MC/0165 - INTERNAL MEDICINE I AND NEPHROLOGY
Academic Year 2021/2022
Free text for the University
ANTONELLA MANDAS (Tit.)
- Teaching style
- Lingua Insegnamento
|[40/39] MEDICINE AND SURGERY||[39/00 - Ord. 2015] PERCORSO COMUNE||10||145|
KNOWLEDGE AND UNDERSTANDING: The part of Internal Medicine that is oriented to study "major syndromes", multidisciplinary pathologies that provide the knowledge of specific specialist pathologies. Course is intended to provide to the students’ knowledge and skills to interpret clinical signs, laboratory tests, and instrumental exams related to "major syndromes". Students will also have to acquire adequate knowledge of the main therapeutic protocols in use.
The nephrological part is more systematic because analyzes individual nephrological pathologies teaching the clinical-diagnostic parts and the therapeutic protocols the student should: i) know the semeiology and clinical methodology in order to evaluate and asses a patient with renal disease, ii) know the epidemiology and clinical nephrology syndromes of primary and secondary nephropathies and chronic kidney disease and what interventions are available to prevent and treat them, iii) be able to discuss how to deal with patients who have acid-base and electrolyte balance disorders and the main therapeutic interventions that can be adopted, iv) define the goals and management of arterial hypertension and of diabetic nephropathy in the renal patient, v)acquire strategies for the diagnosis and management of acute kidney injury and the progression of chronic kidney damage, vi) know how to evaluate and assess patients with tubulointerstitial and vascular nephropathies, with genetic diseases and with rare kidney diseases, vii) acquire immunological and clinical knowledge regarding kidney transplantation, viii) be familiar with the main renal replacement therapies. The student must also be knowledgeable with regard to the main tools for the diagnosis and treatment of these diseases.
APPLIED SKILLS: the student will acquire the ability to deal with the diagnostic and therapeutic pathways of complex multidisciplinary pathologies and of renal diseases and hydro-electrolyte and acid-base disorders learning to distinguish between alternative hypotheses and differential diagnoses. In this context, the student will acquire the ability to rationally and accurately choose which diagnostic tools to use so as to reach a diagnosis and establish the most appropriate therapy.
AUTONOMY OF JUDGEMENT: The student will learn to acquire and integrate anamnestic and instrumental data in order to make a diagnostic evaluation in the field of complex multidisciplinary pathologies and of renal disease.
COMMUNICATION SKILLS: The student will learn to present relevant data from a given clinical case and appropriately report the development and outcome of diagnostic procedures and therapeutic interventions.
LEARNING SKILLS: The student will learn to acquire new information and how to implement their own cultural background through consultation and critical interpretation of recent scientific literature.
PREREQUISITES: have acquired adequate knowledge of the pathophysiology of the main internal diseases, have mastery in carrying out the medical history and physical examination of the individual systems; have acquired good basic knowledge of the pathophysiology of the urinary apparatus and the renal excretory system, the hydro-electrolyte and acid-base control system, the immune system, and the pathological anatomy of the kidney and of the urinary tract.
PROPEDEUTICITY: having taken the exam in General Pathology, Physiology and Clinical Methodology.
Internal Medicine theoretical lectures
Clinical approach to the patient with:
2. Chest pain
4. Sistemic arterial hypertension
5. Pulmonary hypertension
7. Abdominal pain
11. Musculoskeletal pain
12. Recent onset arthritis
15. Alterations of hemostasis
Nephrology theoretical lectures
1. Clinical Nephrology
- Approach to the patient with renal disease (clinical history: urine examination, evaluation of kidney failure, renal ultrasound, immunological study)
- Clinical nephrology syndromes (isolated urinary abnormalities, acute nephritic syndrome, nephrotic syndrome, acute kidney failure, rapidly progressive renal failure, chronic renal failure)
- Glomerulopathies: clinical picture, pathogenesis, primary glomerulopathies
- Secondary glomerulopathies (with detailed information on lupus nephritis, amyloidosis,
essential mixed cryoglobulinemia type II, and monoclonal gammopathy of renal significance [MGRS])
- Acute and chronic kidney damage
- AKI (Acute Kidney Injury) including the topic ‘COVID-19 and AKI’
- CKD (uremic syndrome: epidemiology, pathophysiology, diagnosis and therapy. Secondary factors of renal damage progression and pathophysiology of adaptation to renal damage)
- Tubulointerstitial nephropathies and tubulopathies (Fanconi’s syndrome)
- Renal damage of vascular origin (with emphasis on rapidly progressive renal failure; ANCA-related vasculitis, hemolytic uremic syndrome, renal disease and pregnancy)
- Kidney and hypertension
- Kidney and diabetes
- Kidney and myeloma
- Clinical and metabolic aspects of kidney stones
2. Hydro-Electrolyte and Acid-Base Disorders
- Mechanisms of renal excretion and effects of nephron loss on these mechanisms: pathophysiology of loss of renal excretion mechanisms
- Hydro-Electrolyte alterations (hyponatremia, hypokalemia, hyperkalemia)
- Acid-base alterations (interpretation of blood gas analysis; metabolic acidosis; lactic acidosis; anion gap; metabolic alkalosis)
3. Genetically Determined Kidney Diseases and Rare diseases
- Polycystic kidney disease, Alport syndrome, and other hereditary and rare diseases
4. Immunology and clinical features of kidney transplantation
5. Fundamentals of Renal Replacement Therapies: Hemodialysis, peritoneal dialysis, kidney transplantation and overview of pharmacology and medication use in the renal patient
The course is divided into lectures, which include the use of PowerPoint presentations, (40 hours of Internal Medicine and 30 of Nephrology) distributed in the second semester of the fourth year and practical exercises (Internal Medicine: 50 hours; Nephrology: 25 hours) carried out in the Internal Medicine Departments of the Cagliari AOU and in the ward, dialysis, day hospital and nephrology clinics of the Brotzu Hospital of Cagliari.
