Ateneo - UPO

The contents of the course are related to the approach to the patient, the effective communication, the collection of the anamnesis and the execution of the clinical examination in order to: 1) identify the clinically relevant problems of the person, 2) plan the diagnostic and treatments with a rational use of resources, according to criteria of appropriateness. The most relevant clinical pictures of interest will be described, with the help of real clinical scenarios always emphatizing the gender related differences, when applicable (i.e. heart failure, hydro-electrolyte alterations, chronic obstructive pulmonary disease, diabetes mellitus, pneumonia, pulmonary embolism, anemia, autoimmune diseases). The course will provide students with diagnostic elements and principles of therapy for these conditions. Particular attention is paid to the correct prescription of drugs, adherence to guidelines and prescribing appropriateness with rational use of resources. The main clinical pictures of diseases of internal medicine interest will be described, with the help of real clinical cases, always underlining the differences related to gender, where present (heart failure, hydro-electrolyte alterations, chronic obstructive pulmonary disease, diabetes mellitus, pneumonia, pulmonary embolism, anemia, autoimmune diseases, to name a few). The program also features: principles of therapy, patient education for the effective management of drugs and adherence to prescriptions, identification and correct management of any adverse events.

Harrison's Principles of Internal Medicine. 21°Ed. McGraw-Hill (2022), disponibile on line su Access Medicine The Washington Manual of Medical Therapeutics, 36/E. Lippincott, Williams & Wilkins (2019) Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12ed (Ed. On line su Access Medicine) Drug Monographs (Ed. On line su Access Medicine)

Knowledge of the pathophysiology and clinical manifestations of the dieseases of interest.
Effective communication with the person, relational aspects and acquisition of the informed consent.
Collection and interpretation of anamnestic, clinical, laboratory and instrumental data useful for the diagnosis, in accordance with appropriateness criteria.
Problem solving according to priority criteria. Clinical approach based on the enhancement of gender differences in the different clinical conditions.

Knowledge of clinical semeiotics and methodology, medical pathology, laboratory and imaging diagnostics, clinical microbiology, pathology, general and special pharmacology.

The Internal Medicine module consists of lectures on general methodological and communication aspects and topics relating to single pathologies or specific clinical pictures. The lessons relating to specific clinical topics start from the identification of the problems posed by an exemplary clinical case, through which to analyze the approach to diagnosis, therapy and prognosis of the most common internal medicine conditions observed in clinical practice. Extensive use of the DIR platform, through which the student accesses the podcasts of the frontal lessons provided in the classroom during the current academic year and in previous courses, additional in-depth materials (e.g. international guidelines, procedure videos, etc. ) and self-assessment and learning quizzes, with correct answer commented.

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The examination is taken using the DIR platform and consists of two tests: a multiple-choice quiz consisting of 90 questions with 5 alternative answers, only one of which is correct, and a simulated clinical case. The multiple-choice questions relate to both the Internal Medicine and Medical Therapy programs (respectively 75 and 15 questions). The simulated clinical case, inspired by real clinical practice, is carried out by students through questions (multiple choice with single answer; multiple choice with several possible answers; true or false; associations) addressed to enhance the student's ability to solve problems of physical and instrumental semeiology, diagnostic setting, treatment and follow-up. The case used is always representative of an important medical problem in terms of frequency of occurrence and impact on quantity and quality of life.

