INTERNAL MEDICINE I AND ONCOHEMATOLOGY
Academic year and teacher
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- Versione italiana
- Academic year
- 2017/2018
- Teacher
- ANTONIO CUNEO
- Credits
- 15
- Didactic period
- Primo Semestre
Training objectives
- INTERNAL MEDICINE
To lead a correct clinical examination of an internal medicine patient reaching to the diagnostic hypothesis, estimating the differential diagnoses, also integrating with examinations (laboratory, imaging etc..). Moreover, the integration of knowledge of specific sex/gender factors of certain diseases will represent important issue, with particular attention to the differences, in an integrated diagnostic-therapeutic olistic pathway.
BLOOD DISEASES
To know the epidemiology, the etiology, the pathophysiology, the clinical presentation and therapy of
1)-the benign disorders of hemopoiesis (anemia, leukopenia, thrombocytopenia),
2)-the tumors of the hemopoietic and lymphoid system
3)-the coagulation disorders (thromboses and hemorrahes)
At the end of the course the students will be able to pose a diagnostic hypothesis, to formulate the correct diagnosis by means of laboratory and imaging techniques and to propose a the correct treatment strategy.
MEDICAL ONCOLOGY
To know the risk factors, the clinical symptoms and signs suspicious for cancer, the diagnostic workup, the prognosis, the clinical course and the principles of prevention and treatments of cancer. To be able to discuss the general management and the endpoints of treatment of cancer from different sites and in various clinical settings. Prerequisites
- INTERNAL MEDICINE
Knowledge of the symptomatology, physiopathology of each single apparatus; knowledge of the main etiopathologic causes and risk factors of some selected internistic diseases, as well of the principal related diagnostic procedures.
Passing exams of: Clinical methodology II and Diagnostic Imaging and Radiation Protection
BLOOD DISEASES
Knowledge of the biology of blood cells and of molecular genetic aberrations leading to the neoplastic transformation of the hematopoietic cells.
MEDICAL ONCOLOGY
Knowledge of the cellular and molecular pathogenetic mechanisms of cancer. Knowledge of the techniques for the clinical and biomolecular diagnosis of different cancer types. Knowledge of the general principles of treatment. Course programme
- INTERNAL MEDICINE
Dissertation of a series of internistic diseases, including symptoms, clinical examination, laboratory examinations, imaging, etc, also using clinical case presentations. Moreover, for some diseases, specific sex/gender factors for certain diseases will be discussed, with particular attention to the differences, in an integrated diagnostic-therapeutic olistic pathway. Main topics will include cardiovascular diseases (arterial hypertension, atherosclerosis, vascular diseases, heart failure, arrhythmias, coronary heart disease, cardiomyopathies, myocarditis, endocarditis and valvular diseases, venous thromboelism), respiratory diseases (pneumonia, pleuritis, chronic obstructive pulmonary disease), gastrointestinal diseases (diseases of esophagus, stomach, gut, livel and biliary tract, pancreas), kidney and urinary tract diseases (glomerular and tubular diseases, infections), hematopoietic system ( anaemias, leukemia, lymphoma and plasmacellular diseases, splenomegalic syndromes), endocrinologic and metabolic diseases (diseases of hypothalamus, pituitary, thyroid, parathyroids, adrenals, acid-base and electrolyte status, diabetes insipidus, diabetes mellitus and hypoglycaemia, hyperuricaemia), rheumatologic diseases (rheumatic disease, lupus, rheumatoid arthritis, vasculitis, microcrystalline arthritis), internistic aspects of infections (viruses, bacteria, fungine and parasitic), stroke, neuropathies and myopathies.
BLOOD DISEASES
Anemias: classification and differential diagnosis.
Aplastic anemia, sideropenic anemia, Megaloblastic anemia, Chronic disease anemia, Renal failure anemia, hemolitic anemia (G6PD, autoantibodies), Thalassemia and sickle cell disease.
Pancytopenia
Chronic myeloid disorders: chronic myelogenous leukaemia; polycythemia vera; essential thrombocytemia; myeloid metaplasia with myelofibrosis, hypereosinophilic syndrome, paroxysmal nocturnal hemoglobinuria.
Acute myeloid disorders:- acute myeloid leukaemias (FAB and WHO classifications).Chronic lympoproliferative disorders: chronic lymphocitic leukaemia; prolymphocytic leukaemia; hairy cell leukaemia, Sèzary's Syndrome; Hodgkin's Lymphoma; non Hodgkin's Lymphoma;Monoclonal gammopathes: multiple myeloma; Waldetroms's diseases; amyloidosis; cryoglobulinaemia. Acute lymphoproliferative disorders: acute lymphoblastic leukaemias (B,T)(immunologic classification, FAB and WHO classification).
