Internal Medicine

A.Y. 2020/2021
8
Max ECTS
96
Overall hours
SSD
MED/01 MED/06 MED/09
Language
Italian
Learning objectives
The course is divided into 2 years, the 5th and 6th. It is proposed to provide diagnostic criteria, differential diagnosis and therapeutic tools for the main diseases of interest in internal medicine. As an example: cardiovascular, pulmonary, hematologic, gastro-hepatological, endocrinological, nephrological, infectious diseases. The course also aims to provide the basis for the diagnosis and management of the elderly patient and the neoplastic patient. During the course the main pathophysiological mechanisms will be briefly recalled, with particular attention to polymorbidities that often coexist above all in elderly patients. The bases will be provided to carry out the most probable diagnosis and the most appropriate therapy of internal medical conditions and their complications, to highlight the complexity linked to polymorbidity.
The teaching method involves the discussion of clinical cases, through which to discuss the various possible differential diagnoses and the appropriate therapy setting, according to the most updated guidelines.
Expected learning outcomes
At the end of the course the student must be able to recognize and manage the patient with internal disease, performing differential diagnostics and setting the most suitable therapy. The student must also be able to interpret the most common laboratory and instrumental exams and set up the follow-up of the main internist pathologies. The exam will be done at the end of the 6th year of Internal Medicine course and will consist of a practical test that will take place in the Internal Medicine Units and an oral test with at least two examiners.
Course syllabus and organization

Linea: Policlinico

Responsible
Lectures will still take place in classrooms, if students can't reach the buildings we might consider alternative ways.
Prerequisites for admission
The student need to know the pathogenesis and pathophysiological bases, the risk factors and the prognostic factors of the diseases; their epidemiology and pathology, physical, laboratory and instrumental characterization of the diseases; the pharmacological basis of the therapies; how to evaluate the evidence in medicine
Assessment methods and Criteria
The exam of Internal Medicine will evaluate the student's skills to collect and interpret the data from patients interview and physical examination and plan rational diagnostic procedure to reach a correct diagnosis and to define the most appropriate therapy. The following contents will be specifically evaluated:
1) practice exam: (a) Ability to perform the approach to the patient both in terms of history collection and evaluation of the physical examination (b) Ability of the interpretation of laboratory or instrumental tests and discussion of their meaning in the context of the patient under examination and as differential diagnosis with other clinical pictures.
2) Oral exam
(a) Discussion of a clinical case with particular attention:
- to differential diagnosis
- the definition of a rational diagnostic procedure based on: epidemiological criteria, rational use of diagnostic resources, optimal risk-benefit and cost-effectiveness ratio, expected prognosis
(b) Discussion of the criteria for setting the therapy in the treatment of the various conditions with particular attention to the exposure of:
- methods of clinical use of the main drugs and their therapeutic efficacy
- main contraindications and side effects in the use of the most used drugs.
The evaluation of each of the two parts will constitute the overall mark out of 30
Internal medicine
Course syllabus
Pathologies of the cardiovascular system
Diseases of the respiratory system
Hematopoietic pathologies
