Syllabus

Course name Physical Diagnosis I

V semester
Lecturer of the course Dodona Akhvlediani,Assistant Professor
Mob: 598255525
Email: [email protected]

Tamar Vakhtangadze, Md, Ph.D., FESC; Invited lecturer

Phone: 593907907;
Email: [email protected]
Course status Mandatory
ECTS credits 4 ECTS (1 credit - 30 hours) 120 hours.
Lecture - 15 hrs.
Practical Training – 30 hrs.
Midterm exam- 2 hr.
Students’ workload
Final exam- 3 hrs.
Contact hours –50 hrs.
Individual Hours - 70 hrs.
Consultation days are fixed weekly according to the
Students counseling service
timetable, also online at the specified address.
Course Prerequisite Body Structure IV (Anatomy & Histology & Imaging),
Body Function IV (Physiology & Biochemistry),
Immunology
Course Goals The aim of the course is to develop skills in an interview
and physical examination of the patient, collect medical
history, acquire vital signs, conduct a comprehensive and
focused physical exam of the skin, respiratory and
cardiovascular system, determine normal and abnormal
findings, explain to the patient pathophysiology and
significance of revealed abnormalities, steps of prevention
of common abnormalities, organize the acquired
information of the patients with diseases of the skin,
respiratory and cardiovascular systems in the standard
format of medical record; develop practical skills of
patient-oriented communication and collecting the case
history, performance of relevant procedures, solving
complicated problems in a multidisciplinary environment
using modern methods and approaches, critical analysis of
complicated information, innovative synthesis of
information, evaluation, and making decisions.
Course outcomes Knowledge and Understanding:

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A student:
● Determines the principles of patient-centered
history-taking.
● Determines the principles of communication in case
of a difficult patient.
● Describes the methods of physical examination.

● Determines the method of examination of different

systems of the human body.
Skills:
A student:
● Conducts effective communication with the patients
taking into account their cultural and ethnic etc.
peculiarities.
● Uses patient-oriented interviewing skills for getting
relevant biomedical and psychosocial information.
● Uses knowledge in biomedicine and clinical sciences
in practice.
● Inquires the information from other sources,
including the patients’ family and its analysis.
● Takes the history, perform a physical exam, select
appropriate investigations, and interpret the results
of physical examination for the purpose of diagnosis.
● Communicates using a patient-centered approach
that encourages patient trust and autonomy and is
characterized by empathy, respect, and compassion.
● Interprets the results of physical examination.

● Assesses vital signs.

● Records the electrocardiogram

● Differentiates normal and abnormal findings

● Performs examination and manipulations of

muscular and skeletal, integumentary,
cardiovascular systems

Responsibility and Autonomy

A student:
● Searches for new ideas to solve problems in a
multidisciplinary environment using modern
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 methods and approaches.
● Provides the analysis of complicated information,
synthesizes the information, evaluates, and makes
decisions.
Learning-teaching forms Lecture – a process in which both a lecturer and a student
take part. The basic aim of the lecture is to help students to
comprehend the major notions of the subject taught which
implies interaction and creative and active perception of the
material. Attention is paid to basic concepts, definitions,
designations, assumptions. The lecture provides scientific
concepts. Facts, examples, schemes, drafts, experiments,
and other visual aids help explain the idea conveyed by the
lecture. The lecture ensures the correct analysis of the topic
and is based on the ability of the students to perceive and
understand it.
Seminar - under the supervision of a lecturer a group of
students find and perceive additional information, prepare
presentations, write essays, etc. This enables students to
deepen their knowledge of the themes studied at the lecture.
At the seminar reports are presented and discussed,
conclusions are made. The lecturer coordinates these
processes. Students are provided with anatomical models,
posters, atlases, microscopic specimens, view video
programs.
Practical Training - hands-on learning experience in a
supervised setting aimed at the professional preparation
and training of a student. Students should be exposed to
various areas of the organization in which they work.
Practical training provides learning opportunities related to
all parts of the course program. The student always works
with support and appropriate help from the lecturer.
However, the student is engaged in carrying out a particular
activity. The course is held as practical training in a
simulation lab and at a clinic. During the semester skills are
developed by role-playing or working on manikins. At the
final exam, students perform their skills on manikins
and/or simulated patients.

