Jordan University of Science and Technology

Faculty of Medicine
Department of Internal Medicine
Core Curriculum for 4
th
year Medical Students
--------------------------------------------------------------------------------------------
Course Title: General Medicine
Course Code: M422
Credit Hours: 9 Credits
Calendar Description: 10 Weeks/Year 4
Course Coordinator: Dr. Shaher Samra
I. Goal of the Course: to nderstand the clinical correlation o! "asic science
kno#led$e and to ac%ire !rther medical in!ormation and clinical skills
necessar& !or nderstandin$ and mana$ement o! commonl& encontered
medical 'ro"lems and diseases o! adlt 'atients
II. General objectives:
(& the end o! this corse) stdents are e*'ected to:
1. +c%ire essential kno#led$e a"ot common diseases a!!ectin$ ,arios
or$an s&stems
2. -ake 'ro'er clinical histor&) condct 'ro'er clinical e*amination) and
detect 'h&sical si$ns o! common medical illnesses
.. Generate a 'ro"lem list or di!!erential dia$nosis !or common medical
'ro"lems
4. /n,esti$ate common medical 'ro"lems in a rationale #a&
0. (ild ' 'ro'er relations #ith collea$es) 'atients) sta!! mem"ers)
nrses) and technicians #orkin$ in the hos'ital
III. Methods of Instruction
(edside teachin$ sessions
Seminars
1ectres
1
IV. Evaluation and Distribution of Marks
1. /n-corse e,alation: 20 2
2. 3inal Clinical 4*am 56SC47: 40 2
.. 3inal Written 4*am 5MC8s7: 40 2
V. eco!!ended Te"tbooks
1. Davidsons principles and Practice of Medicine) -#entieth 4dition
2. Kumar and Clark Clinical Medicine) 3i!th 4dition
.. McLeods Clinical Examination
2
#no$led%e &reas
'''''''''''''''''''''''''''''''''''''''''''''''''''

C&DI(V&)C*+& ),)TEM
I. #no$led%e-Mi" of Diseases-.atients
+. /schemic heart disease: nsta"le an$ina and m&ocardial in!arction
(. 9eart !ailre
C. Con$enital heart disease #ith onset o! mani!estations in the adlt
D. :al,lar heart disease;cases
4. Clinical dia$nosis o! rhematic !e,er
3. 9&'ertension: essential and secondar&
G. <ericarditis
9. +rrh&thmias
1. Distinction "et#een ,entriclar and s'ra,entriclar rh&thms
2. +trial !i"rillation) atrial !ltter
.. 9eart "lock 1
o
) 2
o
) .
o
4. (ndle "ranch and hemi"locks
0. Main s'ra,entriclar tach&cardias
II. Histor/ )kills

+. 6"tain histor& o! risk !actors !or coronar& arter& disease
(. 6"tain histor& !or rhematic !e,er or con$enital heart disease
C. =eco$ni>e im'ortance o! !amil& histor& in assessment o! cardio,asclar
disease
D. ?se all modalities in @'ain@ histor& to distin$ish coronar& arter& disease
!rom other cases o! chest 'ain
4. /n h&'ertensi,e 'atient) o"tain care!l histor& o! medication com'liance

III. .h/sical E"a! )kills
+. Determine ,enos 'ressre "& e*amination o! neck ,eins
(. +ssess arterial 'lses and reco$ni>e 'lss alternans) "is!eriens 'lse)
and 'arado*ical 'lse
C. <er!orm he'atoA$lar re!l* test to assess ,enos 'ressre
.
D. 6n cardiac ascltation) reco$ni>e:
1. S&stolic and diastolic mrmr--e!!ects o! 'h&siolo$ic and
'harmacolo$ic inter,entions
2. <ericardial !riction r"
4. 6n cardiac ascltation) reco$ni>e:
1. S-1) S-2) and normal 'h&siolo$ic s'littin$
2. S-.) S-4) and ho# the& are "est a''reciated
.. S&stolic and diastolic mrmr--e!!ects o! 'h&siolo$ic and
'harmacolo$ic inter,entions
4. S'ecial characteristics o! the mrmr o! M:< and 9CM
0. <ericardial !riction r"
IV. Dia%nostic Tests
+. =eco$ni>e a normal 4BG and common 4BG a"normalities
(. =eco$ni>e a normal Chest C-ra&
V. Therapeutic Interventions
+. Bno# thera'etic indications !or an$io'last& and other thera'etic
a''lications o! catheteri>ation
(. Descri"e thera'etic a''roach to clinical s&ndromes descri"ed in /.

