Fundamentals of Clinical Medicine 2
A.Y. 2024/2025
Learning objectives
The Fundamentals of Clinical Medicine 2 course takes the students into clinical medicine with the study of Hematology, Rheumatology and Internal Medicine. Such studies will be dealt on a comprehensive basis, i.e. including diagnostic imaging, pathology, laboratory medicine, to guide the student through a comprehensive path. This will help the student to acquire notions on clinical conditions in a systematic basis, as well as to understand the clinical reasoning that leads to diagnosis starting from symptoms and signs.
The students will acquire knowledge on non-neoplastic hematological conditions with particular focus on anemia, bleeding and thrombotic conditions and transfusion medicine. In rheumatology the students will study the etiopathogenic mechanisms and clinical presentation of inflammatory arthritides, microcristalline arthropathies, non inflammatory musculoskeletal disorders, connective tissue diseases and systemic vasculitides.
The module tackles the multidisciplinary clinical approach to patients with a rheumatological disease, combining history collection, physical examination, laboratory tests, and imaging. The featuresof autoimmunity and chronic inflammation will be discussed, along with a general approach to the main complaints of patients with these conditions.
In internal medicine, lectures will complement what presented in hematology and rheumatology classes. Some topics will be presented more in depth, for some others special emphasis will be put on the semeiology and on the interpretation of blood tests. Principles of management, adjusted for the seniority of the students will be discusses.
The students will acquire knowledge on non-neoplastic hematological conditions with particular focus on anemia, bleeding and thrombotic conditions and transfusion medicine. In rheumatology the students will study the etiopathogenic mechanisms and clinical presentation of inflammatory arthritides, microcristalline arthropathies, non inflammatory musculoskeletal disorders, connective tissue diseases and systemic vasculitides.
The module tackles the multidisciplinary clinical approach to patients with a rheumatological disease, combining history collection, physical examination, laboratory tests, and imaging. The featuresof autoimmunity and chronic inflammation will be discussed, along with a general approach to the main complaints of patients with these conditions.
In internal medicine, lectures will complement what presented in hematology and rheumatology classes. Some topics will be presented more in depth, for some others special emphasis will be put on the semeiology and on the interpretation of blood tests. Principles of management, adjusted for the seniority of the students will be discusses.
Expected learning outcomes
Students are expected to achieve general and specific requirements:
- provide a systematic description of the disease and clinical conditions described in the program above
- comment on the main diagnostic modalities used to evaluate these conditions
- provide principles of treatment when discussed in class.
For hematology, the students will be required to comment on the differential diagnosis of anemias based on morphology and rate of production, navigating through different conditions using clinical and laboratory features. To provide a clinical and laboratory approach to hemorragic and thrombophilic conditions. In each case, the examination will be conducted either/both as a systemic description of conditions and reasoning along case vignettes.
For rheumatology, the students will be required to comment on the differential diagnosis of articular and extra-articular manifestations of inflammatory arthropathies, systemic vasculitis and connective tissue diseases, to interpret positivity for lab tests in rheumatology and to delineate a diagnostic approach to a patient with suspected rheumatological disease.
For internal medicine students will have to demonstrate knowledge of the physical examination in the field of immuno-rheumatological diseases, to know basic notions on the pathogenesis of autoimmunity including the interaction between the intestinal microbiota and the immune system, the interaction between the autonomic nervous system and innate and adaptive immunity as well as knowledge of laboratory tests such as autoantibodies and others, which characterize the basic screening in the suspicion of systemic autoimmune diseases. They will have to be proficient in commenting abnormalities in the full blood count, especially regarding red cell indexes, and coagulation tests. Bleeding/thrombotic episodes will be discussed in terms of clinical presentation, laboratory findings and basic principles of management.
- provide a systematic description of the disease and clinical conditions described in the program above
- comment on the main diagnostic modalities used to evaluate these conditions
- provide principles of treatment when discussed in class.
For hematology, the students will be required to comment on the differential diagnosis of anemias based on morphology and rate of production, navigating through different conditions using clinical and laboratory features. To provide a clinical and laboratory approach to hemorragic and thrombophilic conditions. In each case, the examination will be conducted either/both as a systemic description of conditions and reasoning along case vignettes.