Quiz – written test – a short test for the assessment of

knowledge and/or analytical skills. The question formats
often include multiple choice, fill in the blanks, true or false
and short answer.
Presentation of clinical skills – gather the data for medical
history, physical examination and record medical history;
examination of a patient; the skills are developed at bedside

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 under direct supervision of the course lecturer.

*Students have the possibility to visit labs and specialized classes during
their independent work hours according to the arranged schedule and
practice and learn there by using anatomical models, posters, video
recordings, microscopes and specimens.
Assessment system

Student assessment system includes:

a) Five positive grades
a.a) (A) Excellent – 91-100 grade points;
a.b.) (B) Very good – 81-90 grade points;
a.c) (C) Good – 71-80 grade points;
a.d) (D) Satisfactory – 61-70 grade points;
a.e) (E) Acceptable – 51-60 grade points.

b) Two types of negative grades:

b.a) (FX) Fail – 41-50 grade points, meaning that a professional student requires some more
work before passing and is given a chance to sit an additional examination after independent
work;
b.b) (F) Fail –40 and less grade points, meaning that the work of a professional student is not
acceptable and he/she has to study the subject anew.

In the case of FX assessment, the student can sit for the make-up exam no less than 5 days after
the announcement of the examination results.

The minimum score for passing the midterm and final exams is 50% of the maximum score.
The same applies to the integrated course modules. In each module, the student must score
50% of the points assigned to each module. If a student does not score the required points in a
course or one or two modules of an integrated course, they are eligible to take the makeup
exam.

The minimum score for admission to the final exam is 50% of the sum of ongoing and midterm
assessments.

If a student fails to pass the make-up exam, he/she will study the course / the whole integrated
course (all modules) again.

In the case of failure of the make-up exam, a student shall study the course/integrated course
again with all its modules

Evaluation forms, components, methods and criteria

Midterm Evaluation Final evaluation

(Maximum 60 points)
Activity 40 points Midterm Exam 20 points Final Exam 40
points

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 Class Activity 40 points Presentation of clinical skills OSCE -20 points

Quiz – 10 points Test (MCQs) – 20

Presentation of clinical skills - points
30 points
Methods of assessment Mid-term exam – 20 points Final exam – 40
Quiz – is held five times, max. 20 Presentation of clinical skills points; OSCE
points, consists of 20 questions. according to the checklist – 10 (checklists) – 20
Rubric for MCQs: points points;
Each correctly pointed answer MCQ – 10 points MCQs – 20 points;
earns 0.25 point. consists of 80
Each incorrectly pointed answer questions.
earns 0 point, Rubric:
Each correct answer
earns 0.5 point
Each incorrect
answer earns 0
point.
Presentation of clinical skills –
each student is assessed 4 times,
max. 16 points
Rubric:
Presents a clinical skill properly
– 4 points
Presents a clinical skill with
minor errors – 3 points
Presents a clinical skill with some
errors – 2 points
Presents a clinical skill with
significant errors – 1 point
Can not present a clinical skill –
0 point
Writing Medical record – 4
points

Learning outcomes of the course Learning-teaching forms Evaluation methods

I Knowledge and Lecture Quiz (MCQs, open questions)
Understanding: Seminar Demonstration of clinical
A student: skills
● Determines the principles of
patient-centered history-
taking.
● Determines the principles of
communication in case of a
difficult patient.

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 ● Describes the methods of
physical examination.
● Determines the method of
examination of different
systems of human body.
II Skills: Practical training Demonstration of clinical
A student: skills
● Conducts effective
communication with the
patients taking into
account their cultural
and ethnic etc.
peculiarities.
● Uses patient-oriented
interviewing skills for
getting relevant
biomedical and
psychosocial
information.
● Uses knowledge in
biomedicine and clinical
sciences in practice.
● Inquires the information
from other sources,
including the patients’
family and its analysis.
● Takes the history,
perform a physical
exam, select appropriate
investigations, and
interpret the results of
physical examination for
the purpose of diagnosis.
● Communicates using a
patient-centered
approach that
encourages patient trust
and autonomy and is
characterized by
empathy, respect, and
compassion.

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 ● Interprets the results of
physical examination.
● Assesses vital signs.