Problem based approach and clinical decision-making. Approach to the patient with venous thromboembolism. Value of EGA, ECG, Chest X-Ray and D-Dimer. Diagnostic algorithms (Wells score), indications for placing a cava filter and thrombolysis. Geriatric problems. Care of the elderly person. Evaluation of basic and instrumental daily living activities. Dementias: diagnosis, treatment principles. Comorbidities and geriatric syndromes. Frailty: diagnosis, prevention and treatment. Problems of the hospitalized elderly. Delirium: diagnosis, prognosis, treatment. Falls: risk factors, objectivity, prevention. Deprescribing. ACE Units and models of care in the 21st century. Cardiovascular problems. Approach to the patient with atrial fibrillation. a) clinical manifestations, indications for emergency cardioversion; b) choice of therapeutic strategy; c) oral anticoagulant therapy. Score, anti-VITK agents vs. DOACs. Approach to the patient with angina pectoris: clinical diagnosis, stress test, medical therapy. Gender cardiology: specificity and risks. Diagnostic classification and therapeutic options of the main heart valve diseases. The patient with pericarditis with/without cardiac tamponade. The patient with pulmonary hypertension. Approach to the patient with heart failure: clinical manifestations, diagnostic procedure. Approach to the patient with arterial hypertension: classification, correct measurement of arterial pressure in the various settings. Estimation of global cardiovascular risk and lifestyle measures to reduce it. Breathing problems. Approach to the patient with pleural effusion. Characteristics of pleural fluid and related investigations: Light's criteria and differential diagnosis of exudates and transudates. Tuberculous pleurisy. Eosinophilic pleurisy. Indications for the placement of a pleural drainage. Approach to the patient with acute exacerbation of COPD: causes, diagnosis, assessment of severity, therapy in hospital. Indications for the use of non-invasive ventilation. Prevention: vaccinations, correct use of inhalation therapy and support for smoking cessation. Approach to the patient with a solitary pulmonary nodule. Approach to the patient with community-acquired pneumonia: etiology, risk stratification, initial investigations, therapy in different care settings, criteria for hospitalized patient discharge. Infectious problems. Interpretation of antibiotic resistance assays, "antibiotic stewardship". Treatment of complicated and uncomplicated urinary tract infections. Emerging hospital-acquired infections: Acinetobacter baumannii and carbapenem-resistant Enterobacteriaceae, prevention and treatment. Approach to the patient with S. aureus infection in the various districts. Commonly used anti-staphylococcal drugs. Gastrointestinal problems. Approach to the patient with impaired liver function tests. Patterns of hepatic cytonecrosis and cholestasis and related investigations. Approach to the patient with chronic viral hepatitis; results and limitations of current treatment options. Approach to the cirrhotic patient with salt and water retention: diagnosis and treatment. Spontaneous bacterial peritonitis. The hepatorenal syndrome. Approach to the patient with hepatic encephalopathy. Correct setting of diuretic therapy. Kidney problems. Approach to the patient with electrolyte and/or acid-base disorders. Clinical manifestations of acute and chronic hyponatraemia, differential diagnosis according to volume status. The syndrome of inappropriate antidiuresis: diagnostic criteria and associated conditions. Treatment of hyponatraemia. Hypernatremia: risk factors in the elderly and diagnosis. Diabetes insipidus in its various expressions. Hypokalemia caused by diuretics vs. less common causes: hypertension, ECF/ICF redistribution, reduced GI intake or absorption, acid-base disturbance. Metabolic alkalosis: initiating factors and maintaining factors. Measurement of urinary chlorides key to differential diagnosis. Hyperkalemia: causes, symptoms, differential diagnosis and therapy. Approach to the patient with acute kidney injury. Differential diagnosis. Contrast nephropathy: diagnosis and prevention. Endocrine problems. Calcium metabolism and bone metabolism in men and women. Approach to the patient with hyper/hypocalcemia. Blood problems. Approach to the anemic patient. Interpretation of RBC indices. Iron deficiency anemia diagnosis vs. inflammatory anemia. Macrocytosis and megaloblastic anemia. Causes of Vitamin B12 deficiency and folate deficiency; Clinical manifestations, differential diagnosis and therapy. Diagnostic process, with particular reference to hemolytic anemias and multiple myeloma. Approach to the patient with thrombocytopenia. Classification based on the pathophysiological mechanism and the care setting. Approach to the patient with hypereosinophilia. Musculoskeletal problems. Approach to the patient with arthritis. Diagnostic process: identification of the problem on the musculoskeletal system, anatomical definition, distribution, inflammatory/non-inflammatory pattern, acute/chronic course. Associated events. Acute monoarthritis: the patient with crystal arthritis and its treatment. Approach to the patient with vasculitis: clinical manifestations and diagnostic investigations. Methods of prescribing drugs and reimbursement classes. Treatment of the following conditions or diseases of internal medicine interest: diabetes mellitus, arterial hypertension, COPD, heart failure, pain, arthropathies, general principles of antibiotic therapy, upper and lower respiratory tract infections, venous thromboembolism, treatment of electrolyte disturbances and volume depletion, osteoporosis. Where applicable, differences in approach related to gender are always emphasised.

Epidemiology, Clinical manifestations, Differential diagnosis, Therapy, Monitoring over time and Prognosis of the most common clinical problems of Internal Medicine (Expertise) - Application of the principles of clinical reasoning to a specific clinical case, choosing the most common diagnostic procedures, analyzing and interpreting their results, effectively and efficiently; - Choice of therapies for the individual patient, also taking into account differences in age, gender, liver and/or kidney function, recognizing the degree of urgency with which these therapies must be administered and the possibilities for cost containment; - Ability to undertake adequate preventive and protective actions against diseases, maintaining and promoting the health of the individual, the family and the community. (Transversal skills) - knowing how to present a patient's problems in an orderly and structured way; - be able to read, understand and comment on technical material from treatises or manuals and point-of-care sources. For the achievement of an advanced level, the student must demonstrate: - be able to choose rational solutions for complex problems, using the teaching resources made available, e.g. UpToDate® - giving due importance to the problem of cost containment, for example in view of the Choosing wisely programme; - identify the need for monitoring over time and patient/family involvement in the diagnosis and treatment process.