this process.
We thank Dr Sheetal Raj for the chapter on Comprehensive Geriatric Assessment. We thank Dr Sriraksha Nayak and Dr Vaddi Rohit, for compiling the chapter Approach to Psychiatric Illness.
We thank Dr Kaushiki Kirty, Dr Vishnu B Chandran, Dr Rama Kishore Yalampati and Dr Navyashree HC, for helping us with inputs and proofreading.
Also, we convey our sincere thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Dr Madhu Choudhary (Publishing Head–Education), Ms Pooja Bhandari (Production Head), Ms Sunita Katla (Executive Assistant to Group Chairman and Publishing Manager), Dr Aakanksha Shukla Sirohi (Development Editor), Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Visualizer), Mr Laxmidhar Padhiary (Proofreader), Mr Kapil Dev Sharma (Typesetter), Mr Manoj Pahuja (Graphic Designer) and their team members, for publishing the book in the same format as wanted, well in time.
Special thanks to Dr Ashwini MV, Dr G Suresh Reddy, Dr Lakshmi Nivedana B Dr Sriram M, Dr Pranjal Sharma, Dr Tejaswini Lakshmikeshava, Dr Nagendra C, Dr Thejus Bhaskar, Dr Mohammed Shaheen, Dr Jane Mendonca and Dr Madhav Hande, for helping us with the clinical images, editing, proofreading and designing of this book. They have lived our dream with us.
We are especially grateful for the ongoing encouragement from the management and administration of our university, the Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
We are grateful to our family members, colleagues and friends who have supported us all along the way.
A very special gratitude goes out to all our teachers, who are solely responsible for what we are today and for having ignited the passion of teaching in us.
Lastly, we thank God Almighty, for making us what we are, guiding us through our life, and helping us in bringing this book to you all.
Archith Boloor
Anudeep Padakanti
Abbreviations
°C:
Degree Celsius
°F:
Degree Fahrenheit
ABPA:
Allergic bronchopulmonary aspergillosis
ACA:
Anterior cerebral artery
ACD:
Anemia of chronic disease
ACE:
Addenbrooke's cognitive examination
ACEI:
Angiotensin converting enzyme inhibitor
ACPA:
Anticitrullinated protein antibody
ACR:
American College of Rheumatology
ACS:
Acute coronary syndrome
ACTH:
Adrenocorticotropic hormone
ADC:
Apparent diffusion coefficient
ADHD:
Attention deficit hyperactivity disorder
ADHF:
Acute decompensated heart failure
ADL:
Activities of daily living
ADR:
Adverse drug reaction
AEM:
Ambulatory electrocardiogram monitoring
AF:
Atrial fibrillation
AGN:
Acute glomerulonephritis
AI:
Aortic insufficiency
AICA:
Anterior inferior cerebellar artery
AICD:
Automated implantable cardioverter defibrillator
AIDP:
Acute inflammatory demyelinating polyneuropathy
AION:
Anterior ischemic optic neuritis
AKI:
Acute kidney injury
ALL:
Acute lymphoblastic leukemia
ALL:
Acute lymphoblastic leukemia
ALS:
Amyotrophic lateral sclerosis
AML:
Acute myeloid leukemia
ANS:
Autonomic nervous system
AP:
Anteroposterior
APB:
Atrial premature beat
APLA:
Antiphospholipid antibody syndrome
ARB:
Angiotensin receptor blocker
ARDS:
Acute respiratory distress syndrome
ARF:
Acute renal failure
ARVD:
Arrhythmogenic right ventricular dysplasia
ASCVD:
Atherosclerotic cardiovascular disease
ASD:
Atrial septal defect
AVF:
Arteriovenous fistula
AVM:
Arteriovenous malformation
AVNRT:
AV nodal re-entrant tachycardia
AVR:
Aortic valve replacement
AVRT:
Atrioventricular re-entrant tachycardia
B/L:
Bilateral
BADL:
Basic activities of daily living
BAL:
Bronchoalveolar concentration
B-ALL:
B-cell acute lymphoblastic leukemia
BAV:
Bicuspid aortic valve
BBB:
Bundle branch block
BC:
Bone conduction/blood culture
BCAT:
Brief cognitive assessment tool
BER:
Benign early repolarization
BIH:
Benign intracranial hypertension
BLS:
Basic life support
BM:
Bone marrow
BMI:
Body mass index
BMV:
Bag and mask ventilation/balloon mitral valvotomy
BP:
Blood pressure
BSA:
Body surface area
BT:
Bleeding time
BUN:
Blood urea nitrogen
BVP:
Biventricular pacing
Bx:
Biopsy
C/L:
Contralateral
C/O:
Complaints of
CABG:
Coronary artery bypass graft
CAD:
Coronary artery disease
CAMCOG:
Cambridge cognitive examination
CAUTI:
Catheter-associated UTI
CBC:
Complete blood count
CBD:
Common bile duct
CBE:
Clinical breast examination
CCA:
Common carotid artery
CCCU:
Critical coronary care unit
CCF:
Congestive cardiac failure
CCS:
Canadian Cardiovascular Society
CDAI:
Clinical disease activity index
CDC:
Centers for disease control and prevention
CGA:
Comprehensive geriatric assessment
CHB:
Complete heart block
CHF:
Congestive heart failure
CIDP:
Chronic inflammatory demyelinating polyneuropathy
CKD:
Chronic kidney disease
CLD:
Chronic liver disease
CLL:
Chronic lymphoid leukemia
CML:
Chronic myeloid leukemia
CMT:
Charcot–Marie–Tooth disease
CMV:
Cytomegalovirus
CN:
Cranial nerve
CNS:
Central nervous system
CNS:
Central nervous system
COPD:
Chronic obstructive pulmonary disease
COST:
Cognitive state test
CP angle:
Cerebellopontine angle
CPB:
Cardiopulmonary bypass
CPR:
Cardiopulmonary resuscitation
CRF:
Chronic renal failure
CRP:
C-reactive protein
CSF:
Cerebrospinal fluid
CT:
Computed tomography
CVA:
Cerebrovascular accident
CVP:
Central venous pressure
CVS:
Cardiovascular system
CXR:
Chest X-ray
DAS:
Disease activity score
DDx or D/D:
Differential diagnosis
DIC:
Disseminated intravascular coagulation
DIP joint:
Distal interphalangeal joint
DKA:
