Fundamentals of clinical medicine 1

BLOCK1
INTERNAL MEDICINE AND GENERAL SURGERY
Topic 1. Course presentation
Patient assessment - Comprehensive and focused
· Determining the scope of assessment
· Subjective versus objective data
The surgical patients
· Brief history of surgery and recent development. The operating room and current available technologies
Topic 2. Information research, clinical reasoning, assessment, and plan: the process of clinical reasoning. Identifying problems and making diagnosis, generating the problem list
Topic 3. History taking: a comprehensive health history, the techniques of skilled interviewing, the sequence and context of the interviewing, cultural and cognitive contest, exploring patients' perspective
Topic 5. Signs and symptoms. Beginning the physical examination: general survey, vital signs and pain- Overview of general examination
Topic 6 The thorax, lung, and cardiovascular system: techniques of examinations
Topic 7 The abdomen examination related to medical approach (liver, spleen and pancreas problems)
Topic 8 Surgeon's behavior in the Operating room, basic principles of asepsis and patient's preparation to surgery
Topic 9: Physical examination and clinical signs of the abdomen, chest, breast (surgery related), and genito-urinary apparatus part 1
Topic 10. The vascular system: Arterial diseases, Venous and Vascular diagnosis and anamnesis + English/Italian dictionary
Topic 11. Lump, masses, and ulcer
Topic 12. Doctor-patient relationship: clinical cases
Topic 13. Doctor-patient relationship: clinical cases - the physician perspective
Topic 14. PRACTICE LESSON: Case method and problem solving - clinical cases, a multidisciplinary approach
· The foot
· The big belly
· The fainter
Topic 15. PRACTICE LESSON: Clinical tools
· Chest Rx
· ECG
· Blood gases analysis
· Abdominal ultrasonography
· Vascular ultrasonography
Topic 18. PRACTICE LESSON: Video and multimedia material for asyncrous activities

Synchronous learning: lectures, Clinical Cases, seminars video conferences, interactive webinars, chat-based online discussions, and lectures
Asynchronous learning: audio-video based (pre-recorded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
All teaching materials (files of the teaching presentations and/or recorded lectures) will be made available on a specific myAriel platform.

