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OSTEOARTICULAR APPARATUS DISEASES

Academic year and teacher
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Versione italiana
Academic year
2022/2023
Teacher
LEO MASSARI
Credits
10
Didactic period
Primo Semestre

Training objectives

The integrated course of Diseases of the osteoarticular system includes the modules of:
- Diagnostic imaging
-Diseases of the locomotor system
-Physical Medicine and Rehabilitation
-Rheumatology.
The integrated teaching aims to provide theoretical and practical knowledge in a complex vision of the discipline by investigating the main pathologies of the locomotor system, both in the orthopedic field and in the traumatological field; the pathophysiological mechanisms of the main rheumatic diseases, both inflammatory and degenerative, illustrating the laboratory and imaging tools of the main diseases and the basic principles of rehabilitation, functional recovery and reintegration within the community.

At the end of the integrated course, students should be able to:
1) recognize the onset symptoms and prognostic factors of pathologies with the greatest rheumatological impact;
2) know the main malformations of the skeleton, traumatic and tumoral pathologies of the locomotor system;
3) know the main conservative and surgical therapies for the treatment of diseases of the musculoskeletal system;
4) rationally interpret the main laboratory data and instrumental investigations useful for a correct diagnostic classification;
5) set up the diagnostic decision path;
6) define a basic therapeutic setting and indicate the clinical and instrumental priorities for the purpose of a correct diagnosis through anamnesis, semeiology and instrumental diagnostics;
7) consider the role of gender differences in terms of diagnostic approach, prognosis and response to therapies of the main inflammatory and degenerative rheumatic diseases;
8) master the main methodologies and techniques of rehabilitation intervention in diseases of the locomotor system.

Prerequisites

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Modulo: 015483/6 - MEDICINA FISICA E RIABILITATIVA
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None

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Modulo: 019595/4 - REUMATOLOGIA
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Conoscenze di base di anatomia, biologia molecolare, genetica, fisiopatologia e patologia generale
Conoscenze di anatomia e fisiologia dell'apparato locomotore e dei principali organi ed apparati. Buone conoscenze di biologia e fisiologia cellulare, di immunologia, con particolare riguardo per i processi flogistici immuno-mediati, le malattie autoinfiammatorie e l'autoimmunità. Nozioni generali di farmacologia. Conoscenze di semeiotica medica generale sia fisica che strumentale.
Basic knowledge of anatomy, molecular biology, genetics, physiopatholy and gerel pathology.
The student needs to have good knowledge of the anatomy and physiology of the musculo-skeletal system as well as basic knowledge of the other organs and systems. It is necessary to have good knowledge of the cellular biology and physiology, immunology, with particular emphasis for the immuno-mediated inflammation, autoinflammatory diseases and autoimmunity. Basic knowledge of medical, physical and instrumental, semeiology are required.

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Modulo: 21277 - DIAGNOSTICA PER IMMAGINI
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Knowledge of the principles of radiation physics and the interactions of ionizing radiation with matter. Knowledge of normal human anatomy. Knowledge of the biology of the eukaryotic cell.

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Modulo: 47784 - MALATTIE APPARATO LOCOMOTORE
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Knowledge of anatomy, physics, physiology, pathology.
The student needs to have good knowledge of the anatomy and physiology of the musculo-skeletal system as well as basic knowledge of other relevant organs and systems. Furthermore, it is necessary to have good knowledge of the cellular biology and physiology, immunology, with particular emphasis for the immuno-mediated inflammation and autoimmunity, genetic and molecular biology. Basic knowledge of medical, physical and instrumental, semeiotic is also required.

Course programme

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Modulo: 015483/6 - MEDICINA FISICA E RIABILITATIVA
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Basic principles of rehabilitation. ICF - International Classification of Functioning, Disability and Health. Rehabilitation mode with the implementation of the individual rehabilitation project based on a bio-psycho-social approach that also considers gender differences. The interdisciplinary team in Rehabilitation Medicine. The multidisciplinary rehabilitation team and the definition of the Individual Rehabilitation Project.

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Modulo: 019595/4 - REUMATOLOGIA
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GENERAL PART: classification and epidemiology of rheumatic diseases.
Semeiology of musculo-skeletal pain and clinical approach to the joint and osteoarticular pain.
Interpretation of basic lab test (inflammation tests and diagnostic tests) and of the relevant imaging techniques (conventional Rx, ultrasound, CT, MRI, nuclear medicine).
Early diagnosis of systemic rheumatic diseases and the so-called "red-flags".
Reasoned diagnostic pathways in rheumatology.
Symptomatic therapies (analgesic, NSAIDs, physical therapy). Steroids. Disease-modifying anti-rheumatic drugs including biotechnological and targeted synthetic drugs.
Sex / gender and age related differences in main systemic autoimmune rheumatological diseases.
SPECIAL PART:
Chronic inflammatory arthritis (Rheumatoid arthritis, Spondylo-entesoarthritis: psoriatic arthritis and anlylosing spondylitis).
Connective tissue diseases (SLE, Systemic sclerosis, Systemic Vasculitis, Polymyositis-dermatomyositis, Sjogren syndrome,Antiphospholipid antibodies syndrome, Undifferentiated connective tissue diseases).
Polymyalgia Rheumatica
Infectious arthrtitis
Osteoarthritis.
Crystal induced arthropathies (gout, pyrophosphate arthropathy).
Hints about localized soft tissue rheumatisms and fibromyalgia.
Low back pain (mechanical and inflammatory).
Metabolic bone diseases (osteoporosis)
Hints about main paraneoplastic syndromes of rheumatological interest.
Additional professional skills related to the different topics to be acquired during practical exercises: patient's history, basic semeiological maneuvers in rheumatology, introduction to clinimetry in rheumatology,.
Attend to the following procedures: joint injection and arthrocentesis, capillaroscopy, joint and tendons ultrasound, bone densitometry, synovial fluid analysis

