Psychiatric comorbidities affect 50 to 75% of patients with behavioral addictions

Behavioral addictions are disorders of multifactorial origin most often

There is no known therapeutic management today, apart from benzodiazepines

The therapeutic management of behavioral addictions must be multidisciplinary, involving doctors, psychologists and social workers

Behavioral addictions are characterized by the inability to control a behavior despite the occurrence of negative consequences

Given the recent and emerging nature of these disorders, the diagnostic criteria for most of them are currently not defined in a consensual manner.


Benign prostatic hyperplasia (BPH) is a common pathology favored by aging

The digital rectal examination (DRE) finds a large prostate (> 20 g), firm, very painful, smooth, irregular, with disappearance of the median fold

There is a large prostate (> 20 g), firm, INDOLORE, smooth, REGULAR, with disappearance of the median sulcus

TR is also an opportunity to screen for prostate cancer

The main chronic complication is erectile dysfunction

No report. Chronic complications are chronic bladder retention, bladder lithiasis and chronic obstructive renal failure.

A PSA level > 4 ng / mL is an indication to perform prostate biopsies with histopathological examination unless the TR finds a prostate > 20 g

Despite the increase in PSA with prostate volume, a PSA level > 4 ng/mL is an indication for prostate biopsies with histopathological examination


Which of the following are true about basal cell carcinoma?

These are indeed carcinomas (= cancer = malignant tumor)

They can be fatal depending on the area where they are located. Their complications (ulceration, bleeding, ...) are not to be taken lightly and require treatment.

The most common treatment is excision surgery


Which of the following is the main precursor of mucosal squamous cell carcinomas?

It is the main precursor of cutaneous squamous cell carcinomas

True, by keratinization of the mucosa (especially the lower labial). These are very limited whitish lesions, asymptomatic, adherent and not bleeding on contact 💉. Curative treatment is surgical.

Bright red erythematous lesion of the glans, well limited, sometimes discreetly erosive ➡ it is a carcinoma in situ

Papular lesions localized on the genital areas and related to HPV. So these are STIs. They promote the development of mucosal carcinomas when it is bound to oncogenic papillomaviruses.


Which of the following are true about ventricular septal defect?


Regarding the murmur of the ventricular septal defect. Which of the following are true?

The breath is more intense if the CIV is large

The breath is more intense if the CIV is small.

Mesosystolic murmur is characteristic of aortic stricture


Which of the following are contraindications (IC) to the insertion of an intrauterine device (IUD)?

No longer an IC (watch out for possible consequences, including ectopic pregnancy)

Valvular heart disease at risk of endocarditis


Seizures can start at any age, but 90% start before age 40

The pathophysiology of migraine involves complex genetic factors

Migraine with aura has no impact on comorbidities

Migraine with aura is an independent risk factor for cerebral infarction especially in women under 45 years of age

Migraine without aura is never preceded by prodromes

The crisis is often preceded by prodromes: irritability, asthenia, drowsiness, hunger, yawning

Migraine with aura is preceded or accompanied by transient neurological symptoms that gradually set in


Sexual exhibition is the act of imposing a sexual exhibition/genitals in the public view of a person or group

The competent court is the criminal court

Limitation period: 3 years 2. SUPPORT 2.1. GENERAL Emergency:


Vulnerability to a disorder is a characteristic of a social group

It is an individual characteristic, linked to the fact that the so-called "vulnerable" person has or has been exposed to one or more genetic and/or environmental risk factors.

Some risk factors for psychiatric disorders are more particularly related to the age of the individual

Adolescence is a particularly critical period

There are no known risk factors for schizophrenia

Several risk factors are associated with an increase in the prevalence of schizophrenia such as the age of the father at birth, social and economic status, maternal stress during pregnancy, child abuse, etc.

Relatives of patients with schizophrenia are more sensitive to risk factors


What are the factors of psychiatric pathologies?

However, sports hyperactivity can be concomitant with certain pathologies, such as TCA, without these being recognized risk factors


What are risk factors for schizophrenia?


The choice of treatment used depends on the cause and type of pain

Neuropathic pain and nociceptive pain are of the same type

Analgesic drugs are used only to treat neuropathic pain

Analgesic drugs (or analgesics) are used to treat nociceptive pain are classified into three levels by the World Health Organization. Tramadol & morphine can be used also (https://www.sfetd-douleur.org/wp-content/uploads/2019/06/main.pdf)

The term 'analgesic' is frequently used for level 1 drugs available in self-medication by the patient (paracetamol, nonsteroidal anti-inflammatory drugs)

The term "analgesic" (etymologically "pain-suppressing") refers to WHO Level 3

The term "analgesic" (etymologically "pain-suppressing") can be used for any analgesic drug, even if the etymology sometimes lacks "modesty"


Among these proposals, which correspond to elements of the standard etiological assessment of precocious puberty:

Thumb sesamoid of the non-dominant hand = puberty

As well as a GnRH stimulation test that is possible in girls


Morsier's Kallmann syndrome is associated with impaired sense of smell

A hypothalamic-pituitary MRI is necessary in the etiological assessment to rule out an organic cause

The cause of delayed puberty is always organic

The cause of delayed puberty may be functional, e.g. nutritional

Respiratory failure can lead to delayed puberty

Celiac disease cannot cause delayed puberty


Impetigo is an infection of the epidermis due to a streptococcus most often

The diagnosis of impetigo is microbiological

Grouping multiple lesions can result in polycyclic closets with circined contours

The classic localization is, in children, the perimeter of the mouth, but all areas of the skin can be affected


Among these proposals of histological types, which correspond to malignant tumors?


The Bosniak classification makes it possible to differentiate benign cysts from malignant cysts

The Bosniak classification has 5 categories

4. The first two tend towards benignity (and the last two tend towards malignancy)

The resulting grading greatly influences the action to be taken

Ultrasound is the reference examination for the extension assessment

Kidney tumors are discovered by chance in 50% of cases

According to the College of Urology, in about 80% of cases


Interesting radiological signs can be found

Endoscopy is the second-line examination, after CT angiography


Which of the following proposals regarding screening are true?

Screening should only be carried out systematically when the patient discovers a suspicious mass on self-examination.

They are proposed in the absence of clinical signs, on criteria of sex and age

Organized mass screening is offered every two years to women aged 50 to 74 when they are at high risk for breast cancer

Organized mass screening is for all women aged 50 to 74, even without risk factors. In case of risk factor (high risk), patients should be screened individually.

Individual screening is for women who are at high risk of breast cancer

Organized mass screening is for patients with a BRCA1/2 mutation

For the latter, it is an individual screening that is indicated

Organized mass screening is performed by bilateral mammography, with a minimum of two incidences and with double reading


Adjuvant radiation therapy increases overall survival in patients

The goal of radiotherapy is to reduce the risk of loco-regional relapse

Skin cancers are among the acute side effects

Telangiectasias may appear several years later


Which of the following proposals should be sought for clinical examination in glomerular nephropathies?

Vascular involvement would rather point to vascular nephropathy

True, may suggest GI/rheumatoid purpura nephropathy (GNRP type 2)

True, may suggest rheumatoid purpura or lupus (GNRP type 2)


Mycobacterium tuberculosis is an acid-alcohol-resistant cocci

Mycobacteria of Mycobacterium tuberculosis complex (MTBC), acid-alcohol-resistant bacillus (BAAR)

Transmission of tuberculosis is air-to-human.

Histology contains an epithelioid and gigantocellular granuloma with caseous necrosis

The main lung lesions are pulmonary cave type

Additional droplet precautions should be applied in case of suspected tuberculosis

Additional precautions "AIR", single room


Which of the following propositions are true regarding the onset of abdominal pain and vomiting in a patient treated with IREP for 6 weeks?

The determination of ALT/AST is essential

Isoniazid may be responsible for hepatic cytolysis, peripheral neuropathy and mental disorders

Oral should be replaced with intravenous

Pyrazinamide may be responsible for symptoms

True. Hepatic toxicity and possible hyperuricemia


There is no correlation between serum lipasemia levels and pancreatitis severity

The diagnosis of BP is considered certain when a combination of typical pain and elevation > 3 N of lipasemia

If the lipasemia test is performed 48 hours after the onset of pain, it may be less than 3 N

In case of diagnostic certainty, imaging makes it possible to assess the immediate severity

In case of diagnostic certainty (association pain and typical biological abnormality), no imaging examination is useful for the positive diagnosis and imaging will be performed within 48 to 72 h

Only a CT scan should be done in case of diagnostic doubt in the absence of contraindication


If the patient is dehydrated, the injection of contrast medium should be avoided and a CT scan should be done without injection

the CT scan with contrast injection should be done a few days later to assess the severity of BP (cf.