Pathologies of haemostasis and thrombosis
Hepato-gastroenterological pathologies
Metabolic disorders (diabetes classification)
Approach to autoimmune diseases
Approach to the cancer patient (main pathologies therapeutic treatment side effects ...)
Approach to complex clinical pictures (confusional states, frailty of the elderly subject, weight disorders, electrolyte disturbances, non-typical abdominal pain, nosocomial infections ...)
Statistical and epidemiological evaluation of the main pathologies
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
The book proposed is Harrison Principles of Internal Medicine, 20th edition. During the teaching activities, Professors will provide references for the consultation of the update literature available online, with particular attention to the New England Journal of Medicine, Lancet, British Medical Journal-BMJ; journals published by the American College of Physicians; Cochrane Library, and the most recent guidelines
Ogni lezione del corso presenta i riferimenti bibliografici essenziali circa gli argomenti trattati.
Medical oncology
Course syllabus
1. "Clinical biology" of cancer
2. Clinica methodology in Oncology
3. Principales of multidisciplinary cancer treatment
4. Principales of medical cancer treatment
5. Complications of cancer desease
6. Complications of cancer treatment
7. Evidence building and state of the art on Oncology
8. Rare versus frequent cancers
9. Cancer: Description of 1 Model
10. Cancer: Staging and treatment strategy
11. Principla of communication skills in cancer care
12. Clinical decision-making in Oncology
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
· Harrison's Priciples of Internal Medicine, McGraw Hill19th Edition, chapters: 3, 4, 10, 15, 17, 18, 91, 99, 100, 102, 103, 104, 120, 121, 122, 125 (also available as ebook in the digital library of the University of Milan, http://www.sba.unimi.it/)
· Papadakis MA et al Current Medical Diagnosis & Treatment, McGraw Hill, chapters on the 2017 Edition: 9
· Robbins and Cotran. Pathologic basis of Desease (9th Edizion)
· Goodman & Gilman's. "The pharmacological basis of therapeutics". 12th Edizione. The McGraw-Hill companies
· Slides and scientific material forniti provided during the lectures.
Medical statistics
Course syllabus
Data coding: how to structure a database
- The R software and the R Commander interface module
- Import data into R from an Excel file
- The descriptive statics with R Commader:
graphs, numerical summary indices, contingency tables
- Inference procedures with R commander:
hypothesis tests and confidence intervals for averages and proportions
- The search for general medical information on Medline and Health on the Net Foundation.
- Notes on guided diagnosis systems available on the Internet
- The PubMed database
(search with MeSH terms, search with keywords, basic and advanced methods)
-The Scopus database
(basic and advanced search, how to derive the authors' H index)
- the Impact Factor: The Journal of Citation Report database
- Systematic reviews: the Cochrane Library database
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
The book proposed is Harrison Principles of Internal Medicine, 20th edition. During the teaching activities, Professors will provide references for the consultation of the update literature available online, with particular attention to the New England Journal of Medicine, Lancet, British Medical Journal-BMJ; journals published by the American College of Physicians; Cochrane Library, and the most recent guidelines
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 5
Lessons: 60 hours
Medical oncology
MED/06 - MEDICAL ONCOLOGY - University credits: 2
Lessons: 24 hours
Medical statistics
MED/01 - MEDICAL STATISTICS - University credits: 1
Lessons: 12 hours
Professor: Biganzoli Elia

