1-2 Principles of family medicine S. Chlabicz
- The definition of a Family Physician
- The characteristics of the discipline of general practice/family medicine
- Differences between outpatient & inpatient medicine
- Different methods of payment for Family Physician services
- Measuring quality in Family Medicine – Quality and Outcomes Framework in General Practice in UK
3-4 Principles of antibiotic use in primary care S. Chlabicz
- Clinically important bacterial pathogens in ambulatory setting
- Empiric antibiotic and aimed antibiotic treatment
- Limitations of aimed antibiotic treatment
- Principles of empirical antibiotic use
- Strategies of antibiotic use (immediate, watch and wait, delayed prescribing)
- Monotherapy and combined therapy with antibiotics (examples of combined therapy)
- Duration of treatment. Single dose antibiotic treatments.
- Allergy to antibiotics (immediate and delayed allergy)
- Clinical rules (scales) when deciding to use antibiotics in RTI’s
- Centor/McIsaac scale
- Additional tests in ambulatory care (CRP, radiology, serology, antigen detection, microbiology, molecular biology)
- Interpretation of microbiology results (pathogenic versus normal flora)
- Preventive use of antibiotics – examples
- Routes of administration of antibiotics (oral, topical and parenteral)
5-6 Upper and lower respiratory tract infections S. Chlabicz
- Acute otitis media
- Acute sinusitis
- Acute bronchitis
- COPD exacerbations
- How to differentiate between pneumonia and other respiratory tract infections? Clinical rules and non-specific markers (CRP)
- Assessing the severity of CAP. Hospital referral decision rules (CRB-65)
7-8 Bacterial gastrointestinal infections S. Chlabicz
- Travellers’ diarrhoea
- Clostridium difficile infections
- Salmonella infections
- H. pylori infections
9-10 Vaccinations for adults S. Chlabicz
- Pneumococcal Pneumococcal Polysaccharide Vaccine (PPSV23) Recommendations. Pneumococcal Polysaccharide Vaccine Revaccination Algorithm
- Hepatitis B
Postvaccination Serologic Testing
Need for boosters
- Hepatitis A
- Tetanus Diphteria
Tdap Vaccination of Adults
11-12 Prevention and Screening S. Chlabicz
- Levels of prevention (primary, secondary, tertiary)
- Criteria for Screening
- Screening test properties (sensitivity, specificity, positive and negative predictive value)
- Screening tests – advantages and diadvantages
- Guides to Clinical PreventiveServices (U.S. PreventiveServices Task Force) – general rules
- Cancer screening
- Breast cancer
- Cervical cancer
- Prostate cancer
- Metabolic diseases screening (diabetes, osteoporosis)
- Osteoporosis screening – FRAX algorithm, DEXA
- Screening for Chlamydia
- Screening for abdominal aortic anaeurysms
13 Cardiovascular disease screaning S. Chlabicz
- Total risk of CVS event
- Individual risk factors
- SCORE, calculation, limitations
14 Early diagnosis of cancer in primary care S. Chlabicz
Alarm symptoms in people with:
- Heartburn, dyspepsia, swallowing problems (gastric and oesophageal cancer)
- Constipation, loose stools (colon cancer)
- Cough (lung cancer)
- People with low back pain (metastases, bone cancer)
15-16 Anticoagulants to prevent clot formation and extension used in outpatient setting J. Sawicka-Powierza
- Indirect factor Xa inhibitors
- Direct thrombin inhibitors (DTIs)
- Direct factor Xa inhibitor
- Vitamin K antagonists (VKAs)
2. Heparin-induced thrombocytopenia HIT
3. VTE (venous thromboembolism)
- Diagnosis of deep vein thrombosis and pulmonary embolism (Wells scale).
- Treatment of deep vein thrombosis and pulmonary embolism
- Treatment of patients with atrial fibrillation (CHADS2 and CHA2DS2-VASC score)
- A tooth extraction in patients on VKA
17. Care of the dying patients:
- short history of palliative care medicine
- WHO definition of palliative care medicine medical specialization
- aims of palliative care medicine
- interdisciplinary team
- communication between doctor and patient: delivering bad news, positive language during the conversations with the dying patients, prognosticating
- some psychological problems: conspiracy of silence, denial, the importance of hope
18. Management of symptoms in palliative care
- Pain: definition, pain’s questionnaires and scales, types of the pain, basic
- knowledge about the treatment of the pain
- Dyspnea and its palliative treatment
- Nausea/vomiting and their treatment
- Constipation- serious problem especially during the treatment of the pain
19-20 Communication in family medicine. Establishing rapport. Patient education. Interviewing techniques. Primary care versus hospital care - similarities and differences. Iceberg of illness. Alicja Oltarzewska
1. Approach to a patient with gastrointestinal problems in primary care: functional and non-functional diseases of the alimentary tract diagnosis and management of dyspepsia, gastro-esophageal reflux, gastritis and gastric cancer.
