Educational Course Syllabus

Course title Internal Medicine 3

Differential diagnosis of Internal diseases
Author (authors) of Dr. Aleqsandre Aladashvili
the educational
course
Lecture (lecturers) 1) Name, surname: Dr. Liza Goderdzishvili
Title: Dr., MD, PhD
Workplace: Tbilisi Central Hospital
Phone (if applicable):
Email: l.goderdzishvili@tch.ge
2) Name, surname: Dr. Ketevan Kapanadze
Title:Dr. MD, PhD
Workplace: Tbilis Central hospital
Phone (if applicable):
Email: katekapanadze@yahoo.com
3) Name, surname: Dr. Maia Bitskinashvili
Title: Dr. MD, PhD (associate professor)
Workplace: clinic ,,Vivamedi”
Phone (if applicable):
Email: maia.bitskinashvili@tsu.ge
4) Shorena Chumburidze
Title: Dr., MD, PhD
Invited
Email: shorena.chumburidze@rsu.ge

Code of the course MD-ENG55C

Status of the course Faculty: Medicine

Level of education: Undergraduate Medical Education
Program: Medicine
Status: Mandatory
Semester: X
ECTS Credits: 7
Total number of hours: 175
Contact hours: 70
Seminar/practical: 70 hours
Supervising: 35
Hours for independent work:70
Objectives of the The purpose of the course is to teach students:
educational course  Major syndromes of internal diseases
 Diagnostic principles and methods of differential
diagnostics
 Pathophysiological bases of clinical syndromes
 Classifications of diseases recognized in the medical
practice of the country
 Principles for establishing and substantiating a

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 preliminary and clinical diagnosis
 Basic principles of pharmacotherapy
 Principles of urgent, emergency and planned
treatment for different diseases and syndromes
 Assess patient prognosis in various clinical syndromes
 Principles of management of major clinical syndromes

Prerequisites for Internal Medicine Block 1,2; Pharmacology-2

admission
Learning outcomes By the end of this course, all students will be able to:
Described by sectoral Knowledge and understanding:
and general Discuss the principles of differential diagnosis and
(transferable) management of the following major syndromes:
competences  Hypertension
 Cardialgia
 Tachyarrhythmia
 Bradyarrhythmia
 Shortness of breath
 Swelling
 Pericardial effusion
 Temperature rise
 Cough
 Broncho obstructive syndrome
 Pleural effusion
 Cyanosis
 Pain in the abdomen
 Nausea, vomiting
 Dyspepsia, diarrhea, constipation
 Ascites
 Urinary Syndrome
 Arthralgia
 Jaundice
 Hepatomegaly, splenomegaly
 Syncope

Skills;
 Take proper clinical history
 Conduct proper clinical examination
 Differential diagnosis of the findings of clinical,
laboratory and instrumental examinations
 Filling medical history of patient
 Differential diagnosis of main clinical syndromes of
internal diseases
 Define a management plan for major clinical
syndromes
 The student can form a clinical diagnosis based on
the analytical interpretation of the patient's clinical-
laboratory data and the principles of differential

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 diagnosis.
 Review medication and other treatment activities
and evaluate potential benefits and risks for the
patient.
 Consider the compatibility of medications with a
particular patient when prescribing treatment
 Interpret the electrocardiogram;
 Perform functional respiratory tests;
 Timely identification of emergencies and provision of
first aid treatment
 The student must be able to communicate with the
patient and his/her relatives, as well as medical staff
orally and in writing form by considering social and
democratic values.

