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Clinical Methodology and Semeiotics


Clinical Methodology and Semeiotics


Academic year 2023/2024

Course ID
Piero Paccotti (Coordinator)
Massimo Terzolo (Lecturer)
Giuseppe Maina (Lecturer)
Andrea Veltri (Lecturer)
Maurizio Balbi (Lecturer)
Savino Sciascia (Lecturer)
Silvia Sofia (Lecturer)
2nd year
Teaching period
Second semester
11 (88 hours of lectures, 44 of exercises)
Course disciplinary sector (SSD)
MED/05 - clinical pathology
MED/09 - internal medicine
MED/18 - general surgery
MED/25 - psychiatry
MED/36 - diagnostic imaging and radiotherapy
Formal authority
Type of examination
Written and oral

Sommario del corso


Course objectives

This course will provide a foundation in knowledge and skills necessary for medical students to recognize the most important medical problems and to construct clinical reasoning models.

Students will be required to achieve a general understanding of the major subject areas of medical diseases, with a special focus on signs and symptoms, and the ability to build up a diagnosis and a differential diagnosis.

The same, as for surgical diseases, with a special focus on signs and symptoms of abdominal surgical diseases.

Interactive teaching: students will be skilled:

  • To transform a patient's story into a meaningful clinical problem
  • To perform a hypothesis-driven, focused history
  • To perform a hypothesis-driven, focused physical examination

Results of learning outcomes

Students will be able to formulate a differential diagnosis, assessment and a prioritized plan for the standardized patient. They will be able to gather a focused history and physical examination in a timed simulated testing environment and to critically examine and reflect on most common laboratory tests, and radiological techniques.



Clinical reasoning and critical thinking

  • What is "a problem" in medicine: its perception and interpretation; discuss the definition of an illness script and why it is important to clinical reasoning when compared to "normal" picture;
  • Initial concept and multiple diagnostic hypotheses, to be verified or falsified
  • Probability, certainty and mistake in the diagnostic procedure; diagnostic errors and how to avoid them
  • Measurable variables of clinical reasoning: the likelihood of illness, the diagnostic power of the tests
  • Psychological aspects of clinical thinking
  • The diagnosis as a correct selection among competing theories
  • The steps of medical acting: diagnosis, prognosis, observation, therapy

Collecting clinical information and documents

  • Anamnesis: aspects and techniques
  • General physical examination
  • Laboratory and radiology tools
  • Medical record
  • Cooperation with different healthcare givers
  • Informed consent
  • Professional confidentiality

Diagnostic methods in most important clinical problems

Internal Medicine

  • Pain (thorax, abdomen, joints, lower limb ischemia)
  • Fever
  • Altered state of consciousness
  • Paleness, cyanosis, jaundice
  • Edema
  • Dyspnea
  • Cough
  • Hemoptysis
  • Hypertension
  • Coronary artery disease
  • Arrhythmias
  • Cardiac failure
  • Pre-syncope, syncope, shock
  • Urinary tract diseases
  • Acute renal failure and chronic kidney disease
  • Nephritic and nephrotic syndrome
  • Liver failure
  • Portal vein hypertension
  • Anaemia, polycythemia
  • Hepatomegaly, splenomegaly
  • Acid-base, water and electrolyte disorders


  • Four Abdominal Quadrants and nine Abdominal Regions
  • Differential diagnosis in each Abdominal Region
  • Clinical abdominal examination: inspection, palpation, percussion, and auscultation
  • Main signs and symptoms of abdominal diseases and syndromes
    • Gastroesophageal reflux disease and achalasia
    • Gallstone disease
    • Peptic ulcer
    • Appendicitis
    • Pancreatitis
    • Splenic rupture
    • Inflammatory bowel diseases (Crohn’s disease and ulcerative colitis)
    • Colonic diverticulitis
    • Esophageal cancer
    • Gastric cancer
    • Colonic cancer
    • Rectal cancer
    • Cancer of the head of the pancreas
  • Definition of most important abdominal clinical problems:
    • abdominal pain
    • bowel obstruction
    • gastrointestinal bleeding
    • gastrointestinal perforation
    • acute abdomen
    • portosystemic collateral pathways in portal vein hypertension


The student learns what a mental disorder is and how a mental disorder is diagnosed. Particular attention will be given to learning the mental status examination; a systematic format for recording findings of mental status and behaviour will be provided.