For rheumatology, the students will be required to comment on the differential diagnosis of articular and extra-articular manifestations of inflammatory arthropathies, systemic vasculitis and connective tissue diseases, to interpret positivity for lab tests in rheumatology and to delineate a diagnostic approach to a patient with suspected rheumatological disease.
For internal medicine students will have to demonstrate knowledge of the physical examination in the field of immuno-rheumatological diseases, to know basic notions on the pathogenesis of autoimmunity including the interaction between the intestinal microbiota and the immune system, the interaction between the autonomic nervous system and innate and adaptive immunity as well as knowledge of laboratory tests such as autoantibodies and others, which characterize the basic screening in the suspicion of systemic autoimmune diseases. They will have to be proficient in commenting abnormalities in the full blood count, especially regarding red cell indexes, and coagulation tests. Bleeding/thrombotic episodes will be discussed in terms of clinical presentation, laboratory findings and basic principles of management.
Lesson period: First semester
Assessment methods: Esame
Assessment result: voto verbalizzato in trentesimi
Single course
This course cannot be attended as a single course. Please check our list of single courses to find the ones available for enrolment.
Course syllabus and organization
Single session
Responsible
Prerequisites for admission
To take the Fundamental of Clinical Medicine 2 exam, students must have already passed all the exams of the first year (Fundamentals of Basic Sciences, Cells, Molecules and Genes , Histology, Anatomy, Biochemistry, Fundamentals of biomedical imaging) and all the exams of second years (Functions 1 and 2, Microbiology, Genetics and Mechanisms of diseases
Assessment methods and Criteria
Students' assessment is based on an oral examination. The students must undergo all three examinations on the same day. Separate examinations on different days are seldom possible, and only due to availability of teachers or rooms.
The topics of the examination are the ones outlined in the program below, with particular emphaiss on the expected outcomes.
The final mark is the weighted average of the three marks obtained in the oral examinations expressed out of 30, provided that each mark is above 18/30.
Registration to the exam through SIFA is mandatory.
The topics of the examination are the ones outlined in the program below, with particular emphaiss on the expected outcomes.
The final mark is the weighted average of the three marks obtained in the oral examinations expressed out of 30, provided that each mark is above 18/30.
Registration to the exam through SIFA is mandatory.
Internal medicine
Course syllabus
· Autoinflammatory diseases (2h) Live
Pathogenesis of autoinflammatory diseases
Clinical manifestation of autoinflammatory diseases
· Sarcoidosis (2h) Live
Pathogenesis of sarcoidosis
Clinical manifestation of sarcoidosis
· The gut microbiota and the immune system (2h) Live
The pathophysiology of the gut microbiome
Interaction of gut microbiome with the immune system and recent knowledge of gut microbiota in systemic autoimmune diseases
· The autonomic nervous system and inflammation (2h) Live
The interplay between autonomic nervous system and inflammation
Recent knowledge about autonomic nervous system in systemic autoimmune diseases
· Lab test interpretation and general physical examination in systemic autoimmune diseases (2h) Asynchronous
Clinical cases with differential diagnosis in connective tissue disease
· Patients' perspective: the importance of patients' associations and fundations (2h) Asynchronous
Examples and discussion on patients' societies in rare connective tissue diseases
· Anemia (2h) Live
Clinical presentation and semeiology
· The full blood count (2h) Live
Interpretation of results of a full blood count
· Management of hemorrhagic episodes (4h) Live
Bleeding from anticoagulant therapy and due to hemorragic syndromes
Pathogenesis of autoinflammatory diseases
Clinical manifestation of autoinflammatory diseases
· Sarcoidosis (2h) Live
Pathogenesis of sarcoidosis
Clinical manifestation of sarcoidosis
· The gut microbiota and the immune system (2h) Live
The pathophysiology of the gut microbiome
Interaction of gut microbiome with the immune system and recent knowledge of gut microbiota in systemic autoimmune diseases
· The autonomic nervous system and inflammation (2h) Live
The interplay between autonomic nervous system and inflammation
Recent knowledge about autonomic nervous system in systemic autoimmune diseases
· Lab test interpretation and general physical examination in systemic autoimmune diseases (2h) Asynchronous
Clinical cases with differential diagnosis in connective tissue disease
· Patients' perspective: the importance of patients' associations and fundations (2h) Asynchronous
Examples and discussion on patients' societies in rare connective tissue diseases
· Anemia (2h) Live
Clinical presentation and semeiology
· The full blood count (2h) Live
Interpretation of results of a full blood count
· Management of hemorrhagic episodes (4h) Live
Bleeding from anticoagulant therapy and due to hemorragic syndromes
Teaching methods
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Teaching Resources
- Harrison's Principles of Internal Medicine, 21th Edition, McGraw Hill, 2022 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/);
- Additional material, and in particular online content, will be made available during the course.
