21331 - Internal Medicine and Geriatrics

Learning outcomes

To understand the mechanisms and the clinical manifestations of diseases addressed by modules 1-4. To comprehend the techniques for recognizing and managing emergencies pertaining to the diseases addressed by modules 1-4, such as acute liver failure, anaphylaxis, and delirium, within the confines of one's professional competence.

Course contents

1. Diseases of the liver and biliary tract (6 hours)

  

Clinical anatomy and physiology. The hepatic lobule. The portal circle. The functional segments of the liver. The biliary system. The functions of the hepatocyte. Formation of bile. Metabolism and transport of bilirubin. Synthesis of coagulation factors. Metabolism of carbohydrates, lipids and proteins (hints). Vitamin D metabolism. The liver as a reserve of nutrients. Metabolism of drugs and toxic substances.

 

Clinical manifestations. Hepatic failure. Icterus. Encephalopathy. Hemorrhage. Ascites. Portal hypertension.

 

Laboratory evaluation. Liver chemistry tests.

Instrumental evaluation (hints). Hepatic ultrasound. Hepatic elastography. Computed axial tomography (CT). Magnetic resonance imaging (MRI). Cholangio-MRI. Examination of ascitic fluid.

Acute hepatitis related to viruses (HAV, HBV, HCV, HDV, HEV, other viruses), drugs and alcohol. Chronic hepatitis related to viruses (HBV, HCV), drugs and alcohol. Non-alcoholic steatopatitis. Chronic autoimmune hepatitis. Alcoholic liver disease. Non-alcoholic fatty liver disease. Cirrhosis. Cholelithiasis.

2. Diseases of the immune system (3 hours)

 
The immune response. Anatomical, molecular and cellular components of the immune system. The HLA (Human Leucocyte Antigen) system. The complement system. Principles of immunotherapy (hints). Classification of hypersensitivity reactions. Allergy and atopy. Allergic rhinitis. Anaphylaxis. Angioedema. Hypersensitivity to drugs. Food allergies. Primary immunodeficiencies (hints). Transplant immunology (hints).


3. Diseases of the musculoskeletal system and connective tissue (3 hours)

Clinical anatomy.

Laboratory and instrumental evaluation. Autoantibodies (hints relevant to diagnostic use).

Rheumatoid arthritis. Seronegative spondyloarthritis (ankylosing spondylitis, psoriatic arthritis, reactive arthritis). Sjögren's syndrome. Systemic lupus erythematosus. Progressive systemic sclerosis. Polymyalgia rheumatica. Dermatomyositis-polymyositis (hints). Antiphospholipid antibody syndrome (hints). Mixed connective tissue (hints).

4. Geriatrics (12 hours)

Approach to the older person. Changes in bodily functions associated with aging. Peculiarities of the clinical evaluation of the older person. Atypical presentation of diseases in the older person. Quality of life and therapeutic goals in the older person.

Importance of multidimensional assessment in the older person. Scales for multidimensional assessment, in detail: activities of daily living (ADL), instrumental activities of daily living (IADL), geriatric depression scale (GDS), mini-mental status examination (MMSE).

Problems associated with drug treatment of the older person. Pharmacological prescription in the older person. The Beers criteria for drug prescribing/deprescribing in the older person.

Abuse of the older person.

Falls. Movement disorders (geriatric aspects)

Dementia (geriatric aspects). Delirium.

Frailty. Sarcopenia.

Readings/Bibliography

Massini R, Izzi D, Marchetti P, Passeretti F, Recine U. Medicina Interna (collana Laura Infermieristica). Milano: McGraw Hill Education; 2019

For further information an excellent and continuously updated resource is the Merck Handbook Professional Edition https://www.msdmanuals.com/it-it/professionale

Teaching methods

classroom-taught lesson

Assessment methods

The exam consists of a written test (multiple choice questions).

Being an integrated course, the test consists of 90 questions (15 questions x 6 subjects).

Each question has three answers, of which only one is true.

To pass the exam, the student must correctly answer at least

- 5 of 15 questions per subject and
- 54 of 90 total questions (18/30).

The scheme for converting the score to 30ths is as follows:

18/30 score from 54 to 54
19/30 score from 55 to 58
20/30 score from 59 to 60
21/30 score from 61 to 62
22/30 score from 63 to 64
23/30 score from 65 to 66
24/30 score from 67 to 68
25/30 score from 69 to 70
26/30 score from 71 to 72
27/30 score from 73 to 74
28/30 score from 75 to 76
29/30 score from 77 to 78
30/30 score from 79 to 84
30L/30 score from 85 to 90

The time allowed for the exam is 80 minutes.

Teaching tools

The course handouts (PDF) will be available for the duration of the academic year at the web address provided by the teacher at the beginning of the course.

Office hours

See the website of Elisa Fabbri