Basics of Diagnostic Imaging

  • Fundamentals of radiological techniques (conventional radiology, US, CT, MRI and nuclear medicine) in terms of equipment (including physical principles) and operating principles;
  • Contrast agents;
  • Radiological semiotics and anatomy, according to different imaging modalities.

Clinical Pathology

The course represents an introduction to Clinical Pathology and will provide key concepts in laboratory medicine, correlate them to the associated clinical or laboratory information, and apply them to the diagnosis and management of human disease. Laboratory testing key concepts will be covered, including variability, quality control, reference intervals, predictive value, decision levels.

Basic concepts in Clinical Research Methodology 

  • Introduction to clinical research
  • Classification of clinical studies
  • Concept of primary sources, observational and experimental studies, secondary sources, systematic reviews
  • Concept of guidelines and randomized clinical trials
  • Method for evaluating a guideline
  • Principles for setting up an experimental clinical study

Course delivery

 Formal authority.

Lectures' keynote slides, and other learning material will be made available through the Campusnet page of each module.

Semeiotics exercises will be organized in the Advanced Medical Simulation Center.

They will be given to small groups (10-12 students), during the semester. Each group will participate in a four-day exercise, in the afternoon (16:00-18:00), as follows:

1. General approach to the physical examination, vital parameters

2. Physical examination of the lungs

3. Physical examination of the heart and of the circulatory system

4. Physical examination of the abdomen



Learning assessment methods

The exam test covers all the disciplines included in the course and the final score proportionally takes into account results of each module.




Number and type of questions:

Module CFU Long Essay Multiple Choice
Internal Medicine 6 4 4
Surgery 1 0 10
Clinical pathology 1 0 10
Clinical and Analytical Methodology 1 0 10
Diagnostic imaging 1 0 10
Psychiatry 1 0 10


  • Long Essay Questions:
    • 0 to 10 points for each answer
  • Multiple-choice questions (1 out of 4):
    • +1 point for each right answer
    • 0 point for each missing answer
    • -0.25 point for each wrong answer

Students must reach the sufficiency (18/30) in each discipline in the written test to pass the exam and/or to have access to the oral part of the exam (optional, see below). 

The result of the written test may be valid, at the student's discretion, until the next exam session.
If a student fails the oral exam, the written test has to be taken again.


Internal Medicine only. It is possible on request, but optional, to critically examine and reflect on the outcomes of the written test, and demonstrate understanding of all the disciplines part of the integrated course. At the end of the oral, the Internal Medicine grade (written) can increase or decrease by not more than 3/30.


The final grade will be given with a weighted average of the results obtained in each module and expressed in thirtieths.

Suggested readings and bibliography




Please be aware that the teaching materials for the course in Clinical Methodology and Semeiotics is divided into various teaching modules. The teaching materials are available for download on the specific pages of each teaching module at the following links:


  • MED/09 - Internal medicine - 6 CFU
  • MED/09 - Clinical and Analytical Methodology - 1 CFU
  • MED/05 - Clinical pathology - 1 CFU
  • MED/18 - Surgery - 1 CFU
  • MED/25 - Psychiatry - 1 CFU
  • MED/36 - Diagnostic imaging - 1 CFU

Students with DSA or disabilities are kindly requested to take note of the reception services and support services offered by the University of Turin, and in particular of the procedures required for exam support.


Teaching Modules

Last update: 08/03/2024 10:48
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