Diabetic ketoacidosis
DLCO:
Diffusion lung capacity for carbon monoxide
DLE:
Disseminated lupus erythematosus
DM:
Diabetes mellitus
DNR:
Do not resuscitate
DPI:
Dry powder inhaler
DR:
Diabetic retinopathy
DSM:
Diagnostic and statistical manual of mental disorders
DTA:
Descending thoracic aorta
DTR:
Deep tendon reflex
DVT:
Deep venous thrombosis
DWI:
Diffusion weighted imaging
EAT:
Ectopic atrial tachycardia
ECA:
External carotid artery
ECD:
Endocardial cushion defects
ECF:
Extracellular fluid
ECG:
Electrocardiogram
ECHO:
Echocardiogram
ECMO:
Extracorporeal membrane oxygenation
EDH:
Extradural hematoma
EDM:
Early diastolic murmur
EF:
Ejection fraction
EM:
Erythema multiforme
EOM:
Extraocular muscles/movement
EPO:
Erythropoietin
EPS:
Extrapyramidal system
ESM:
Ejection systolic murmur
ESRD:
End-stage renal disease
ESV:
End-systolic volume
ET:
Endotracheal tube
EULAR:
European League Against Rheumatism
FBS:
Fasting blood sugar
FEV1:
Forced expiratory volume in first second
FMS:
Fibromyalgia syndrome
FTT:
Failure to thrive
FVC:
Forced vital capacity
GBS:
Guillain–Barré syndrome
GCS:
Glasgow Coma Scale
GERD:
Gastroesophageal reflux disease
GH:
Growth hormone
GI:
Gastrointestinal
HAI:
Hospital-acquired infection
Hb:
Hemoglobin
HBV:
Hepatitis B virus
HCC:
Hepatocellular carcinoma
HD:
Huntington's disease
HDL:
C-High density lipoprotein cholesterol
HDS:
Hemodynamically stable
HE:
Hepatic encephalopathy
HIT:
Heparin-induced thrombocytopenia
HIV/AIDS:
Human immunodeficiency virus/acquired immunodeficiency syndrome
HL:
Hodgkin lymphoma
HMF:
Higher mental functions
HOCM:
Hypertrophic obstructive cardiomyopathy
HTN:
Hypertension
HUS:
Hemolytic uremic syndrome
IADL:
Instrumental activities of daily living
IBD:
Inflammatory bowel disease
IBS:
Irritable bowel syndrome
ICA:
Internal carotid artery
ICD:
Intercostal drain
ICH:
Intracerebral hemorrhage
ICP:
Intracranial pressure
ICS:
Intercostal space/inhaled corticosteroid
ICSOL:
Intracranial space-occupying lesion
IDDM:
Insulin-dependent diabetes mellitus— Type 1 diabetes
IGF:
Insulin-like growth factor-1
IHD:
Ischemic heart disease
IJV:
Internal jugular vein
ILD:
Interstitial lung disease
IMN:
Infectious mononucleosis
INH:
Isoniazid
INO:
Internuclear ophthalmoplegia
INR:
International Normalized Ratio
IP joint:
Interphalangeal joint
IPPV:
Intermittent positive pressure ventilation
ITP:
Immune thrombocytopenic purpura
IV:
Intravenous
IVC:
Inferior vena cava
IVH:
Intraventricular hemorrhage
JME:
Juvenile myoclonic epilepsy
JRA:
Juvenile rheumatoid arthritis
JVP:
Jugular venous pressure
KDIGO:
Kidney disease improving global outcomes
KF Ring:
Kayser–Fleischer ring
KUB:
Kidney, ureters, and bladder
L/A:
Local anesthetic
LDL:
C-Low density lipoprotein cholesterol
LGIB:
Upper gastrointestinal bleed
LMN:
Lower motor neuron
LOC:
Loss of consciousness
LP:
Lumbar puncture
LQTS:
Long QT syndrome
LSM:
Late systolic murmur
LV:
Left ventricle
LVE:
Left ventricular enlargement
LVF:
Left ventricular failure
LVH:
Left ventricular hypertrophy
MAP:
Mean arterial pressure
MAT:
Multifocal atrial tachycardia
MCA:
Middle cerebral artery
MCP joint:
Metacarpophalangeal joint
MCTD:
Mixed connective tissue disease
MCTD:
Mixed connective tissue disease
MDI:
Metered dose inhaler
MDM:
Mid-diastolic murmur
MDS:
Myelodysplastic syndrome
MI:
Myocardial infarction
MLF:
Medial longitudinal fasciculus
mMRC:
Modified Medical Research Council
MMSE:
Mini-mental state examination
MND:
Motor neuron disease
MoCA:
Montreal cognitive assessment
MODS:
Multiorgan dysfunction syndrome
MRC:
Medical Research Council
MRI:
Magnetic resonance imaging
MS:
Mitral stenosis/multiple sclerosis
MSA-C:
Multisystem atrophy—cerebellar
MSA-P:
Multisystem atrophy—Parkinson's
MVP:
Mitral valve prolapse
MVR:
Mitral valve replacement
NASH:
Non-alcoholic steatohepatitis
NCV:
Nerve conduction velocity
NG Tube:
Nasogastric tube
NHL:
Non-Hodgkin lymphoma
NMJ:
Neuromuscular junction
NPH:
Normal pressure hydrocephalus
NPPV:
Noninvasive positive pressure ventilation
NREM:
Non-rapid eye movement
NSAIDs:
Nonsteroidal anti-inflammatory drugs
NST:
Non-stress test
NSTEMI:
Non-ST-elevation myocardial infarction
NTS:
Nucleus tractus solitarius
NYHA:
New York Heart Association
O/E:
On examination
OA:
Osteoarthritis
OP:
Organophosphorus
OSA:
Obstructive sleep apnea
PA:
Posteroanterior
paCO2:
Partial pressure of carbon dioxide
PAH:
Pulmonary artery hypertension
PAH:
Pulmonary artery hypertension
PAN:
Polyarteritis nodosa
PCA:
Posterior cerebral artery
PCI:
Percutaneous coronary intervention
PCV:
Packed cell volume
PCWP:
Pulmonary capillary wedge pressure
PD:
Parkinson's disease
PDA:
Patent ductus arteriosus
PE:
Pulmonary embolism
PEEP:
Positive end expiratory pressure
PEFR:
Peak expiratory flow rate
PICA:
Posterior inferior cerebellar artery
PIP Joint:
Proximal interphalangeal joint
PLS:
Progressive lateral sclerosis
PMI:
Point of maximal impulse
PND:
Paroxysmal nocturnal dyspnea
pO2/paO2:
Partial pressure of oxygen
PPBS:
Post-prandial blood sugars
PUO/FUO:
Pyrexia (fever) of unknown origin
PVC:
Premature ventricular contractions
QSART:
Quantitative sudomotor axon reflex test
qSOFA:
Quick sequential organ failure assessment
RA:
Rheumatoid arthritis
RAI scan:
Radioactive iodine scan
RAPD:
Relative apparent pupillary defect
RAS:
Reticular activating system
RCC:
Renal cell carcinoma
RCM:
Restrictive cardiomyopathy
