The Medical Semeiotics module aims to impart the following knowledge and skills to students:

Knowledge and Understanding:

- Collection and organization of clinical data: Students will learn to accurately collect and organize the clinical data needed for history taking. This includes identifying and recording the signs and symptoms reported by the patient.

- Integration of objective signs: Students will be trained to integrate the collected data with objective signs observed during the clinical examination, to accurately define and interpret clinical problems.

- Critical interpretation of clinical, functional, instrumental and laboratory findings: Skills will be developed to critically interpret clinical, instrumental, and laboratory findings, analyzing them from a pathophysiological perspective.

- Contextualization in the overall clinical picture: Students will acquire the ability to place clinical findings within the patient's overall clinical context, enhancing the comprehensive understanding of the patient's conditions.

- Diagnosis and prognosis: The course will provide the necessary tools to formulate accurate diagnoses and to predict patient prognoses, considering disease progression and potential complications.

- Clinical ultrasound (POCUS): Students will know the main ultrasound windows (lung, heart, inferior vena cava, abdomen, thyroid, vessels) and will understand what bedside ultrasound adds to the physical examination and when it is appropriate to request it.

- Assessment of the older and frail patient: Students will know models of frailty and the principles of comprehensive geriatric assessment, including sarcopenia and polypharmacy.

Applying Knowledge and Understanding:

- Detection of clinical signs: Students will apply advanced methodologies to detect clinical findings during clinical examinations, developing essential practical skills for diagnosis.

- Functional, instrumental, and laboratory analysis: The importance of functional, instrumental, and laboratory analyses in evaluating patient conditions will be emphasized, with practical exercises to improve analytical skills.

- Formulation of differential diagnoses: Students will be trained to formulate accurate differential diagnoses, distinguishing between clinical conditions with similar symptoms but different etiologies.

- Diagnostic pathway proposals: The course will teach how to develop and propose appropriate diagnostic pathways, integrating all the collected information to plan diagnostic interventions and general assessment of pathologies.

- Clinical adaptation skills: Students will learn to adapt clinical decisions to the patient's specific conditions, with particular attention to elderly patients and complex situations.

- Use of clinical guidelines: Tools will be provided for the critical use of clinical guidelines, with a particular focus on their practical application in patient management.

- Interpretation and indication of POCUS: Students will be able to recognise basic ultrasound findings and place them within diagnostic reasoning, formulating the indication for the examination. Operator competence is not an objective of this course and remains the remit of specialist training.

The effective acquisition of these knowledge and skills will be verified through theoretical and practical exams simulating real clinical scenarios, ensuring that students have achieved an adequate level of competence.

General Semeiotics

- The role and importance of clinical semeiotics, dialogue with the patient, reasons for admission

- Medical history: subdivision and terminology, common hereditary conditions

- General physical examination: the classical sequence of the physical examination (observation, auscultation, palpation, percussion), disorders of growth and stature

- Semeiotics of the skin and mucous membranes; cutaneous patterns of systemic disease and dermatological red flags

- Fluid and electrolyte disorders: syndromes and signs

- Examination of adipose tissue and lymph nodes

- Fever and febrile syndromes

- Pain

- Introduction to clinical case presentation

- Error in medicine

Ultrasound Semeiotics (POCUS): the fifth pillar

- Physical principles, probes and modes (B-mode, Doppler); basic scanning, orientation and artefacts

- Normal ultrasound anatomy of the main systems

- Ultrasound integrated into the organ-based physical examination: chest and lung, heart and pericardium, inferior vena cava, abdomen, neck and thyroid, arteries and veins, bladder, spleen, liver and gallbladder

- Ultrasound patterns in differential diagnosis and emergency: effusions, B-lines, acute abdomen, congestion (BLUE, FAST and VExUS protocols)

- Indication, limitations and place of POCUS within clinical reasoning

Semeiotics of the Digestive System

- Oropharyngeal cavity: symptoms and signs of alterations of the lips, tongue, oral cavity, and pharynx