● Records the
electrocardiogram
● Differentiates normal
and abnormal findings
● Performs examination
and manipulations of
muscular and skeletal,
integumentary,
cardiovascular systems

Course content

Study Teaching-learning hour Topic

week methods s
Lecture 1 Physical Examination and History Taking
Clinical Reasoning, Assessment, and Recording Findings
Interviewing and the Health History
Practical Classes 2 Physical Examination and History Taking
● Patient Assessment: Comprehensive or Focused
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● Comprehensive Assessment of the Adult – health
history, physical exam.
● Beginning the Examination: Setting the Stage

● Techniques of Examination
Clinical Reasoning, Assessment, and Recording Findings
● The process of clinical reasoning: Assessment and
plan
● Identifying Problems and Making Diagnoses: Steps
in Clinical Reasoning
● Generating the Problem List

● Recording the findings – THE CASE

● Evaluation of Clinical evidence

● Displaying Clinical Data

● Lifelong learning, integrating clinical reasoning,

assessment and analysis of clinical evidence.
Interviewing and the Health History 55
● Different kinds of health history
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 ● The Sequence of the Interview

● The Cultural Context of the Interview

● Advanced interview

● Sensitive Topics

● Ethics and professionalism

Clinical skills session: Independent work of student –
reviewing of virtual patient
1. Interview the patient - Collecting Medical history
2. Determine functional ability of the patient
2. Conducting comprehensive and focused exam
3. Generating the problem list
4. Generating clinical hypothesis
5. Writing Medical record
6. Use of Standard and Universal Precautions
7. Knowledge of explanation of Cardinal Techniques of
Examination (Inspection, Palpation, Auscultation)
8. The Physical Examination: Suggested Sequence and
Positioning.
9. Discussion regarding presented cases
II Lecture 1 Beginning the Physical Examination: General Survey, Vital
Signs, and Pain
Practical Classes 2 QUIZ 1 - Interview of the patient; Medical record
The assessment of knowledge of students, evaluation of
homework.
Topic: Beginning the Physical Examination: General
Survey, Vital Signs, and Pain
The Health History: Common or Concerning Symptoms
Health Promotion and Counselling: Evidence and Recommendations The General S

General Appearance - Level of consciousness, signs of distress, apparent state of he

The Vital Signs: BLOOD PRESSURE (Special Situations), HEART RATE AND R

Acute and Chronic Pain

Behavior and Mental Status
● Patient Identifiers for Selective Mental Health

● Screening
Clinical Skills Session: Determine the Common or
Concerning Symptoms; General Survey and Acquisition of
Vital Signs – Pulses, Respiratory rate, Blood pressure,
Temperature; Determine normal and abnormal findings;
Determine BMI, General principles of Prevention and
Screening of disease; Signs of diseases – the general
appearance of the patient; Differentiation of Pain; Case

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 study; Recording the findings; Bedside training in
interviewing of patient and assessment of vital signs and
mental state. Training in Techniques of Examination –
inspection, palpation, percussion, auscultation
III Lecture 1 The Skin, Hair and Nails

Practical Classes 2 QUIZ II - Vital Signs, and Pain, Assessment of knowledge of

the student, evaluation of homework.
Topic: The Skin
Anatomy and Physiology, The Health History; Common or
Concerning Symptoms;
Health Promotion and Counseling: Evidences and Recommendations

Techniques of Examination of skin – inspection, palpation, evaluation of color, mo

