The teaching is organized as follows:

Learning outcomes

AIM OF THE COURSE
The present course is intended to provide participants with a clinical diagnostic capacity on the basis of the recognition of signs and symptoms presented by the patient.
The students should demonstrate to already possess established notions of physiology, pathology and pathophisiology of a broad range of diseases involving all organ systems, and to be able to use them in the interpretation of the patient’ clinical picture.
The students should therefore to infer pathogenetic processes starting from the knowledge of the molecular bases and leading to the most frequent clinical situations and syndromes. The students must demonstrate the requisite skills in physical examination, being able to recognize the main signs characterizing the different diseases. Moreover they have to synthesize and prioritize effectively the problems of the patient, hypothesizing a diagnostic management plan with the support of biochemical and instrumental data and bearing in mind the need of an objective confirmation in the differential diagnostic process.

Classroom lectures will be centered on the analysis of emblematic case-reports on which will be developed and discussed the diagnostic rationale, formulated differential diagnoses, resumed topics of systematic disease in order to define the clinical picture, explain its severity, urgency, clinical relevance; finally, will be discussed and motivated the diagnostic procedures that are necessary to lead to a definitive diagnosis and formulation of a prognosis.

Program

Module: DIDATTICA PRATICA MEDICINA DI FAMIGLIA E TUTORIAL PROBLEM SOLVING
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Module: RICERCA CLINICA
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Module: MEDICINA INTERNA
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Program
1) The recognition of the anemic syndrome will lead to systematically review the following diseases:
-hemoglobinopathies, hypo- or aplastic anemia, megaloblastic anemia,
-hemolytic and acute hemorrhagic anemia,
-myelodysplastic disorders, myeloproliferative disorders, lymphatic neoplasms,
-anemia related to chronic inflammatory diseases

2) Dyspnea, chest pain, abnormal cardiac rhythm will lead to review the following pathologies:
-heart rhythm disorders and diseases (heart failure, valvular heart disease, diseases of the pericardium, myocardium, heart lung),
-atherosclerosis, ischemic heart disease, diseases of the blood vessels and the aorta,
- pneumonia, bronchial asthma, COPD, pulmonary interstitial diseases, diseses of pleura, mediastinum and diaphragm, primary pulmonary hypertension.
Particular importance will be given to the differential diagnosis of the different causes of chest pain.

3) Oedema will lead to review the following pathologies:
-Kidney diseases: glomerulonephrites, acquired and congenital disorder of the renal tubules, interstitial nephropathy, nephrolithiasis
-Heart diseases: heart failure.
-Intestinal malabsorption: inflammatory intestinal diseases and related differential diagnosis, irritable bowel, mesenterial vasculopathies.
-Liver diseases: cirrhosis; acute and chronic hepatitis; infiltrative, genetic and metabolic liver disorders; diseases of the gallbladder and biliary tract.

4) Jaundice will lead to review the inherent systemic diseases:
liver cirrhosis, acute and chronic hepatitis, infiltrative, genetic and metabolic liver disorders; diseases of the gallbladder and biliary tract.

5) Diarrhea and constipation will lead to review the following systematic diseases: disorders of intestinal absorption, celiac disease, acute and chronic pancreatitis.

6) The osteoarticular and muscle pain, alterations of sensitivity and motility, changes in skin diseases will lead to systematic review regarding:
-systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjogren's syndrome, ankylosing spondylitis, reactive arthritis, and infectious, Behcet's syndrome, vasculitis, sarcoidosis, amyloidosis, gout and crystal arthropathies, osteoarthritis, Guillain-Barre syndrome, polymyositis, dermatomyositis, chronic granulomatous disease, autoinflammatory diseases.
-Atopy, allergy to inhalant agents, adverse reactions to foods and drugs. Eosinofilic and hypereosinophilic syndrome. Acquired Immunodeficiency.
- Parathyroid disease, Paget’ disease, porphyria, storage diseases such as Wilson's disease, lysosomal storage diseases, abnormal metabolism of purine and pyrimidine , glycogen storage diseases, inherited metabolic abnormalities of carbohydrates, membrane transport and fatty tissue.

7) Fever will lead to review the differential diagnosis involving:
fever of unknown origin (FUO), factitia fever, sepsis and septic shock, bacterial endocarditis, osteomyelitis, diseases due to gram-positive and gram-negative bacteria, mycobacteria, spirochetes, rickettsia, mycoplasma, chlamidia, DNA or RNA virus, infections by fungi, da protozoa and helminths.

8) Recurrent or frequent infections will lead to consider:
the primary immunodeficiencies with particular attention to CVID and IgA deficiency.

8) The cough will lead to review the following systemic diseases:
bronchial asthma, hypersensitivity pneumonia, pneumonia, bronchiectasiae, COPD, interstitial lung diseases , primary pulmonary hypertension, pulmonary embolism, diseases of the pleura, mediastinum, diaphragm.

9) Abnormal blood pressure will lead to review:
-primary and secondary hypertension, resiatnt and low-renin hypertension;
- cardiovascular risk factors, the atherosclerosis, the abnormalities of lipoproteins metabolism;
-pheochromocitoma, primary aldosteronism, the Cushing syndrome;
- revascular disease (fibrodysplastic and atheromatous stenosis of renal artery), the aortic diseases.

10) Weight and appetite disturbance will lead to review:
- nutritonal status and balance, vitamins and oligoelements deficiency;
-lymphatic neoplasms, skin cancer, lung and breast cancer, gastro-intestinal cancers, liver and biliary tract cancer, pancreas cancer, neoplasms of kidney, prostatic gland, testis, ovary, bone and soft tissues,;
- paraneoplastic syndrome;
- environmental pathologies, poisoning and overdose of drugs.

11) Hemorragic lesions of the skin or abnormal venous drainage will lead to review: coagulative disorders, thrombosis and thrombophilia, platelet and vessel diseases. In such context will be also considered the clinical picture due to thrombosis in unusual sites.

Examination Methods

Final assessment - Methodology
The final examination is divided into two parts:

1) Practical test at the bedside: execution of maneuvers for the patient’ physical examination, which will be verified by the teacher. Suitability, procedural fairness and understanding of their meaning from the student will be specifically evaluated*.
2) Oral exam: it will be focused on a real patient’ situation, in order to describe an appropriate management plan and possible differential diagnoses. It will allow to test learning not only of the specific pathology but also of the interrelationships in the holistic context of the single patient.


*N.B: passing practical test is the necesary condition to be admitted to the oral exam ; for this reason, it may be useful for the student to show written documentation of the previous practical training.
In the event that a positive practical test is followed by a negative judgment in the oral examination, the practical test will be considered valid for the next exam.