Abdominal ultrasound is of interest for the diagnosis of severity

Abdominal ultrasound has no interest for positive diagnosis or severity

Ultrasound for the diagnosis of vesicular lithiasis and must therefore be done very quickly (as soon as the patient is admitted), and systematically

Abdominal X-ray without preparation has no interest


• Severe AP is associated with significant mortality

Multidisciplinary management involving the emergency physician, surgeon, anaesthetist-resuscitator, radiologist and microbiologist is necessary

BP is defined as acute pancreatic inflammation that can affect nearby or distant organs.

Lesions are associated with interstitial oedema, cytosteatonecrosis, necrosis of the pancreatic parenchyma or surrounding tissues

The severity of pancreatitis is defined by the existence of at least three organ failures or a local complication such as necrosis, abscess or pseudocyst

The severity of pancreatitis is defined by the existence of one or more organ failures or a local complication such as necrosis, abscess or pseudocyst


Antibiotic therapy targeting commensal bacteria of the digestive tract (mainly enterobacteriaceae, streptococci and anaerobes) has an adjuvant role and may be brief once the surgical procedure has been performed.

Antibiotic therapy is to be started as soon as blood cultures are carried out

Enterococci is not taken into account in the probabilistic treatment of community peritonitis, its pathogenic role is not formally demonstrated

Whatever the result of microbiological samples, the spectrum of antibiotic therapy must always include anaerobic bacteria, because of their frequency and their difficulty of isolation in the laboratory.

Amoxicillin – clavulanic acid probabilistic monotherapy is the treatment of choice

Amoxicillin – clavulanic acid has no place in probabilistic monotherapy, because of the frequency of acquired resistance of enterobacteriaceae (a quarter of E coli)


Concerning venous surroundings and their complcations

The number of manipulations of the injection routes and aseptic errors on these routes protects against infection

Obviously the number of manipulations of the injection routes and the aseptic errors on these routes or worse during the preparation of injectable drugs will promote this contamination.

On the other hand, the catheter cannot be contaminated by hematogenous route during a bacteremic episode

Finally, the catheter, like any device implanted in the body, can be contaminated hematogenous during a bacteremic episode.

These central line infections are serious since it is estimated that mortality attributable to intensive care units is in the order of 30%.

These central line infections are serious as mortality in intensive care units is estimated to be in the order of 3%.

An infection can occur early in the subcutaneous compartment of the chamber catheter box which will require its replacement


Antibiotic treatment uses C3G as a first-line treatment, which is the most active molecule on pneumococcus

Antibiotic treatment uses first-line amoxicillin, which is the most active molecule on pneumococcus

Except the rare necrotizing otitis externa due to Pseudomonas aeruginosa (mainly on diabetic ground)

Cholestomatous otitis is most frequently of infectious origin

Management of cholestoma ear infections is surgical

Purulent acute otitis media corresponds to acute bacterial superinfection of the middle ear


Which of the following is the recommended duration of antibiotic therapy for acute otitis media in children over two years of age (with severe symptoms)?


Regarding walking disorders in Parkinson's disease:

It is not specific to Parkinson's syndrome. It is also found in chronic hydrocephalus in adults and in incomplete conditions.

Feast = when the patient runs after his center of gravity

Freezing (trampling on the spot) appears at the beginning of the evolution of Parkinson's disease


Is or are causes of walking disorders with small steps:

In a person with careful walking and phobia of falling


What anomaly(s) is/are likely to cause lameness by greeting?

By a loss of strength of the quadriceps muscle

Because it is impossible to control the active extension of the knee

This causes a hip extension defect (need for a 10° extension for normal walking)


20% of patients who are admitted to intensive care die

17 25% of deaths according to the College of Pain Pal Care

A quarter of patients who die are due to a decision to limit/stop active therapies

Basic comfort and supportive care should be discontinued at the same time as active therapies

If it is possible to interrupt certain active therapies (curative or substitute), basic comfort and supportive care should always be continued.

Unreasonable obstinacy is defined as the initiation or continuation of a curative therapy or a diagnostic strategy that is unnecessary and/or unjustified.

Palliative care has no place in intensive care because patients are unconscious


The intention of the decision is not to cause death but to let the physiological process take place without technical or drug intervention deemed of no benefit to the patient.

The cessation of active therapies is defined by the interruption of one or more treatments including organ replacement techniques ensuring artificial life support

The decision to limit or stop active therapies is a cessation of care

The decision to limit or stop active therapies is in no way a cessation of care and abandonment of the patient: comfort care, pain management, etc.

Financial or structural arguments (need for resuscitation space) have no place in decision-making


Regarding vestibular nystagmus and vestibular examination:

Vestibular examination is based on the detection of oculomotor abnormalities and vestibular ataxia

Nystagmus is a totally irregular eye movement back and forth of the eyes

It is regular and composed of at least one slow phase

The direction of beating of a nystagmus is given by that of the rapid phase

Convention because more instinctive under consideration

Vestibular nystagmus appears only in the eccentration of the gaze

Vestibular nystagmus may be spontaneous in the position of the gaze straight ahead, or appear only under certain search conditions: eccentration of the gaze: peripheral vestibular nystagmus is often found in the direction of the rapid phase

Peripheral vestibular nystagmus is attenuated by eye fixation


Which of the following proposals can confirm the diagnosis of chronic lymphocytic leukemia?

True, essential for diagnosis in addition to NFS

Lymphocyte analysis by molecular biology


Which of the following are possible evolutions of CML (Chronic Myeloid Leukemia)?

True, after 12-18 months of chronic phase

Transformation to acute lymphocytic leukemia

In MLL most often. But ALL is also possible

Transformation into myeloid splenomegaly


In CML, there is no increase in hemoglobin

There is polycythemia in essential thrombocythemia

No, it is a criterion of distinction with primary polycythemia (or polycythemia vera)

Sedimentation Rate (ESR) is falsely zero or very low in polycythemia vera

True, because of the large excess of red blood cells and the hyperviscosity induced by them

Hydroxycarbamide gives quite frequently mucocutaneous lesions

Ruxolitinib is a kinase inhibitor targeting JAK1 and JAK2


Regarding carbohydrate metabolism hormones:

Insulin is the main hyperglycemic factor

Insulin is one of the only hypoglycemic hormones, its concentration rises after the meal and decreases during fasting

iGF 1 and iGF 2 are growth factors with hypoglycemic properties when their concentrations are very high (pharmacological or tumoral)

IGF2 is hypoglycemic at supraphysiological concentrations


Regarding the assessment of the severity of impairments:

During paraplegia, the functioning of the upper limbs is preserved, but depending on the level of the lesion, the trunk, lower limbs and pelvic organs can be affected.

Standardized assessment of incomplete lesions based on ASIA standard

The rating (from 0 to 5) of each muscle/key function is done according to the motor testing of the Medical Research Council or MRC is part of the ASIA standard

– grade B: preservation of a sensory function but not of the motor function at the level of the last sacral segments (S4-S5)

– grade D: motor preservation below the neurological level of the lesion with at least half of the key muscles with a rating greater than 3


Diarrhoea occurring during antibiotic treatment is by definition antibiotic diarrhoea

More than 10% of subjects receiving antiobiotics have transit changes

In front of a dysenteric syndrome, it is necessary to prescribe a CRP, a stool culture and a blood count

In front of any diarrhea the signs of dehydration should be sought

Acute diarrhea is nosocomial when it occurs within 2 days of admission

must occur more than three days after admission


Which of the following proposals are part of the initial management of common low back pain?

No additional examination in the absence of a red flag

No rest to prescribe. The latter only seems to increase the duration of low back pain


Which of the following are differential diagnoses of coma?

True, lesions of the foot of the protrusion

True, bilateral internal or peduncular frontal lesions

Post-critical phase of a comitial crisis

True, << the simulation of disorders of consciousness is not exceptional >> according to the college, but it is necessary to be << extremely rigorous>>


From what value of the Glasgow score are we talking about Coma?


Which of the following proposals regarding Renal Puncture-Biopsy (PBR) are true?

Severe hypertension is a contraindication to PBR

Always indicated, unless typical presentation

This is an emergency in rapidly progressive glomerulonephritis (GNRP)

Complications of PBR can, very rarely, go as far as the death of the patient


Taste, smell and vision are achieved with the same intensity with aging

Anorexia, then Weight loss, then Asthenia

A hearing impairment can lead to cognitive disorders

Vision impairment can lead to depression

There are no effective treatments for these neurosensory disorders


Which of the following are complications of nasopharyngitis?


Alcohol increases the epileptogenic threshold

Alcohol lowers the epileptogenic threshold

Gayet-Wernicke encephalopathy is due to vitamin B1 deficiency

Wernicke-Korsakoff encephalopathy is due to vitamin B1 deficiency

Be careful, Gayet-Wernicke encephalopathy is also called Wernicke-Korsakoff (not to be confused with Korsakoff syndrome)

Myelinosis centropontin is due to vitamin B9 deficiency

Centropontin myelinosis is due to too rapid correction of deep hyponatremia

Pellagrean encephalopathy is due to vitamin B12 deficiency

Pellagrese encephalopathy is due to vitamin PP deficiency (= Vitamin B3)


There are two patch-type treatments for cocaine but neither has been shown to be effective.