Autonomy and responsibility:

 Demonstrate critical reading skills in selected journal
articles, and identify characteristics of effective
medical articles.
 Identify gaps in own knowledge and skills and
understand the obligation of necessary lifelong
learning, work out the ability of constant
improvement of personal and professional
development;
 Adapt to difficult clinical situations and work
independently and with the sense of responsibility
when needed
 Show respect to patients and their rights
 Demonstrate the ability to communicate adequately
with colleagues, healthcare professionals, law
enforcement or the media representatives, as well as
with the team, in order to perform the professional
duties effectively

Teaching and 1. seminar discussions

learning methods 2. Direct patients contact
3. practical training (bedside teaching),
4. Case-based learning(CBL)
5. team work
Assessment system Assessment forms and points:
and criteria The assessment of the knowledge - is accomplished by
100 points evaluation system. During the semester student
gathers 60 points in intermediate assessment and 40 points
in final exam (total 100 points).
Intermediate assessment involves the following
components:

 Activity -20 points(cased based discussion,

teamwork)

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  clinical skills - 20 points(clinical diary)
 Presentation - 5 points
 Midterm exam -15 points
Final Exam - 40 points
written part-20 points(cases, esseys, MCQ)
OSCE- 20 points

Total grade - 100 points

See the Evaluation Criteria in the Evaluation Guide.
Prerequisites for the admission to the exam:
 The student should have collected at least 31 points in
the semester.
 If student attends less than 70% of lectures/seminars,
he/she will not be admitted to the final exam.
Evaluation system:

91-100 points from maximum grading

(A) Excellent
points
81-90 points from maximum grading
(B) Very good
points
71-80 points from maximum grading
(C) Good
points
(D) 61-70 points from maximum grading
Satisfactory points
51-60 points from maximum grading
(E) Sufficient
points
Two types of negative assessments
41-50 points from maximum grading
points; considerable further work
(FX)
required from the student; after
Unsatisfactory
independent work he/she will have only
one chance to pass additional exam
40 and less from maximum points,
meaning that the work performed by
(F) Failed the student is not enough and further
work required to learn the subject over
again
In case of receiving (FX), an additional exam is
scheduled at least 5 calendar days after the final exam
results are announced

Mandatory/basic 1. “Differential Diagnosis in Internal Medicine, symptoms to diagnosis.

literature and other 1st Edition, 2011 Siegenthaler Walter
study material 2. “Harrison’s Principles of Internal Medicine”, 20 th edition,
McGraw-Hill Education. 2018

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Supplementary
literature and other 1. Differential Diagnosis of Common Complaints,
study material 7e 7th Edition, by Andrew B. Symons MD
MS, Robert H. Seller MD

2. “Symptom to Diagnosis” An Evidence Based

Guide, Third Edition (Lange Medical Books)

3. “Case files in Internal Medicine” 4th edition,

Additional Consultations with students will be conducted in
information/conditions accordance to the schedule, agreed with the faculty
related to taking the administration.
course (If applicable)
Special attention is focused on the academic honesty at
this learning course. The student must present only his/her
own work/presentation, in which author of idea/words or
concept must be mention (in accordance with academic
referencing rules). The student shouldn’t present the
project/work or part of it, that was prepared for another
course; Also, the student shouldn’t falsify the
data/information and shouldn’t copy the other’s work. In
case of above-mentioned actions occur, disciplinary
procedure (indicated in the ethical code) will be used
against the students due to the violation of the principles of
academic honesty which are integral parts of true academic
education system and a fundamental value of the
University. The sanction might be as follows: Re-
preparation of the work, giving them unsatisfactory
assessment and/or termination of the student status.

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 Content of the course

Subject of the lecture/Workshop/Practicums/ Literature and

N laboratory-based work etc. other study
material
1. Seminar /clinical practice; 3 hours; “Siegenthaler,
Presentation of syllabus Differential Diagnosis
in Internal Medicine”,
General Aspects of Diagnosis and Differential A Comprehensive
Diagnosis
Study Guide
a. Elements of the Differential Diagnosis:
 Disease and Differential Diagnosis
 Practical Procedure for Establishing a
Diagnosis
 Correct Evaluation of Evident Findings and
the Differential Diagnosis
 How to Handle Errors in the Medical Field
 Factors That Can Lead to False Diagnoses
 Physician-specific Problems and Patient-
specific Problems
Factors That Can Influence the Differential Diagnostic
Thought Process
Prevalence of Diseases, Age, Gender, Lifestyle, Eating,
Season, Time of Day, and Weather, Geographic
Distribution , Ethnic Groups, Profession and Leisure,
Precluding or Promoting Diseases

