Cardiac troponins are sensitive biomarkers of myocardial injury and are widely used in clinical practice. Although troponin testing plays a central role in the diagnosis of myocardial infarction, an elevated troponin level does not necessarily indicate myocardial ischemia. Many cardiac and non-cardiac conditions commonly encountered in internal medicine, including sepsis, severe anaemia, renal dysfunction, inflammatory or immune-mediated diseases, and several metabolic or treatment-related complications, may also be associated with elevated troponin levels. Their interpretation should therefore integrate the clinical presentation, electrocardiographic findings, biomarker kinetics, and the underlying clinical context. This review provides a practical and rational approach to troponin testing in internal medicine, highlighting its main indications and aiming to avoid unnecessary investigations or inappropriate management.

Alveolar echinococcosis (AE) is a zoonotic disease caused by a cestode of the Taenidae family: Echinococcus multilocularis. Alveolar echinococcosis is a serious parasitosis, which represents a major public health issue. The diagnosis of AE is based on clinical presentation, epidemiology, lesion characteristics on imaging and serological test results. Surgical management, when possible, is the preferred option, under antiparasitic cover. When surgery is not possible, the treatment is only medicated and long, sometimes for life. Although great progress has been made in the last 10 years to improve the diagnosis of AE, particularly with the development of molecular techniques and the increasing use of imaging - often performed for other indications, thus allowing for earlier detection of the infection - therapeutic options remain limited. Indeed, drug treatment with albendazole, a parasitostatic molecule sometimes responsible for serious side effects (hepatic cytolysis), remains the main effective and available alternative. In case of imidazole intolerance and impossible surgical access, some patients may be in therapeutic dead end.

Organizing pneumonia is a condition first described in 1941. Its symptoms are nonspecific (fever, arthromyalgia, etc.), and its diagnosis relies primarily on histology, when this is not feasible, it is based on a combination of clinical, laboratory, and radiological findings, in the absence of a differential diagnosis particularly active infections. It is a rare condition that may be secondary to another condition or primary and referred to as cryptogenic. Numerous causes of organized pneumonia have been described: post-infectious, associated with connective tissue diseases, drug-induced, etc. It affects all age groups, with the idiopathic form predominantly occurring between the ages of 50 and 60. A non-contrast chest CT scan may be suggestive but remains nonspecific and must rule out infection. Bronchoalveolar lavage can help rule out active infectious causes and provide diagnostic clues; however, the gold standard remains histological examination, which reveals endoalveolar buds, an inflammatory infiltrate of the alveolar walls, and thickening of the alveolar walls. Treatment is usually based on corticosteroid therapy for the cryptogenic form but must be tailored to the underlying condition when the disease is secondary. The prognosis is generally favorable in the cryptogenic form and depends on the cause in the secondary form.

Explicit training in clinical reasoning and rational decision-making improves the quality of diagnostic judgments, patient safety, and the ethical dimension of decisions by strengthening metacognition, enriching illness scripts built from clinical practice, and incorporating patients' values. To be effective, it should rely on a longitudinal curriculum, active strategies (deliberate practice, SNAPPS+, one-minute preceptor, test-enhanced learning), and a climate of cognitive safety. The challenge is to structure such teaching within clinical environments under heavy time pressure, workload and patient turn-over, with unpredictable teaching opportunities, limited institutional recognition, and large, heterogeneous groups of learners.