ECTS - University of Pisa
Corso Integrato di Clinica Medica
CORE CURRICULUM
Integrated Course of Medical Clinic
CORE CURRICULUM
Le conoscenze verranno verificate attraverso la prova d'esame.
Ai fini dell'attribuzione del voto finale, espresso in trentesimi, la commissione valuterà i seguenti aspetti:
Knowledge will be verified through the exam.
For the purposes of assigning the final mark, expressed in thirtieths, the commission will evaluate the following aspects:
Le capacità dello studente saranno valutate con l’aiuto di un caso clinico reale. Lo studente dovrà dimostrare di essere in grado di redigere un’anamnesi, eseguire un esame obiettivo, programmare gli opportuni esami diagnostici e discutere le conseguenti scelte terapeutiche.
The student's skills will be assessed with the help of a real clinical case. The student must demonstrate that he/she is able to draw up a medical history, perform an objective examination, plan the appropriate diagnostic tests and discuss the consequent therapeutic choices.
Sarà svolto il tirocinio formativo nelle quattro settimane prima dell’esame in modo che lo studente acquisisca le capacità cliniche previste dall’insegnamento.
The training internship will be carried out in the four weeks before the exam so that the student acquires the clinical skills required by the course.
Lo studente imparerà le principale norme che regolano il rapporto medico-paziente
Lo studente imparerà a relazionarsi con i colleghi e con il personale infermieristico.
The student will learn the main rules governing the doctor-patient relationship
The student will learn to relate to colleagues and nursing staff.
Durante il tirocinio saranno svolte delle riunioni periodiche durante le quali si discuteranno gli aspetti principali, i punti di forza e le criticità di ciascun studente nella relazione medico-paziente, e nelle altre relazioni professionali.
During the internship periodic meetings will be held during which the main aspects, strengths and critical issues of each student in the doctor-patient relationship and in other professional relationships will be discussed.
E’ necessario che lo studente conosca in modo dettagliato la semeiotica medica e abbia già acquisito le conoscenze relative alle principali specialità mediche nonché le conoscenze della farmacologia generale e specialistica.
The student must be familiar with medical semeiotics in detail and have already acquired the knowledge relating to the main medical specialties as well as the knowledge of general and specialist pharmacology.
Programma di Clinica Medica
Gli argomenti del Programma di Clinica Medica – Medicina Interna, rivolto a Studenti del VI anno di Medicina e Chirurgia, sono scelti con la finalità di approfondire tematiche particolarmente rilevanti nell’ambito della pratica clinica quotidiana.
La finalità del corso è quelle di preparare medici in grado di sapersi orientare in modo corretto di fronte alle più comuni patologie che caratterizzano la professione medica.
Si riconoscono alcune caratteristiche di base di metodo di approccio allo studio:
Argomenti caratterizzanti:
Condizioni determinanti, manifestazioni multi‐organo, essenzialità diagnostica, strategie terapeutiche e follow‐up delle grandi sindromi:
polimialgia‐Horton)
Approfondimenti nosografici:
Strategie diagnostiche di profilo internistico/geriatrico
Terapie condivise e opzioni preferenziali: suggerimenti dalla quotidianità clinica
Medical Clinic Program
The topics of the Medical Clinic - Internal Medicine Program, aimed at students of the sixth year of Medicine and Surgery, are chosen with the aim of investigating particularly relevant issues in the context of daily clinical practice.
The aim of the course is to prepare doctors who are able to orient themselves correctly in the face of the most common pathologies that characterize the medical profession.
These are some basic characteristics of the study approach method:
1. In general, the clinical therapeutic approach will be based on Evidence Based Medicine (EBM), seeking to develop, when possible, forms of interactive teaching.
2. Awareness of the nosological and applicative relevance of the knowledge of gender differences, as well as the peculiarities of the frail elderly patient from a clinical, pathophysiological and therapeutic profile.
3. Contextual definition of clinical problems, using patients belonging to the different Operating Units and clinical cases from asynchronous presentations as a model.
4. Systematic exemplification of the patient-doctor interview, of the clinical visit, of the indication of the modalities of therapy based on the recognition of the highlighted priorities. The priorities are presented in terms of urgency, evolutionary gravity, and / or psycho-social profile pressure, and related management and solution methods using the most common tools: problem-solving, guidelines, direct cascade flow chart or for subsequent eliminations - options.