CARDIOLOGY
Topic 1. Cardiovascular risk
Understand the approaches used to identify the genetic predisposition and environmental factors to cardiovascular diseases
To be able to define monogenic vs. multifactorial cardiovascular diseases: description of examples
Understand the clinical impact of risk stratification
Evaluation of the role as cardiovascular risk factors of race and economical condition
Topic 2 Grading the severity of cardiovascular diseases
Perform a medical interview and a general examination of the cardiac patient
Recognize cardiac sounds and the severity of the cardiovascular disease
Capability to define the severity of heart failure
Topic 3 Resting ECG
Understanding of the cellular and molecular mechanisms involved in the electrical activity of the heart; the anatomy and physiology of the conduction system; and the electrical vectors throughout the cardiac cycle
Understanding the philosophy behind ECG
Understanding the normal ECG and learning to recognize the characteristic appearances of, and the explanation for, the ECG in the main pathological conditions
Topic 4 Arrhythmias
Understanding the epidemiology, pathophysiology, diagnosis and clinical features of arrhythmias and conduction disturbances
Understanding of the classification and definition of bradycardias, tachycardias, supraventricular arrhythmias (including atrial fibrillation and flutter) and ventricular arrhythmias
Describe the use of contrast media
Topic 6 Heart-lung interaction
Discuss of the pathophysiology of lung-heart interactions
Discuss of the clinical and physiological modifications that occur during exercise
Evaluate exercise tolerance and differentiate between cardiovascular and pulmonary aetiology of exercise intolerance
Discuss the difference between cardiac and lung dyspnea
Topic 7 O2 consumption
Discuss of Wasserman plots, CPET parameters and their correlation with prognosis
Discuss the use of VO2 to determine heart failure prognosis
Discuss exercise ventilator efficiency for cardiac, pulmonary and cardiopulmonary diseases
Topic 8 Ischemic heart disease
Understand myocardial ischemia: from pathophysiology to the clinical spectrum (angina, myocardial infarction)
Comprehend the diagnostic tools for assessing myocardial ischemia
Define the basis of the therapeutic approaches
Topic 9 Valvular heart disease
Learning the definition of mitral valve diseases
Learning the definition of aortic valve diseases
Learning the definition of tricuspid valve diseases
Learning the definition of pulmonary valve diseases
Hemodynamics of valvular heart diseases
Topic 10 Pericarditis and endocarditis and cardiomyopathy
Myocarditis and pericarditis: understanding of the mechanisms underlying the disease, the pathophysiology of cardiomyopathy classification the disease and diagnostic and therapeutic approaches
Endocarditis: understanding of the epidemiology, aetiopathogenesis, pathophysiology, diagnosis and therapeutic approaches
Topic 11 Heart failure part 1
Understanding the evolution of concept of Hearth Failure (HF)
Understanding of the epidemiology and prognosis of heart failure with reduced and preserved ejection fraction
Understand the definition of heart failure and recognize the different underlying causes and the precipitating factors of heart failure
Understanding of the pathophysiology of heart failure and systolic and diastolic dysfunction
Topic 12 Heart failure part 2
To be able to evaluate the prognosis of the heart failure patient
To be able to manage acute and chronic HF
Understanding of the role of exercise training programmes in HF patients
Understand the complications of HF
Understanding the therapy approach of HF
Topic 13 Pulmonary hypertension
Understanding of the pathophysiological classification of pulmonary hypertension and the type of investigations used for diagnosing pulmonary hypertension and recognizing the etiology
Understanding of the medical, surgical and interventional management of pulmonary hypertension
Topic 14 Congenital heart diseases
Discuss the anatomy of the heart, veins and great vessels, their major congenital malformations, and the principles of nomenclature
Discuss the physiology of the fetal and transitional circulations; aetiology of congenital heart disease, including the developmental anatomy of the heart and vasculature
Discuss the pathophysiology, natural history and complications of: valve and outflow tract lesions; septal defects; patent ductus arteriosus; Eisenmenger syndrome; coarctation of the aorta; Ebsteins's anomaly; aortic and pulmonary artery malformations; venous anomalies; transposition of the great arteries (complete and congenitally corrected); tetralogy of Fallot; congenital malformations of coronary arteries; cyanotic congenital heart disease and secondary erythrocytosis; and pulmonary hypertension in congenital heart disease.
Evaluate adolescent and adult patients with simple congenital heart defects (grown-up congenital heart disease - GUCH), including those who have undergone cardiac surgery
Describe and recognize physical signs of congenital heart disease and its complications