No medicinal product has a marketing authorisation (MA) in France for the treatment of harmful use and dependence

Cocaine is extracted from coca leaves, grown mainly in South America, Indonesia and eastern Africa.

Cocaine is the most frequently used illicit stimulant substance in Europe

The average age of first consumption is 16 years

The average age of first consumption is 22 years

On average, men are three to four times more consumers than women


Acute viral pericarditis is the most common, but rarely proven, etiology related to viral infection and associated immune response.

The course is most often favorable in viral pericarditis

The recidivism rate is low and is around 3 to 5%

Recurrence is common, ranging from 30% to 50% of cases, and is the most common complication

The occurrence of tamponade or progression to pericardial constriction is rare

Treatment of recurrent viral pericarditis remains purely symptomatic

In some forms of recurrent chronic pericarditis, after viral diagnosis, the prescription of specific treatments (immunoglobulins, interferon α) is discussed


A diagnosis of a behavioural disorder can only be made after at least 3 months

ITEP orientation requires MDPH notification

A diagnosis of a behavioural disorder can only be made after at least 6 months

PAP orientation requires MDPH notification

MDPH notification is required for WEPP and ITEP only

The AEEH requires the completion of an MDPH dossier


Which of these proposals can cause weight stunting with a change of corridor on the curve?

Hypercorticism can cause a statural delay


Which of these substances are analgesics?

Activates neurons of the extra-lemniscale pathway

Promotes activation of neurons of the extra-lemniscale pathway


PDE5 inhibitors thus promote the maintenance and quality of erection

Smooth muscle relaxation allows the opening of sinusoid spaces and inhibits erection

The opening of the sinusoid spaces allows blood flow, and therefore erection

Neural NO triggers smooth muscle cell contraction and allows erection

Neural NO triggers smooth muscle cell relaxation

When the spaces are filled, the compression of the subalbugineal veins will oppose the exit of the blood and allow to obtain the rigidity of the penis (veno-occlusive mechanism)

One in nine men has erectile dysfunction after age 40


Residual erectile capacity is a factor in good prognosis

There is no known iatrogenic cause of ED.

Drug iatrogenesis is often at the origin of ED: antidepressants, neuroleptics, non-selective beta-blockers, antihypertensives (antialdosterone and thiazide diuretics), 5-α reductase inhibitors and antiandrogens

The digital rectal examination for prostate enlargement or prostate cancer is performed after age 50, or from age 45 if there is a family history

An intracavernous injection pharmacological test is useful if PDE5 inhibitors are ineffective or if anrectile dysfunction is carried out


Pruritus is present during flare-ups in 50% of cases

Psoriasis regresses without leaving a scar

Lesions can be painful, especially on palms and soles where cracks may appear

Scalp psoriasis is one of the leading causes of alopecia


The diagnosis of the type of shock is clinical and paraclinical (using examinations quickly achievable)

The treatment of shock is based on specific treatments of the type of shock

Shock is defined as acute circulatory failure that permanently alters oxygenation and metabolism of tissues and organs.

Cardiac output (CD) is a function of total blood volume and blood pressure

At the macrocirculatory level: Cardiac output (DC) is a function of preload, inotropism, afterload and heart rate (HR)

MPA is schematically the result of DC and systemic vascular resistance


Derealization is a modified perception of the world with a sense of strangeness

Depersonalization is the act of changing one's personality in the acute phase of schizophrenia

Depersonalization is a perception of oneself as different and strange and a sense of being an observer of one's own mental functioning.

Hypoprosexia is a difficulty concentrating

Paramnesia is the creation of false memories

Paramnesia is decontextualized or distorted recollection


Functional signs may be pelvic pain only

Pelvic pain is always lateralized on the GEU side

The speculum makes it possible to specify the endouterine origin of bleeding

The vaginal touch finds a uterus less voluminous than the theoretical duration of gestation would like


Drug therapy is considered when the βHCG level is less than or equal to 10,000 IU/L

drug therapy (methotrexate 1 mg/kg) may be discussed with the patient provided that: • none of the above 3 severity criteria is present, • the βHCG level is less than 5,000 IU/L, • the patient has no contraindication to methotrexate (respiratory failure

Respiratory failure is one of the contraindications of methotrexate

Methotrexate has significant side effects on slow-reproducing cell tissues such as the heart and brain

This explains the precautions for use and the side effects occurring on rapidly dividing cell tissues: bone marrow, gastrointestinal mucosa, respiratory epithelium

The patient should be informed of adverse reactions to methotrexate such as nausea and diahrrea

The correct decrease of βHCG is monitored once a month

The correct decrease of βHCG is monitored once a week, the risk of treatment failure being about 25%"


Which of the following are risk factors for UEM?

Upper genital infections (salpingitis and endometritis), the most common germ of which is Neisseria gonorrhoeae

The most common germ is Chlamydia trachomatis.
It is the first risk factor for alteration of tubal motility.

Dose-effect relationship. This is the 2nd risk factor.


Regarding the surgical treatment of ectopic pregnancy. Which of the following are true?

There are 2 therapeutic options: conservative treatment (salpingotomy) and radical treatment (salpingectomy)

True. Salpingotomy is the opening of a fallopian tube. It is often performed under laparoscopy, but also by laparotomy. It allows, among other things, to evacuate an ectopic pregnancy by aspiration, when the state of the tube allows its conservation. A salpingectomy is removal of one or more fallopian tubes.

Surgical treatment is indicated as a first-line treatment in case of hemodynamically unstable patient

Surgical treatment is indicated as a first-line treatment for β-HCG > 500 mIU/mL

Surgical treatment is indicated as a first-line treatment in case of > 2 cm haematosalpinx on ultrasound

Surgical treatment is indicated as a first-line treatment in case of contraindication to drug treatment with methotrexate

True, CI as severe renal impairment or severe hepatic impairment.


Regarding methotrexate treatment for GEU. Which of the following proposals is/are the contraindication(s) to treatment?

50,000 G/L. Remember that methotrexate is an anti-metabolic treatment of DNA, so it will limit the production of blood cells by the bone marrow. It is not uncommon for it to cause leukopenia or thrombocytopenia.

True, especially in coronary artery patients (in whom transfusion threshold = 10 g/dL)


Atherosclerosis is a combination of reshuffling of the weed of large and medium-sized arteries, all accompanied by changes in the media

The weed is respected. It is the media and the intima that are being reshuffled.

The accumulation of low-density lipoproteins in the intima is the first histological abnormality found in the formation of atheroma

The accumulation of LDLc then attracts monocytes

Lipid streak is formed by the accumulation of foam cells

Foam cells are macrophages that have endocytized LDLc.

In the stages of atheroma formation, there is a migration of smooth muscle fibers to the intima.

As well as a differentiation of these fibers

An old atheromatous plaque is more unstable than a young plaque

The fibrous screed is stronger in the case of an old plate. The rupture is all the more likely as the plaque is young, very lipidic and very inflammatory


Which of the following are areas at high risk of atheroma?

2 risk areas: areas of mechanical stress and bifurcation zones of large arteries (carotid, subclavicular, vertebral, coronary, etc.)


Regarding contraindications to lumbar puncture

A Glasgow < 15 is always a contraindication to lumbar puncture

With the new recommendations, a Glasgow < 15 is not a contraindication

Taking antiplatelet agents is a contraindication to PL

It is necessary to make a lumbar puncture in front of a purpura fulminans

Often, PL is not possible because purpura fulminancs is associated with hemostate disorders with DIC, and hemodynamic disorders, which are contraindications

Thrombocytopenia < 100 G / L is a contraindication to PL

An abnormality of pupillary tone is a contraindication to PL

This is a sign suggestive of cerebral engagement by damage to the 3rd cranial nerve (oculomotor)


Regarding the biological analysis of purulent meningitis:

Purulent meningitis is defined as purulent fluid or fluid rich in PNN (> 50%) and hypoglycorachia

If a gram-positive diplococcus is found on direct examination, treatment should be treated with IV C3G and dexamethasone

If a gram-positive bacillus is found on direct examination, treatment should be treated with C3G IV and dexamethasone

This is listeria that is resistant to C3G. It must be treated with amoxicillin + gentamicin.

In case of beta-lactam allergy and the presence of a gram-positive bacillus, treatment should be treated with vancomycin and rifampicin

Treatment should be taken with vancomycin + rifampicin + cotrimoxazole

If gram-negaitf diplococcus is found, treatment with C3G IV and dexamethasone should be treated

Gram-negative diplococcus = meningococcal


During clinical practice, any physician may have his responsibility engaged

As a citizen, he is accountable to society for his actions

The doctor may be sanctioned by a criminal law court

Criminal liability cannot lead to punishment

Criminal Responsibilities Responsibility leading to a SANCTION: Ordinal/disciplinary responsibility

Civil liability can lead to compensation


Which of these responsibilities lead to compensation?