RDW:
Red cell distribution width
REM:
Rapid eye movement
REMS:
Regional examination of musculoskeletal system
RF:
Rheumatoid factor
RHD:
Rheumatic heart disease
RLN:
Recurrent laryngeal nerve
RR:
Respiratory rate
RS:
Respiratory system
RSOV:
Ruptured sinus of Valsalva
RS3PE:
Remitting seronegative symmetrical synovitis with pitting edema
RV:
Right ventricle
RVF:
Right ventricular failure
RVH:
Right ventricular hypertrophy
SAAG:
Serum–ascites albumin gradient
SACD:
Subacute combined degeneration of cord
SAH:
Subarachnoid hemorrhage
SANRT:
Sinoatrial node re-entrant tachycardia
SCM:
Sternocleidomastoid
SDAI:
Simplified disease activity index
SDH:
Subdural hematoma
SIRS:
Systemic inflammatory response syndrome
SLE:
Systemic lupus erythematosus
SLICC:
Systemic Lupus International Collaborating Clinics
SLRT:
Straight leg raise test
SMA:
Spinal muscular atrophy
SOFA:
Sequential organ failure assessment
SSPE:
Subacute sclerosing pan-encephalitis
SSR:
Sympathetic skin response
STEMI:
ST-elevation myocardial infarction
STMS:
Short test of mental status
SV:
Stroke volume
SVC:
Superior vena cava
SVT:
Supraventricular tachycardia
TAPVC:
Total anomalous pulmonary venous connection
TB:
Tuberculosis
TBI:
Traumatic brain injury
TG:
Triglycerides
TIA:
Transient ischemic attack
TIN:
Tubulointerstitial nephritis
TMJ:
Temporomandibular joint
TSH:
Thyroid stimulating hormone
TST:
Thermoregulatory sweat test
U/L:
Unilateral
UA:
Unstable angina
UGI:
Upper gastrointestinal
UGIB:
Upper gastrointestinal bleed
UIP:
Usual interstitial pneumonitis
UMN:
Upper motor neuron
URTI:
Upper respiratory tract infection
US/USG:
Ultrasonogram
UTI:
Urinary tract infection
V/Q:
Ventilation/perfusion
VA:
Visual acuity
VAP:
Ventilator-acquired pneumonia
VC:
Vital capacity
VDRL:
Venereal Disease Research Laboratory
VPC:
Ventricular premature contractions
VSD:
Ventricular septal defect
VT:
Ventricular tachycardia
VUR:
Vesicouretreric reflux
WHO:
World Health Organization
WPW:
Wolff–Parkinson–White syndrome
ZES:
Zollinger–Ellison syndrome
Competency Table
Number | COMPETENCY The student should be able to | CORE Y/N | Suggested learning methods | Suggested assessment methods | Chapter number | Page number |
|---|---|---|---|---|---|---|
IM1.10 | Elicit document and present an appropriate history that will establish the diagnosis, cause and severity of heart failure including: presenting complaints, precipitating and exacerbating factors, risk factors exercise tolerance, changes in sleep patterns, features suggestive of infective endocarditis | Y | Bedside clinic | Skill assessment | 4 | 97–140 |
IM1.11 | Perform and demonstrate a systematic examination based on the history that will help establish the diagnosis and estimate its severity including: measurement of pulse, blood pressure and respiratory rate, jugular venous forms and pulses, peripheral pulses, conjunctiva and fundus, lung, cardiac examination including palpation and auscultation with identification of heart sounds and murmurs, abdominal distension and splenic palpation | Y | Bedside clinic, DOAP session | Skill assessment | 2 | 9–54 |
IM1.12 | Demonstrate peripheral pulse, volume, character, quality and variation in various causes of heart failure | Y | Bedside clinic, DOAP session | Skill assessment | 4 | 138 |
IM1.13 | Measure the blood pressure accurately, recognize and discuss alterations in blood pressure in valvular heart disease and other causes of heart failure and cardiac tamponade | Y | Bedside clinic, DOAP session | Skill assessment | 2 | 19–25 |
IM1.14 | Demonstrate and measure jugular venous distension | Y | Bedside clinic, DOAP session | Skill assessment | 4 | 23, 103 |
IM1.15 | Identify and describe the timing, pitch quality conduction and significance of precordial murmurs and their variations | Y | Bedside clinic, DOAP session | Skill assessment | 4 | 130 |
IM1.17 | Order and interpret diagnostic testing based on the clinical diagnosis including 12-lead ECG, chest radiograph, blood cultures | Y | Bedside clinic, DOAP session | Skill assessment | 4, 11 | 104, 387–427 |
IM1.18 | Perform and interpret a 12-lead ECG | Y | Bedside clinic, DOAP session | Skill assessment | 4, 11 | 104, 387–427 |
IM1.20 | Determine the severity of valvular heart disease based on the clinical and laboratory and imaging features and determine the level of intervention required including surgery | Small group discussion, Lecture, Bedside clinic | Written/Skill assessment | 6 | 313 | |
IM1.21 | Describe and discuss and identify the clinical features of acute and subacute endocarditis, echocardiographic findings, blood culture and sensitivity and therapy | Y | Bedside clinic, Small group discussion, Lecture | Skill assessment | 4 | 113 |
IM1.23 | Describe, prescribe and communicate non-pharmacologic management of heart failure including sodium restriction, physical activity and limitations | Lecture, Small group discussion | Skill assessment | 4 | 101 | |
IM1.26 | Develop document and present a management plan for patients with heart failure based on type of failure, underlying etiology | Y | Bedside clinic, Skill assessment, Small group discussion | Bedside clinic/Skill assessment/Written | 16 | 520, 537 |
IM2.6 | Elicit document and present an appropriate history that includes onset evolution, presentation risk factors, family history, comorbid conditions, complications, medication, history of atherosclerosis, IHD and coronary syndromes | Bedside clinic, DOAP session | Skill assessment | 4 | 97–140 | |