NEPHROLOGY.
Topic 1 Management of the patient with renal disease
How to identify renal syndromes from the patient's clinical presentation (nephrotic syndrome, nephritic syndrome, positive uranalysis examination, rapidly progressive renal failure, chronic kidney disease) and through specific laboratory investigations, including microscopic urinary sediment analysis.
How to measure kidney function (glomerular filtration rate, tubular and endocrine renal function)
The renal biopsy
Define the impact of preanalytical variables in clinical studies.
Topic 2 The body fluid imbalance and the pathophysiology of the edema
Evaluation of hypovolemia and volume overload in patients with normal and altered renal function
Clinical management and diagnostic algorithm of hyponatremia and hypernatremia
Clinical management and diagnostic algorithm of hypokalemia and hyperkalemia
Clinical management and diagnostic algorithm of acid-base disorders
Topic 3 Glomerular disorders
Clinical presentation and management of most frequent primary and secondary glomerulonephritis, microscopic urinary sediment analysis, follow up of chronic glomerulonephritis
Topic 4 Management of patients with tubulo-interstitial nephritis
Common etiologies, clinical presentation, diagnostic algorithm for both acute nephritis and chronic interstitial nephritis
Topic 5 Approach to patients with urinary tract and renal infection
Common etiologies and clinical presentation of cystitis, acute and chronic pyelonephritis, reflux nephropathy, CAKUT syndrome
Topic 6 Acute kidney injury/acute renal failure
Common etiologies and clinical presentation of acute kidney injury in the hospital and community settings
Differential diagnosis of the various clinical presentations (pre-renal, parenchymal, obstructive renal injury)
Topic 7 Chronic kidney disease - CKD
Common etiologies and clinical presentation of CKD
Systemic consequences of CKD, based on loss of physiologic functions of the kidneys
Endocrine abnormalities linked to CKD. Introduction to the artificial kidney
Topic 8 Introduction to artificial kidney
Topic 9 Renal vascular diseases
Vascular injury to the kidney
Hypertensive vascular disease
Topic 10 Case studies
Four hours of non-formal teaching will be devoted to case studies, where students will be challenged to understand and explain pathophysiological mechanisms of kidney diseases based on a simulated clinical case and on information derived from published articles
Topic 11 Principles of renal transplantation
How to get on the transplant waiting list, selection of the recipients, management of the waiting list, different types of donors, early and late complications of renal transplantation
Topic 12. Management of patients with diabetes
When to suspect a renal involvement and how to detect an early diabetic nephropathy (signs, symptoms and specific laboratory investigations)
The stages of diabetic nephropathy: microalbuminuria, nephrotic syndrome, renal failure and uremia
Treatment and follow-up of diabetic patients
Topic 13 Management of patients with hereditary nephropathies
When to suspect a hereditary nephropathy and how to conduct a clinical interview in such conditions (autosomic dominant polycystic kidney disease, Alport Syndrome, benign familial hematuria, Fabry disease)
Inherited renal tubular disorders : Bartter, Gitelman, RTA etc.)
When to suspect a hereditary nephropathy and how to conduct a clinical interview in such conditions (autosomic dominant polycystic kidney disease, Alport Syndrome, benign familial hematuria, Fabry disease)
Topic 14. Analysis of the urinary sediment
To learn how to recognize diseases based on the characteristics of the urine composition and microscopic analysis

BLOCK1
INTERNAL MEDICINE AND GENERAL SURGERY
Topic 1. Course presentation
Patient assessment - Comprehensive and focused
· Determining the scope of assessment
· Subjective versus objective data
The surgical patients
· Brief history of surgery and recent development. The operating room and current available technologies
Topic 2. Information research, clinical reasoning, assessment, and plan: the process of clinical reasoning. Identifying problems and making diagnosis, generating the problem list
Topic 3. History taking: a comprehensive health history, the techniques of skilled interviewing, the sequence and context of the interviewing, cultural and cognitive contest, exploring patients' perspective
Topic 5. Signs and symptoms. Beginning the physical examination: general survey, vital signs and pain- Overview of general examination
Topic 6 The thorax, lung, and cardiovascular system: techniques of examinations
Topic 7 The abdomen examination related to medical approach (liver, spleen and pancreas problems)
Topic 8 Surgeon's behavior in the Operating room, basic principles of asepsis and patient's preparation to surgery
Topic 9: Physical examination and clinical signs of the abdomen, chest, breast (surgery related), and genito-urinary apparatus part 1
Topic 10. The vascular system: Arterial diseases, Venous and Vascular diagnosis and anamnesis + English/Italian dictionary
Topic 11. Lump, masses, and ulcer
Topic 12. Doctor-patient relationship: clinical cases
Topic 13. Doctor-patient relationship: clinical cases - the physician perspective
Topic 14. PRACTICE LESSON: Case method and problem solving - clinical cases, a multidisciplinary approach
· The foot
· The big belly
· The fainter
Topic 15. PRACTICE LESSON: Clinical tools
· Chest Rx
· ECG
· Blood gases analysis
· Abdominal ultrasonography
· Vascular ultrasonography
Topic 18. PRACTICE LESSON: Video and multimedia material for asyncrous activities