Hematologic problems in cancer. Bone marrow failure. Hypecalcemic syndrome. Tumor lysis syndrome. Sequelae of chemotherapy: nausea and vomiting, cutis and mucosae, secondary leukemias and tumors, lungs, CNS, heart, endocrine system
Hemorrhagic diseases:
Congenital, acquired, auto-immunologic and consumption thrombocytopoeniae, (PTT, DIC)
Coagulation Factor deficiency: congenital and acquired.
Thrombotic diseases:
Coagulation Factor deficiency: congenital and acquired.
Regarding all the pathologies, it will discuss physiopathological, clinical and therapeutical aspects.
MEDICAL ONCOLOGY
General principles of prevention, natural history, diagnosis and staging of cancer. Prognostic and predictive factors. Biomolecular characterization of tumors useful for tailored therapies. Approaching patient with cancer. General endpoints of therapy in the different setting of disease (early, advanced, terminal). Principles of the main oncological systemic treatments (chemotherapy, hormonal therapy, immunotherapy), and of their side effects. Principles of palliative care in oncology.
Oncological emergencies. Paraneoplastic syndromes.
Risk factors, clinical, diagnostic and therapeutic pictures of breast cancer, cancers of thorax, head and neck cancers, gastrointestinal cancers, urogenital cancers, gynaecological cancers, CNS cancer, neuroendocrine tumors, melanoma. Didactic methods
- INTERNAL MEDICINE
Frontal lessons (even in collaboration with colleagues expert of the various medical branches) and discuss of clinical cases
Practical on-field attendance in the Ward (taking medical history, supervised physical examination, participation to the morning staff briefing with discussion of clinical cases and medical visit)
BLOOD DISEASES and MEDICAL ONCOLOGY
Lectures, including the presentation of clinical cases. Practical teaching on patients and clinical cases
Hematology
Lectures on the principal blood diseases to help the student understand how to suspect, diagnose and treat each disease. Active participation is required
Presentation of clinical cases with anemia
Practical teaching in the ward to learn how to read and interpret the laboratory tests
ONCOLOGIA
Lectures on the principal diseases to help the student understand how to suspect, diagnose and treat each disease. Active participation is required
Presentation of clinical cases
Practical teaching in the ward to learn how to read and interpret the clinical picture and laboratory tests in oncology Learning assessment procedures
- INTERNAL MEDICINE
Multiple choice written test: 60 closed-answer questions, with 4-5 possible responses each (one only right response), with a score definition of 0,5 point for each correct response, 0 point for each ungiven response, - 0.25 point for each wrong response. Positive test: equal or higher than 36/60(18/30). Allowed time: 60 minutes.
BLOOD DISEASES
Oral examination 20-25 minutes in length, with 4-5 questions, 1 on benign hemopoietic disorders, 1 on hemopoietic tumors, 1 on the disorders of the coagulation system, one on the interpretation of alteration of the blood count or other laboratory o imaging tests pertaining to hematologic disorders. The student must show to have acquired the capability to diagnose and treat the principal hemopoietic disorders
The final score will be assigned based on the completeness and clarity of presentation and on the capability to organize reasoning on a clinical case.
MEDICAL ONCOLOGY
Oral examination (15-20 minutes), with 2 main questions (one about general aspects of oncology and one about a specific cancer), with discussion exploring collateral aspects of the main issue.
The student must demonstrate to know the basic principles of the discipline, and to be able to argument on the clinical aspects of cancer of specific sites, discussing the management of suspect symptoms and signs, the diagnostic workup and the differential diagnosis and therapeutic strategy.
The final score will be assigned based on the skillness in presenting the data and on the appropriateness of discussion.
THE FINAL GRADE IS A WEIGHTED AVERAGE OF THE MARKS OBTAINED IN EACH TEST. Reference texts
- INTERNAL MEDICINE
Rugarli, Medicina Interna Sistematica, Masson
Harrison's, Principles of Internal Medicine, McGraw-Hill
Teodori, Trattato Italiano di Medicina Interna, SEU
Fradà & Fradà, Semeiotica Medica nell’adulto e nell’anziano, Piccin Editore
Padakis & McPhee, Current Medical Diagnosis & Treatment, Piccin Editore
and any other internal medicine textbook.
Teaching material provided by the professor
BLOOD DISEASES
Castoldi G.L., Liso V. Cuneo A., Specchia G., Rigolin G.M., Ematologia, McGraw-Hill Ed., Milano 2009
Castoldi G.L., Liso V., Malattie del sangue e degli organi emopoietici, Ed. McGraw-Hill, Milano 2012
MEDICAL ONCOLOGY
Bianco AR, De Placido S, Tortora G, Conte P. Core Curriculum Oncologia Clinica, McGraw-Hill Ed., Milano 2016.
Material provided by teacher