- Functional dyspepsia (definition, symptoms and differentiation, diagnosis, treatment);
- Gastritis (diagnostic criteria, Sydneyclassification – general principles, possibilities of treatment);
- Gastric cancer (early gastric cancer (EGC) – definition, diagnostic possibilities, treatment of EGC (and advanced stage);
- Diagnosis and management of irritable bowel syndrome, inflammatory bowel diseases and colon cancer W. Łaszewicz
- Irritable bowel syndrome (IBS) (definition, symptoms, diagnostic criteria and differentiation, treatment);
- Inflammatory bowel diseases – CU and CD (diagnostic criteria and differentiation, treatment);
- Coloncancer – (screening, symptoms, diagnosis and differentiation, treatment, prevention)
3. Management of Vitamin K Antagonists (VKAs) J Sawicka-Powierza
- Genetic and environmental factors modified VKAs effect.
- Management of Nontherapeutic INRs
- Managament patients on VKA with low, moderate and high risk of thromboembolism who require temporary interruption of VKA before invasive procedure
- Choice of screening test in adults S. Chlabicz
- See lectures
- Depression, Insomnia, Anxiety J. Strumiło
- etiology: genetics, stressors, psychosocial risk factors, exposure to pharmacologic agents
5) symptoms and diagnosis: DSM-IV criteria for MDD
6) depression scales and inventories
7) depression in Primary Care -common complaints
8) morbidity and mortality
a) risk factors
b) primary care prevention of suicide
10) treatment of depression in Primary Care-clinical response and duration of treatment
11) pharmacological treatment of depression
12) SSRIs- characteristics
13) psychotherapy in treatment of depression
14) other therapies in treatment of depression
15) treatment-resistant depression
16) antidepressants and the elderly
17) antidepressants and pregnancy
18) groups of patients who need hospitalization
19) patient education in depression
- health consequences
- precipitating factors
- sleep hygiene
- pharmacologic treatment of insomnia
- NBBRAs- characteristics
- precautions using sedative hypnotics
- acute anxiety - symptoms, treatment of acute anxiety attacks
- Empirical use of antibiotics S. Chlabicz
- Use of medications in chronic conditions S. Chlabicz
Pharmacolological treatment of:
- Ischaemic heart disease
- Post MI care
- Cardiac failure
- Permanent atrial fibrillation
- Erectile dysfunction
- Nicotine dependance
3. Diabetes mellitus: Diagnosis, diagnostic tests, screening A. Gryko
- Routine medical visit of diabetic patient in family doctor’s office (lab
- tests, specialist consultations, vaccinations, self-management)
3.Prevention of diabetic foot
4.Oral diabetic medications (stages of treatment, dosage, the most common side effects and contraindications)
5. Insulin therapy: when necessary in t 2 Diabetes and how to start the treatment
6. The goals of treatment of diabetes t 2: what values are the target (HbA1C, blood
glucose self-management, lipids, RR)
4. Eye and ear examination J Sawicka-Powierza
- Classification of Diabetic Retinopathy
- Classification of Hypertensive retinopathy
- The crossing syndrome (Gunn)
- Principles of otoscopic examination
- Typical otoscopic findings in: middle ear infection, wax, otitis externa, perforation of ear drum
5. Alkohol abuse, nicotine addiction
1.Define patterns of alkohol consumption: low risk drinking, hazardous, harmful
and binge drinking.
2.What is European definition of unit of alcohol?
3.What diagnostic tools do you know helpful to recognize misuse of alcohol?
4.What amounts of wine, beer and vodka are the equivalents of one unit of
5.Clinical representations of harmful drinking: facts from patients medical
history, symptoms, syndromes, diseases, lab tests.
1. Evidence relationship between smoking and a cancer.
2.Evidence relationship between smoking and non-cancer disease in adults.