- Additional material, and in particular online content, will be made available during the course.
Reumathology
Course syllabus
Introduction to rheumatology (2h) Asyncronous
· Overview of Rheumatological conditions
· Signs and symptoms in Rheumatology
· How to examine a patient
Lab in Rheumatology (2h) Asyncronous
· Lab tests in Rheumatology
· Autoantibodies
Rheumatoid arthritis (2h) Live
· Pathogenesis of Rheumatoid arthritis
· Clinical manifestations of rheumatoid arthritis
Spondyloarthropathies (2h) Live
· Pathogenesis of Spondyloarthropathies
· Clinical manifestations of spondyloarthropathies
Microcrystal arthropathies and arthritis due to infectious agents (2h)
· Pathogenesis of microcristal arthropathies
· Clinical manifestations of microcristal arthropathies
· Pathogenesis of arthritis due to infectious agents
· Clinical manifestations of arthritis due to infectious agents
Extra articular pain syndrome, CRPS and osteoarthritis (2h) Live
· Pathogenesis of extra articular pain syndrome
· Clinical manifestations of extra articular pain syndrome
· Pathogenesis of CRPS
· Clinical manifestations of CRPS
· Pathogenesis of osteoarthritis
· Clinical manifestations of osteoarthritis
Systemic lupus erythematosus and anti-phospholipid syndrome (2h) Live
· Pathogenesis of systemic lupus erythematosus
· Clinical manifestations of systemic lupus erythematosus
· Pathogenesis of anti-phospholipid syndrome
· Clinical manifestations of anti-phospholipid syndrome
Systemic sclerosis and Sjogren's syndrome and mixed connective tissue disease (2h) Live
·
· Pathogenesis of systemic sclerosis
· Clinical manifestations of systemic sclerosis
· Pathogenesis of Sjogren's syndrome
· Clinical manifestations of Sjogren's syndrome
· Pathogenesis of mixed connective tissue disease
· Clinical manifestations of mixed connective tissue disease
Inflammatory myopathies, Takayasu arteritis, giant cell arteritis and polymyalgia rheumatica (2h) Live
· Pathogenesis of inflammatory myopathies
· Clinical manifestations of inflammatory myopathies
· Pathogenesis of Takayasu arteritis
· Clinical manifestations of Takayasu arteritis
· Pathogenesis of giant cell arteritis
· Clinical manifestations of giant cell arteritis
· Pathogenesis of polymyalgia rheumatica
· Clinical manifestations of polymyalgia rheumatica
ANCA-associated vasculitides, cryoglobulinemia, panarteritis nodosa (2h) Live Pathogenesis of ANCA-associated vasculitides
· Clinical manifestations of ANCA-associated vasculitides
· Pathogenesis of cryoglobulinemia
· Clinical manifestations of cryoglobulinemia
· Pathogenesis of panarteritis nodosa
· Clinical manifestations of panarteritis nodosa
Teaching cases (2h) Asynchronous
· Clinical cases with differential diagnosis of inflammatory arthritides
Teaching cases (2h) Asynchronous
· Clinical cases with differential diagnosis of systemic vasculitides
· Overview of Rheumatological conditions
· Signs and symptoms in Rheumatology
· How to examine a patient
Lab in Rheumatology (2h) Asyncronous
· Lab tests in Rheumatology
· Autoantibodies
Rheumatoid arthritis (2h) Live
· Pathogenesis of Rheumatoid arthritis
· Clinical manifestations of rheumatoid arthritis
Spondyloarthropathies (2h) Live
· Pathogenesis of Spondyloarthropathies
· Clinical manifestations of spondyloarthropathies
Microcrystal arthropathies and arthritis due to infectious agents (2h)
· Pathogenesis of microcristal arthropathies
· Clinical manifestations of microcristal arthropathies
· Pathogenesis of arthritis due to infectious agents
· Clinical manifestations of arthritis due to infectious agents
Extra articular pain syndrome, CRPS and osteoarthritis (2h) Live
· Pathogenesis of extra articular pain syndrome
· Clinical manifestations of extra articular pain syndrome
· Pathogenesis of CRPS
· Clinical manifestations of CRPS
· Pathogenesis of osteoarthritis
· Clinical manifestations of osteoarthritis
Systemic lupus erythematosus and anti-phospholipid syndrome (2h) Live
· Pathogenesis of systemic lupus erythematosus
· Clinical manifestations of systemic lupus erythematosus
· Pathogenesis of anti-phospholipid syndrome
