Cardiovascular and respiratory systems — the essentials of the condensed module for 3rd year students.
Medical psychology studies the human and relational dimension of care: how the patient experiences their illness, and how the doctor establishes a quality therapeutic relationship.
The clinical encounter is based on a verbal and non-verbal communication. The doctor must practiceactive listening, theempathy (understanding the feeling without replacing it) and the absence of judgment. The quality of this alliance determines the compliance and effectiveness of the treatment.
The announcement is a structured act (standard protocol SPIKES): choose a quiet place, assess what the patient knows, ask them what they want to know, deliver the information in stages, welcome their emotions, then define a care plan. Lying is prohibited, but information is progressive and adapted.
The stress is an adaptation response (general Selye adaptation syndrome: alarm → resistance → exhaustion) with axis friendly (adrenaline) and axis corticotrope (cortisol). Chronic stress promotes so-called psychosomatic disorders (hypertension, ulcer, asthma, eczema, etc.) where the psyche affects the body.
Empathy, active listening and shared decision-making are at the heart of the care relationship. Delivering bad news follows a protocol. Chronic stress has a neurohormonal substrate (cortisol/adrenaline) and pain is both a physical and psychological experience.
Semiology is the science of signs: collecting, describing and grouping symptoms and signs to arrive at a diagnosis.
| Term | Definition |
|---|---|
| Symptom | Disorder felt and reported by the patient (subjective) — e.g. pain. |
| Sign | Objective manifestation noted by the doctor — e.g. fever, breath. |
| Syndrome | Set of signs/symptoms occurring together. |
| Diagnosis | Disease identification from data. |
| Prediction | Predictable course of the disease. |
It always takes place in the same rigorous order:
The whole thing is recorded in themedical observation, structured written document.
Hypothetico-deductive approach: from the signs, we build diagnostic hypotheses (differential diagnoses), confirmed or ruled out by additional targeted examinations.
BMI = weight (kg) / height² (m). Weight loss < 18.5; normal 18.5–25; overweight 25–30; obesity > 30. We analyze weight loss and weight gain according to their speed and their cause.
Fever = temperature > 38°C. We specify type (continuous, remitting, intermittent), duration and associated signs. Hypothermia < 35°C is also pathological.
Distinguish between symptom/sign/syndrome. The clinical examination always follows the order inspection → palpation → percussion → auscultation, preceded by questioning. Everything ends with a written medical observation.
Recognize the signs of the heart and vessels, then group them into major syndromes (hypertension, angina, heart attack, heart failure, etc.).
Inspection and palpation of peak shock (5ᵉ left intercostal space), then auscultation of the 4 foci (aortic, pulmonary, tricuspid, mitral):
Taking pulse (regularity, symmetry), measurement of blood pressure, looking for edema, jugular turgor and hepatojugular reflux.
| Review | Intake |
|---|---|
| ECG | Rhythm, conduction, ischemia (ST elevation/depression), hypertrophies. |
| Chest x-ray | Cardiomegaly (cardiothoracic index > 0.5), pulmonary overload. |
| Cardiac Doppler ultrasound | Ventricular function (LVEF), valves, pericardium. |
| Biology | Troponin (myocardial necrosis), BNP/NT-proBNP (heart failure), lipid profile. |
BP ≥ 140/90 mmHg. Often silent; major risk factor for stroke, MI and kidney failure.
Myocardial ischemia due to coronary insufficiency. The acute coronary syndrome includes unstable angina and infarction (with or without ST elevation).
Myocardial necrosis: prolonged pain, ST elevation, troponin elevation.
Inflammation of the pericardium: pain increased on inspiration and calmed when leaning forward, pericardial friction, diffuse concave ST elevation.
Narrowing (stenosis) or leaking (insufficiency) of the mitral and aortic valves → characteristic murmurs.
Acute pulmonary edema: respiratory distress, crackles, foamy expectoration — left heart failure emergency.
Five key functional signs: chest pain, dyspnea (NYHA), palpitations, syncope, claudication. B1/B2 and murmurs on auscultation. Troponin = heart attack, BNP = heart failure.