3. Why passive smoking is dangerous?
4. How to asses nicotine dependence?
5. What are the methods of pharmacotherapy of nicotine addiction?
6. When pharmacotherapy is recommended?
6.Spirometry Alicja Oltarzewska
- Why doctors perform spirometry?
- What are essential features of obstruction and restriction in spirogram?
- Definitions of FVC and FEV1.
- How to perform bronchodilator reversibility test?
- When bronchodilator reversibility test is considered significant?
- What are the most common mistakes made by patients during spirometry?
- Criteria of good spirometry reproducibility.
7. The hospice program and its services B. Klim
- Different kinds of the services in palliative care medicine and requirements
- according WHO
- Practical skills:
- pain treatment, practical aspects of the measure of the pain, different
- kinds of the medications, breakthrough pain
- superior vena cava syndrome
8. Urethral catheterization M. Chlabicz
1. Indication for urethral catheterization.
2. Contraindication for urethral catheterization.
3. Equipment for urethral catheterization.
4. Types of catheters.
9. Electrocardiography M. Chlabicz
1. Duration and amplitude of the waves in normal ECG (P wave, PR interval, QRS, QT interval, QTc interval).
2. The criteria for right atrial enlargement.
3. The criteria for left atrial enlargement.
4. The criteria for left ventricular hypertrophy.
5. The criteria for right ventricular hypertrophy.
6. Localization of myocardial infarction.
7. The criteria for atrioventricular blocks.
8. The criteria for right bundle-branch block (complite und uncomplite).
9. The criteria for left bundle-branch block (complite und uncomplite).
10. The criteria for left anterior divisional block (LAH).
10. Chest pain
1. The common causes of chest pain.
2. The criteria for tipical pain in stable angina pectoris.
3. The criteria for pain in Prinzmetal's angina.
4. The criteria for pain in acute myocardial infarction.
5. The criteria for pain in pericarditis.
6. The criteria for pain in gastroesophageal reflux.
7. The criteria for pain in costochondritis or in cervical spine disease.
8. Pulmonary causes of chest pain.
11.Care of the newborn.
2. The newborn reflexes
3. The hip examination
5. Prophylaxis of rikets and bleeding
7. Postnatal development
12. Drug administration.
1. Calculating doses
2. Oral versus parenteral rout
3. Complications of intramuscular injection
4. Contraidications to im injection
13.Pediatric cases (M. Chabowska)
1.Assesing child with feverish illness
2.Traffic light system
3.Detection of fever
4.Ways of reducing temperature( Reye’s syndrome)
5.Symptoms of UTI
6.Signs of dehydration
7.When should we prescribe antibiotics?
8.Tonsillitis, pneumonia, slapped cheek disease, infectious mononucleosis, Kawasakisyndrome, rubella, mumps, measles, meningococcal septicaemia
14.Emergencies in Primary Care (J. Strumiło)
1. Cases of patients with emergencies in Primary Care:
a) myocardial infarction complicated with pulmonary oedema.
c) vasovagal syncope
e) child bitten by a dog
c) causes of the hypoglycemic episode
d) management in a conscious patient
an unconscious patient
a) precipitant factors
b) anamnesis and physical examination
c) red flag symptoms in syncope
d) treatment and management
d) treatment (eg adrenaline dosage)
5. Dyspnea :
b) most common causes of dyspnea
c) epiglottitis vs laryngotracheobronchitis
d) asthma - symptoms, differentiation, treatment of exacerbation
e) COPD - symptoms of exacerbation, treatment
b) diagnostic considerations
c) potential complications
d) seizure management
f) febrile seizures - characteristics, management
15.Low back pain M.CHABOWSKA
2.Classification of back pain( acute,chronic)
5.Groups of drugs used in treatment of low back pain
6.Nerve root pain
7.Non – specific low back pain
8.Spinal cord compression
9.Cauda equina syndrome
11.Compression fracture of the spine (risk factors of osteoporosis)
16. Children Immunizations
- Common adverse effects.
- Concerns about the safety of the vaccines.
- Number of doses a child needs.
- Postexposure vaccination.
- Characteristics of the particular vaccines:
- meningococcal vaccine
- rotavirus vaccine
- varicella vaccine
- influenza vaccine
- Vaccinations before pregnancy.
- Comparing Polish/Norwegian/Swedish/US vaccination schedule.
- Cases-what vaccines do they need?
- Risk factors for hepatitis A, hepatitis B, meningitis, pneumococcal disease.
- CDC self-test on vaccinations- what vaccines different groups of patients need.