Uniwersytet Medyczny w Białymstoku. Issues covered by Family Medicine Curriculum.
  • Issues covered by Family Medicine Curriculum.
  • Ostatnia zmiana 17.01.2024 przez Zakład Medycyny Rodzinnej

    Issues covered by Family Medicine Curriculum


    1-2 Principles of family medicine S. Chlabicz

    1. The definition of a Family Physician
    2. The characteristics of the discipline of general practice/family medicine
    3. Differences between outpatient & inpatient medicine
    4. Different methods of payment for Family Physician services
    5. 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

    1. Clinically important bacterial pathogens in ambulatory setting
    2. Empiric antibiotic and aimed  antibiotic treatment
    3. Limitations of aimed antibiotic treatment
    4. Principles of empirical antibiotic use
    5. Strategies of antibiotic use (immediate, watch and wait, delayed prescribing)
    6. Monotherapy and combined therapy with antibiotics (examples of combined therapy)
    7. Duration of treatment. Single dose antibiotic treatments.
    8. Allergy to antibiotics (immediate and delayed allergy)
    9. Clinical rules (scales) when deciding to use antibiotics in RTI’s
    10. Centor/McIsaac scale
    11. Additional tests in ambulatory care (CRP, radiology, serology, antigen detection, microbiology, molecular biology)
    12. Interpretation of microbiology results (pathogenic versus normal flora)
    13. Preventive use of antibiotics – examples
    14. Routes of administration of antibiotics (oral, topical and parenteral)


    5-6 Upper and lower  respiratory tract infections S. Chlabicz

    Management of:

    1. Pharyngitis/tonsillitis
    2. Acute otitis media
    3. Acute sinusitis
    4. Acute bronchitis
    5. COPD exacerbations
    6. CAP 
    7. How to differentiate between pneumonia and other respiratory  tract infections? Clinical rules and non-specific markers (CRP)
    8. Assessing the severity of CAP. Hospital referral decision rules (CRB-65)


    7-8 Bacterial gastrointestinal infections S. Chlabicz

    Management of:

    1. Travellers’ diarrhoea
    2. Clostridium difficile infections
    3. Salmonella infections
    4. H. pylori infections


    9-10 Vaccinations for adults S. Chlabicz

    1. Pneumococcal Pneumococcal Polysaccharide Vaccine (PPSV23) Recommendations. Pneumococcal Polysaccharide Vaccine Revaccination Algorithm
    2. Influenza
    3. Hepatitis B

    Postvaccination Serologic Testing

    Long-Term Efficacy

    Need for boosters

    1. Hepatitis A
    2. Tetanus Diphteria
    3. Pertussis

    Tdap Vaccination of Adults


    11-12 Prevention and Screening S. Chlabicz

    1. Levels of prevention (primary, secondary, tertiary)
    2. Criteria for Screening
    3. Screening test properties (sensitivity, specificity, positive and negative predictive value)
    4. Screening tests  – advantages and diadvantages
    5. Guides to Clinical PreventiveServices (U.S. PreventiveServices Task Force) – general rules
    6. Cancer screening
    7. Breast cancer
    8. Cervical cancer
    9. Colon cancer
    10. Prostate cancer
    11. Metabolic diseases screening (diabetes, osteoporosis)
    12. Osteoporosis screening – FRAX algorithm, DEXA
    13. Screening for Chlamydia
    14. Screening for abdominal aortic anaeurysms


    13 Cardiovascular disease screaning S. Chlabicz

    1. Total risk of CVS event
    2. Individual risk factors
    3. SCORE, calculation, limitations


    14 Early diagnosis of cancer in primary care S. Chlabicz

    Alarm symptoms in people with:

    1. Heartburn, dyspepsia,  swallowing problems (gastric and oesophageal cancer)
    2. Constipation, loose stools (colon cancer)
    3. Cough (lung cancer)
    4. People with low back pain (metastases, bone cancer)


    15-16 Anticoagulants to prevent clot formation and extension used in outpatient setting J. Sawicka-Powierza

    1. Anticoagulants
      1. Indirect factor Xa inhibitors
      2. Direct thrombin inhibitors (DTIs)
      3. Direct factor Xa inhibitor
      4. Vitamin K antagonists (VKAs)

    2. Heparin-induced thrombocytopenia HIT

    3. VTE (venous thromboembolism)

    1. Diagnosis of deep vein thrombosis and pulmonary embolism (Wells scale).
    2. Treatment of deep vein thrombosis and pulmonary embolism
      1. Treatment of patients with atrial fibrillation (CHADS2 and CHA2DS2-VASC score)
      2. A tooth extraction in patients on VKA


    17. Care of the dying patients:

    1.  short history of palliative care medicine
    2. WHO definition of palliative care medicine medical specialization
    3. aims of palliative care medicine
    4. interdisciplinary team
    5. communication between doctor and patient: delivering bad news, positive language during the conversations with the dying patients, prognosticating
    6. some psychological problems: conspiracy of silence, denial, the importance of hope


    18. Management of symptoms in palliative care

    1. Pain: definition, pain’s questionnaires and scales, types of the pain, basic
      1. knowledge about the treatment of the pain
    2. Dyspnea and its palliative treatment
    3. Nausea/vomiting and their treatment
    4. 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 W. Łaszewicz

