The main objective of the course is to teach students the knowledge of Surgical Semeiotics, so as to be able to detect and interpret (in relation to the pathophysiological knowledge partly already matured or in the process of learning) the symptoms and clinical signs complained by the patient and direct the subsequent clinical, laboratory and instrumental investigations. The second objective, equally important, is to provide him with a technical language, a diagnostic methodology and finally to be able to communicate/explain the results of the investigations carried out onto the patient. The main points of the course can therefore be summarized as follows: KNOWLEDGE AND UNDERSTANDING. At the end of the course the student must demonstrate knowledge of the symptoms and signs of the main organ failures and pathologies. He must demonstrate ability to understand the fundamental principles of semiotics. APPLIED KNOWLEDGE AND UNDERSTANDING. At the end of the course the student must have acquired the basis for a correct approach to the patient, must be able to collect the family, physiological, remote pathological and proximate pathological anamnesis and to report all data in the medical record. The student must be able to conduct an objective examination by applying the fundamental principles of semiotics: inspection, palpation, percussion and auscultation. AUTONOMY OF JUDGMENT. At the end of the course the student must demonstrate that he has not only acquired knowledge and concepts, but also that he is able to recognize the signs and symptoms through a correct examination methodology, he will have to demonstrate that he is able to apply a clinical methodology in the diagnostic process and be able to provide an initial prognostic evaluation COMMUNICATION SKILLS. At the end of the course the student must be able to express and argue appropriately with the correct use of the glossary acquired during the lessons, in the teaching material and reference texts. LEARNING ABILITY. At the end of the course the student will have to demonstrate that he has understood well and that he is able to apply the knowledge, skills and competences described in this Syllabus.

A good knowledge of the human body phisiology and anatomy.

CONTENT OF THE COURSE TISSUE LESIONS DIFFERENTIAL DIAGNOSIS BETWEEN HOT ABSCESS AND COLD ABSCESS. MEDICAL RECORD ANAMNESIS GENERAL PRINCIPLES OF THE PATHOLOGICAL ANAMNESIS OF THE MAIN GASTROINTESTINAL TRACT. FEVER CHEST PAIN ADDOMINAL PAIN BREAST GENERAL OBJECTIVE EXAMINATION OBJECTIVE EXAMINATION OF TUMORS ADDOME OBJECTIVE EXAM ACUTE ABDOMINAL SYNDROMES: RECTAL EXAMINATION. EXAMINATION OF THE NECK KIDNEY: EXAMINATION OF THE EXTERNAL GENITALIS AND HERNIAS HERNIAS PHYSICAL EXAMINATION CHRONIC VENOUS INSUFFICIENCY. PHYSICAL EXAMINATION OF THE LYMPHATIC SYSTEM:

“METODOLOGIA CLINICA” Cirenei, Stipa, EMSI publishing house, second edition. "Semeiotica Chirurgica e Metodologia Clinica", L. Gallone - Ambrosiana publishing house