IM2.7 | Perform, demonstrate and document a physical examination including a vascular and cardiac examination that is appropriate for the clinical presentation | Y | Bedside clinic, DOAP session | Skill assessment | 2,11 | 8–51 and 399 |
IM2.8 | Generate document and present a differential diagnosis based on the clinical presentation and prioritize based on “cannot miss”, most likely diagnosis and severity | Y | Bedside clinic, DOAP session | Skill assessment | 2, 11 | 8–51 and 399 |
IM2.9 | Distinguish and differentiate between stable and unstable angina and AMI based on the clinical presentation | Y | Bedside clinic, DOAP session | Skill assessment | 4 | 107 |
IM2.10 | Order, perform and interpret an ECG | Y | Bedside clinic, DOAP session | Skill assessment | 4,11 | 104, 387–427 |
IM2.11 | Order and interpret a chest X-ray and markers of acute myocardial infarction | Y | Bedside clinic, DOAP session | Skill assessment | 12 | 428–441 |
IM2.12 | Choose and interpret a lipid profile and identify the desirable lipid profile in the clinical context | Y | Bedside clinic, DOAP session | Skill assessment | 16 | 545 |
IM3.4 | Elicit document and present an appropriate history including the evolution, risk factors including immune status and occupational risk | Y | Bedside clinic, DOAP session | Skill assessment | 3 | 59–95 |
IM3.5 | Perform, document and demonstrate a physical examination including general examination and appropriate examination of the lungs that establishes the diagnosis, complications and severity of disease | Y | Bedside clinic, DOAP session | Skill assessment | 3 | 59–95 |
IM3.6 | Generate document and present a differential diagnosis based on the clinical features, and prioritize the diagnosis based on the presentation | Y | Bedside clinic, DOAP session | Skill assessment | 3 | 59–95 |
IM3.7 | Order and interpret diagnostic tests based on the clinical presentation including: CBC, chest X-ray PA view, Mantoux, sputum Gram stain, sputum culture and sensitivity, pleural fluid examination and culture, HIV testing and ABG | Y | Bedside clinic, DOAP session | Skill assessment | 3 | 59–95, 428–451 |
IM3.8 | Demonstrate in a mannequin and interpret results of an arterial blood gas examination | Y | Bedside clinic, DOAP session | Skill assessment | 2 | 39 |
IM3.11 | Describe and enumerate the indications for further testing including HRCT, viral cultures, PCR and specialized testing | Y | Bedside clinic, DOAP session | Skill assessment | 12 | 428–451 |
IM3.13 | Select, describe and prescribe based on culture and sensitivity appropriate impaling antimicrobial based on the pharmacology and antimicrobial spectrum | Y | Bedside clinic, DOAP session | Skill assessment/Written/Viva voce | 3 | 59–95 |
IM3.14 | Perform and interpret a sputum Gram stain and AFB | Y | DOAP session | Skill assessment | 13 | 455 |
IM3.18 | Communicate and counsel patient on family on the diagnosis and therapy of pneumonia | Y | DOAP session | Skill assessment | 3 | 59–95 |
IM4.9 | Elicit document and present a medical history that helps delineate the etiology of fever that includes the evolution and pattern of fever, associated symptoms, immune status, comorbidities, risk factors, exposure through occupation, travel and environment and medication use | Y | Bedside clinic, DOAP session | Skill assessment | 16 | 518 |
IM4.10 | Perform a systematic examination that establishes the diagnosis and severity of presentation that includes: general skin mucosal and lymph node examination, chest and abdominal examination (including examination of the liver and spleen) | Y | Bedside clinic, DOAP session | Skill assessment | 2 | 8–57 |
IM4.11 | Generate a differential diagnosis and prioritize based on clinical features that help distinguish between infective, inflammatory, malignant and rheumatologic causes | Y | Bedside clinic, DOAP session | Written/Viva voce | 2 | 29–33 |
IM4.12 | Order and interpret diagnostic tests based on the differential diagnosis including: CBC with differential, peripheral smear, urinary analysis with sediment, chest X-ray, blood and urine cultures, sputum Gram stain and cultures, sputum AFB and cultures, CSF analysis, pleural and body fluid analysis, stool routine and culture and QBC | Y | Bedside clinic, Skill assessment | Skill assessment | 2, 16 | 29–33, 518–519 |
IM4.15 | Perform and interpret a malarial smear | Y | DOAP session | Log book/Documentation/Skill assessment | 15 | 476 |
IM4.17 | Observe and assist in the performance of a bone marrow aspiration and biopsy in a simulated environment | N | Skills laboratory | Log book/Documentation/ DOAP session | 13 | 458 |
IM4.20 | Interpret a PPD (Mantoux) | Y | DOAP session | Log book/Documentation | 13 | 457 |
IM4.23 | Prescribe drugs for malaria based on the species identified, prevalence of drug resistance and national programs | Small group discussion | Skill assessment | 15 | 476 | |
IM4.24 | Develop an appropriate empiric treatment plan based on the patient's clinical and immune status pending definitive diagnosis | Y | DOAP session | Skill assessment | 16 | 518 |
IM4.25 | Communicate to the patient and family the diagnosis and treatment | Y | DOAP session | Skill assessment | 16 | 518 |