DI)E&)E) (0 THE #ID1E, &1D *I1&, T&CT
I. #no$led%e-Mi" of Diseases-.atients
+. +cte renal !ailre---he stdent mst distin$ish 'rerenal) renal) and 'ost
renal disease sin$ clinical and la"orator& 'arameters
(. Chronic renal !ailre and its associated meta"olic-endocrine) G/)
cardio,asclar hematolo$ic) and neromsclar com'lications
C. -he maAor $lomerlo'athies
D. -"lointerstitial disease
4. :asclar inAr&
II. Histor/ )kills
4
/n the 'atient #ho 'resents #ith a 'ro"lem o! the rinar& tract) the stdent
#ill determine "& histor&:
+. 3re%enc& and ,olme o! rine 5'ol&ria) oli$ria) anria7
(. ?rine color) hematria
C. D&sria) diminished stream
D. 4!!ects o! ne'hroto*ic dr$s or dr$s that e!!ect "ladder em't&in$ or
rine color
4. -he clinical s&ndrome o! remia
III. .h/sical E"a! )kills
+. =eco$ni>e si$ns o! remia--co$niti,e) asteri*is) odor o! "reath
(. +scltate !or "rits
C. +ttem't to 'al'ate !or kidne&s
D. <ercss "ladder si>e
IV. Dia%nostic Tests
-he stdent shold "e a"le to:
+. Calclate !ractional e*cretion o! sodim as a measre o! 'rerenal ,s 'ost
renal a>otemia
(. 4,alate the 'atient #ith $lomerlone'hritis !or mltis&stem disease
C. Choose the most a''ro'riate ima$in$ test !or the s'eci!ic 'atient 'ro"lem
V. Therapeutic Interventions
-he stdent shold "e a"le to:
+. Mana$e the 'atient #ith acte renal !ailre and kno# all indications !or
dial&sis
(. =eco$ni>e the 'ossi"ilit& o! rinar& tract o"strction
DI)(DE) (0 THE E).I&T(, ),)TEM
I. #no$led%e-Mi" of Diseases-.atients
+. Diseases o! air!lo# limitation
1. +sthma
2. (ronchitis
.. 4m'h&sema
0
4. (ronchiectasis
0. C&stic !i"rosis
(. /nterstitial ln$ diseases
1. 6cc'ational ln$ disease
2. 9&'ersensiti,it& 'nemonias
.. Sarcoidosis
4. /dio'athic 'lmonar& !i"rosis
C. /n!ectios ln$ diseases
1. Commnit& ac%ired 'nemonia
2. Dosocomial 'nemonias
.. -"erclosis
D. <lmonar& ,asclar ln$ diseases
1. <lmonar& throm"oem"olism
2. <lmonar& h&'ertension
.. Doncardio$enic 'lmonar& edema 5+=DS7
4. Deo'lastic disease o! the ln$
1. (roncho$enic carcinoma
2. <araneo'lastic s&ndromes
3. Diseases o! the 'lera
1. <leral e!!sion
2. <nemothora*
II. Histor/ )kills
+. Correctl& characteri>e res'irator& s&m'toms o! d&s'nea) co$h) and
e*'ectoration
(. 6"tain care!l histor& o! accidental or occ'ational e*'osre to 'otential
ln$ to*ins
C. 6"tain a 'recise histor& o! to"acco se) incldin$ 'assi,e ci$arette smoke
D. 6"tain !amil& histor& !or c&stic !i"rosis) em'h&sema) asthma)
t"erclosis) colla$en ,asclar diseases) and ln$ neo'lasm
4. 6"tain histor& o! dr$ e*'osre and medication se
3. Determine risk !actors !or 9/: and -(
III. .h/sical E"a! )kills

+. 4*amine the chest "& ins'ection
1. /denti!& a"normal res'irator& 'atterns
2. =eco$ni>e !indin$s s$$estin$ 'lmonar& disease sch as de,iated
trachea) di$ital cl""in$
E
(. 4*amine the chest "& 'al'ation
1. +''reciate the si$ni!icance o! s'racla,iclar adeno'ath&)
cre'itation) and tenderness
C. 4*amine the chest "& 'ercssion
1. Distin$ish normal and a"normal resonance
2. 3rther de!ine areas o! dllness "& s'ecial mane,ers sch as ,ocal
and tactile !remits
D. 4*amine the chest "& ascltation
1. =eco$ni>e normal "reath sonds and characteri>e
2. =eco$ni>e ad,entitios "reath sonds sch as crackles) rhonchi)
and #hee>es
.. ?nderstand the dia$nostic im'lications o! the ad,entitios sond
IV. Dia%nostic Test )kills