TISSUE LESIONS: (wounds, ulcers, fissures). Characteristics of the most common ulcers. Wound Healing Modes. DIFFERENTIAL DIAGNOSIS BETWEEN HOT ABSCESS AND COLD ABSCESS. MEDICAL RECORD: structure and compilation ANAMNESIS: family history, personal. GENERAL PRINCIPLES OF THE PATHOLOGICAL ANAMNESIS OF THE MAIN GASTROINTESTINAL TRACT. FEVER: how to evaluate the thermal curve, suppurative fever, septic and septicemia CHEST PAIN: pleural pain, parietal pain, pain in the aorta dissecting aneurysm. ADDOMINAL PAIN: pure visceral pain, visceral-parietal pain, major areas of reported pain, parietal pain. Neuro-vegetative phenomena. BREAST: History of breast lesions. The objective examination of the breast and the division into quadrants. The clinical and instrumental semeiotics of the breast related to the nature of the breast lesions. GENERAL OBJECTIVE EXAMINATION: The general physical examination and the local state: the physical examination of the patient through inspection, palpation, percussion and auscultation. OBJECTIVE EXAMINATION OF TUMORS: Differential diagnosis of tumors in relation to their location and nature. ADDOME OBJECTIVE EXAM: Topographic Division/ Abdominal examination and Clinical Methodology of Major impairments of Surgical Interest: 1. Abdomen and abdominal tumors (differential diagnosis in relation to objective and clinical characteristics); 2. Liver (hepatomegaly, cirrhosis, portal hypertension, ascites); 3. Pancreatitis and pancreatic neoplasia (pain location and mode of irradiation, abdominal objectivity) 4. Physical examination of biliary tract 5. Calcifications of gallbladder and cholecystitis (seat of pain and mode of irradiation, abdominal objectivity and pain points) 6. Bladder and jaundice (clinical methodology in the itteric patient, Charcoyt-Villard triad; Courvoisier-Terrier law); 7. Ascites (differential diagnosis between paracentesis) 8. Esophagus-stomach (dyspepsia, regurgitation, dysphagia, pyrosis); 9. Splenomegaly and hypersplenism (objective features of splenomegaly, differential diagnosis with the other swelling of left hypochondria). 10. ACUTE ABDOMINAL SYNDROMES: Pathophysiolog and physical examination in bowel obstruction, in peritonitis and acute pancreatitis. 11. Pathophysiology of gastrointestinal bleeding RECTAL EXAMINATION. EXAMINATION OF THE NECK in reference to congenital disease, thyroid, , lymph node stations KIDNEY: Clinical characteristics (polyuria, oliguria, anuria, disuria, nicturia, urinary retention, incontinence, pollachiuria, stranguria). Emotions of piuria. EXAMINATION OF THE EXTERNAL GENITALIA AND HERNIAS HERNIAS : Definition, location, differential diagnosis with wall swellings. Clinical methodology in differential diagnosis of major complications of hernias THE CLINICAL HISTORY AND PHYSICAL EXAMINATION CHRONIC VENOUS INSUFFICIENCY. VARICOSE LOWER LIMBS: diagnosis, major semeiological tests (trendellemburg, phertes, swarz) Clinical methodology in differential diagnosis of inguinal swelling. ACUTE ABDOMINAL SYNDROMES: physical examination in bowel obstruction, in peritonitis, acute pancreatitis. Elements of instrumental semiotics.

The course consists mainly of traditional lectures but some slides in English will be provided during the course even if most of them will be in Italian. There will be meeting with all teachers of the integrated course and experts of other subjects. Matters of common interest will be treated in these meetings, such as medical language, fever, jaundice/icterus, chest pain. In the end there will be some practical training in small groups, each with a tutor, at first in the simulation room, then among volunteer students and in the end with patients.

At the end of each lesson slides will be given to students and the teacher will answer questions or any requests for further information.

LEARNING EVALUATION METHODS The learning evaluation includes a practical test on a dummy in the simulation classroom and an oral test. In the practical test on the dummy, the student must be able to recognize and graph a cardiac and pulmonary auscultatory finding. The outcome of the test will be evaluated with a score of 0.5 (recognition of one auscultatory finding) or 1 (recognition of both auscultatory findings). This score will be added to the score that the student will receive in the medical semeiotics oral exam. The oral test, organized in the form of an interview, includes up to three questions of medical semeiotics (among which there is always a question of cardiological semeiotics), three questions of surgical semeiotics (one of which is electively addressed to the "practical" modality of the ) and an application for laboratory medicine. The interview has an average duration of about 30 minutes and involves verifying the level of knowledge of the topics of the program, the level of mastery of the specialized language and the acquisition of a clinical methodology in the analysis of clinical anamnestic findings, i.e. the ability to develop a reasoning starting from the anamnestic-objective findings and applying the theoretical knowledge already acquired. The exam is based on the whole program of the course. The evaluation grid adopted is the following: Excellent (30–30 cum laude): excellent knowledge of all topics, excellent language skills, excellent analytical skills; the student is able to brilliantly apply theoretical knowledge to concrete cases. Very good (27–29): good knowledge of the topics, very good fluency, good analytical skills; the student is able to correctly apply theoretical knowledge to concrete cases. Good (24–26): good knowledge of the main topics, good command of the language; the student shows an adequate ability to apply theoretical knowledge to concrete cases. Satisfactory (21–23): the student does not show full command of the main topics of the teaching, although he/she possesses the fundamental knowledge; however, he/she shows satisfactory command of language and sufficient ability to apply theoretical knowledge to concrete cases. Sufficient (18-20): minimal knowledge of the main teaching topics and technical language, limited ability to adequately apply theoretical knowledge to concrete cases. Insufficient: the student does not have an acceptable knowledge of the contents of the different topics of the program.

This course explores topics closely related to one or more goals of the United Nations 2030 Agenda for Sustainable Development (SDGs)