2 Seminar /clinical practice; 3 hours; “Siegenthaler,

How to Approach Clinical Problems Differential Diagnosis
 Approach to the Patient: in Internal Medicine”,
o History, Medical Examination, Laboratory and
A Comprehensive
Imaging assessment
Study Guide
 Interpretation of test results using pretest &posttest
probability & likelihood ratio
 Approach to Clinical Problem Solving
Approach to Reading
Consideration of cases, scenario, group work,
individual work:
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

3 Seminar /clinical practice; 3 hours; “Siegenthaler,

Systemic Arterial Hypertension Differential
Diagnostic Management of Hypertension Diagnosis in
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 Primary (Idiopathic) Hypertension Internal
Secondary Hypertension Medicine”, A
Discussion of the material studied in the lecture, and Comprehensive
patient cases. Work in the Internal Medicine department with Study Guide
patients under supervision of lecturer and local staff;

4 Seminar /clinical practice; 3 hours; “Siegenthaler,

Chest Pain Differential Diagnosis
 Pain Originating from the Heart: Angina Pectoris, in Internal Medicine”,
Angina Pectoris Caused by Myocardial Ischemia,
A Comprehensive
Pericarditis and Pericardial Effusion, Arrhythmias
 Pain Originating from Diseases of the Large Vessels: Study Guide
Aortic Aneurysm, Aortic Dissection, PE
 Pain Originating from the Pleura: Pleuritis, Pleural Harrison’s Principles
Effusion, Pleural Neoplasms, of Internal Medicine
o Spontaneous Pneumothorax (20th edition.)
o Intercostal Pain
 Pain Originating from Joints and the Vertebral
Column
o Musculoskeletal Thoracic Pain
 Pain Originating from the Esophagus
 Other Causes for Thoracic Pain
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

5 Seminar /clinical practice; 3 hours; “Siegenthaler,

Arrhythmias Differential Diagnosis
Differential Diagnosis of Arrhythmias in Internal Medicine”,
Bradyarrhythmias
A Comprehensive
Junctional Rhythms
Extrasystoles Study Guide
Tachyarrhythmias
Narrow-Complex Tachycardia Harrison’s Principles
Wide-Complex Tachycardia of Internal Medicine
Discussion of the material studied in the lecture, and (20th edition.)
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

6 Seminar /clinical practice; 3 hours; “Siegenthaler,

Cardiac Symptoms Differential Diagnosis
Dyspnea Due to Cardiovascular Diseases in Internal Medicine”,
Differential Diagnostic Criteria
A Comprehensive
Symptoms of Heart Failure and Other Cardiac
Diseases: Dyspnea, Signs of Venous Congestion, General Study Guide
Symptoms
Clinical Examination and Findings: General Physical Harrison’s Principles

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 Examination, Pulse, Volume Status, Perfusion Status, of Internal Medicine
Rales, Expiratory Wheeze Cardiac Examination, (20th edition.)
Diagnostic Studies: Laboratory Tests, ECG, Chest
Radiograph Echocardiography, Doppler Echocardiography,
Transesophageal Echocardiography, Contrast
Echocardiography, Intracardiac Echocardiography,
Computed Tomography (CT), Magnetic Resonance Imaging
(MRI), Stress Testing, Cardiac Catheterization
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

7 Seminar /clinical practice; 3 hours; “Siegenthaler,

Acute Heart Failure Differential Diagnosis
Pulmonary Edema and Cardiogenic Shock in Internal Medicine”,
Chronic Heart Failure
A Comprehensive
Causes of Heart Failure
Cyanosis Study Guide
Hemoglobin Cyanosis
Central Cyanosis: Harrison’s Principles
Peripheral Cyanosis of Internal Medicine
Hemiglobin Cyanosis (20th edition.)
Methemoglobinemia
Pseudocyanosis
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

8 Seminar /clinical practice; 3 hours; “Siegenthaler,

Differential Diagnosis
Edema: in Internal Medicine”,
Generalized Edema
A Comprehensive
Localized Edema:
Study Guide
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with Harrison’s Principles
patients under supervision of lecturer and local staff; of Internal Medicine
(20th edition.)