5. Exemplification of the context analyzes, both from the patient's point of view and from the point of view of the health organization of immediate reference:
1. what clinical-diagnostic strategies and itineraries are possible for a specific patient and in a specific context;
2. assessment of adequacy and appropriateness for the achievement of an optimal result:
3. sustainable, or viable options, and analysis of the related cost-benefits.
6. Unitary approach taking into account the need to connect the knowledge deriving from epidemiology and prevention with a pragmatic clinical approach: evaluation and interventions on lifestyle and clinical nutrition are an integral part of it.
7. Deliberate reference to bioethical aspects, strategies to prevent or manage possible medical-legal disputes, aspects of psychological approach to problems with a view to tolerance and civilization. Main topics:
• Heart failure
• Kidney failure
• Diabetes
• Hypertension
• Respiratory failure
• Liver disease
• Thyroid diseases
• Purpura and thrombocytopenia
• Malnutrition and malabsorption syndromes (including syndromes secondary to cancer and celiac disease)
• Esophagus-gastro-duodenal dyspeptic diseases (including Helicobacter Pylori disease)
• Inflammatory, granulomatous, neoplastic and / or dysfunctional affections of the small intestine and colon.
• anemia
• Genetic-based diseases (hyper-homocysteinemia and MTHFR mutations, thalassemias, Gaucher and Fabry diseases)
• Fevers of unknown origin (diagnostics also with Mediterranean periodic fever, osteoid osteoma, other)
• Headaches and dizziness: elements of internal interest Nosographic insights:
• Valves, most frequent congenital heart disease of adults, myocardiopathies
• Inflammatory diseases of the heart: myocarditis, endocarditis, pericarditis and pericardial effusions
• Ischemic heart disease: appropriate indication for medical and interventional therapeutic approaches.
• Glomerulonephritis and nephrotic syndrome
• Persistent or "emerging" infectious diseases: Lyme, leptospirosis, brucellosis, viral hepatitis, aids
COPD, interstitial lung disease, sleep apnea syndromes
• Metabolic syndrome
• Diseases with hepatic steatosis
• Metabolic bone diseases
• Hyperlipidemia Diagnostic strategies with an internistic / geriatric profile
• The clinical visit: essential and neglected aspects, including cognitive impairment and delirium
• Nutritional evaluation
• Characterizing non-invasive diagnostics: ecg, abdominal and thyroid ultrasound, echocardiography, basic spirometry
• Laboratory tests: essentiality and futility. Shared therapies and preferential options: suggestions from clinical everyday life
• Diuretics
• Ace-inhibitors and sartanics
• Beta blockers
• Calcium channel blockers
• Nitro-derivatives
• Cardiac glycosides
• Antiplatelet and anticoagulant
• Infusion therapies: electrolytes, sugars, amino acids, albumin, immunoglobulins other plasma derivatives
• Supportive therapy in the malnourished patient: neuro-psychiatric disabilities, neoplastic pathologies and unfavorable effects of therapies.
• Antibiotics in acute respiratory diseases, in urinary infections, in sepsis
• Diet, oral hypoglycemic agents and insulins
• "Pump" inhibitors and eradicating therapies for HP
• Oxygen therapy, respiratory rehabilitation and de ‐ sensitizing therapies
• Steroids and other drugs in allergic diseases and asthma
• Symptoms therapies, acute and / or chronic: nausea, vomiting, diarrhea, constipation, dizziness, headaches, "asthenia"
Testi Consigliati:
Il materiale didattico include le slides dei casi simulati presentati e discussi durante le lezioni frontali
Recommended Texts:
The teaching material includes the slides of the simulated cases presented and discussed during the lectures
Discussione di un caso clinico con valutazione della capacità del candidato di effettuare una accurata anamnesi ed esame obiettivo, postulare diagnosi differenziali, discuterne le motivazioni.
Proporre il più appropriato percorso diagnostico e suggerire la terapia più opportuna, facendo riferimento anche ai potenziali eventi avversi dei farmaci, soprattutto nel paziente anziano fragile.
Discussion of a clinical case with evaluation of the candidate's ability to carry out an accurate medical history and objective examination, postulate differential diagnoses, discuss the reasons.
Propose the most appropriate diagnostic path and suggest the most appropriate therapy, also referring to the potential adverse events of the drugs, especially in the frail elderly patient.
RICEVIMENTO STUDENTI
I docenti ricevono su appuntamento preso via e-mail o per telefono o al termine della lezione.
RECEPTION FOR STUDENTS
The teachers receive by appointment made by e-mail or by phone or at the end of the lesson.