2 main types of responsibilities lead to patient compensation: civil (in liberal) and administrative (in hospital)


The clinical examination must be supplemented by a search for hepato-splenomegaly

A hard consistency and a fixed character (= not mobile) are rather in favor of an infectious etiology

A hard consistency and a fixed character (= not mobile) are rather in favor of a neoplastic etiology

Sus clavicular lymphadenopathy is frequently associated with a neoplastic cause (thoracic if left supraclavicular lymphadenopathy and abdominopelvic lymphadenopathy if right lymphadenopathy)

Thoracic if right supraclavicular lymphadenopathy and abdominopelvic if left lymphadenopathy

An axillary lymphadenopathy evokes in priority: cat scratch disease, breast cancer or metastases, inflammatory reaction to a foreign body (breast prosthesis)

Epitrochlear lymphadenopathy should be tested for local infection of the hand and forearm


What are the biological signs that can be found?

Anemia is aregenerative since the involvement is central


What type of acute leukemia is at high risk of being complicated by DIC?


Myelodysplastic syndromes frequently occur in people under the age of 50

Myelodysplastic syndromes can be de novo or secondary

Cytogenetic abnormalities in myeloid cells have prognostic value

The number of peripheral cytopenias have prognostic value

Hematopoietic stem cell transplantation is the only currently known curative treatment


Cancer cells carry multiple genetic abnormalities

Somatic mutations on drivers can be the target of certain therapeutic molecules

Somatic mutations on drivers are often the same

They most often differ from one tissue to another

About 30% of cancers are linked to a genetic predisposition syndrome

The constitution strictly regulates oncogenetic tests

The supervision of oncogenetic tests is highly regulated by the Bioethics Act (but not by the constitution)


Which of the following proposals do not require imaging for follow-up?

Surveillance is clinical (+/biomarkers such as Ca 125)


At what dosage should IM adrenaline be introduced?


What is a grade III severity according to the Ring and Messmer classification?

Severe life-threatening multi-organ disease

True, collapse, tachycardia or bradycardia, heart rhythm disturbances, bronchospasm

Cardiocirculatory inefficiency and respiratory arrest


What is the prevalence of obesity in France?


Regarding the diagnosis of myasthenia gravis:

Severe crises require hospitalization in intensive care

Myasthenia gravis is not impacted by pregnancy

Possible worsening of myasthenia gravis during the first 3 months of pregnancy and postpartum

Anti-RAC is present in 15% of patients, so their sensitivity is low

Anti-acetylcholine receptor (anti-RAC) antibodies are present in 80% of patients with generalized myasthenia gravis and in 50% of those with ocular myasthenia gravis

Anti-MuSK antibodies are present in 75% of cases of generalized myasthenia gravis


Which of the following proposals are essential for the annual check-up of a diabetic patient?


Which of the following are protective factors lowering the level of risk?

This is a measure taken, so testifying to a scenario, so it fits into the emergency (rUd) and not the risk (Rud)


The HBV seroconversion rate following AES in an unvaccinated or non-responding person is:

This is 0% if the person is vaccinated and has an HBsAg level > 10 IU.

50% in the case of sexual intercourse with an HBV+ person


Which of the following propositions are true about taeniosis?

True, especially if brain cysts are present

True, preceded by corticosteroid therapy

True, they are T. Saginata and T. Solium


Concerning the monitoring of vascular prosthesis wearers

There is a high thromboembolic risk if the patient wears a ball or single-disc prosthesis.

The patient's thromboembolic risk factors include: atrial fibrillation, LVEF > 50%, thromboembolic history

AF, LVEF < 35%, thromboembolic history, mitral or tricuspid prosthesis, associated mitral stenosis, hypercoagulability (only in the USA)

TAVI stands for Trans Aortic Valve Implantation

In post-op, INR is checked 1 to 2 times a week until equilibrium and then 1 time per month.

The patient notes his INR in a VKA monitoring log

Antibiotic prophylaxis for risky procedures (dental ablation or scaling) is performed with Clindamycin as a first-line treatment.


To date, there is no official French recommendation for "mass" screening for bronchial cancer.

False negatives on PET-CT are possible when the size of the nodule is less than 1 cm

This is the resolution limit of current machines

CT exposes to false positives are encountered in connection with inflammatory and granulomatous processes

Irregular contours are criteria for benignity

Irregular contours are criteria for malignancy

Benign tumors and attenuated malignancy tumors account for 1/10th of thoracic nodules

They are in the form of a single, spherical and regular contour opacity.


Regarding the epidemiology and history of abortion:

The number of abortions performed in France is constantly increasing

The number has been virtually stable since 2006

Every year, 14.7 abortions per 1,000 women aged 15 to 49 are performed in France

The 1953 decree authorizes therapeutic abortion if the mother's life is seriously threatened

It was on 28 June 1974 that the national representation voted the bill of Simone Veil, then Minister of Health, on the liberalisation of contraception.

Social Security reimburses the pill from 1974


In case of medical abortion and negative Rhesus, anti-D IGG is injected in IV on the day of taking mifepristone

Contraception must be prescribed for the day after the abortion

The insertion of an IUD is possible intraoperatively in case of surgical abortion

Post-abortion consultation is recommended but not mandatory

TRUE. There is a discrepancy with the fourth edition of the College of Gynecology. Indeed, in the latter, Table 8.1 page 79 says the capital D explain that post-IVg consultation is advisable but not mandatory. However, the HAS sheet on abortion (which you can find here: https://www.has-sante.fr/upload/docs/application/pdf/2018-06/cteval351_fiche_bum_ivg_medicamenteuse.pdf) explains that, from now on, <<A follow-up visit is mandatory within 14 to 21 days for both surgical abortion and medical abortion>>.


Concerning the different types of epidemiological studies

Events occurred before the start of the study in prospective surveys

Prospective studies: at the beginning of the investigation, events (e.g. disease onset) have not yet occurred, it is necessary to wait for events to occur to observe data.

Cohort studies are always retrospective.

They can be. But the idea is to be as forward-looking as possible.

The objective of epidemiological investigations must be as clear as possible

Cohort studies can be retrospective or prospective

Cross-sectional studies have no temporality parameter


The semiology of the elderly is atypical

Frailty is an irreversible state due to age

Fecal impaction is a chronic pathology in the elderly

The elderly may present a borrowed semiology


A medical team is a group of professionals who are committed to working together around a common patient-centered project.

Teamwork is the meeting of a group whose objective is to jointly carry out a set of specific tasks.

The patient is the recipient of the fruit of teamwork but is never integrated into it

The patient is at the centre of teamwork and is encouraged to participate in this work. "Effective" teams have:

A team is formed on the basis of a shared project

The choice of members is based on the search for necessary and complementary skills


The scientific question asked must be relevant and innovative

The scientific question asked must be infeasible, hence the need for research

The scientific question asked must arouse the interest of the investigators

The scientific question posed must not be original or innovative

The scientific question posed must be ethical.


Concerning the literature search of Methodology in clinical research

Analytical databases are accessible via the Internet and provide systematic reviews

The Cochrane library is an electronic database initiated in 2018 in Switzerland

The Cochrane library: Electronic database Initiated in 1995 in Great Britain It provides regularly updated systematic reviews of the literature Major source of information for practitioners Medical bibliographic databases

MEDLINE, created in 1966 in the USA, is the best known and most widely used database

EMSABE is a database founded in Russia during the Cold War

Pubmed is the search engine for accessing MEDLINE data


Regarding the different types of clinical studies:

Non-interventional research consists of introducing only placebos for patients randomized to the Control group

All acts and products are used in the usual way, without additional procedure

Patient cohort research may be non-interventional

Research on samples is most often non-interventional

As long as it doesn't change anything for patients

Non-interventional research does not require patient consent

Research on medical data is most often non-interventional and makes it possible to dispense with patient consent

Consent is a necessity for all types of research."


In pharmacology, clinical research is dominated by studies of the drug, as part of clinical trials.

Clinical trials follow a technique (clinical trial methodology), legislation and ethics

These studies take place exclusively in hospitals and research laboratories.

These studies can either in town medicine, or in hospitals, or legislation and one (cf. item 8). ethics take place research in public or private approved structures. The different phases of drug development 1.Exploratory research of a molecule:

The filing of the patent by the industrialist has a duration of 35 years

Filing of a patent by the industrialist, candidate who assures him exploitation rights for a period of 20 years

The establishment of a research program is usually subsequent to the filing of a patent


Regarding Clinical Practice Recommendations (CPR)

The task of the working group is to bring together international experts to discuss the subject.