- Semeiotics of the esophagus

- Clinical and instrumental semeiotics of the abdomen: inspection, palpation, percussion, auscultation, radiological examination, ultrasound, and main ultrasound findings

- Semeiotics of the stomach: symptoms, signs, and main disorders (pain, heartburn, regurgitation, nausea, vomiting, melena, appetite disturbances, etc.); instrumental analyses pertinent to gastroesophageal pathology (EGDS, pH-metry and manometry, EUS)

- Concept and etiology of dyspepsia (dyspepsia, ulcer, gastritis), dumping syndrome, gastroparesis: main signs, symptoms, and etiologies

- Intestinal semeiotics: main symptoms and disorders (pain, transit, bloating, etc.), constipation, and diarrhea, instrumental investigations

- Anorectal semeiotics: digital rectal examination, haemorrhoids, fissures, perianal abscesses and fistulae, red flags

- Clinical cases of the digestive system

Semeiotics of the Endocrine System

- Thyroid and parathyroids

- Adrenal glands and pituitary gland

- Main acute and chronic syndromes of the endocrine system: signs and symptoms of excess or deficiency of function, main anatomical alterations, instrumental investigations

- Diabetes

- Clinical cases of the endocrine system

Exocrine Glands

- Semeiotics of the breast

Semeiotics of the Liver, Biliary Tracts, and Gallbladder

- History taking in liver diseases, main symptoms

- Physical examination of the liver, biliary tracts, and gallbladder

- Jaundice and liver failure

- Portal hypertension, cirrhosis, and ascites: instrumental investigations

- Clinical cases of the liver/biliary tracts

Semeiotics of the Spleen

- History taking in diseases involving the spleen, main symptoms

- Physical examination of the spleen, instrumental investigations

- Clinical cases of the spleen

Semeiotics of the Respiratory System

- History taking in diseases involving the respiratory system

- Physical examination of the respiratory system: main symptoms and signs (cough, sputum, cyanosis, pathological breathing)

- Pleural and mediastinal syndromes

- Chronic obstructive bronchitis, asthma, occupational diseases: instrumental investigations

- Clinical cases of the respiratory system

Semeiotics of the Cardiovascular System

- History taking in cardiovascular diseases: symptoms (pain, palpitations, dyspnea, cough, pre-syncope, syncope, shock, collapse, etc.)

- Inspection, palpation, percussion, and auscultation of the precordial region

- Semeiotics of arteries, veins, and lymphatic vessels: main symptoms (acute and chronic peripheral ischemia syndromes, venous and lymphatic insufficiency, arterial hypertension and hypotension, stenosis, and aneurysms), instrumental investigations

- Rhythm and conduction disorders

- Semeiotics of valvular diseases

- Coronary syndromes

- Heart failure

- The pericardium and associated syndromes

- Clinical cases of the cardiovascular system

Semeiotics of the Urinary and Gynecological Systems

- History taking in diseases of the urinary and gynecological systems: symptoms (pain, urinary and micturition disorders, hematuria, pyuria, edema, extrarenal manifestations of urinary diseases, etc.)

- Inspection, palpation, percussion, and auscultation of the abdomen and lumbar region

- Urological semeiotics: prostate, scrotum and testis, bladder (volume and post-void residual)

- Outline of gynaecological semeiotics

- Semeiotics of urine examination, instrumental investigations of the urinary system

- Glomerulopathies and nephrotic syndrome, interstitial nephropathies, vascular nephropathies

- Acute and chronic renal failure

- Clinical cases of the urinary system

Semeiotics of the Musculoskeletal System

- Semeiotics of degenerative and inflammatory arthropathies of the musculoskeletal system

- Main systemic syndromes with implications for the musculoskeletal system

- Spinal alterations, low back pain

Semeiotics of the Hematopoietic System

- Anemia, polycythemia, platelet count and coagulation disorders: main symptoms and signs

