The course consists of the presentation of clinical cases concerning the main rheumatological and pneumological pathologies of internal medicine interest in order to acquire the ability to design differential diagnosis paths and to set up appropriate pharmacological and non-pharmacological therapies taking into account the gender differences in the various pathologies.
KNOWLEDGE AND UNDERSTANDING. At the end of the course, students will have to demonstrate knowledge and ability to understand the fundamental concepts and principles on which the differential diagnosis and therapy of the main rheumatological and pneumological pathologies of internal medicine interest is based.
ABILITY TO APPLY KNOWLEDGE AND UNDERSTANDING. At the end of the course the student must be able to apply the knowledge acquired in the previous point in order to apply the appropriate methodologies for the practical management of the patient's clinical problem. You must also know how to prescribe and appropriately interpret laboratory tests (chemical, microbiological and genetic) and instrumental tests (diagnostic imaging and pathophysiological tests) aimed at differential diagnosis. You must know how to plan the appropriate therapy by evaluating the risk-benefit ratio of drugs and non-pharmacological therapies. At the end of the course, students should be able to manage patients' clinical internal problems.
MAKING JUDGEMENTS. At the end of the course, students will have to demonstrate that they have not only acquired knowledge and concepts, but also that they are able to provide appropriate judgments in relation to the setting of the diagnostic-therapeutic process, patient safety and management of the clinical risk.
COMMUNICATION SKILLS. At the end of the course, students must be able to express themselves and argue appropriately through the specific terminology acquired through the lessons provided, the teaching material and/or the reference text. Students must also be able to communicate with patients and family members in a clear and empathetic way using simple terminology and avoiding technical terms.
LEARNING ABILITY. At the end of the course, students will have to demonstrate that they are able to apply the minimum knowledge, skills and competences described in this Syllabus.

Pathophysiology of endocrine, metabolic and liver diseases and methods of clinical examination. Pharmacology of endocrine, metabolic and liver disease therapies.

Clinical cases of rheumatology and pneumology with analysis of gender differences in various pathologies. Polyarthritis and mild anemia. Right knee pain and stiffness in a seronegative patient. Chest pain with pancytopenia and arthritis. Recurrent sinusitis and dyspnea in a patient with microscopic hematuria. Acute dyspnea and unilateral edema of the lower limb. Fever, productive cough and dry state. Chronic non-productive cough. Worsening of dyspnea and productive cough in smokers.

Oxford Manuale di Medicina Clinica Decima Edizione. Current Medical Diagnosis & Treatment 2024. McGraw Hill LANGE. SIMI HANDBOOK Terapia Medica. Seconda edizione 2022. EDRA Ed.