IM4.26 | Counsel the patient on malarial prevention | Y | DOAP session | Skill assessment | 15 | 476–477 |
IM5.9 | Elicit document and present a medical history that helps delineate the etiology of the current presentation and includes clinical presentation, risk factors, drug use, sexual history, vaccination history and family history | Y | Bedside clinic, DOAP session | Skill assessment | 5 | 146 |
IM5.10 | Perform a systematic examination that establishes the diagnosis and severity that includes nutritional status, mental status, jaundice, abdominal distension ascites, features of portosystemic hypertension and hepatic encephalopathy | Y | Bedside clinic, DOAP session | Skill assessment | 5 | 518 |
IM5.14 | Outline a diagnostic approach to liver disease based on hyperbilirubinemia, liver function changes and hepatitis serology | Y | Bedside clinic, Small group discussion | Viva voce/ Writte | 5 | 147–151 |
IM5.15 | Assist in the performance and interpret the findings of an ascitic fluid analysis | Y | DOAP session | Documentation in log book | 5 | 147–151 |
IM5.17 | Enumerate the indications, precautions and counsel patients on vaccination for hepatitis | Written, Small group discussion | Written/Viva voce | 5 | 142–162 | |
IM6.7 | Elicit document and present a medical history that helps delineate the etiology of the current presentation and includes risk factors for HIV, mode of infection, other sexually transmitted diseases, risks for opportunistic infections and nutritional status | Y | Bedside clinic, DOAP session | Skill assessment | 15 | 500–501 |
IM6.8 | Generate a differential diagnosis and prioritize based on clinical features that suggest a specific etiology for the presenting symptom | Y | Bedside clinic, DOAP session, Small group discussion | Skill assessment | 15 | 500 |
IM6.15 | Demonstrate in a model the correct technique to perform a lumbar puncture | Simulation | Skill assessment | 13 | 459 | |
IM6.20 | Communicate diagnosis, treatment plan and subsequent follow-up plan to patients | Y | DOAP session | Skills assessment | 15 | 500–501 |
IM7.11 | Elicit document and present a medical history that will differentiate the etiologies of disease | Y | Bedside clinic, DOAP session | Skill assessment | 7 | 334–337 |
IM7.12 | Perform a systematic examination of all joints, muscle and skin that will establish the diagnosis and severity of disease | Y | Bedside clinic, DOAP session | Skill assessment | 7 | 338–357 |
IM7.17 | Enumerate the indications and interpret plain radiographs of joints | Y | Bedside clinic, Small group discussion | Skill assessment/Written | 7 | 353 |
IM7.18 | Communicate diagnosis, treatment plan and subsequent follow-up plan to patients | Y | DOAP session | Skill assessment/Written | 7 | 334–357 |
IM7.20 | Select, prescribe and communicate appropriate medications for relief of joint pain | Y | DOAP session | Skill assessment/Written | 7 | 334 |
IM7.22 | Select, prescribe and communicate treatment option for systemic rheumatologic conditions | Y | DOAP session | Skill assessment/ Written | 7 | 334–358 |
IM7.24 | Communicate and incorporate patient preferences in the choice of therapy | Y | DOAP session | Skill assessment | 7 | 334–358 |
IM7.25 | Develop and communicate appropriate follow-up and monitoring plans for patients with rheumatologic conditions | Y | DOAP session | Skill assessment | 7 | 334–358 |
IM7.26 | Demonstrate an understanding of the impact of rheumatologic conditions on quality of life, well-being, work and family | Y | DOAP session | Skill assessment | 7 | 334–358 |
IM8.9 | Elicit document and present a medical history that includes: duration and levels, symptoms, comorbidities, lifestyle, risk factors, family history, psychosocial and environmental factors, dietary assessment, previous and concomitant therapy | Y | Bedside clinic, DOAP session | Skill assessment | 16 | 516–517 |
IM8.10 | Perform a systematic examination that includes: an accurate measurement of blood pressure, fundus examination, examination of vasculature and heart | Y | Bedside clinic, DOAP session | Skill assessment | 2 | 19–23 |
IM8.11 | Generate a differential diagnosis and prioritize based on clinical features that suggest a specific etiology | Y | Bedside clinic, DOAP session | Skill assessment | 2 | 19–23 |
IM8.15 | Recognise, prioritize and manage hypertensive emergencies | Y | DOAP session | Skill assessment/ Written | 16 | 517 |
IM8.16 | Develop and communicate to the patient lifestyle modification including weight reduction, moderation of alcohol intake, physical activity and sodium intake | Y | DOAP session | Skill assessment | 10 | 381–382 |
IM8.17 | Perform and interpret a 12-lead ECG | Y | DOAP session | Documentation in log book/ Skills station | 4 and 11 | 104, 387–427 |
IM8.18 | Incorporate patient preferences in the management of HTN | Y | DOAP session | Skill assessment | 10 | 381–382 |
IM9.3 | Elicit document and present a medical history that includes symptoms, risk factors including GI bleeding, prior history, medications, menstrual history, and family history | Y | Bedside clinic, DOAP session | Skill assessment | 16 | 522 |
IM9.4 | Perform a systematic examination that includes: general examination for pallor, oral examination, DOAP session of hyper dynamic circulation, lymph node and splenic examination | Y | Bedside clinic, DOAP session | Skill assessment | 2, 3, 4, 5, 16 | 34, 60, 94, 115, 143, 162, 517 |