SKIN LESIONS IN CONTEXT – patterns and shapes, primary

and secondary, elevated and depressed skin abnormalities,
vascular and purpuric. Diseases and Related Skin Conditions.
Skin tumors. Evaluating bedbound patient pressure ulcers.
Benign and Malignant Nevi. Screening for skin cancer, skin
self-examination.
Demonstration of audio and video material regarding
examination of skin, hair, nails.
Bedside training - evaluation of patient, writing record.
IV Lecture 1 Skin self-examination
Skin tumours
Internal diseases and Related Skin Conditions
Pressure ulcers
Practical Classes 2 Skin self-examination
Skin tumors
Internal Diseases and Related Skin Conditions
Pressure ulcers
Clinical skills session: Evaluation of skin, nails, and hair;
Interview the patient with skin, nail and hair disorders;
determine the warning signs of melanoma, basal cell
carcinoma; determine the skin signs of internal diseases,
teach the patient the self-examination techniques of skin.
Recording the findings. Bedside training
V Lecture 1 The Thorax and Lungs - Anatomy, Physiology, Pathology.
Breathing, gas exchange.
The Health History, Common or Concerning Symptoms.
Health Promotion and Counseling – Tobacco cessation,
Immunization.
Practical Classes 2 Quiz III. Skin, Nails, Hair
Assessment of knowledge of the student, evaluation of
homework.
The Thorax and Lungs - Anatomy, Physiology, Pathology.
Breathing, gas exchange.
The Health History, Common or Concerning Symptoms.
Health Promotion and Counseling – Tobacco cessation,
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 Immunization.
Demonstration of audio and video material regarding
examination Respiratory system.
Case study: Assessment of virtual patients.
Clinical skills session: Techniques of Examination - INITIAL
SURVEY OF RESPIRATION AND THE THORAX, Interview the
patient with Cough and Hemoptysis, Dyspnea; Chest pain;
Evaluate the breathing pattern; Deformities of the thorax,
Major landmarks of chest; Palpation of the chest, Testing
chest expansion, feeling for tactile fremitus, Percussion of
the chest – normal findings and pathologic examples,
Identifying the descent of the diaphragm or diaphragmatic
excursion.
Recording the findings.
VI Lecture 1 The Thorax and lungs – Auscultation, normal and
abnormal findings.
Practical Classes 3 Assessment of knowledge of the student, evaluation of
homework.
Auscultation of chest: Altered Breath and Voice sounds.
Adventitious (Added) Lung sounds: Causes and Qualities.
Demonstration of audio and video material regarding
examination Respiratory system.
Assessment of virtual patients.
Recording the findings.
Clinical skills: Interview the patient with respiratory
complaints; Physical exam of the patient; Differentiation
the diseases presenting with similar complaints; Case study,
Record the medical history
VII Lecture 1 Complaints and Physical findings in selected Respiratory
Disorders.
Practical Classes 2 Assessment of knowledge of the student, evaluation of
homework.
Physical findings in selected Chest Disorders, Bronchitis,
Left-sided heart failure, Consolidation, Atelectasis, Pleural
effusion, Chronic obstructive pulmonary disease,
Pneumothorax, Asthma – Correlation with tests.
SPECIAL TECHNIQUES- Clinical Assessment of Pulmonary
Function.
Demonstration of audio and video material regarding
examination Respiratory system.
Clinical skills session: Interview the patient, generate the
problem list and hypothesis, conduct focused physical
exam; Bedside training, evaluation of the patient. Recording
the Findings Physical Examination—The Thorax and Lungs.
Quiz IV – Respiratory system
VIII Midterm MCQ/Oral assessment

Lecture 1 The Cardiovascular System

IX
Practical Classes 2 Evaluation of homework.
The Cardiovascular System – Surface projection of Heart
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 and Great vessels, Cardiac chambers and valves, Cardiac
cycle, Physiology of heart sounds, the splitting. Auscultation
of heart, Relation of the Auscultatory findings to the chest
wall. Physiology of Normal and abnormal findings. Heart
murmurs. Grading of Murmurs
Clinical skills session: Sounds and Murmurs in certain
diseases – Mitral regurgitation and stenosis, Aortic
regurgitation and stenosis, Tricuspid regurgitation and
stenosis, Pulmonary regurgitation, and stenosis,
Cardiomyopathies, Pericarditis. Assessment of CVD risk of
the patient with SCORE Chart, Framingham risk Chart,
Assessment of Functional Ability and NYHA class of the
patient.
X Lecture 1 The Cardiovascular System

Practical Classes 2 Demonstration of audio and video material regarding the

physiology of the Circulatory system.

Evaluation of virtual patient. Recording the Findings

Physical Examination—Auscultation of Heart

Clinical skills session: Cardiac Physiology, Development of

Heart Sounds and Murmurs, Conduction system of the
heart, genesis of ECG – waves and intervals

XI Lecture 1 Important Topics for Health Promotion and Counselling.

The challenges of cardiovascular disease (CVD) screening

Practical Classes 2 Important Topics for Health Promotion and Counselling.