+. -he stdent shold "e a"le to:
1. /nter'ret arterial "lood $ases
2. ?nderstand the se o! the 'lse o*&meter
.. /nter'ret s'irometr& incldin$ 3lo#-:olme loo's
4. /nter'ret the chemical 'ro!ile o! 'leral e!!sions
(. -he stdent shold nderstand the indications !or:
1. <lmonar& !nction tests
2. -horacentesis
.. <leral "io's&
V. Therapeutic )kills

+. -he stdent mst "e !amiliar #ith the $eneral mana$ement o! all diseases
listed in /.
(. -he stdent shold "e a"le to:
1. Correctl& select antimicro"ial a$ents !or res'irator& in!ection
2. =eco$ni>e a si$ni!icant reaction to <<D
.. Bno# the indications and side e!!ects !or the commonl& sed
medications in 'lmonar& medicine

E1D(CI1(+(G, &1D MET&2(+I)M
I. #no$led%e-Mi" of Diseases-.atients
F

+. Diseases o! the 'ititar&
1. Dia"etes insi'ids
2. <ititar& tmors
a. +crome$al&
". Cshin$ Disease
c. <rolactinoma
.. 9&'o'ititarism
4. 4m't& Sella S&ndrome
(. -h&roid disease
1. 9&'oth&roidism cases
2. 9&'erth&roidism
a. Gra,es disease
". -o*ic mltinodlar $oiter
c. -o*ic adenoma
d. 3actitios
.. -h&roiditis
a. Chronic th&roiditis 59ashimotoGs7
". S"acte th&roiditis 5'ain!l and 'ainless7
4. +''roach to th&roid nodle
C. Diseases o! the adrenal corte*
1. Cshin$ S&ndrome
2. 9&'eraldosteronism
.. +ddisonGs Disease
D. <heochromoc&toma
4. Dia"etes mellits
1. Dia$nosis
2. Classi!ication and 'atho$enesis
.. Clinical !eatres
4. Com'lications
0. -reatment
a. Diet
". /nslin
c. 6ral a$ents
3. 9&'o$l&cemia
1. 3astin$
2. =eacti,e
G. Disorders o! the 'arath&roid $land and o! calcim meta"olism
9. Meta"olic "one disease
1. 6steo'orosis
H
2. 6steomalacia
.. <a$etGs
4. =enal osteod&stro'h&

II. Histor/ )kills

+. Demonstrates kno#led$e necessar& to take a 'ro'er histor& !or a 'atient
ss'ected o! ha,in$ an endocrine or meta"olic disorder.
(. /n a 'atient #ith dia"etes mellits) the stdent mst o"tain and 't in
chronolo$ical order a detailed histor& o! the disease) incldin$ all
com'lications) hos'itali>ations) medications.
III. .h/sical E"a!

+. Bno# im'ortance o!:
1. Wei$ht
2. 9ei$ht
.. Skeletal 'ro'ortions
(. =eco$ni>e e*o'hthalms and a"normal oclar motilit&
C. 4,alate th&roid si>e) nodlarit&) tenderness) and "rit
D. 4,alate skin-tem'eratre) moistre) 'i$mentation) 'reti"ial m&*edema)
dia"etic dermo'ath&
4. 4,alate %alit& o! ,oice
3. 4,alate te*tre and 'attern o! hair
G. =eco$ni>e dia"etic retino'ath&

IV. Dia%nostic )kills

+. ?nderstand the se o! th&roid !nction tests
(. Descri"e the tests necessar& to dia$nose diseases listed in /.

