Ateneo - UPO

The degree course is characterized by lessons during which clinical cases and videos are presented. An informal discussion between teachers and students follows.

Manuale MDS - Versione per i professionisti https://www.msdmanuals.com/it-it/professionale

Gianandrea Pasquinelli, Luigi Barbieri
Lezioni di Medicina di Laboratorio, I edizione digitale
Rimini, Campus di Rimini, 2014

The Internal Medicine module aims at guiding the student through the diagnostic and therapeutic path of 8 major general clinical problems, namely oedema, bldding, fever, pain, dyspnoea, coma, icterus, itching. The student will learn the physiopathologic basis for each of the above major pathologic phenomena and the organ-specific ones. The students will also get familiar with the most common tests and treatments prescribed in the management of the above problems by the GP, the ED or the internist.

Know the principles of anatomy and physiology

Lessons and discussion of clinical cases. Some videos will also be presented and commented regarding some complex pathologic paths like hemostasis or some invasive procedurs such as bone marro biopsy.

33 multi-choice quiz will be samples in a whole set of 300 questions available for auto-assessment (without solutions).
The tests will focus on physiopathologic, diagnostic and therapeutic options discussed during the lessons.
The students will complete the exam in 33 minutes.
The final score will be 1.0 per each fully solved question and 0.5 for partially correct answes.

1 - OEDEMA: elderly with chronic declivous oedema and nocturia, puerpera with edema and leg pain, young male with cape edema, young diabetic woman with periocular edema. Pathophysiology: Sterling's law and its role in the various districts and various pathologies. Diseases: SCC, liver cirrhosis, nephrotic syndrome, NHL, hereditary angioedema, hypercortisolemia, DVT, thrombophilia. Test: ECG, heart echocolordoppler, abdominal ultrasound, BNP, GGT, HCV and HBV serology, D-dimer, ATIII, PS, homocysteine, anti-phospholipids, venous Doppler, chest CT, PET, C1q assay, cortisolemia, cortylosuria, albuminemia, albuminuria, renal retentives, TSH-R, FT3, FT4. Therapies: ACE inhibitors, sartanics, beta-blockers, diuretics, CRTs, oral and parenteral anticoagulants, CIT and biological therapies for lymphomas, levothyroxine, loop diuretics. Methodological aspects: Bayes and related tests.
2 - HEMORRAGIA: triathlete with petechiae spread to the lower limbs, girl with chronic metrorrhagia, elderly with asthenia and melena. Diseases: ITP, congenital haemophilia, Schonlein-Henoch purpura, acute leukemia, vWD, vitamin K deficiency, CRC, peptic disease, angiodysplasias. Tests: PT, aPTT, coagulation factors, morphological and flow cytometric examination of leukocytes, endoscopy of the gastrointestinal tract. Therapies: igev, TPO-mimetics, anti-fibrinolytics.
3 - FEVER: diabetic elderly with fever, dysuria and absolute lymphocytosis; lady with chronic low-grade fever and undulating arthro-myalgia; Obese diabetic with high fever and cough in ongoing COVID19 pandemic. Disorders: Urosepsis, glucose decompensation, CLL, fibromyalgia, TB infection, paraneoplastic syndromes, COVID19 infection. Therapy: pH and hydro-electrolyte balance, BTK inhibitors and Moab anti CD20.
4 - SENSORY REDUCTION: elderly with urinary syncope, progressive drowsiness with low-grade fever in diabetic, agitation and coma in non-diabetic elderly. Pathologies: situational / vagal syncope, seizure, BAV, SSS, stroke, meningitis, CO poisoning, intracranial lesions, diabetic coma, uremic coma. Test: electrocardiogram, blood gas analysis, chemical-physical analysis of the CSF.

5 - PAIN: acute chest pain in hypertensive smoker, chronic joint and abdominal pain in young woman, acute postprandial abdominal pain contextual to chronic bone pain, worsening neuropathic pain in vegetarian diabetic. Diseases: SCA, pericarditis, TEP, aortic dissection, RA, familial Mediterranean fever, celiac disease, pancreatitis, cholecystitis, IBD, bone metastases, diabetic peripheral neuropathy, peripheral neuropathy from rare diseases. Test: enzymatic curve, FR, ANA, ENA, fecal calprotectin. Therapies: diphosphonates, amitriptyline, anti-TNF, primary PTCA, treatment of type 2 diabetes mellitus. 6 - Dyspnea: worsening dyspnea with tachypnea in obese smokers, acute post-traumatic dyspnea, chronic exertional dyspnea. Diseases: COPD, community-acquired pneumonia, EPA, COVID19 infection, pulmonary neoplasm, haemopericardium, pulmonary hypertension. Test: arterial EGA, D-dimer, chest x-ray. Therapies: empirical antibacterial treatment of CAP, C-PAP.
7 - Jaundice: young woman with subacute jaundice, nausea and asthenia; alcoholic with chronic jaundice and skin hyperchromia. Diseases: chronic liver disease, hepatocellular carcinoma, hemochromatosis, thalassemia major, autoimmune haemolytic anemia, biliary tract obstruction, Gilbert's disease, hereditary spherocytosis. Tests: Hemoglobin electrophoresis, ferritin, genetic tests for hemochromomatosis, direct Coombs test, transaminases, fractionated bilirubin, HCV and HBV serology. Therapies: bloodletting, steroids, rituximab.
8 - ITCH: young woman with recurrent anaphylactoid reactions to heterogeneous stimuli, elderly with chronic aquagenic itching. Pathologies: mastocytosis, PV, MAS, scabies, colostasis. Test: tryptase, IgE, JAK2V617F. Therapies: anti-histamines, inteferon-alpha, midostaurin

KNOWLEDGE
The students will get familiar with the most common systemic and organ-specific, acute &chronic, non-surgical diseases, like chronic heart failure, liver cyrrhosis, diabetes, venous thrombosis, coronary artery disease... The student will also have the opportunity to know some rare disorders which are most commonly considered in the differential diagnosis, such as hereditary hemocromatosis. In order to avoid overlapping with other modeules or courses, infective and neurologic disorders will not be specifically managed, since other two modeules are devoted to such specialties. Similarly, emergency medicine topics will be fully exploited in a different module.
EXPERTISE
The principal physiopathologic processes are causes of different clinical problems: flux interruption, peremability alteration, masses, inflammation, inherited metabolic disorders, acquired metabolic disorders. The student will therefore acknowldge benchmark pathologic processes in some very common clinical scenarios.
TRANSVERSAL CAPABILITIES
The student will learn the most common symptoms and signs of the major internist pathologies. The student will understand urgent diagnostic test results and the most common genetic tests. Finally he/she will be introduced to the principal therapeutic modalities for acute and chronic internistic diseases, such as coronary revascularization, cardiac resynchronization, immunotherapy, target therapy of blood cancers, anticoagulants....