The course consists of the presentation of clinical cases concerning the main nephrological and cardiological pathologies of internal medicine interest in order to acquire the ability to design differential diagnosis paths and to set up appropriate pharmacological and non-pharmacological therapies taking into account the gender differences in the various pathologies.
KNOWLEDGE AND UNDERSTANDING. At the end of the course, students will have to demonstrate knowledge and ability to understand the fundamental concepts and principles on which the differential diagnosis and therapy of the main nephrological and cardiological pathologies of internal medicine interest is based.
ABILITY TO APPLY KNOWLEDGE AND UNDERSTANDING. At the end of the course the student must be able to apply the knowledge acquired in the previous point in order to apply the appropriate methodologies for the practical management of the patient's clinical problem. You must also know how to prescribe and appropriately interpret laboratory tests (chemical, microbiological and genetic) and instrumental tests (diagnostic imaging and pathophysiological tests) aimed at differential diagnosis. You must know how to plan the appropriate therapy by evaluating the risk-benefit ratio of drugs and non-pharmacological therapies. At the end of the course, students should be able to manage patients' clinical internal problems.
MAKING JUDGEMENTS. At the end of the course, students will have to demonstrate that they have not only acquired knowledge and concepts, but also that they are able to provide appropriate judgments in relation to the setting of the diagnostic-therapeutic process, patient safety and management of the clinical risk.
COMMUNICATION SKILLS. At the end of the course, students must be able to express themselves and argue appropriately through the specific terminology acquired through the lessons provided, the teaching material and/or the reference text. Students must also be able to communicate with patients and family members in a clear and empathetic way using simple terminology and avoiding technical terms.
LEARNING ABILITY. At the end of the course, students will have to demonstrate that they are able to apply the minimum knowledge, skills and competences described in this Syllabus.

Pathophysiology of renal and cardiovascular diseases and methods of clinical examination. Pharmacology of renal and cardiovascular therapies.

Clinical cases of nephrology and cardiology with analysis of gender differences in various pathologies. Stage IV chronic kidney disease in a patient with type 2 diabetes. Edema and increased body weight in a patient with type 2 diabetes acute kidney injury after coronary angiography. Macroscopic hematuria and edema. Pathological fracture in a patient with dehydration and hypercalcemia. ECG in a patient with palpitations. Syncope in a patient with bradycardia. Palpitations and shortness of breath. Fever with new murmur. Exercise-induced chest pain rapidly relieved by rest. Chest pain and diaphoresis. Breathlessness on exertion. Hypertension resistant to pharmacological therapy.

Oxford Handbook of Clinical Medicine
Current Medical Diagnosis & Treatment 2023. McGraw Hill Medical

Clinical cases of nephrology and cardiology. STAGE IV CHRONIC KIDNEY DISEASE IN A PATIENT WITH TYPE 2 DIABETES. Recognize chronic kidney disease (CKD) and its complications in its various stages of severity. Causes of CKD. Treatment principles to slow progression and control complications. Indications for dialysis treatment. EDEMA AND INCREASED BODY WEIGHT IN A PATIENT WITH TYPE 2 DIABETES. Recognize nephrotic syndrome. Principles of therapy. ACUTE KIDNEY INJURY AFTER CORONARY ANGIOGRAPHY. Recognizing acute kidney disease (AKI). Control of risk factors. Differential diagnosis of pre-renal, parenchymal and post-renal forms. Principles of therapy. Indications for dialysis treatment. MACROSCOPIC HEMATURIA AND EDEMA. Recognize nephritic syndrome secondary to glomerulonephritis. Recognize glomerular hematuria. Differential diagnosis of hematuria. Principles of medical therapy of renal colic and nephrolithiasis.
PATHOLOGICAL FRACTURE IN A PATIENT WITH DEHYDRATION AND HYPERCALCEMIA. Know the principles of differential diagnosis and therapy of hypercalcemia. Recognize multiple myeloma by differentiating it from monoclonal gammopathy of uncertain significance (MGUS). Treatment of neoplastic hypercalcemia. Primary and secondary amyloidosis. Recognize primary hyperparathyroidism. Hypocalcemia. Know the risk factors and diagnostic criteria for osteoporosis. Primary prevention and therapy of osteoporosis. Identify vitamin D deficiency. Paget's disease. ECG IN A PATIENT WITH PALPITATIONS. Learn a systematic approach to ECG interpretation. Recognize the main electrocardiographic pictures in relation to clinical manifestations. Hyperkalemia. Hypokalemia. SYNCOPE IN A PATIENT WITH BRADYCARDIA. Recognize cardiogenic (associated with arrhythmias or myocardial structural anomalies) and neurogenic (vasovagal and orthostatic) syncope. Cardiorespiratory arrest. Recognize and monitor the progression of aortic stenosis. PALPITATIONS AND SHORTNESS OF BREATH. Recognize mitral valve disease and the outcomes of rheumatic disease. Recognizing atrial fibrillation. Goals of atrial fibrillation therapy. Principles of anticoagulant therapy. FEVER WITH NEW MURMUR. Recognizing bacterial endocarditis. Principles of therapy. EXERCISE-INDUCED CHEST PAIN RAPIDLY RELIEVED BY REST. Recognize the clinical manifestations of ischemic heart disease. Diagnosis of stable angina. Principles of therapy of stable angina: drugs that slow the progression and symptomatic drugs. CHEST PAIN AND DIAPHORESIS. Recognizing acute coronary syndrome. Differential diagnosis of STEMI and non-STEMI. Principles of therapy and follow-up of myocardial infarction. Complications. Differential diagnosis of chest pain. Recognize acute pericarditis and cardiac tamponade.

Lectures and clinical case studies on real or simulated patient. Attendance of a two-week internship in an internal medicine department (UCO Clinica Medica, Cattinara Hospital, Trieste, ASUGI) is required. The teaching material is made available to students via the Moodle and MS-Teams platforms.

Any changes to the methods described here will be communicated on the Department, Course of Study and teaching website.
Prof. Gianni Biolo. Department of Medical, Surgical and Health Sciences. University of Trieste. UCO Clinica Medica - Cattinara Hospital – ASUGI. Strada di Fiume 447, 34100 Trieste. e-mail: biolo@units.it
tel. 040-3994432
Consultation is by appointment.

Evaluation of clinical skills through an oral exam which includes discussion of clinical cases and topics included in the program.
Score 29-30 cum laude: the student has an IN-DEPTH knowledge of the subject, has excellent communication skills and masters medical-scientific language.
Score 26-28: the student has a GOOD knowledge of the subject and explains the topics clearly using appropriate medical-scientific language;
Score 22-25: the student has a DISCRETE knowledge of the subject, even if limited to the main topics and explains the topics quite clearly with a reasonable command of language;
Score 18-21: the student has the MINIMUM knowledge of the subject and explains the topics clearly enough although the language skills are poorly developed; Exam not passed: the student DOES NOT HAVE THE MINIMUM KNOWLEDGE required of the main contents of the course. The ability to use specific language is very poor or non-existent and he is unable to apply the knowledge acquired independently.