    1. Functional dyspepsia (definition, symptoms and differentiation, diagnosis, treatment);
    2. Gastritis (diagnostic criteria, Sydney classification – general principles, possibilities of treatment);
    3. Gastric cancer (early gastric cancer (EGC) – definition, diagnostic possibilities, treatment of EGC (and advanced stage);

    2. Diagnosis and management of irritable bowel syndrome, inflammatory bowel diseases and colon cancer W. Łaszewicz

    1. Irritable bowel syndrome (IBS) (definition, symptoms, diagnostic criteria and differentiation, treatment);
    2. Inflammatory bowel diseases – CU and CD (diagnostic criteria and differentiation, treatment);
    3. Colon cancer – (screening, symptoms, diagnosis and differentiation, treatment, prevention)


    3.  Management of Vitamin K Antagonists (VKAs) J Sawicka-Powierza

    1. Genetic and environmental factors modified VKAs effect.
    2. Management of Nontherapeutic INRs
    3. Managament patients on VKA with low, moderate and high risk of thromboembolism who require temporary interruption of  VKA before invasive procedure


    4. Choice of screening test in adults S. Chlabicz

    See lectures


    5. Depression, Insomnia, Anxiety J. Strumiło


    1. epidemiology
    2. etiology: genetics, stressors, psychosocial risk factors, exposure to    pharmacologic agents
    3. co-morbidity

    4) pathophysiology

    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

    9) suicide:

            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


    1. efinition
    2. health consequences
    3. precipitating factors
    4. classification
    5. sleep hygiene
    6. psychotherapy
    7. pharmacologic treatment of insomnia
    8. NBBRAs- characteristics
    9. precautions using sedative hypnotics


    Anxiety disorders

    1. classification
    2. treatment
    3. acute anxiety -     symptoms, treatment of acute anxiety attacks



    1      1. Empirical use of antibiotics S. Chlabicz

    See lectures

    2. Use of medications in chronic conditions S. Chlabicz

    Pharmacolological treatment of:

    1. ypertension
    2. Ischaemic heart disease
    3. Post MI care
    4. Cardiac failure
    5. Permanent atrial fibrillation
    6. Hyperlipidaemia
    7. Hypothyresois
    8. Migraine
    9. Erectile dysfunction
    10. BPH
    11. COPD
    12. Nicotine dependance


    3. Diabetes mellitus: Diagnosis, diagnostic tests, screening A. Gryko

    1. Routine medical visit  of  diabetic patient in family doctor’s office  (lab
    2. 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

    1. Classification of Diabetic Retinopathy
    2. Classification of Hypertensive retinopathy
    3. The crossing syndrome (Gunn)
    4. Principles of otoscopic examination
    5. Typical otoscopic findings in: middle ear infection, wax, otitis externa, perforation of ear drum


    5.Alkohol abuse, nicotine addiction

    Alcohol abuse

    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.

    Nicotine addiction

    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

    1. hy doctors perform spirometry?
    2. What are essential features of  obstruction  and restriction in spirogram?
    3. Definitions of FVC and FEV1.
    4. How to perform bronchodilator reversibility test?
    5. When  bronchodilator reversibility test  is considered significant?
    6. What are the most common mistakes made by patients during spirometry?
    7. Criteria of  good spirometry reproducibility.


    7.  The hospice program and its services B. Klim

    1. Different kinds of the services in palliative care medicine and requirements
    2. according WHO
    3. Practical skills:
      • pain treatment, practical aspects of the measure of the pain, different
    4. kinds of the medications, breakthrough pain
      • superior vena cava syndrome
      • mourning


    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.
    1.Apgar score
    2. The newborn reflexes
    3. The hip examination
    4. Feeding
    5. Prophylaxis of rikets and bleeding
    6. Vaccinations
    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, Kawasaki syndrome, 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.

    b) anaphylaxis

    c) vasovagal syncope

    d) hypoglycemia

    e) child bitten by a dog


    2. Hypoglycemia:

    a) definition

    b) symptoms

    c) causes of the hypoglycemic episode

    d) management in a conscious patient                    

    an unconscious patient

    3. Syncope:

    a) precipitant factors

    b) anamnesis and physical examination

    c) red flag symptoms in syncope

    d) treatment and management


    4. Anaphylaxis:

    a) definition

    b) causes

    c) symptoms

    d) treatment (eg adrenaline dosage)

    5. Dyspnea :

    a) definition

    b) most common causes of dyspnea

    c) epiglottitis vs laryngotracheobronchitis

    d) asthma - symptoms, differentiation, treatment of exacerbation

    e) COPD - symptoms of exacerbation, treatment

    6. Seizure:

    a) definition

    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)

    3.Red flags

    4.Yellow flags

    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

    10.Bone metastasis

    11.Compression fracture of the spine (risk factors of osteoporosis)


    16. Children Immunizations1.

    Common adverse effects.

    2. Concerns about the safety of the vaccines.

    3. Number of doses a child needs.

    4. Postexposure vaccination.

    5. Characteristics of the  particular vaccines:

      1. BCG
      2. meningococcal vaccine
      3. rotavirus vaccine
      4. varicella vaccine
      5. influenza vaccine

    6. Vaccinations before pregnancy.

    7. Comparing Polish/Norwegian/Swedish/US  vaccination schedule.

    8. Cases-what vaccines do they need?

    9. Risk factors for hepatitis A, hepatitis B, meningitis, pneumococcal disease.

    10. CDC self-test on vaccinations- what vaccines different groups of patients need.