Mission: write the recommendations after reading the bibliographic data

The working group is composed of 3 researchers and 3 doctors

It is composed of 15 to 20 professionals and representatives of patients or users, with good professional knowledge.

The reading group is composed of 30 to 50 people concerned by the theme treated, expert or not

All members of the reading group must come from a single discipline: the one most concerned by the question

It is multidisciplinary, professional and representative of the diversity of the more than 3.3.3. Method 1. Phase of systematic review and synthesis of the literature"


Rarely, autoimmune diseases are called "monogenic diseases", when the occurrence of a mutation of a single gene is enough to confer a very marked increase in the risk of developing the disease.

The weight of genetics is greater in forms of revelation in adulthood

The weight of genetics is greater in forms with pediatric revelation

Many environmental factors could play a role in the occurrence of autoimmune diseases

In practice, the diagnosis of autoimmune disease is based on the association of suggestive clinical and / or biological manifestations and evidence of autoimmunity (or biological stigmas thereof)

The presence of autoantibodies indicates the existence of an autoimmune disease

The presence of autoantibodies does not necessarily indicate the existence of an autoimmune disease, since any stimulation of the immune system (for example during certain infections) can lead to the formation of autoantibodies


Which of the following proposals are suspect of a Gougerot-Sjögren?

Possible association with rheumatoid arthritis


A thyroid volume of 18 mL is normal in an adult male

The ultrasound criteria for a goiter are a thyroid volume > 16 ml in adolescents, > 18 ml in women and > 20 ml in men.

The existence of a goiter does not prejudge thyroid function.

Thyroid goiters affect more than 70% of the population

It is a pathology encountered in more than 10% of the population


Which health security agencies have a direct role in health surveillance?


Which of the following are true about leishmaniasis?

The involvement can be cutaneous or visceral


The prevalence of immunodeficiencies is about 2000 cases in France

More than 700,000 causative genes have been identified

Iron deficiency may be a secondary cause of immune deficiency

Anemia. Zinc deficiency causes immune deficiency.

Selective IgA deficiency is often asymptomatic


pH: 7.41. pO2: 68 mmHg. pCO2: 52 mmHg. Bicarbonates: 31 mmol/L.

True, offset by the increase in Bicarbonates

It is potentially a compensated METABOLIC alkalosis but not respiratory :)


Which of the following may be ECG abnormalities secondary to hypokalemia?

PR < 0.2s normal (between 0.12 and 0.20)

QRS < 0.1s normal (between 100 and 120 ms: incomplete branch block. Beyond 120 ms: branch block)

True, QT prolongation is an abnormality of hypokalemia


The orificial area of a normal aortic valve is 2 to 3.5 cm2

In case of aortic narrowing, the valve surface increases sharply

This surface decreases: the valve opens less well.

We speak of tight aortic narrowing for an area < 1 cm2 or < 0.60 cm2/m2 of body surface area

The criteria for tight AR are a Vmax > 4 m/sec; an average gradient > 40 mmHg; an aortic surface < 1 cm2 or < 0.6 cm2/m2

In AR, ETT can also rule out another valve involvement and measure the size of the aorta

RA is often accompanied by an aneurysm of the ascending aorta


Carpentier type II is characterized by elongations or breaks of ropes responsible for valacular prolapse

Functional mitral insufficiency is frequently encountered at an advanced stage of heart disease, in case of dilation of the LV

because of the dilation of the valve ring (Type I according to the Carpentier classification)

Acute mitral regurgitation may ultimately be responsible for a serious hemodynamic picture justifying emergency management

The regurgitated volume depends on three main factors: the size of the regurgitating orifice; the pressure gradient; the duration of systole

Functional signs of MI are headache, exertional dyspnea and stress syncope.

Main functional signs of symptomatic MI: palpitations, exertional dyspnoea or exertional asthenia


About cholelithiasis and its complications

There are 3 types of gallstones: cholesterolic (80%), pigmentary (20%), mixed

female sex; overweight (and significant changes in weight); multiparity; Prolonged fasting are risk factors for cholesterolic gallstones

100% of patients in total parenteral nutrition have vesicular lithiasis after one month

Pigmentosa lithiasis is due to deconjugation of bilirubin which is soluble in deconjugated form and insoluble in conjugated form

Pigmentosa lithiasis is due to a deconjugation of bilirubin which is soluble in conjugated form and insoluble in deconjugated form

Risk factors for urolithiasis pigmentosa include certain geographical origins, biliary infections, biliary obstructions


Regarding child development and intelligence:

Neurodevelopmental disorders have a multifactorial origin

Management of patients with neurodevelopmental disorders should be multidisciplinary

Intelligence is the ability to solve complex mathematical problems

According to the College of Psychiatry, intelligence is a set of abilities that allow an individual to adapt to his environment. Solving mathematical problems therefore does not define intelligence

Age-standardized tests estimate ITQ – Total IQ

IQ measures ability, but not intelligence. The ITQ can only be calculated if the scores on the different subscales are homogeneous.

ITQ scores average 120 with a standard deviation of 35 in the general population

ITQ scores average 100 with a standard deviation of 15 in the general population


Which of the following are the causes of secondary polycythemia?

True, other cardiovascular (hypertension) and renal signs

True, it is a very rare deficit. Present in red blood cells, 2-3 DPG promotes the dissociation of oxyhemoglobin in tissues. This 2-3 DPG deficiency may therefore be responsible for tissue hypoxia with its own consequences.


Cardiac evaluation is recommended in case of signs suggestive of cardiac disease or cardiovascular comorbidity

CBC looks for polycythemia reactive to hypoxemia, anemia that may worsen dyspnea

The alpha-1 antitrypsin assay is indicated in case of § Early COPD (< 45 years)

t pharmacological management of COPD must be accompanied in particular Smoking cessation aid • Vaccinations • Physical activity advice • Dietary advice are an integral part of the treatment

Smoking cessation is the main measure that can interrupt the progression of bronchial obstruction and delay the onset of respiratory failure


It is a decrease or absence of sexual desire and interest

It is extremely rare to be averse to all or part of sexual activities

We can often observe an aversion to all or part of sexual activities

We must think about systematically eliminating a non-psychiatric differential diagnosis of hypogonadism

The assessment of the impairment is done by the psychologist

The assessment of impairment is made by the clinician who must take into account factors that may affect sexual functioning such as age and general and sociocultural contexts of the subject's life.

Erectile dysfunction affects 30% of men over 50


What is the neurotransmitter that increases arousal and desire?

Researchers believe that serotonin curbs arousal and desire

College does not report GABA role in sexuality

Endorphins are involved in the refractory phase mainly


Regarding insulin resistance during pregnancy, which proposals are true?

It allows the fetus to have more glucose

The two main organs affected by this increase in insulin resistance are the muscles and the liver.


Regarding vitamin supplementation, which proposals are true?

Vitamin B9 supplementation is recommended pre-conception

Vitamin A supplementation is recommended from the third trimester

It is contraindicated because it is teratogenic

Vitamin D supplementation is contraindicated in pregnant women

Vitamin K supplementation is indicated in pregnant women with anti-tuberculosis drugs


For diabetic women who want to become pregnant:

The HbA1c target is less than or equal to 6.5%

There is a significant risk of miscarriage in the 3rd trimester

The risk of miscarriage is especially present in the first trimester. In the third trimester, there is a risk of prematurity or the need for caesarean section

There is a risk of fetal tissue hypoxia in the 2nd trimester

There is an increased risk of retinopathy for the mother during pregnancy


Which of the following are not associated with an increased risk of gestational diabetes (GDM)?


Complete this sentence: Macrosomia is defined for a birth weight beyond ..... th percentile.


Which of the following proposals about meningiomas are true?

Meningioma has a high potential for malignancy

Meningioma develops in the subdural space from arachnoid cells

Meningioma is part of neurofibromatosis type 2

True, neurological, ocular and cutaneous involvement. The diagnosis is made according to the Manchester criteria


False: gliomas very rarely metastasize at the systemic level


Which of these proposals are risk factors for eristele?

Spironolactone is an anti-aldosterone (in the renal collecting tube) and therefore acts as a potassium-sparing hard. It is not considered a risk factor for erisipelas

Erysipelas is a bacterial dermohypodermatitis


Hemorrhoids are anatomical structures normally present in the healthy individual

Hemorrhoidal disease is the most frequently encountered condition in proctology

There is parallelism between the importance of hemorrhoidal anatomical disease and the symptoms

There is no parallelism between the importance of hemorrhoidal anatomical disease and the symptoms

1/3 of adults report having suffered at least once from a hemorrhoidal problem

Pregnancy is a risk factor for hemorrhoids


Headache is an objective symptom that motivates frequent consultations

Secondary headaches are symptomatic of a local (neurological, ENT, ophthalmological) or general cause

Cranial neuralgia, headaches type of electric shocks in the territory of a sensitive nerve, are all essential and without found cause

They are also divided into essential neuralgia and secondary neuralgia.