Classroom lessons may be employed together with innovative teaching methods which aim to actively involve students in the learning process (active learning) by analyzing and interpreting clinical cases.
Verification of learning
The final exam consists of an oral test.
In particular cases the teacher reserves the right, in agreement with the student, to administer a written test which includes three open-ended questions that are based on the study program, similarly to what is proposed in the oral test.
Oral test: the student will have to answer 3 open-ended questions on three of the program topics which can also include clinical cases that may have been presented during the course. Each question is assigned a score from 0 to 10.
The final grade for both the oral and written exam is expressed in thirtieths. A score of at least 18/30 must be obtained to pass the test.
The student’s knowledge of course topics, their ability to formulate diagnostic hypotheses and test them by setting up an appropriate diagnostic program are evaluated. Non-specialized knowledge of the therapies related to the various pathologies that were discussed will also be evaluated. Finally, the ability to express oneself, the use of appropriate terminology, and the ability to summarize will be evaluated.
The final grade takes into account;
Quality of knowledge, skills, competencies possessed and/or manifested:
a) appropriateness, correctness, and congruence of knowledge.
b) appropriateness, correctness and congruence of skills
c) appropriateness, correctness, and congruence of expertise.
a) Expressive ability;
b) Appropriate use of the discipline-specific terminology;
c) Reasoning skills and consequentiality in linking content;
d) Ability to connect different topics by finding overlapping characteristics and establishing a coherent overall design, i.e. overall design with regard to the structure, organization and logical connections of the descriptive discourse;
e) Ability to summarize.
Grading is as follows:
(a) Sufficient (18 to 20/30).
The candidate demonstrates a few acquired notions though at a superficial level, he/she shows many gaps in knowledge, modest expressive abilities but enough to support a coherent dialogue; reasoning skills and consequentiality in connecting topics of elementary level; poor ability to summarize and to provide written text; little interaction with the teacher during the test.
b) Fair (from 21 to 23/30)
The candidate demonstrates discrete acquisition of notions, but little depth, some gaps in knowledge; more than sufficient expressive ability to sustain a coherent dialogue; acceptable mastery of scientific terminology; reasoning ability and consequentiality in connecting topics of moderate complexity; more than sufficient capacity to summarize and to provide written text.
c) Good (from 24 to 26/30)
The candidate demonstrates a fairly wide range of knowledge, moderate depth, with small gaps in knowledge; satisfactory expressive abilities and significant mastery of scientific terminology; evident dialogical skills and critical spirit; good ability to summarize and more than acceptable ability to provide written text.
d) Very good (from 27 to 29/30)
The candidate demonstrates extensive, well developed knowledge of the subject, with marginal gaps; remarkable expressive abilities and high mastery of scientific terminology; remarkable dialogical ability, good competence and relevant aptitude for logical synthesis; high capacity to summarize and to provide written text.
e) Excellent (30/30)
The candidate demonstrates extensive and in-depth knowledge of the subject, with any existing gaps being irrelevant; high expressive ability and extremely good mastery of scientific terminology; excellent dialogue skills, strong ability to make connections between different topics; excellent ability to summarize and superior level written text.
Honors are given to candidates who are clearly well above average, and whose notional, expressive, conceptual, and reasoning limits are irrelevant.
Harrison’s Principi di Medicina Interna, Harrison - Fauci - Braunwald - Kasper - Hauser - Longo - Jameson - Loscalzo, publishing house Ambrosiana. The most recent edition translated into Italian
Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2) [English Language] (English)
Goldman-Cecil. Internal Medicine, publishing house Edra. The most recent edition translated into Italian
Brenner and Rector's, The Kidney, 2-Volume Set 11th Edition, Oct. 2019
Harrison’s, Nephrology and Acid-Base Disorders. Jameson JL, Loscalzo J, 3rd edition 2019
Registration for exams will be done by logging into ESSE3.
Students will be eligible to take the exam if they have attended no less than 70% of the total in-person classes and no less than 50% of each module and carried out all hours scheduled for professional activities.
Locations of interactive teaching and professional trainings
Azienda Ospedaliero-Universitaria di Cagliari
Presidio di Monserrato
Department of Medicine
UOC Medicina Interna
Azienda Ospedaliera G. Brotzu di Cagliari
Departiment of Renal Disease
UOC Nefrologia e Dialisi
The teacher of the course of Internal Medicine 1 of the odd channel is Prof. Antonella Mandas, who can be contacted at the following e-mail address: firstname.lastname@example.org
The teacher of the course of Nephrology of the odd channel is Prof. Antonello Pani, who can be contacted at the following e-mail address: email@example.com