- Acute and chronic alterations of the white blood cell count and differential

- Main pathologies of the hematopoietic system (myeloproliferative, myelodysplastic, and lymphoproliferative syndromes): signs and symptoms, instrumental investigations

- Clinical cases of the hematopoietic system

Neurological Semeiotics

- Physical examination: signs and symptoms, gait alterations, main syndromes, most frequent metabolic causes of neurological alterations, instrumental investigations

Geriatric Semeiotics

- Frailty and models of frailty; comprehensive geriatric assessment

- Sarcopenia, falls, polypharmacy

- Peculiarities of clinical presentation in the older patient

Introduction to Imaging and Instrumental Semeiotics

- Advanced imaging techniques (CT, MRI, PET) and their role in clinical diagnosis, with particular emphasis on ultrasound

- Imaging in the emergency setting: criteria for choice and priority

Semeiotics of the Immune System

- Discussion of autoimmune and autoinflammatory diseases, with emphasis on clinical signs and instrumental investigations

Advances in Diagnostic Methods

- Emerging and innovative diagnostic methodologies: genomics, proteomics and other -omics disciplines

- Artificial intelligence in medicine and precision imaging: screening, radiomics, liquid biopsy; critical use and place within clinical reasoning

Exam Methods

Written Exam: Electronic Quizzes over 60 minutes

- Semeiotics: 30 questions

- Laboratory Medicine: 15 questions

- Bioethics: 15 questions

Passing Criteria:

- Semeiotics: minimum of 24 correct answers

- Laboratory Medicine: minimum of 11 correct answers

- Bioethics: minimum of 9 correct answers

A pass obtained in only one part of the written examination cannot be carried over. Only by passing all sections of the written exam can students access the practical exam at the Advanced Simulation Center (SIMAV).

Practical Exam:

- The practical exam at SIMAV awards a graded pass, valid for the academic year.

- In exceptional circumstances and due to logistical contingencies, the SIMAV exam may be taken before the written exam.

Oral Exam:

- The oral exam is conducted in person with two examiners for each candidate.

- The discussion starts from a clinical case seen in the attended wards, which must be co-signed by a ward tutor.

- The clinical case can be retained for the entire academic year.

Clinical ultrasound (POCUS):

- POCUS is assessed through questions on the interpretation of findings and on clinical indication, in both the written and the oral exam.

- No operator competence is assessed or certified as acquired.

Final Grade:

- The final grade is calculated as the average of the oral and written exam scores, proportional to the CFU (credits).

The oral exam aims to verify that the student has effectively acquired the knowledge and skills described in the "Detailed Learning Objectives" section. During the exam, students will be evaluated based on a real clinical case observed during their ward rotations, signed by a ward tutor. This approach ensures consistency between the learning objectives and the assessment methods.

Discussing the clinical case allows for assessing the student's ability to accurately collect and organize clinical data needed for history taking, integrate objective signs observed during the clinical examination, and critically interpret clinical, functional, instrumental and laboratory findings. Students must demonstrate the ability to place these findings within the patient's overall clinical context, enhancing the comprehensive understanding of their condition.

Furthermore, students must be able to formulate accurate differential diagnoses, distinguishing between clinical conditions with similar symptoms but different etiologies, and develop appropriate diagnostic pathways. The ability to adapt clinical decisions to the patient's specific conditions, with particular attention to elderly patients and complex situations, and the critical use of clinical guidelines in patient management will also be assessed.

The oral exam is conducted by two examiners for each candidate and is based on the discussion of the clinical case, allowing for a detailed verification of the competencies described. Consistency between the learning objectives and the assessment methods is ensured through an integrated and practical approach to evaluation.

The discussion also covers the interpretation of the basic ultrasound findings encountered during the course and the formulation of the indication for POCUS; the ability to perform the ultrasound examination is not assessed.