The respiratory system is explored through functional and physical signs, grouped into major pleuropulmonary syndromes.
| Time | Search |
|---|---|
| Inspection | Respiratory rate, drawing, cyanosis, chest deformities. |
| Palpation | Vocal vibrations (increased if condensation, decreased if effusion). |
| Percussion | Dullness (fluid/condensation) or tympanism (pneumothorax). |
| Auscultation | Vesicular murmur, rattles (crackles, snoring, sibilants), tubal murmur. |
Dullness, increased vocal vibrations, tubal murmur, crackles (e.g. pneumonia).
Dullness, abolition of gallbladder murmur and vocal vibrations (pleurisy).
Tympanism, auscultatory silence, abolition of vocal vibrations.
Snoring and wheezing rales, productive cough (bronchitis, asthma).
Dry “Velcro” crackles, exertional dyspnea (fibrosis, edema).
Compression: dysphonia, dysphagia, superior cava syndrome.
The coupling vocal vibrations + percussion + auscultation directs the syndrome: condensation (dullness + increased VV) ≠ fluid effusion (dullness + abolished VV) ≠ pneumothorax (tympanism + abolished VV).
Medical imaging is based on four main techniques with distinct physical principles; each has its own indications.
| Technical | Principle | Special features |
|---|---|---|
| X-ray | X-rays passing through tissues (densities). | Radiant. 4 densities: air (black), fat, water/tissue, bone/calcium, metal (white). |
| Ultrasound | Reflected ultrasound (echoes). | Non-irradiating, real time; hampered by air and bone. |
| CT (scanner) | X-rays + sectional reconstruction. | Very radiant, high resolution. |
| IRM | Magnetic field + radio frequencies (H protons). | Non-irradiating, excellent for soft tissues. |
They increase the contrast: iodized (scanner, radio) and gadolinium (MRI). Beware of contraindications (allergy, renal insufficiency).
The frontal chest x-ray (standing, inhaling) is the basis. The big ones thoracic radiological syndromes : alveolar, interstitial, pleural, mediastinal, bronchial. The silhouette sign locates an opacity according to the disappearance of a cardiac or diaphragmatic edge.
Analysis of the cardiac silhouette (cardio-thoracic index), large vessels, and dedicated explorations: echocardiography, CT angiography, cardiac MRI.
Know the 4 radiological densities and know which technique to choose: bone/lung → radio/CT, soft tissues → MRI, abdomen/heart in real time → ultrasound.
Understand the mechanisms that cause the transition from normal to pathological: hydro-electrolyte balance, heart failure, shock and respiratory failure.
Heart failure: inability of the heart to provide sufficient flow. Cardiac output depends on the preload, from the afterload, from the contractility and frequency (Frank-Starling law). Compensatory mechanisms: tachycardia, dilatation/hypertrophy, neurohormonal activation.
Acute circulatory failure → tissue hypoperfusion and cellular suffering.
| Type | Mechanism |
|---|---|
| Hypovolemic | Decrease in blood volume (hemorrhage, dehydration). |
| Cardiogenic | Heart pump failure (massive MI). |
| Septic | Vasodilation and capillary leak of infectious origin. |
| Anaphylactic | Vasoplegia of allergic origin (histamine release). |
HTA : elevation of BP by increase in peripheral resistance and/or flow, with role of the renin-angiotensin system.
Cardiac output = preload × contractility × rate / afterload. The 4 shocks: hypovolemic, cardiogenic, septic, anaphylactic. AKI = hematosis defect; Virchow's triad explains thrombosis.
Biochemistry provides the markers that confirm and track unit pathologies.
The notion of“healthy man” defines the reference values. Any analysis goes through three phases: pre-analytical (withdrawal), analytical (dosage), post-analytical (interpretation).
The analysis of puncture fluids (pleural) distinguishes transudate (hydrostatic mechanism, poor in proteins) and exudate (inflammatory mechanism, rich in proteins) according to Light's criteria.
Troponin = heart attack; BNP = heart failure; LDL = atherosclerotic risk. Pleural fluid: transudate (hydrostatic) vs exudate (inflammatory).
Educational summary of UE1 — summary produced from the official 3rd year medical program (Psychology, general semiology, cardiovascular and respiratory system). Revision document: it does not replace detailed lessons and teacher handouts.
Program source: univ.ency-education.com — 3rd year course, Unit 1.