The unusual or habitual nature of the pain is absolutely essential to determine


Attention allows the selection and maintenance of information in the field of consciousness

Short-term memory is also called working memory

Long-term memory is divided into procedural memory and declarative memory

Procedural memory engages unconscious processes

In routine clinical practice, it is not assessed


It lasts 1 year and is renewable once. It is a transitional measure, which can be put in place very quickly. It can be requested by the patient himself, his relatives or his doctors. The representative is appointed by the judge. The patient retains all his civil rights. There are two types of safeguards of justice: medical and judicial.

The safeguarding of justice is halfway between curatorship and guardianship

Curatorship is halfway between safeguarding justice and guardianship

Curatorship allows civil rights to be partially preserved

The safeguard of justice is renewable only three times


Which of the following are symptoms or signs of Hodgkin lymphoma?


Amenorrhea is the asbsence of menstruation in a woman of childbearing age

Amenorrhea is physiological in 3 cases: pregnancy, lactation and menopause

Primary amenorrhea and impuberism are synonyms

Impubertism is the absence of development of secondary sexual characteristics while amenorrhea is the absence of a rule

In impuberism, there is no estrogenic secretion

Primary amenorrhea may or may not be accompanied by impuberism

It can be: • primary: absence of menarche (appearance of the first menstrual period) at 16 years


Vaginal examination is offered to all patients to look for a laterouterine mass

The TV makes it possible to search for a large uterus

A digital rectal exam is used to check for the existence of a uterus

a digital rectal exam can be used to perceive a hematocolpos if necessary

It is the retention of menstrual blood in the vagina (for several reasons: hymeneal imperforation, complete vaginal diaphragm, one-eyed hemivagin, etc.)

The gynecological examination is completed by the search for galactorrhea

Senological examination is part of the general examination and gynecological examination


Within 24 hours of the admission of a patient who is required for psychiatric care:

A somatic examination must be performed by a doctor

A medical certificate attesting to his mental state must be drawn up

He must confirm or not the need for continued care

The medical certificate must be carried out by the city psychiatrist

By the psychiatrist of the receiving institution

Paramedical examination may cause care to be stopped if staff feel that the patient does not consent

The medical certificate of admission can be made by a somatic doctor


Under what conditions can psychiatric care without consent be stopped?

By decision of the liberty and detention judge

Departmental Commission for Psychiatric Care

This is the principle of care without consent

Unless a psychiatrist at the facility certifies that stopping care would result in a life-threatening risk to the patient


Which of these proposals refer to signs of pregnancy?

Rather a tachycardia reactive to hemodilution


Type A follow-up should be performed by a physician

Regular follow-up can be provided by a midwife or a doctor (general practitioner)

A medical gynecologist can follow a type A pregnancy

An obstetrician-gynecologist cannot follow a type A pregnancy

or gynecologist-obstetrician according to the woman's choice

The opinion of an obstetrician gynecologist is necessary in an A2 follow-up


From the following proposals, check the exact answer(s):

Physiotherapists are not allowed to prescribe

A decree published in 2006 (decree 2006-415 of 6 April 2006) authorizes physiotherapists to prescribe a number of medical devices concerning, in particular, the prevention of pressure ulcers and ambulation.

Deep transverse massage allows the treatment of low back pain

It is indicated for the treatment of certain tendonitis and lymphatic drainage

Joint manipulations are not allowed in the usual therapeutic arsenal

Strengthening proprioceptive sensitivity requires correction of visual acuity if necessary

It uses joint stress exercises without ocular control

Motor, sensory and articular deficiencies of the upper limb are indications for occupational therapy


The cerebral predisposition to generate repetitive seizures is argued in particular by

The occurrence of at least two click-confirmed unprovoked seizures spaced at least 24 hours apart

A pre-existing neurodevelopmental disorder

The presence of paroxysmal abnormalities on ECG

Pre-existing epileptogen brain injury on imaging


Epilepsis is a chronic brain disease characterized by a lasting predisposition to generate seizures with clinical and social repercussions

Epilepsy is a heterogeneous group of diseases that can begin from the neonatal period to old age.

Epileptic syndromes are often age-dependent

Epileptic seizures are rarely predictable, clinically very polymorphic, but are often stereotyped for the same patient

Epileptic seizures have very different clinical aspects from one patient to another but most often stereotyped in the same patient


Which of the following are causes of lesional partial epilepsy?

True, meningoencephalitis and parenchymal abscesses for example


Regarding gastroesophageal reflux disease

Endobrachyesophagus is defined by the presence of intestinal metaplasia

Endobrachyoesophagus at risk of squamous cell carcinoma of the esophagus and should be monitored

It exposes to the risk of adenocarcinoma

Treatment of GERD relies primarily on proton pump inhibitors

PPIs should be prescribed at full dose during GERD without esophagitis

Very noisy symptoms may be present without esophagitis


Which of the following proposals support gastroesophageal reflux disease (GERD) in small children?

The frequency of regurgitation is not an element of gravity

Pathological GERD, according to the College of Pediatrics (2021) is defined as GERD accompanied by pathological consequences for the child, such as esophagitis, extradigestive manifestations (ENT, respiratory) or malaise.

May indicate pathological GERD in children, it is a nonspecific sign


Decision-making for a given patient should be:

Curative, Palliative, Non-therapeutic, etc.


Be careful, it should not be confused with Fanconi anemia (which is, indeed, a genetic disease)

The most found light chains are kappa type

It may reveal MGUS or underlying myeloma


Outpatient care refers to all care that does not involve hospitalization

The medical-psychological centers (CMP) allow a coordination of the psychiatric care pathway

CMPs bring together multiple skills within multidisciplinary teams (doctors, psychologists, social workers, occupational therapists, sociotherapists, etc.) that ensure a diversified offer of care.

Permanent reception centres (CAPs) offer 24-hour response

Liaison psychiatry corresponds to liberal psychiatrists

Liaison psychiatry meets the needs for psychiatric interventions in non-psychiatric inpatient units, in the emergency reception departments of general hospitals or in medico-social structures.


Patients stay there for less than 2 days

This is the psychiatry side of the somatic UAA

U72s are different from psychiatric UAAs


Regarding the diagnosis of these disorders:

There are two main somatoform disorders: somatization disorder and neurological disorder

There are three main somatoform disorders: somatization disorder, conversion disorder and pain disorder

The necessary additional assessments of non-psychiatric medical pathologies are therefore to be carried out, but it is also necessary to know how to stop them once the psychiatric diagnosis has been made.

Psychiatrists distinguish conversion disorders according to the sphere of neurological appearance preponderant of the symptoms

This is called motor or sensory conversion disorder only.

Thus we will speak of conversion disorder of motor, sensory / sensory type, and malaise / convulsion type

To maintain the diagnosis of pain disorder, it is necessary that the painful symptoms are then insufficiently explained by the associated non-psychiatric medical pathology


Questioning and physical examination, if necessary repeated, are the two key stages of etiological diagnosis

See item in the latest edition of the college

The management strategy for a patient with prolonged fever must be methodical and persistent

The tympanic route may be defective in case of obstruction of the external auditory canal (earwax plug)

In case of prolonged fever, it is essential that the body temperature is taken at irregular intervals and by varying the measuring tools

In case of prolonged fever it is essential that the body temperature is well taken in a standardized and regular way.

Infective endocarditis is one of the main causes of prolonged fever

Infections, in general, are responsible for more than 40% of prolonged fevers


Which of the following proposals define a metabolic syndrome?

True, hypertension, or normotension treated

Waist circumference> 94 cm in men and > 80 cm in women

HDL cholesterol< 0.5 g/L in women and < 0.4 g/L in men


Overactive confusion is most often accompanied by apathy

We find, as its name suggests, a psychomotor agitation that is in the foreground

Hypoactive confusion is often accompanied by patient opposition to care

The patient undergoes a frank psychomotor slowdown. No agitation, and no opposition to care most often

Overactive confusion is often mistaken for depression

This is the case of hypoactive confusion

There are mixed forms (hypoactive hyperactive)

The most widely used screening tool is the MMSE

This is the CAM: Confusion Assessment Method, which lasts less than 10 minutes


Which of the following proposals about radiotherapy are true?

The total dose depends on the patient's weight

The dose of radiation therapy in breast cancer depends on SBR grade and HER2 status

Radiation therapy usually lasts 5 to 6 weeks

Radiation therapy can cause diarrhea and nausea

Radiation therapy may be accompanied by localized radiodermatitis


Which of these colours makes it possible to study fungi (fungi)?

Be careful, it does not count as a coloring. This is a different microscopy technique

It is used in histology for the visualization of fungi, certain pathogens, basement membranes


Which of these stains can highlight beta-amyloid peptides?

It is an acidic dye, that is, it tends to attach preferentially to basic structures.