Linea: San Donato

Responsible
Lectures will still take place in classrooms, if students can't reach the buildings we might consider alternative ways.
Prerequisites for admission
The student need to know the pathogenesis and pathophysiological bases, the risk factors and the prognostic factors of the diseases; their epidemiology and pathology, physical, laboratory and instrumental characterization of the diseases; the pharmacological basis of the therapies; how to evaluate the evidence in medicine
Assessment methods and Criteria
The exam of Internal Medicine will evaluate the student's skills to collect and interpret the data from patients interview and physical examination and plan rational diagnostic procedure to reach a correct diagnosis and to define the most appropriate therapy. The following contents will be specifically evaluated:
1) practice exam: (a) Ability to perform the approach to the patient both in terms of history collection and evaluation of the physical examination (b) Ability of the interpretation of laboratory or instrumental tests and discussion of their meaning in the context of the patient under examination and as differential diagnosis with other clinical pictures.
2) Oral exam
(a) Discussion of a clinical case with particular attention:
- to differential diagnosis
- the definition of a rational diagnostic procedure based on: epidemiological criteria, rational use of diagnostic resources, optimal risk-benefit and cost-effectiveness ratio, expected prognosis
(b) Discussion of the criteria for setting the therapy in the treatment of the various conditions with particular attention to the exposure of:
- methods of clinical use of the main drugs and their therapeutic efficacy
- main contraindications and side effects in the use of the most used drugs.
The evaluation of each of the two parts will constitute the overall mark out of 30
Internal medicine
Course syllabus
Pathologies of the cardiovascular system
Diseases of the respiratory system
Hematopoietic pathologies
Pathologies of haemostasis and thrombosis
Hepato-gastroenterological pathologies
Metabolic disorders (diabetes classification)
Approach to autoimmune diseases
Approach to the cancer patient (main pathologies therapeutic treatment side effects ...)
Approach to complex clinical pictures (confusional states, frailty of the elderly subject, weight disorders, electrolyte disturbances, non-typical abdominal pain, nosocomial infections ...)
Statistical and epidemiological evaluation of the main pathologies
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
The book proposed is Harrison Principles of Internal Medicine, 20th edition. During the teaching activities, Professors will provide references for the consultation of the update literature available online, with particular attention to the New England Journal of Medicine, Lancet, British Medical Journal-BMJ; journals published by the American College of Physicians; Cochrane Library, and the most recent guidelines
Ogni lezione del corso presenta i riferimenti bibliografici essenziali circa gli argomenti trattati.
Medical oncology
Course syllabus
1. "Clinical biology" of cancer
2. Clinica methodology in Oncology
3. Principales of multidisciplinary cancer treatment
4. Principales of medical cancer treatment
5. Complications of cancer desease
6. Complications of cancer treatment
7. Evidence building and state of the art on Oncology
8. Rare versus frequent cancers
9. Cancer: Description of 1 Model
10. Cancer: Staging and treatment strategy
11. Principla of communication skills in cancer care
12. Clinical decision-making in Oncology
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
· Harrison's Priciples of Internal Medicine, McGraw Hill19th Edition, capitoli: 3, 4, 10, 15, 17, 18, 91, 99, 100, 102, 103, 104, 120, 121, 122, 125 (disponibile anche in ebook nella libreria digitale dell'Università di Milano, http://www.sba.unimi.it/)
· Papadakis MA et al Current Medical Diagnosis & Treatment, McGraw Hill, capitolo nell'Edizione 2017: 9
· Robbins and Cotran. Pathologic basis of Desease (9th Edizione)
· Goodman & Gilman's. "The pharmacological basis of therapeutics". 12th Edizione. Compagnie McGraw-Hill
· Slides and materiale scientifico forniti durante le lezioni.
Medical statistics
Course syllabus
Data coding: how to structure a database
- The R software and the R Commander interface module
- Import data into R from an Excel file
- The descriptive statics with R Commader:
graphs, numerical summary indices, contingency tables
- Inference procedures with R commander:
hypothesis tests and confidence intervals for averages and proportions
- The search for general medical information on Medline and Health on the Net Foundation.
- Notes on guided diagnosis systems available on the Internet
- The PubMed database
(search with MeSH terms, search with keywords, basic and advanced methods)
-The Scopus database
(basic and advanced search, how to derive the authors' H index)
- the Impact Factor: The Journal of Citation Report database
- Systematic reviews: the Cochrane Library database
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
The book proposed is Harrison Principles of Internal Medicine, 20th edition. During the teaching activities, Professors will provide references for the consultation of the update literature available online, with particular attention to the New England Journal of Medicine, Lancet, British Medical Journal-BMJ; journals published by the American College of Physicians; Cochrane Library, and the most recent guidelines
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 5
Lessons: 60 hours
Medical oncology
MED/06 - MEDICAL ONCOLOGY - University credits: 2
Lessons: 24 hours
Medical statistics
MED/01 - MEDICAL STATISTICS - University credits: 1
Lessons: 12 hours