IM9.5 | Generate a differential diagnosis and prioritize based on clinical features that suggest a specific etiology | Y | Bedside clinic, DOAP session | Skill assessment/ Written | 16 | 517 |
IM9.6 | Describe the appropriate diagnostic work up based on the presumed etiology | Y | Bedside clinic, DOAP session | Skill assessment/ Written | 15 | 506 |
IM9.15 | Communicate the diagnosis and the treatment appropriately to patients | Y | DOAP session | Skill assessment | 16 | 517 |
IM9.20 | Communicate and counsel patients with methods to prevent nutritional anemia | Y | DOAP session | Skill assessment | 2 | 34 |
IM10.12 | Elicit document and present a medical history that will differentiate the aetiologies of disease, distinguish acute and chronic disease, identify predisposing conditions, nephrotoxic drugs and systemic causes | Y | Bedside clinic, DOAP session | Skill assessment | 16 | 523–524 |
IM10.15 | Describe the appropriate diagnostic work up based on the presumed etiology | Y | DOAP session, Small group discussion | Skill assessment/ Written/Viva voce | 16 | 523 |
IM10.17 | Describe and calculate indices of renal function based on available laboratories including fractional excretion of sodium (FENa) and creatinine clearance (CrCl) | Y | DOAP session, Small group discussion | Skill assessment/ Written/Viva voce | 16 | 523 |
IM10.18 | Identify the ECG findings in hyperkalemia | Y | DOAP session, Small group discussion | Skill assessment/Written/Viva voce | 11 | 401 |
IM10.20 | Describe and discuss the indications to perform arterial blood gas analysis: interpret the data | Y | DOAP session, Bedside clinic | Documentation in logbook | 2 | 39 |
IM10.21 | Describe and discuss the indications for and insert a peripheral intravenous catheter | N | DOAP session | Skill assessment with model | 13 | 461 |
IM11.7 | Elicit document and present a medical history that will differentiate the etiologies of diabetes including risk factors, precipitating factors, lifestyle, nutritional history, family history, medication history, comorbidities and target organ disease | Y | Bedside clinic, DOAP session | Skill assessment | 10 | 380 |
IM11.11 | Order and interpret laboratory tests to diagnose diabetes and its complications including: glucoses, glucose tolerance test, glycosylated hemoglobin, urinary microalbumin, ECG, electrolytes, ABG, ketones, renal function tests and lipid profile | Y | Bedside clinic, DOAP session | Skill assessment | 10 | 381 |
IM11.19 | Demonstrate and counsel patients on the correct technique to administer insulin | Y | DOAP session | Skill assessment | 13 | 452 |
IM12.5 | Elicit document and present an appropriate history that will establish the diagnosis cause of thyroid dysfunction and its severity | Y | Bedside clinic | Skill assessment/Short case | 10 | 383–384 |
IM12.6 | Perform and demonstrate a systematic examination based on the history that will help establish the diagnosis and severity including systemic signs of thyrotoxicosis and hypothyroidism, palpation of the pulse for rate and rhythm abnormalities, neck palpation of the thyroid and lymph nodes and cardiovascular findings | Y | Bed side clinic, DOAP session | Skill assessment | 10 | 383–384 |
IM12.9 | Order and interpret diagnostic testing based on the clinical diagnosis including CBC, thyroid function tests and ECG and radioiodine uptake and scan | Y | Bedside clinic, DOAP session | Skill assessment | 11 | 387–401 |
IM12.10 | Identify atrial fibrillation, pericardial effusion and bradycardia on ECG | Y | Bedside clinic, Laboratory | Skill assessment | 11 | 387–401 |
IM12.10 | Identify atrial fibrillation, pericardial effusion and bradycardia on ECG | Y | Bedside clinic, Laboratory | Skill assessment | 16 | 545 |
IM14.7 | Perform, document and demonstrate a physical examination based on the history that includes general examination, measurement of abdominal obesity, signs of secondary causes and comorbidities | Y | Bedside clinic, Skills laboratory | Skill assessment | 2 | 56 |
IM15.2 | Enumerate, describe and discuss the evaluation and steps involved in stabilizing a patient who presents with acute volume loss and gastrointestinal bleed | Y | Bedside clinic | Skill assessment | 5 | 142–185 |
IM15.4 | Elicit and document and present an appropriate history that identifies the route of bleeding, quantity, grade, volume loss, duration, etiology, comorbid illnesses and risk factors | Y | Bedside clinic, Skills laboratory | Skill assessment | 5 | 142–185 |
IM15.5 | Perform, demonstrate and document a physical examination based on the history that includes general examination, volume assessment and appropriate abdominal examination | Y | Lecture, Small group discussion | Short note/Viva voce | 5 | 142–185 |
IM15.6 | Distinguish between upper and lower gastrointestinal bleeding based on the clinical features | Y | DOAP session | Skill assessment | 5 | 142–185 |
IM15.7 | Demonstrate the correct technique to perform an anal and rectal examination in a mannequin or equivalent | Y | Bedside clinic, Skills laboratory | Skill assessment/Short note/Viva voce | 5 | 142–185 |
IM15.8 | Generate a differential diagnosis based on the presenting symptoms and clinical features and prioritize based on the most likely diagnosis | Y | Bedside clinic, DOAP session, Small group discussion | Skill assessment/Short note/Viva voce | 5 | 142–185 |