Histological analysis requires fixed samples

Cytological analysis requires fixed samples

Not necessarily. For example, the blood count does not require fixation

In indirect immunofluorescence, fluorochrome is provided by the second antibody

In direct immunofluorescence, fluorochrome is provided by the second antibody

Fluorochrome is directly attached to the first antibody

The search for fat contraindicates the fixation of the sample


Hypermenorrhea refers to periods that are too long

Menstruation is normal but too heavy (> 80 mL)

In macromenorrhea, menstruation is normal but too abundant

Periods are too long but of normal abundance (> 6 days)

In pllakimenorrhea, menstruation is too frequent and cycles are too short

Menorrhagia is more abundant than metrorrhagia

Not necessarily. Does not fit into the definition


In case of intolerance observed to transfusion:

Transfusion is stopped and the route is removed first

We leave the route first, which will be very useful in case of hemodynamic instability

Adverse reaction is reported to haemovigilance

The patient is transferred to intensive care

Only in case of relevant clinical-biological arguments. Transfusion intolerance can have multiple explanations, many of them benign, and be quite transient

Transfusion continues, unless intolerance impacts constants

Transfusion is stopped in case of intolerances


What to transfer preferentially to an AB+ patient?

Unless we cannot do otherwise, we transfuse the same group and the same rhesus


Regarding the etiologies of edema and their pathophysiology:

During heart failure, decreased cardiac output leads to increased redistribution of blood flow to the kidney

There is a decrease in renal blood flow, thus a decrease in "effective" blood volume. This activates the mechanisms responsible for water retention

Edema is formed especially during severe acute oligo-anuric renal failure

Edema is not seen in chronic renal failure

Edema can be seen in the pre-terminal stage

The regulation of the sodium and water balance remains globally assured in chronic non-pre-terminal renal failure

In nephrotic syndrome, the decrease in oncotic pressure causes hypovolemia and RAAS activation


Regarding the certification of health facilities

The evaluation is done by external stakeholders

They concern public and private health institutions

It is carried out by independent professionals


Epithelio-gigantocellular granulomas without caseous necrosis are very suggestive of Crohn's disease

Resection surgery is considered at the stage of complications and should be as conservative as possible

More than 50% of patients are operated on within 10 years of diagnosis

The life expectancy of patients is close to that of the general population

Tobacco is a protective factor against Crohn's disease


Active smoking has a protective effect on UC

Following the diagnosis of sclerosing cholangitis, it will be necessary to evoke the diagnosis of UC

The association is common between the two

Endoscopic signs are varied and non-specific

The evolution is generally done by flare-ups separated from more or less long periods of remission

Severe flare-up of severe acute colitis occurs in 20% of patients


Regarding progressive visual acuity decline:

A transparency of normal environments points to corneal damage

Transparency of normal media without improvement by optical correction = damage to the retinal macula or optic nerve damage

Improvement by optical correction signs optic nerve damage

Damage to the isolated optic nerve is accompanied by an impairment of the transparency of the media

The damage (such as the integrity) of the optic nerve does not impact the transparency of the environments

The clinical examination concerns only the diseased eye

The transparency of the media is normal during an isolated attack of the macula

It has been clearly specified "An isolated attack of the macula"


They may reflect impaired peripheral vision

They are accompanied by a systematic decrease in visual acuity

Only if the campimetric attack reaches the central region

Toxic optic neuropathies are most often unilateral

Whether it is a toxic or metabolic etiology, there is bilateral and progressive involvement

Tumors developed at the expense of nerve fibers in the optic nerve are meningiomas

These are gliomas. Meningiomas are developed from the optic nerve sheath

Sphenoid meningiomas can compress optic pathways


In a normal pregnancy, the ovular sac is visible as early as 2SA

In a normal pregnancy, the ocular sac is visible as early as 5 weeks of amenorrhea (AS) in the form of an intrauterine fluid image surrounded by an echogenous crown (the trophoblast).

The embryo and its cardiac activity become visible as early as 3 SA

The embryo and its cardiac activity become visible between 5.5 and 6 SA

Hemorrhages with clots and "debris" are in favor of a spontaneous abortion

A soft, permeable cervix in favor of a spontaneous abortion

Painless uterine mobilization is in favor of spontaneous abortion


Which of these proposals is (are) in favor of a placenta previa:

Abundant, recurrent, red, coagulable blood hemorrhage

a flexible uterus (between contractions) and painless

A presentation of the normal fetus most often

Fetal presentation is frequently pathological (transverse or seat)

On the contrary, fetal cardiac activity is generally well perceived

Multiparity, history of curettage, uterine surgery or caesarean section are risk factors for placenta previa.


Regarding complications of breastfeeding:

A normal milky rise is not accompanied by fever

infra)The milky rise is a natural phenomenon occurring on the 2nd–3rd day of postpartum, which may be accompanied by a transient fever at 38 ° C and doule'is very common that this passage is accompanied by a fever and breast pain or discomfort

It is self-limiting within a few days, in the absence of nipple stimulation

In case of galactophoritis, breastfeeding should be stopped

Active antibiotic treatment with Staphylococcus aureus (penicillin M type, 2–3 g/d) should be administered for 10 days, in addition to symptomatic treatment.

Breastfeeding should be stopped in case of breast abscess


Which of the following are causes of esophageal dysphagia without organ damage?


It is one of the 4 major causes, along with asthma, chronic rhinorrhea and GERD.

The appearance of a cough in a chronic smoker must suggest bronchial cancer

Treatment of chronic cough is exclusively symptomatic

Chronic cough associated with purulent bronchiorhea is an important sign of bronchiectasis


Regarding focal nodular hyperplasia (UFH):

Unlike hepatocellular adenoma, focal nodular hyperplasia is not related to estrogen-progestin

UFH is an area of liver receiving only portal blood and not arterial blood

UFH, on the other hand, receives only arterial blood (and no portal blood at all)

Biopsy is contraindicated in view of the risk of bleeding

It is not contraindicated (unlike the hydatid cyst for example) and it is even sometimes necessary


Which of the following are true for hepatic adenoma?

True, favored by taking an oral estrogen-progestin contraception

Adenoma = benign (such as UFH, benign hemangioma and simple biliary cyst)

It can escalate and therefore requires monitoring

The most common complications are hemorrhage and malignant transformation


An epistaxis is a bloody discharge from the bronchi

This bleeding is very common and mostly benign.

It is never a real medical-surgical emergency

In some cases, it can become, by its abundance, its repetition or the fragility of the terrain, a real medical-surgical emergency.

The lining of the nasal cavity is also called the pituitary mucosa

The mucosa of the nasal cavity is very thick and highly vascularized

It has the particularity of being fine, in direct contact with the skeleton, and richly vascularized — three characteristics explaining the frequency of epistaxis


Regarding diagnosis and general examination:

Management of severe epistaxis will most often require vitamin K

Management of severe epistaxis will most often require previous tamponaking or placement of a double-balloon probe

In hemoptysis, bleeding is externalized during coughing efforts

Hematemesis is an epistaxis that is exteriorized through the mouth

Hematemesis: bleeding is mainly expressed through the mouth and during vomiting efforts. Blood comes from the digestive system

The side of the beginning of epistaxis is essential to determine because bilateral hemorrhages are rare

It is essential to quickly place a venous line


Psychiatric disorders in the elderly are often underdiagnosed

Psychiatric disorders in the elderly are characterized by semiological specificities

Alzheimer's disease and related diseases are not only manifested by cognitive alterations

The iatrogenic risk associated with the use of psychotropic drugs is major in the elderly

Characterized depressive disorder is a common pathology in the elderly


In the general population, it is estimated that 1 to 4% of people over the age of 65 suffer from a characterized depressive episode (EDC)

It can be considered normal to "suffer and be sad as we get older"

It is absolutely not normal to "suffer and be sad as you get older" because the prevalence of EDCs is less than 5 percent.

The diagnostic criteria for the EDC of the elderly subject are the same as for the young subject

The reason for consulting older people suffering from EDC is often not a depressed mood

There are few age-related clinical specificities for anxiety disorders


Regarding the classification of Salter & Harris, which propositions are true?

It concerns fractures of growth cartilage

Fractures between the metaphysis and the epiphysis

It concerns children and young adolescents (who still have growth cartilage)

Stage 2 indicates orthopaedic management alone

Stage 4 indicates orthopaedic management alone


Daughters born to mothers who consumed Distilbene (diethystilbestrol) during pregnancy (1950 to 1977) have an increased risk of uterine malformations

The determination of the blood group (ABO, complete rhesus, Kell) is part of the pre-conception assessment. Only 1 determination is required.

If the mother is rhesus negative, it is interesting to determine the blood type of the future father. And if the latter is positive, a genotype of fetal rhesus may be prescribed from 9 weeks.

False. Indeed, we can make a genotype of fetal rhesus if the father is rhesus + and if the mother is rhesus -, but it is done from 11 SA.