Linea: San Giuseppe

Responsible
Lectures will still take place in classrooms, if students can't reach the buildings we might consider alternative ways.
Prerequisites for admission
The student need to know the pathogenesis and pathophysiological bases, the risk factors and the prognostic factors of the diseases; their epidemiology and pathology, physical, laboratory and instrumental characterization of the diseases; the pharmacological basis of the therapies; how to evaluate the evidence in medicine
Assessment methods and Criteria
The exam of Internal Medicine will evaluate the student's skills to collect and interpret the data from patients interview and physical examination and plan rational diagnostic procedure to reach a correct diagnosis and to define the most appropriate therapy. The following contents will be specifically evaluated:
1) practice exam: (a) Ability to perform the approach to the patient both in terms of history collection and evaluation of the physical examination (b) Ability of the interpretation of laboratory or instrumental tests and discussion of their meaning in the context of the patient under examination and as differential diagnosis with other clinical pictures.
2) Oral exam
(a) Discussion of a clinical case with particular attention:
- to differential diagnosis
- the definition of a rational diagnostic procedure based on: epidemiological criteria, rational use of diagnostic resources, optimal risk-benefit and cost-effectiveness ratio, expected prognosis
(b) Discussion of the criteria for setting the therapy in the treatment of the various conditions with particular attention to the exposure of:
- methods of clinical use of the main drugs and their therapeutic efficacy
- main contraindications and side effects in the use of the most used drugs.
The evaluation of each of the two parts will constitute the overall mark out of 30
Internal medicine
Course syllabus
Pathologies of the cardiovascular system
Diseases of the respiratory system
Hematopoietic pathologies
Pathologies of haemostasis and thrombosis
Hepato-gastroenterological pathologies
Metabolic disorders (diabetes classification)
Approach to autoimmune diseases
Approach to the cancer patient (main pathologies therapeutic treatment side effects ...)
Approach to complex clinical pictures (confusional states, frailty of the elderly subject, weight disorders, electrolyte disturbances, non-typical abdominal pain, nosocomial infections ...)
Statistical and epidemiological evaluation of the main pathologies
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
The book proposed is Harrison Principles of Internal Medicine, 20th edition. During the teaching activities, Professors will provide references for the consultation of the update literature available online, with particular attention to the New England Journal of Medicine, Lancet, British Medical Journal-BMJ; journals published by the American College of Physicians; Cochrane Library, and the most recent guidelines
Ogni lezione del corso presenta i riferimenti bibliografici essenziali circa gli argomenti trattati.
Medical oncology
Course syllabus
1. "Clinical biology" of cancer
2. Clinica methodology in Oncology
3. Principales of multidisciplinary cancer treatment
4. Principales of medical cancer treatment
5. Complications of cancer desease
6. Complications of cancer treatment
7. Evidence building and state of the art on Oncology
8. Rare versus frequent cancers
9. Cancer: Description of 1 Model
10. Cancer: Staging and treatment strategy
11. Principla of communication skills in cancer care
12. Clinical decision-making in Oncology
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
· Harrison's Priciples of Internal Medicine, McGraw Hill19th Edition, chapters: 3, 4, 10, 15, 17, 18, 91, 99, 100, 102, 103, 104, 120, 121, 122, 125 (also available as ebook in the digital library of the University of Milan, http://www.sba.unimi.it/)
· Papadakis MA et al Current Medical Diagnosis & Treatment, McGraw Hill, chapters on the 2017 Edition: 9
· Robbins and Cotran. Pathologic basis of Desease (9th Edizion)
· Goodman & Gilman's. "The pharmacological basis of therapeutics". 12th Edizione. The McGraw-Hill companies
· Slides and scientific material forniti provided during the lectures.
Medical statistics
Course syllabus
- Data coding: how to structure a database
- The R software and the R Commander interface module
- Import data into R from an Excel file
- The descriptive statics with R Commader:
graphs, numerical summary indices, contingency tables
- Inference procedures with R commander:
hypothesis tests and confidence intervals for averages and proportions
- The search for general medical information on Medline and Health on the Net Foundation.
- Notes on guided diagnosis systems available on the Internet
- The PubMed database
(search with MeSH terms, search with keywords, basic and advanced methods)
-The Scopus database
(basic and advanced search, how to derive the authors' H index)
- the Impact Factor: The Journal of Citation Report database
- Systematic reviews: the Cochrane Library database
Teaching methods
The course uses the teaching tools listed below in relation to the diversified teaching activities foreseen during the course.
· Frontal lessons - Presentation of clinical cases aimed at promoting the discussion of methodological aspects (clinical epidemiology, medical reasoning); specific pathological conditions which, due to their prevalence, exemplarity and complexity, require a more in-depth treatment, or have recently been updated or reviewed (guidelines, reviews according to EBM); analysis of the ethical dimensions of clinical decisions.
· Tutorial professional activities "Medical Clinical Practice Skills" - Training course carried out at the Hospital Medicine Departments following dedicated tutors, oriented towards the acquisition of Elementary Teaching Units relating to specific practical skills (ETU). This part is defined by a section of the skills booklet for the 3 last years which will be delivered to the students and signed by the tutor chosen to acquire each of the UDE.
Teaching Resources
The book proposed is Harrison Principles of Internal Medicine, 20th edition. During the teaching activities, Professors will provide references for the consultation of the update literature available online, with particular attention to the New England Journal of Medicine, Lancet, British Medical Journal-BMJ; journals published by the American College of Physicians; Cochrane Library, and the most recent guidelines
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 5
Lessons: 60 hours
Medical oncology
MED/06 - MEDICAL ONCOLOGY - University credits: 2
Lessons: 24 hours
Medical statistics
MED/01 - MEDICAL STATISTICS - University credits: 1
Lessons: 12 hours
Professor: Biganzoli Elia