IM15.9 | Choose and interpret diagnostic tests based on the clinical diagnosis including complete blood count, PT and PTT, stool examination, occult blood, liver function tests, H. pylori test | Y | Bedside clinic, DOAP session, Small group discussion | Skill assessment/Short note/Viva voce | 5 | 142–185 |
IM16.4 | Elicit and document and present an appropriate history that includes the natural history, dietary history, travel, sexual history and other concomitant illnesses | Y | Bedside clinic, Skills laboratory | Skill assessment | 5, 15, 16 | 149, 150, 507, 521 |
IM16.5 | Perform, document and demonstrate a physical examination based on the history that includes general examination, including an appropriate abdominal examination | Y | Bedside clinic, Skills laboratory | Skill assessment | 5, 15, 16 | 149, 150, 507, 521 |
IM16.6 | Distinguish between diarrhea and dysentery based on clinical features | Y | Lecture, Small group discussion | Short note/Viva voce | ||
IM16.7 | Generate a differential diagnosis based on the presenting symptoms and clinical features and prioritize based on the most likely diagnosis | Y | Bedside clinic, Skills laboratory | Skill assessment/short note/Viva voce | 5, 15, 16 | 149, 150, 507, 521 |
IM16.8 | Choose and interpret diagnostic tests based on the clinical diagnosis including complete blood count, and stool examination | Y | Bedside clinic, Skills laboratory, Small group discussion | Skill assessment/Short note/Viva voce | 5, 15, 16 | 149, 150, 507, 521 |
IM17.2 | Elicit and document and present an appropriate history including aura, precipitating aggravating and relieving factors, associated symptoms that help identify the cause of headaches | Y | Bedside clinic, Small group discussion | Bedside clinic/Skill assessment | 6 | 187 |
IM17.4 | Perform and demonstrate a general neurologic examination and a focused examination for signs of intracranial tension including neck signs of meningitis | Y | Bedside clinic, Small group discussion | Bedside clinic/Skill assessment | 6, 13 | 187, 460 |
IM17.5 | Generate document and present a differential diagnosis based on the clinical features, and prioritize the diagnosis based on the presentation | Y | Bedside clinic, Small group discussion | Bedside clinic/skill assessment | 6 | 187 |
IM17.8 | Demonstrate in a mannequin or equivalent the correct technique for performing a lumbar puncture | Y | DOAP session | Skill assessment | 13 | 459 |
IM17.9 | Interpret the CSF findings when presented with various parameters of CSF fluid analysis | Y | Small group discussion, Bedside clinic | Skill assessment | 16 | 546 |
IM18.3 | Elicit and document and present an appropriate history including onset, progression, precipitating and aggravating relieving factors, associated symptoms that help identify the cause of the cerebrovascular accident | Y | Bedside clinic | Skill assessment | 6 | 193, 312 |
IM18.5 | Perform, demonstrate and document physical examination that includes general and a detailed neurologic examination as appropriate, based on the history | Y | Bedside clinic, DOAP session | Skill assessment | 6 | 186–193 |
IM18.6 | Distinguish the lesion based on upper versus lower motor neuron, side, site and most probable nature of the lesion | Y | Bedside clinic, DOAP session | Skill assessment | 6 | 235 |
IM18.7 | Describe the clinical features and distinguish, based on clinical examination, the various disorders of speech | N | Bedside clinic, DOAP session | Skill assessment | 6 | 290 |
IM18.10 | Choose and interpret the appropriate diagnostic testing in young patients with a cerebrovascular accident (CVA) | Lecture, Small group discussion | Written/Viva voce | 6 | 193, 312 | |
IM18.16 | Enumerate the indications describe and observe the multidisciplinary rehabilitation of patients with a CVA | Lecture, Small group discussion | Written/Viva voce | 6 | 193, 312 | |
IM19.3 | Elicit and document and present an appropriate history including onset, progression precipitating and aggravating relieving factors, associated symptoms that help identify the cause of the movement disorders | Y | Bedside clinic | Skill assessment | 6 | 303 |
IM19.4 | Perform, demonstrate and document a physical examination that includes a general examination and a detailed neurologic examination using standard movement rating scales | Y | Bedside clinic | Skill assessment | 6 | 303 |
IM19.5 | Generate document and present a differential diagnosis and prioritize based on the history and physical examination | Y | Bedside clinic | Skill assessment | 6 | 303 |
IM19.6 | Make a clinical diagnosis regarding on the anatomical location, nature and cause of the lesion based on the clinical presentation and findings | Y | Bedside clinic | Skill assessment | 6 | 303 |
IM20.4 | Elicit and document and present an appropriate history, the circumstance, time, kind of snake, evolution of symptoms in a patient with snake bite | Y | Bedside clinic, DOAP session | Skill assessment | 6 | 220, 221 |
IM20.6 | Choose and interpret the appropriate diagnostic testing in patients with snake bites | Small group discussion | Written/Viva voce | 6 | 220, 221 | |