The challenges of cardiovascular disease (CVD) screening

Special populations at risk: women and African Americans

Screening for cardiovascular risk factors, Criteria for diabetes screening and diagno

Promoting lifestyle and risk factor modification, Lifestyle modifications to prevent

Demonstration of audio and video material regarding

examination Demonstration of audio and video material
regarding examination Respiratory system.

Bedside training, evaluation of patients. Recording the

Findings Physical Examination—The Cardiovascular
system.

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XII Lecture 1 The Cardiovascular system - Symptoms, Physical exam:
Inspection, Palpation, Percussion, Auscultation

Practical Classes 3 Assessment of knowledge of the student, evaluation of

homework.

Physical Exam of the Heart – Positioning the Patient,

sequence of the Cardiac examination, Location and Timing
of Cardiac Findings, Inspection, Apical impulse, Palpation,
Percussion, Auscultation, Maneuvers to Identify Systolic
Murmurs and Heart Failure

Variations and abnormalities of the ventricular impulses

Variations in the first heart sound—s1

Variations in the second heart sound—s2

Extra heart sounds in systole

Extra heart sounds in diastole.

Clinical skills session: Interview of the patient with

circulatory disorders: Chest Pain, Dyspnea: Palpitations,
interpret results. Physical exam of the patient with
Circulatory disorders; Interpret results. Special Maneuvers –
Valsalva, squatting, standing, inspiration,

Case study; Interview of the patient; Generating the problem

list; Recording Findings

XIII Lecture 1 Symptoms and signs of Diseases of the Circulatory

systems: Angina; Myocardial Infarct, Heart Failure,
Pericarditis, Arrhythmias, Valvular Heart Diseases, Arterial
Hypertension

Practical Classes 2 Clinical skills session: Interview of the patient with

circulatory disorders: Chest Pain, Dyspnea: Palpitations,
interpret results. Physical exam of the patient with
Circulatory disorders; Interpret results. Special Maneuvers –
Valsalva, squatting, standing, inspiration,

Case study; Interview of the patient; Generating the problem

list; Recording Findings

Evaluation of the ECG

XIV Lecture 1 THE CONDUCTION SYSTEM, ECG, ECG waves and intervals,

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 Alterations of rate and rhythm

Practical Classes 2 THE CONDUCTION SYSTEM, ECG,

THE HEART AS A PUMP 342

selected heart rates and rhythms

selected irregular rhythms

Clinical Skills Session: Evaluation of virtual patients.

Recording the Findings

Evaluation of ECGs of Patients with Rhythm and Conduction

Abnormalities

XV Lecture 1 The Peripheral Vascular System; Arterial pulses, Blood

pressure, Jugular venous pressure

Practical Classes 2 Quiz V – Cardiovascular system

Assessment of knowledge of the student, evaluation of

homework.

ARTERIAL PULSES AND BLOOD PRESSURE 343

JUGULAR VENOUS PRESSURE (JVP) AND PULSATIONS 344

CHANGES OVER THE LIFESPAN 344

The Health History

Practical Classes 2 - The Peripheral Vascular System –

Arteries, Veins, Lymphatic system. Fluid exchange and
capillary bed.

The Health History - Common or Concerning Symptoms

Health Promotion and Counseling: Evidence

and Recommendations - Important Topics for Health

Promotion and Counseling

Techniques of Examination – Arms, Abdomen, Legs.

SPECIAL TECHNIQUES

Recording the Physical Examination—The Peripheral

Vascular System.

Case study

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XVI Lecture 1 General Principles of Clinical Reasoning in the practice

Practical Classes 2 Case evaluation; Medical Record

XVII- Final exam

XVIII
XVII-XIX Make-up exam

Literature and course materials

Required literature 1. Bate’s Guide to Physical Examination and History Taking,
Lynn S. Bickley, 2023, Wolters Kluwer
Additional literature 1. Merck Manual Professional;
https://www.msdmanuals.com/professional.
2. Seidel’s Guide to Physical Examination: An Interprofessional
Approasch, by J. W. Ball, Joyce E. Dains, et al., 2018, Mosby
3. Clinical Examination Essentials, 4th edition, Nicholas J.
Talley, Simon O’Connor, 2016, Elsevier

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