9 Seminar /clinical practice; 3 hours; “Siegenthaler,

Pericardial effusion Differential Diagnosis
Pleural effusion in Internal Medicine”,
Discussion of the material studied in the lecture, and A Comprehensive
patient cases. Work in the Internal Medicine department with Study Guide
patients under supervision of lecturer and local staff;
Harrison’s Principles

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 of Internal Medicine
(20th edition.)

10 Seminar /clinical practice; 3 hours; “Siegenthaler,

Fever Differential Diagnosis
1. General Remarks: in Internal Medicine”,
 Medical History and Clinical Findings,
A Comprehensive
Differential Diagnostic Considerations, Fever
of Unknown Origin Study Guide
2. Fever without Localized Symptoms
3. Fever with Associated Cardinal Symptoms Harrison’s Principles
Fever with Multiple Organ Involvement of Internal Medicine
Fever in Autoimmune Diseases (20th edition.)
Fever in Immune Deficiencies
Fever in Various Noninfectious Conditions
Significance of Individual Findings for the
Differentiation of Febrile States
Course of the Temperature, Chills, Inflammation
Parameters, Blood Count
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

11 Seminar /clinical practice; 3 hours; “Siegenthaler,

Pulmonary Symptoms Differential Diagnosis
Cough, Expectoration, and Shortness of Breath in Internal Medicine”,
 Cough
A Comprehensive
 Expectoration: Hemoptysis
 Dyspnea: Extrapulmonary Dyspnea: Cardiac Study Guide
Dyspnea, Anemia, Metabolic Acidosis, Panic
Reaction (Hyperventilation), Diseases Characterized Harrison’s Principles
by Extrapulmonary, Restriction, Respiratory of Internal Medicine
Dysregulation (20th edition.)
Respiratory Failure:
o Obstructive Ventilatory Defects
o Restrictive Ventilatory Defects
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

12 Seminar /clinical practice; 3 hours; “Siegenthaler,

Pulmonary Opacities Differential Diagnosis
Infectious Pulmonary Infiltrates (Pneumonias) in Internal Medicine”,
1. Bacterial Pneumonia: Classification
A Comprehensive
2. Clinical Presentation of Bacterial Pneumonias:
Pneumonias Due to Gram-Positive Study Guide

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 Microorganisms , Pneumonias Due to Gram-
Negative Bacteria and Microorganisms not Harrison’s Principles
Identifiable under Light Microscopy , Pneumonia of Internal Medicine
Due to Multiple Gram-Positive and Gram-Negative
(20th edition.)
Organisms (“Mixed Flora”)
3. Pulmonary Tuberculosis
4. Disease Due to Mycobacteria Other Than
Tuberculosis (MOTT)
5. Viral Pneumonia
6. Fungal Pneumonia: Pneumocystis carinii
Pneumonia, Endemic Fungal Infection, Allergic
Bronchopulmonary Aspergillosis and Mycetoma
7. Pulmonary Parasitosis
Noninfectious Pulmonary infiltrates
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