V. Therapeutic Interventions
+. ?nderstand the indications) side e!!ects) and ad,erse reactions !or each o!
the !ollo#in$:
1. 1-th&ro*ine
2. Glcocorticoids
.. +ntith&roid dr$s
4. 6ral h&'o$l&cemics
0. /nslin 5all !orms7
9
G&)T(E1TE(+(G,
I. #no$led%e-Mi" of Diseases-.atients

+. Diseases o! the eso'ha$s: anatomic and motor cases o! eso'ha$itis
5G4=D7
(. 9 <&lori and <?D
C. Disorders o! a"sor'tion
D. /n!lammator& "o#el disease
4. 1i,er and "iliar& tract disease
1. +cte and chronic he'atitis
2. Cirrhosis and alcoholic li,er disease
.. +''roach to 'atients #ith a"normal 13-s
3. <ancreatic diseases
1. +cte 'ancreatitis
2. Chronic 'ancreatitis
.. <ancreatic cancer
4. 4ndocrine tmors
II. Histor/ )kills

/n o"tainin$ histor& !rom a 'atient #ith a G/ com'laint:
+. Descri"e all characteristics o! a"dominal 'ain
(. =eco$ni>e 'otential im'ortance o! !amil& histor& and medication histor&
and G/ side e!!ects o! all dr$s
C. 9istor& o! diet) #ei$ht) !ood intolerance) "o#el 'attern) and "leedin$
D. Com'are and contrast histor& o! in!lammator& "o#el disease ,s. irrita"le
"o#el s&ndrome
4. <recise histor& takin$ in G4=D and d&s'ha$ia
III. .h/sical E"a! )kills

+. Stdents mst do com'lete e*am o! a"domen and rectal e*am incldin$:
1. +scltation !or "o#el sonds and "rits
2. <ercssion !or li,er si>e
.. <al'ation !or s'leen
(. =eco$ni>e need !or additional 'h&sical e*am mane,ers sch as:
1. Shi!tin$ dllness and !lid #a,e #hen ascites is ss'ected
10
2. Mr'h&Gs si$n !or ri$ht ''er %adrant 'ain or tenderness
.. 4licitin$ si$ns o! 'eritonitis
4. <er!orm rectal di$ital e*am and check !or !ecal "lood

IV. Dia%nostic )tudies
+. Bno# indications !or 'aracentesis
(. Bno# indications !or 'lacement o! naso$astric t"e
C. <ro'erl& inter'ret the !ollo#in$ la"orator& tests:
1. Serolo$ic stdies !or ,iral and atoimmne he'atitis
2. 1i,er !nction tests
V. Therapeutic )kills
+. -he stdent shold kno# indications) side e!!ects) interactions and
!ollo#-' !or the most commonl& sed G/ medications 5e.$. <</s) 1a*ati,es)
<rokinetic a$ents7

HEM&T(+(G,
I. #no$led%e-Mi" of Diseases-.atients

+. <atho'h&siolo$& o! anemia
(. +nemia o! chronic disease
C. /ron de!icienc& anemia
D. Me$alo"lastic anemia
4. 9emol&tic anemias 5con$enital and ac%ired7
3. M&elo'roli!erati,e disorders
G. 1ekemias 5acte and chronic7
9. 1&m'homa 59od$kins) non-9od$kins and 'lasma cell m&eloma7
/. Clottin$ disorders
1. <latelet and ,essel #all
2. Coa$lation and throm"osis
.. 9&'ercoa$la"le state
II. Histor/ )kills
+. Bno#in$ 'resentin$ si$ns o! anemia
(. =eco$ni>e that di>>iness) shortness o! "reath) headache) e*ercise
intolerance) and sensiti,it& to cold ma& "e 'resentin$ s&m'toms o! anemia
11
C. =eco$ni>e that s&m'toms o! an$ina) cladication) -/+ ma& "e nmasked
"& anemia
D. =eco$ni>e the ,ale o! re,ie#in$ all 're,ios hematolo$ic la" data in
e,alation o! hematolo$ic disorders
4. =eco$ni>e s&m'toms o! 'latelet disorders 5s'ontaneos mcoctaneos
"leedin$) immediate "leedin$ #ith tri,ial trama7 ,erss s&m'toms o!
clottin$-!actor de!icienc& 5dela&ed "leedin$) dee' msclar hematomas)
hemarthroses7
3. =eco$ni>e the im'ortance o! @(@ s&m'toms 5!e,er) ni$ht-s#eats) #ei$ht
loss7 in 'atients #ith l&m'homa
G. =eco$ni>e the im'ortance o! the !amil& histor& in 'atients #ith anemia
and coa$lation disorders