IM23.5 | Counsel and communicate to patients in a simulated environment with illness on an appropriate balanced diet | Y | DOAP session | Skill assessment | 2 | 51 |
IM24.2 | Perform multidimensional geriatric assessment that includes medical, psycho-social and functional components | Y | Bedside clinic, DOAP session | Skill assessment | 8 | 360–366 |
IM25.5 | Perform a systematic examination that establishes the diagnosis and severity of presentation that includes: general skin, mucosal and lymph node examination, chest and abdominal examination (including examination of the liver and spleen) | Y | Bedside clinic, DOAP session | Skill assessment | 2 | 8–57 |
IM25.6 | Generate a differential diagnosis and prioritize based on clinical features that help distinguish between infective, inflammatory, malignant and rheumatologic causes | Y | Bedside clinic, DOAP session | Written/Viva voce | 16 | 512 |
IM25.9 | Assist in the collection of blood and other specimen cultures | Y | DOAP session | Log book documentation | 13 | 452 |
IM25.11 | Develop an appropriate empiric treatment plan based on the patient's clinical and immune status pending definitive diagnosis | Y | DOAP session | Skill assessment | 16 | 511 |
IM25.12 | Communicate to the patient and family the diagnosis and treatment of identified infection | Y | DOAP session | Skill assessment | 16 | 511 |
IM25.13 | Counsel the patient and family on prevention of various infections due to environmental issues | Y | DOAP session | Skill assessment | 16 | 511 |
IM26.19 | Demonstrate ability to work in a team of peers and superiors | Y | Bedside clinic, DOAP session | Skill assessment | 1 | 1–3 |
IM26.20 | Demonstrate ability to communicate to patients in a patient, respectful, non-threatening, non-judgmental and empathetic manner | Y | Bedside clinic, DOAP session | Skill assessment | 1 | 1–7 |
IM26.21 | Demonstrate respect to patient privacy | Y | Bedside clinic, DOAP session | Skill assessment | 1 | 1–7 |
IM26.22 | Demonstrate ability to maintain confidentiality in patient care | Y | Bedside clinic, DOAP session | Skill assessment | 1 | 1–7 |
IM26.23 | Demonstrate a commitment to continued learning | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.24 | Demonstrate respect in relationship with patients, fellow team members, superiors and other healthcare workers | Y | Bedside clinic, DOAP session | Skill assessment/Viva voce | 1 | 1–7 |
IM26.25 | Demonstrate responsibility and work ethics while working in the healthcare team | Y | Bedside clinic, DOAP session | Skill assessment/Viva voce | 1 | 1–7 |
IM26.26 | Demonstrate ability to maintain required documentation in health care (including correct use of medical records) | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.27 | Demonstrate personal grooming that is adequate and appropriate for healthcare responsibilities | Small group discussion | Skill assessment | 1 | 1–7 | |
IM26.28 | Demonstrate adequate knowledge and use of information technology that permits appropriate patient care and continued learning | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.29 | Communicate diagnostic and therapeutic options to patient and family in a simulated environment | Y | Bedside clinic, DOAP session | Skill assessment/Viva voce | 1 | 1–7 |
IM26.30 | Communicate care options to patient and family with a terminal illness in a simulated environment | Y | Bedside clinic, DOAP session | Skill assessment/Viva voce | 1 | 1–7 |
IM26.31 | Demonstrate awareness of limitations and seeks help and consultations appropriately | Y | Bedside clinic, DOAP session | Skill assessment/Viva voce | 1 | 1–7 |
IM26.32 | Demonstrate appropriate respect to colleagues in the profession | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.33 | Demonstrate an understanding of the implications and the appropriate procedures and response to be followed in the event of medical errors | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.34 | Identify conflicts of interest in patient care and professional relationships and describe the correct response to these conflicts | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.35 | Demonstrate empathy in patient encounters | Y | Bedside clinic, DOAP session | Skill assessment/Viva voce | 1 | 1–7 |
IM26.36 | Demonstrate ability to balance personal and professional priorities | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.37 | Demonstrate ability to manage time appropriately | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.38 | Demonstrate ability to form and function in appropriate professional networks | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.39 | Demonstrate ability to pursue and seek career advancement | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.40 | Demonstrate ability to follow risk management and medical error reduction practices where appropriate | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.41 | Demonstrate ability to work in a mentoring relationship with junior colleagues | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.42 | Demonstrate commitment to learning and scholarship | Small group discussion | Skill assessment/Viva voce | 1 | 1–7 | |
IM26.49 | Administer informed consent and appropriately address patient queries to a patient being enrolled in a research protocol in a simulated environment | Y | Bedside clinic, DOAP session | Written/Viva voce | 1 | 1–7 |