· Clinical manifestations of anti-phospholipid syndrome
Systemic sclerosis and Sjogren's syndrome and mixed connective tissue disease (2h) Live
·
· Pathogenesis of systemic sclerosis
· Clinical manifestations of systemic sclerosis
· Pathogenesis of Sjogren's syndrome
· Clinical manifestations of Sjogren's syndrome
· Pathogenesis of mixed connective tissue disease
· Clinical manifestations of mixed connective tissue disease
Inflammatory myopathies, Takayasu arteritis, giant cell arteritis and polymyalgia rheumatica (2h) Live
· Pathogenesis of inflammatory myopathies
· Clinical manifestations of inflammatory myopathies
· Pathogenesis of Takayasu arteritis
· Clinical manifestations of Takayasu arteritis
· Pathogenesis of giant cell arteritis
· Clinical manifestations of giant cell arteritis
· Pathogenesis of polymyalgia rheumatica
· Clinical manifestations of polymyalgia rheumatica
ANCA-associated vasculitides, cryoglobulinemia, panarteritis nodosa (2h) Live Pathogenesis of ANCA-associated vasculitides
· Clinical manifestations of ANCA-associated vasculitides
· Pathogenesis of cryoglobulinemia
· Clinical manifestations of cryoglobulinemia
· Pathogenesis of panarteritis nodosa
· Clinical manifestations of panarteritis nodosa
Teaching cases (2h) Asynchronous
· Clinical cases with differential diagnosis of inflammatory arthritides
Teaching cases (2h) Asynchronous
· Clinical cases with differential diagnosis of systemic vasculitides
Teaching methods
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Teaching Resources
- Oxford Textbook of Rheumatology, 4th edition, 2013; Edited by Richard A. Watts, Philip G. Conaghan, Christopher Denton, Helen Foster, John Isaacs, and Ulf Müller-Ladner;
- EULAR Textbook on Rheumatic Diseases, 3rd edition, 2018; edited by JWJ Bijlsma and E Hachulla, http://www.eular.org/index.cfm?framePage=/edu_textbook.cfm;
- Additional material, and in particular online content, will be made available during the course.
- EULAR Textbook on Rheumatic Diseases, 3rd edition, 2018; edited by JWJ Bijlsma and E Hachulla, http://www.eular.org/index.cfm?framePage=/edu_textbook.cfm;
- Additional material, and in particular online content, will be made available during the course.
Blood diseases
Course syllabus
Introduction to hematology (2h) Asyncronous
· Introduction to the integrated course
· blood as a tissue: components and function
· Interpreting a complete blood count with focus on red cell indexes
Overview of hemostasis and thrombosis (2h) Live
· Overview of the pathways involved in hemostasis and their regulation
· Describe and interpret coagulation laboratory tests
· Who to test and when
Bleeding disorders (3h) Live
· Describe the main disorders of primary hemostasis (Platelet function disorders, ITP, HIT, von Willebrand disease)
· Describe the main disorders of secondary hemostasis (Hemophilia A and B)
· Principles of diagnosis of TMA
Thrombotic disorders (3h) Live
· Describe thrombophilic disorders (factor V Leiden, prothrombin mutations, protein C deficiency, protein S deficiency, antithrombin deficiency, antiphospholipid antibodies, factor VIII elevation)
· Outline and characterize anticoagulant drugs
· Illustrate venous thromboembolism (superficial thrombophlebitis, deep vein thrombosis and pulmonary embolism)
Principles of erythropoiesis and hypo-regenerative anemias (3h) Live
· Illustrate the clinico-pathological assessment of the anemic patient
· Gain insight into classifications of anemias and their meanings
· Describe iron-deficiency, vit. B12 and folate deficiency, and anemias of chronic disorders: clinical features, diagnosis and principles of management
Hemoglobinopathies, red cell enzymopathies and membrane disorders (3h) Live
· Principles of diagnosis of hemolytic anemias
· Explain thalassemias and sickle cell anemia: genetics, different clinical pictures, management, complications
· Describe the main abnormalities of RBC membrane
· Describe the main abnormalities of RBC enzymes
Hemolitic anemias and transfusional medicine (2h) Live
· Causes and clinical consequences of immune hemolytic anemias
