The module aims to provide the necessary skills to collect and interpret clinical data. Students will learn to integrate medical history and signs, developing the ability to reach an accurate differential diagnosis. The course also includes learning instrumental and laboratory semiotics techniques for a comprehensive assessment of clinical problems. This approach will enable students to handle non-surgical clinical cases with a solid foundation for a correct approach to differential diagnosis and the formulation of diagnostic process proposals.

The Medical Semiotics (Signs and Symptoms) 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 necessary for anamnesis. 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 semiotic, 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 semiotic 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.

Applying Knowledge and Understanding:

- Detection of semiotic findings: Students will apply advanced methodologies to detect semiotic 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.

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 Semiotics (Signs and Symptoms)

- The role and importance of semiotics, dialogue with the patient, reasons for hospitalization

- Medical history: subdivision and terminology, common hereditary conditions

- General physical examination: classical conduction of the physical examination (observation, auscultation, palpation, percussion), developmental and stature alterations

- Semiotics of the skin and mucous membranes

- Syndromes and signs of hydroelectrolytic metabolism disorders

- Semiotics of adipose tissue and lymph nodes

- Fever and febrile syndromes

- Pain

- Introduction to clinical case presentation

- Errors in medicine

 Semiotics of the Digestive System

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

- Semiotics of the esophagus

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

- Semiotics 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, EUS)

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

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

- Clinical cases of the digestive system

 Semiotics 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

- Semiotics of the mammary gland

 Semiotics of the Liver, Biliary Tracts, and Gallbladder

- Anamnestic elements peculiar to 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

 Semiotics of the Spleen

- Anamnestic elements peculiar to diseases involving the spleen, main symptoms

- Physical examination of the spleen, instrumental investigations

- Clinical cases of the spleen

 Semiotics of the Respiratory System

- Anamnestic elements peculiar to 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

 Semiotics of the Cardiovascular System

- Anamnestic peculiarities of cardiovascular diseases: symptoms (pain, palpitations, dyspnea, cough, pre-syncope, syncope, shock, collapse, etc.)

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

- Semiotics 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

- Semiotics of valvular diseases

- Coronary syndromes

- Heart failure

- The pericardium and associated syndromes

- Clinical cases of the cardiovascular system

 Semiotics of the Urinary and Gynecological Systems

- Anamnestic peculiarities 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

- Semiotics 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

Semiotics of the Musculoskeletal System

- Semiotics of degenerative and inflammatory arthropathies of the musculoskeletal system

- Main systemic syndromes with implications for the musculoskeletal system

- Spinal alterations, low back pain

 Semiotics 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 Semiotics

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

Introduction to Instrumental Semiotics

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

Semiotics of the Immune System

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

Advances in Diagnostic Methods

- Emerging and innovative diagnostic methodologies, such as genomics and proteomics

R. Nuti. Metodologia Clinica X Ed. Minerva Medica

LS Bickley. Bates Esame obiettivo e anamnesi. Piccin 2018

Fradà & Fradà. Semeiotica medica nell'adulto e nell'anziano. Metodologia clinica di esplorazione morfofunzionale. Piccin 2018

 Exam Methods

Written Exam: Electronic Quizzes over 60 minutes

- Semiotics: 30 questions

- Laboratory Medicine: 15 questions

- Bioethics: 15 questions

Passing Criteria:

- Semiotics: minimum of 21 correct answers

- Laboratory Medicine: minimum of 11 correct answers

- Bioethics: minimum of 9 correct answers

Passing only one section of the written exam is not sufficient. 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 grants a qualification 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 commissioners 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.

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 necessary for anamnesis, integrate objective signs observed during the clinical examination, and critically interpret semiotic, 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 commissioners 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.