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Modulo: 21277 - DIAGNOSTICA PER IMMAGINI
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- Principles of technique and method, radiological equipment (planar methods, computed tomography, magnetic resonance, ultrasound, gamma camera, positron emission tomography, angiograph), contrast media.
- The structured radiological report: prescriber-reporter communication.
- Appropriateness in diagnostic imaging
- Muscular-skeletal radiological clinical methodology: diagnostic pathways related to aspects of Gender Medicine.
- Multiparametric radiological anatomy of the musculoskeletal system.
- Fundamental radiological semiotics
- Radiology in the traumatology of extreme sports

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Modulo: 47784 - MALATTIE APPARATO LOCOMOTORE
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ORTHOPAEDICS AND TRAUMATOLOGY
Classifications and types of fractures. Healing processes of the fractures. Fractures' complications. Fractures of the joints. Femoral neck fractures. Vertebral fractures.
Osteoarthritis of the hip, knee, spine. Congenital dysplasia of the hip. Meniscal and ligamentous lesions of the knee. Femoral head necrosis. Herniated disk. Scoliosis. Shoulder tendinopathy. Benign and malignat tumors of the skeleton and metastases.

Didactic methods

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Modulo: 015483/6 - MEDICINA FISICA E RIABILITATIVA
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Lectures.

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Modulo: 019595/4 - REUMATOLOGIA
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The course forecasts 16 hours of teaching (frontal lectures) and 1 professionalizing CFU provided in practical exercises to be achieved (o the basis of scheduled calendar) bedside, in day hospital and outpatients acticvities, in the UOC di Reumatologia dell'Azienda Ospedaliero-Universitaria S. Anna di Cona.

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Modulo: 21277 - DIAGNOSTICA PER IMMAGINI
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The course includes lectures and online assisted teaching. The online teaching hours on the certification moodle platform consist of in-depth study of some topics covered and indicated by the teachers at the beginning of the course. The teaching activity will be supplemented by simulation of clinical cases in the classroom, discussion of clinical cases in small groups.

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Modulo: 47784 - MALATTIE APPARATO LOCOMOTORE
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ORTHOPAEDICS AND TRAUMATOLOGY
The course forecasts 24 hours of teaching (frontal lectures) and 1 professionalizing CFU provided in practical exercises dedicated mainly to the vision and description of radiographic and instrumental images

Learning assessment procedures

RHEUMATOLOGY
Normally multiple-choice QUIZ exam (60 questions + 1 for awarding honors, 4 answers, only 1 correct answer; 0.5 points for each correct answer. 0 points for missing or wrong answer. Honors (additional question, or synthetic clinical case) is applied only if the answers to the 60 questions are correct.The allotted time will be 1 hour.
The teacher may (at his discretion) also opt for oral exam sessions: on average 1-2 questions on program topics, duration 15 min (the clarity of the presentation is assessed, the ability to connect, the rigor in the use of the technical vocabulary and communication skills). The final assessment will also take into account the professionalizing part.

DISEASES OF THE LOCOMOTIVE SYSTEM
Multiple choice quiz exam (only one correct answer out of four-five possible) composed of 31 quizzes. Correct answers are evaluated. OMR mode will be used.
The teacher may opt (at his discretion), for students who attended the course before the A.Y. 2020/21, also for appeals with Oral exam modality: on average 2 questions on topics of the program, one of which on a specific pathology and 1 on the vision and identification of a specific radiographic image (lasting approximately 15 minutes). The clarity of the presentation, the ability to connect, the rigor and the communicative ability are evaluated. The final assessment will also take into account the professionalizing part.

PHYSICAL AND REHABILITATION MEDICINE
Written multiple-choice exam (only one correct answer out of four-five possible) consisting of about 15-20 questions.

DIAGNOSTICS BY IMAGES
The exam takes place in written form. The questions focus on the methodological technical knowledge of the tools used in Diagnostic Imaging (Ultrasound, Traditional Radiology, Computed Tomography, Magnetic Resonance), on the knowledge of the issues of appropriateness with a diagnostic-instrumental orientation in the musculoskeletal field on simulated clinical cases, already treated during classroom exercises.

THE FINAL MARK RESULTS FROM THE ARITHMETIC AVERAGE OF THE MARKS ACHIEVED IN EACH TEST. Grades = 0.5 are rounded up.
The final assessment will also take into account the practical part.

Reference texts

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Modulo: 015483/6 - MEDICINA FISICA E RIABILITATIVA
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N. Basaglia (Ed). Medicina Riabilitativa. 4 volumi. Napoli: Idelson-Gnocchi, 2009
N. Basaglia (Ed). Progettare la Riabilitazione. Il lavoro in team interprofessionale. Milano: EdiErmes, 2002

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Modulo: 019595/4 - REUMATOLOGIA
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UNIREUMA: Reumatologia per studenti e medici di medicina generale, Idelson-Gnocchi ed., 2022
QUICK REVIEW REUMATOLOGIA a cura di F. Trotta e M. Govoni. Edizioni EdiSES 2020

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Modulo: 21277 - DIAGNOSTICA PER IMMAGINI
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Didactic material provided by the teacher.

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Modulo: 47784 - MALATTIE APPARATO LOCOMOTORE
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ORTHOPAEDICS AND TRAUMATOLOGY
Grassi F.A., Pazzaglia U.E., Pilato G., Zatti G., Manuale di Ortopedia e Traumatologia, Elsevier Ed. 2012