13 Seminar ;1 hours; “Siegenthaler,

Pulmonary Nodules Differential Diagnosis
Solitary Pulmonary Nodules: Malignant Neoplasms, in Internal Medicine”,
Benign Tumors, Inflammatory Pulmonary Nodules,
A Comprehensive
Tuberculoma, Echinococcosis, Pulmonary Nodules of
Various Etiology, Study Guide
Multiple Pulmonary Nodules: Metastasis, Wegener
Granulomatosis, Arteriovenous Aneurysms Harrison’s Principles
Cavernous and Cystic Lung Diseases of Internal Medicine
Tuberculous Cavitary Lesion (20th edition.)
Pulmonary Abscess :,
Lung Cysts
Cavernous and Cystic Lesions of Various Etiologies

Midterm exam; 2 hours

14 Seminar /clinical practice; 3 hours; “Siegenthaler,

 Acute Abdominal Pain Differential Diagnosis
o Acute Abdomen in Internal Medicine”,
o Intestinal Pain: Ileus, Mechanical Ileus, A Comprehensive
Paralytic Ileus, Acute Appendicitis
Study Guide
o Peritoneal Pain: peritonitis
o Pain from Vascular Causes: Mesenteric
Infarction and Abdominal, Angina, Aortoiliac Harrison’s Principles
Steal Syndrome, Aortic Aneurysm, Thrombosis of of Internal Medicine
the Mesenteric and Portal Veins (20th edition.)
o Splenic Pain
o Retroperitoneal Pain
Abdominal Pain from Intoxication and in Systemic
Diseases

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 Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

15 Seminar /clinical practice; 3 hours; “Siegenthaler,

Chronic or Recurring Abdominal Pain Differential Diagnosis
 Pain Originating from the Stomach and Small in Internal Medicine”,
Intestine
A Comprehensive
 Pain Originating from the Colon: Irritable Bowel
Syndrome (IBS) Study Guide
 Pain Originating from Bile Ducts and Liver:
Cholelithiasis, Liver Diseases Associated with Harrison’s Principles
o Cholelithiasis, Complaints after of Internal Medicine
Cholecystectomy, (20th edition.)
Diseases of the Pancreas
Nausea and Vomiting
16 Seminar /clinical practice; 3 hours; “Siegenthaler,
Gastrointestinal Symptoms Differential Diagnosis
Jaundice in Internal Medicine”,
o General Differential Diagnosis of Jaundice
A Comprehensive
o Pathophysiology of Jaundice
Study Guide
o Clinical Symptoms
o Laboratory Parameters
o Imaging Techniques Harrison’s Principles
o Liver Biopsy of Internal Medicine
o Special Differential Diagnosis of Jaundice (20th edition.)
Dysphagia
o Structural Lesions
o Esophageal Motility Disorders
o Mucosal Disease (Odynophagia)
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

17 Seminar /clinical practice; 3 hours; “Siegenthaler,

Diarrhea Differential Diagnosis
o Acute Diarrhea in Internal Medicine”,
o Chronic Diarrhea A Comprehensive
o Diseases with Abnormal Findings on
Study Guide
Endoscopy
o Diseases Without Abnormal Findings on
Endoscopy Harrison’s Principles
o Malassimilation (Maldigestion and of Internal Medicine
Malabsorption) (20th edition.)
o Endocrine and Hormonal Causes of Diarrhea
Constipation
o Acute Constipation

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 o Chronic Constipation
o Temporary Constipation
o Anorectal Dysfunction
o Megacolon and Megarectum
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

18 Seminar /clinical practice; 3 hours; “Siegenthaler,

Hepatomegaly Differential Diagnosis
Splenomegaly in Internal Medicine”,
Ascitices A Comprehensive
Discussion of the material studied in the lecture, and Study Guide
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff; Harrison’s Principles
of Internal Medicine
(20th edition.)