III. .h/sical Dia%nosis )kills

+. =eco$ni>e ecch&motic or 'etechial rash
(. <al'ate all l&m'h node areas) s'leen and li,er
IV. Dia%nostic )kills
+. Bno# the ,ale o! the !ollo#in$ tests in the #ork-' o! a 'atient #ith
hemol&tic anemia:
1. (lood smear re,ie#
2. =eticloc&te cont
.. Coom"s test
4. Serm ha'to$lo"in
0. Glcose E 'hos'hate deh&dro$enase de!icienc&
E. 9emo$lo"in electro'horesis
F. ?rine hemosiderin
(. Bno# the 'ro'er e,alation !or "leedin$ disorder

V. Therapeutic Interventions

+. Bno# the a''ro'riate indications !or trans!sion o! er&throc&tes and
'latelets
(. Bno# indications !or !resh !ro>en 'lasma) cr&o'reci'itate) and 'ri!ied
!actor concentrates
I10ECTI(*) DI)E&)E)
12
I. #no$led%e-Mi" of Diseases-.atients
+. Clinical s&ndromes
1. Gram-ne$ati,e se'sis
2. /n!ecti,e endocarditis
.. ?''er and lo#er res'irator& in!ections
4. ?rinar& tract in!ections
0. So!t tisse in!ection
E. -"erclosis
F. M&co'lasma 'nemoniae 'nemonia
(. :iral in!ection
1. /n!len>a and 're,ention
2. 9er'es in!ection)
.. 9e'atitis +) ( and C
C. 3e,er o! nkno#n ori$in

II. Histor/ )kills

+. Demonstrate at "edside a"ilit& to elicit histor& #ith s'ecial attention to
rele,ant tra,el and residential histor&) animal contact) #ork and recreational
acti,it&) dr$ se and se*al histor&
(. 4licit an& co-e*istin$ disease #hich ma& "e rele,ant to 'atho$enesis o!
in!ection

III. .h/sical E"a!ination

+. Demonstrate a"ilit& to 'er!orm thoro$h 'h&sical e*am in e!!ort to
determine sorce o! in!ection
(. =eco$ni>e skin lesions #hich ma& 'ro,ide dia$nostic cles to etiolo$& o!
in!ection
C. =eco$ni>e !e,er 'atterns and their 'ossi"le dia$nostic indications
D. <er!orm Berni$ and (rd>inski tests in e,alatin$ !or menin$itis

IV. Dia%nostic Tests
+. 6"tain s'tm on 'atients #ith 'nemonia
(. /nter'ret "od& !lid reslts 5CS3) 'leral) 'eritoneal) Aoint7
V. Therapeutic Interventions
1.

+. Choose a''ro'riate anti"iotic re$imens !or most common in!ections
(. Bno# maAor side e!!ects o! anti"iotics
HE*M&T(+(G,
I. #no$led%e

+. Clinical mani!estations o! S14
(. =hematoid arthritis
C. Scleroderma
D. Mi*ed connecti,e tisse disease
4. SAo$renGs s&ndrome
3. +nk&losin$ s'ond&litis
G. :asclitic s&ndromes
9. Sarcoidosis
/. 6steoarthritis
I. <soriatic arthritis and arthritis associated #ith G/ diseases
B. 3M3
1. (ehcetJs disease
M. Got
II. Histor/ )kills

+. Demonstrate a"ilit& to elicit histor& o! mltis&stem disease. Bno#
im'ortance o! e*tra-articlar s&m'toms sch as rash) ,eitis) a'hthos
lcers) alo'ecia) 'leritic 'ain
(. /n 'atient #ith Aoint disease) determine 'resence or a"sence o! mornin$
sti!!ness) redness) heat) s#ellin$) restricted mo,ement
III. .h/sical E"a! )kills

+. Bno# the 'h&sical !indin$s associated #ith each o! the diseases listed in
/.
(. 4,alate each Aoint !or s#ellin$) er&thema) tenderness) cre'itation)
contractre) de!ormit&.
C. Determine ran$e o! motion and com'are to normal. /denti!& 9e"erden
node) (ochard node) lnar de,iation) S#an neck de!ormit&.
D. Demonstrate Aoint e!!sion.
14
4. 4*amine the s'ine. 4,alate chest e*'ansion !or s'ond&litis.
IV. Dia%nostic Tests
-he stdent shold "e a"le to:
+. Bno# the "asics o! dia$nostic Aoint as'iration
(. Bno# #hen to order the !ollo#in$ tests: rhematoid !actor) anti DD+)
anti SM) anti =D<) anti =6 5SS+7) anti 1+ 5SS(7) +DC+
V. Therapeutic Interventions

+. Bno# $eneral treatment o'tions !or all diseases listed in /
'End'
10