Clinical cases in rheumatology and pneumology. POLYARTHRITIS AND MILD ANEMIA. Recognize rheumatic diseases and their prevalence. Differential diagnosis of arthritis. Recognize the extra-articular manifestations of rheumatic diseases. Serology of rheumatic diseases. Clinical and serological diagnostic criteria of rheumatoid arthritis. Principles of therapy with anti-inflammatory, immunosuppressive and biological drugs. Recognize anemia associated with chronic inflammation. RIGHT KNEE PAIN AND STIFFNESS IN A SERONEGATIVE PATIENT. Differential diagnosis of monoarthritis and seronegative oligoarthritis. Know the risk factors and treatment principles of osteoarthritis. Common features of seronegative spondyloarthropathies: ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, and reactive arthritis. Lyme disease. Differential diagnosis of acute monoarthritis: gout attack, pseudo-gout (deposition of calcium pyrophosphate crystals), septic arthritis. Risk factors, natural history and therapy of gout. Asymptomatic hyperuricemia. Tumor lysis syndrome. CHEST PAIN WITH PANCYTOPENIA AND ARTHRITIS. Clinical, instrumental and serological diagnostic criteria of systemic lupus erythematosis. Reynaud's phenomenon. Systemic sclerosis. Sicca syndrome. RECURRENT SINUSITIS AND DYSPNEA IN A PATIENT WITH MICROSCOPIC HEMATURIA. Recognize the clinical and serological manifestations of vasculitis. Vasculitis of small, medium and large vessels. Cryoglobulinemia. Recognizing temporal arteritis in the differential diagnosis of headaches in the elderly. Principles of therapy with glucocorticoid drugs. Rheumatological emergencies. ACUTE DYSPNEA AND UNILATERAL EDEMA OF THE LOWER LIMB. Differential diagnosis of lower limb edema. Recognizing deep vein thrombosis (DVT). Differential diagnosis of acute dyspnea. Recognizing pulmonary embolism (PE). Principles of prophylactic therapy for DVT and PE. Principles of differential diagnosis of congenital and acquired thrombophilias. FEVER, PRODUCTIVE COUGH AND DRY STATE. Diagnosis of pneumonia. Define the pneumonia treatment setting based on the definition of clinical severity levels (CURB-65, SOFA score, qSOFA). Etiological diagnosis of pneumonia. Multiresistant bacteria. Principles of empirical antibiotic therapy of pneumonia (CAP-community, HAP-nosocomial, HCAP-associated with healthcare treatment). Antimicrobial stewardship. Antibiotic deescalation. Recognize sepsis and septic shock as complications of pneumonia. Definition of sepsis as an infection associated with organ complications mediated by an abnormal immune response (2016 Sepsis 3). Recognize other complications of pneumonia. CHRONIC NON-PRODUCTIVE COUGH. Differential diagnosis of chronic cough. Recognize bronchial asthma based on anamnesis, physical examination and instrumental investigations. Principles of therapy of chronic asthma and acute asthma. Indicators of severity of acute asthma. Mechanisms of action of bronchodilator drugs. Recognizing sarcoidosis. Interstitial lung diseases. WORSENING OF DYSPNEA AND PRODUCTIVE COUGH IN SMOKERS. Recognize chronic obstructive bronchitis (COPD) based on anamnesis, physical examination and instrumental investigations. Principles of pathophysiology of respiratory failure. Spirometry: obstructive and restrictive patterns. Distinguish the different clinical patterns of COPD: prevalent emphysema or prevalent chronic bronchitis. Complications of COPD. Principles of therapy for COPD in its various stages of severity. Treatment of COPD flare-ups. Indications for home oxygen therapy. Recognize pulmonary hypertension and chronic cor pulmonale.

Lectures and clinical case studies on real or simulated patient. Attendance of a two-week internship in an internal medicine department (UCO Clinica Medica, Cattinara Hospital, Trieste, ASUGI) is required. The teaching material is made available to students via the Moodle and MS-Teams platforms.

Any changes to the methods described here will be communicated on the Department, Course of Study and teaching website.
Prof. Gianni Biolo. Department of Medical, Surgical and Health Sciences. University of Trieste. UCO Clinica Medica - Cattinara Hospital – ASUGI. Strada di Fiume 447, 34100 Trieste; e-mail: biolo@units.it; tel. 040-3994432. Consultation is by appointment.

Evaluation of clinical skills through an oral exam, which includes discussion of clinical cases and topics included in the program. Score 29-30 cum laude: the student has an IN-DEPTH knowledge of the subject, has excellent communication skills and masters medical-scientific language.

Score 26-28: the student has a GOOD knowledge of the subject and explains the topics clearly using appropriate medical-scientific language;
Score 22-25: the student has a DISCRETE knowledge of the subject, even if limited to the main topics and explains the topics quite clearly with a reasonable command of language;
Score 18-21: the student has the MINIMUM knowledge of the subject and explains the topics clearly enough although the language skills are poorly developed; Exam not passed: the student DOES NOT HAVE THE MINIMUM KNOWLEDGE required of the main contents of the course. The ability to use specific language is very poor or non-existent and he is unable to apply the knowledge acquired independently.