19 Seminar /clinical practice; 3 hours; “Siegenthaler,

Nephrologic Symptoms; Differential Diagnosis
Abnormal Renal Function in Internal Medicine”,
Symptoms and Signs of Altered Renal Function
A Comprehensive
Differential Diagnosis of Pathologic Urine Findings
Differential Diagnosis of Reduced Glomerular Study Guide
Filtration Rate
Acute Renal Failure (ARF) Harrison’s Principles
Chronic Renal Failure (CRF) of Internal Medicine
Differential Diagnosis of Nephrologic Syndromes (20th edition.)
Glomerular Syndromes and Glomerulopathies
Tubulointerstitial Nephritides (TIN)
Urinary Tract Syndromes
Differential Diagnosis of Pathologic
Sonography Findings
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

20 Seminar /clinical practice; 3 hours; “Siegenthaler,

Pain in Joint Diseases Differential Diagnosis
 Inflammatory Rheumatic Joint Disorders: in Internal Medicine”,
Rheumatoid Arthritis, Spondylarthropathies
A Comprehensive
 Arthropathies Associated with Metabolic Diseases,
Other Arthropathies Study Guide
 Degenerative Joint Disorders: Osteoarthritis,
Degenerative Disease of the Spine Harrison’s Principles
 (Ostearthritis of the Intervertebral Joints, of Internal Medicine

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 Spondylosis Deformans) (20th edition.)
 Fibromyalgia . Periarthropathies
Localized Bone Changes : Bone Tumors, Gaucher
Disease, Mastocytosis , Diseases with Hyperostosis,
Osteonecrosis Paget Disease of Bone
Generalized Bone Changes: Osteoporosis ,
Osteomalacia
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

21 Seminar /clinical practice; 3 hours; “Siegenthaler,

Anemia Differential Diagnosis
Microcytic Hypochromic Anemia: in Internal Medicine”,
Iron Deficiency Anemia, Anemia of Chronic Disease,
A Comprehensive
Other Disorders of Iron Metabolism, Disorders of
Hemoglobin Synthesis (Thalassemia), Sideroachrestic Study Guide
Anemia
Macrocytic Normochromic Anemia Harrison’s Principles
Pernicious Anemia, Other Causes of Vitamin B12 of Internal Medicine
Deficiency, Folic Acid Deficiency, Other Causes of (20th edition.)
Macrocytic Anemia
Hyporegenerative Normochromic Normocytic
Anemia
Renal Anemia, Hepatic Anemia, Anemia Associated with
Endocrine Disorders, Aplastic Anemia
Erythroblast Aplasia (Pure Red-Cell Aplasia),
Myelodysplastic Syndrome, Bone Marrow Infiltration,
Plasma Volume Expansion
Hemolytic Anemia
Discussion of the material studied in the lecture, and
patient cases. Work in the Internal Medicine department with
patients under supervision of lecturer and local staff;

22 Seminar /clinical practice; 3 hours; “Siegenthaler,

Water, Electrolyte, and Acid−Base Disorders Differential Diagnosis
 Disorders of Sodium and Water Homeostasis in Internal Medicine”,
a. Physiologic Principles
A Comprehensive
b. Disorders of Volume Homeostasis
(Extracellular Volume Contraction and Study Guide
Expansion)
c. Disorders of Water Homeostasis and Harrison’s Principles
Osmoregulation (Hyponatremia and of Internal Medicine
Hypernatremia) . (20th edition.)
 Disorders of Potassium Homeostasis
a. Physiologic Principles
b. Hypokalemia and Hyperkalemia
Students presentations.

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23 Seminar; 3 hours; “Siegenthaler,
Diagnostic Evaluation of Syncope Differential Diagnosis
 Cardiac Syncope in Internal Medicine”,
 Vascular Syncope
A Comprehensive
Syncope and coma Study Guide
 Cerebral Syncope
o Cerebral Seizures and Epilepsy Harrison’s Principles
o Narcolepsy . of Internal Medicine
o Eclampsia . (20th edition.)
o Abnormal Mental Status Due to a Behavioral
Disorder .
 Coma Due to Metabolic Disorders
o Hypoglycemic Coma
o Diabetic Coma
o Coma Due to Lactic Acidosis
o Other Types of Metabolic Coma

Students presentations.

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