· Get awareness in RBC, PLT and plasma transfusion facts
· Understand and illustrate transfusional risks
Laboratory techniques in hematology (2h) Asyncronous
· Describe the morphology of hematopoietic precursor cells
· Describe the examination of bone marrow aspirate and peripheral blood smears
· Principles and applications of immunohistochemistry
· Describe the basics of flow cytometry
· Define cytogenetics and fluorescence in situ hybridization (FISH)
· Illustrate the basic aspects of molecular diagnostics in hematology
Teaching cases (4h) Asyncronous
· self reflection on clinical cases with differential diagnosis of anemia
· self reflection on clinical cases with differential diagnosis of bleeding disorders
· Introduction to the integrated course
· blood as a tissue: components and function
· Interpreting a complete blood count with focus on red cell indexes
Overview of hemostasis and thrombosis (2h) Live
· Overview of the pathways involved in hemostasis and their regulation
· Describe and interpret coagulation laboratory tests
· Who to test and when
Bleeding disorders (3h) Live
· Describe the main disorders of primary hemostasis (Platelet function disorders, ITP, HIT, von Willebrand disease)
· Describe the main disorders of secondary hemostasis (Hemophilia A and B)
· Principles of diagnosis of TMA
Thrombotic disorders (3h) Live
· Describe thrombophilic disorders (factor V Leiden, prothrombin mutations, protein C deficiency, protein S deficiency, antithrombin deficiency, antiphospholipid antibodies, factor VIII elevation)
· Outline and characterize anticoagulant drugs
· Illustrate venous thromboembolism (superficial thrombophlebitis, deep vein thrombosis and pulmonary embolism)
Principles of erythropoiesis and hypo-regenerative anemias (3h) Live
· Illustrate the clinico-pathological assessment of the anemic patient
· Gain insight into classifications of anemias and their meanings
· Describe iron-deficiency, vit. B12 and folate deficiency, and anemias of chronic disorders: clinical features, diagnosis and principles of management
Hemoglobinopathies, red cell enzymopathies and membrane disorders (3h) Live
· Principles of diagnosis of hemolytic anemias
· Explain thalassemias and sickle cell anemia: genetics, different clinical pictures, management, complications
· Describe the main abnormalities of RBC membrane
· Describe the main abnormalities of RBC enzymes
Hemolitic anemias and transfusional medicine (2h) Live
· Causes and clinical consequences of immune hemolytic anemias
· Get awareness in RBC, PLT and plasma transfusion facts
· Understand and illustrate transfusional risks
Laboratory techniques in hematology (2h) Asyncronous
· Describe the morphology of hematopoietic precursor cells
· Describe the examination of bone marrow aspirate and peripheral blood smears
· Principles and applications of immunohistochemistry
· Describe the basics of flow cytometry
· Define cytogenetics and fluorescence in situ hybridization (FISH)
· Illustrate the basic aspects of molecular diagnostics in hematology
Teaching cases (4h) Asyncronous
· self reflection on clinical cases with differential diagnosis of anemia
· self reflection on clinical cases with differential diagnosis of bleeding disorders
Teaching methods
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Teaching Resources
Harrison's Principles of Internal Medicine, 21th Edition, McGraw Hill, 2022 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
Blood diseases
MED/15 - BLOOD DISEASES - University credits: 2
Lessons: 16 hours
: 8 hours
: 8 hours
Professor:
Bolli Niccolo'
Shifts:
Turno
Professor:
Bolli Niccolo'
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 2
Lessons: 16 hours
: 8 hours
: 8 hours
Shifts:
Reumathology
MED/16 - RHEUMATOLOGY - University credits: 2
Lessons: 16 hours
: 8 hours
: 8 hours
Professors:
Chighizola Cecilia Beatrice, Favalli Ennio Giulio
Shifts:
Professor(s)
Reception:
Please request an appointment via e-mail
Reception:
Wednesday, 16.00-18.00 (only by appointment to be made by email)
ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milano