If the mother is rhesus negative and the father rhesus positive, genotyping of fetal rhesus may be prescribed. This genotyping can be done from which week of amenorrhea?


Multidisciplinary medical and psychosocial care is essential in case of trisomy 21

Trisomy 21 (T21), or Down syndrome, is a genetic disease linked to aneuploidy

Aneuploidy is an abnormal number of chromosomes (by excess or defect) so T21 (or Down syndrome in English) fits well into this framework.

It is due to the presence of an extra chromosome 21 (3 chromosomes instead of 2)

This does not mean that the chromosome is always free and homogeneous since a translocation can be found

Diagnostic confirmation relies on an increase in genes from chromosome 21 to genetic sequencing

No sequencing, a karyotype is enough.  (Note: in a few years maybe...)

It is the most common chromosomal abnormality in France


Only a fetal karyotype makes it possible to make an antenatal diagnosis of Trisomy 21 certainty

Antenatal diagnosis is systematically proposed during pregnancy

Antenatal "screening" is systematically offered during pregnancy

Antenatal screening involves making a karyotype of the fetus

This is the case with diagnosis, not screening. These are two very different things that must be distinguished

Screening makes it possible to distinguish pregnancies considered to be at risk for which a diagnostic procedure will be proposed

Antenatal screening measures screen approximately 99.9% of T21s


The woman is free to accept or refuse antenatal screening

It is mandatory for the physician to offer, but not for the patient to accept

The Lheman Score must be greater than or equal to 3/9 for the risk estimate to be reliable

Herman score greater than or equal to 4/9. The Lheman score does not exist.

An antenatal diagnosis is offered to women with a 1/50 ≥ risk of having a fetus carrying T21

Karyotype study. The threshold has changed since the routine introduction of circulating fetal DNA analysis, which is proposed between 1/1000 and 1/51.

The markers measured in the 2nd trimester are β-HCG and α-fetoprotein in particular

This examination is not mandatory but the information must be given to all pregnant women, regardless of their age

The discovery of hygroma colli (or cystic) is frequently associated with a fetal chromosomal abnormality


With regard to eruptive diseases of childhood, what are the right proposals?

Measles can be complicated by pulmonary superinfection or encephalitis.

True, MMR vaccination (to M12 and M16-18) is mandatory to prevent these complications, which are even more serious if the infection occurs in adulthood.

The rash characteristic of Kawasaki disease does not affect the plantar surface of the extremities.

False, erythematous involvement of the palms and soles with secondary desquamation is one of the criteria frequently found

Rubella is a benign disease for children

True, the disease is often asymptomatic. However, vaccination is mandatory to protect pregnant women from the risk of fetal malformation.

False, it is a complication of megalerythema, infection with parvovirus B19 that gives PRCA.

Scarlet fever is due to an infection with HHV6, also called 6th disease

False, this is the case of the sudden exanthema. Scarlet fever is a bacterial infection caused by Streptococcus pyogenes (GAS = Group A Beta-Haemolytic Streptococcus). Diagnosis is made by RDT and treatment is based on amoxicillin.


Physiological prurirut is more important in the evening

Each individual scratches many times in a day without causing any major inconvenience.

Pruritus becomes pathological when it occurs more than 5 times a day

Pruritus becomes pathological when it induces scratching lesions

Pruritus becomes pathological when it encourages consultation because of its impact

The pathophysiology of pruritus is complex


Concerning infectious disease surveillance

During direct transmission the infectious agent passes from the eye to the cibel directly

Inciscidence: this is the number of new cases of infection in a population, during a given period, compared to the entire population followed during the period

The attack rate is calculated by relating the number of new infections during a specified period to the total number of uninfected contacts at the beginning of the period.

Sensitivity is the proportion of subjects classified as sick (= whose test result is positive) among all subjects actually affected by the disease

Specificity: this is the proportion of subjects classified as non-sick (= whose test result is negative) among all subjects not affected by the disease


Positive predictive value and negative predictive value are indcators of the diagnostic test

Are extrinsic indicators because they depend on the prevalence of the disease in the population

If the disease is rare, a very specific test may still have poor positive predictive value

Negative predictive value: this is the proportion of non-sick subjects among subjects classified as non-sick (whose test result is negative)

The list of diseases to be evicted is set by the High Council of Public Health

Public Health France has a regional network made up of interregional epidemiology units (CIRE) which relay its actions and carry out part of its missions at the regional level


How many notifiable diseases were there (in 2018)?

True, 32 infectious diseases and 2 non-infectious diseases (mesotheliomas and lead poisoning in minor children)


Which of the following are notifiable diseases?

False. The full list is available on santepubliquefrance.fr


The diagnosis of sarcoidosis is based on a compatible clinical picture, the detection of granulomas in histology, and the elimination of other granulomatosis

Half of patients with sarcoidosis have a spontaneously favorable course of their disease within 2 months of diagnosis

Half of sarcoidosis patients have a spontaneously favorable course of their disease within 2 years of diagnosis

Some sarcoidosis attacks can involve the functional prognosis of the affected organ (lung, eye, liver, kidney) or the vital prognosis (lung, heart, central nervous system)

Pulmonary fibrosis is the main progressive risk of sarcoidosis:

Oral corticosteroid therapy is the main general treatment


Regarding sarcoidosis, what are the true propositions? (one or more exact propositions)

Extrarespiratory manifestations are very polymorphic

Ankle biarthritis is highly evocatric when associated with mediastinopulmonary involvement, affirming the systemic nature of the disease

Skin involvement is mainly observed in chronic forms of sarcoidosis and must seek ENT involvement

Sarcoidosis is the most common cause of erythema nodosum in France

Sarcoidosis remains a relatively rare pathology, compared to streptococcal infections for example.

The combination of erythema nodosum and hilar and mediastinal lymphadenopathy defines Löfgren's syndrome


The national convention organizes the relationship between private doctors and health insurance

The national convention is concluded between UNCAM and the unions of liberal doctors.

There are three non-exclusive methods of remuneration for physicians: fee-for-service, lump sum payment and remuneration based on public health objectives.

Fee-for-service payments weigh very little on physicians' remuneration


Regarding the position of the doctor in the doctor-patient relationship

The physician must pour his knowledge on the patient to show him that he is competent

The doctor must, of course, provide scientific information, but also moral support to the patient and must take into account the representations and actions of the patient concerning his health.

Medical studies lead to the construction of a secular and experimental theory of diseases

Medical studies lead to the construction of a learned theory of diseases

The doctor acquires semiological, nosographic, and therapeutic knowledge

The disease is "the feeling of pain or discomfort unexplained by the patient"

The definition of the disease by the French Academy of Medicine is "a clinical entity that is perfectly defined by its etiology and pathophysiology as well as by its symptomatic and clinical presentation or by a well-identified combination of clinical signs"

A disease is a set of symptoms and clinical signs due to an underlying organic pathology


A morbidity and mortality review is a personal and prospective analysis of events that cause harm to a patient

Collective, retrospective and systemic analysis of cases marked by the occurrence of a death, a complication, or an event that could have caused harm to a patient.

The main purpose of morbidity and mortality reviews is to publish them in journals at Impact-Factor > 30

Implementation of actions to improve patient care and safety of care.

It is a global analysis of the situation, taking into account all the elements (organizational, technical and human) in interaction that have contributed to the care of a patient.

It makes it possible to go beyond the sole reflection centered on one or more individuals.

At the end of the analysis, the people who made the mistakes are identified and punished.

At the end of the analysis, lessons can be learned about existing strengths and vulnerabilities in order to carry out actions to improve the quality and safety of care.


It is forbidden to conduct it within the framework of a feedback committee

The tree of causes is one of the methods of ACR

3 ACR methods: cause tree, alarm method and grid, and the ORION method (r)


What is the first-line treatment for a non-severe Clostridium difficile infection in hospitalization?

True, digestive (local) so no need for blood bioavailability. Oral vancomycin is now the first-line treatment recommended by most learned societies, including the American Society of Infectious Diseases.


It is defined by taking the pulse just before, just after and 2 minutes after 60 push-ups


Alactic anaerobic concerns long-term efforts

Prolonged efforts required oxidative metabolism

Lactic anaerobic is dependent on glycogen

Alactic anaerobic is dependent on oxygen


Tobacco increases the risk and worsens the course of MS

The myelin sheath and axon are the target of the immune system

It is a demyelinating disease, so especially myelin

Inter-individual variability in the topography of clinical symptoms is zero

The clinical symptoms of flare-ups are related to the location of the plaque, which explains their diversity

In most cases, the onset of symptoms is brutal

Neurological symptoms most often set in (85 to 90% of cases) subacutely, within hours or days, and then regress, defining the flare-up. More rarely, symptoms are insidious from the outset, worsening over several months or years (10 to 15% of cases).

A flare-up is defined as the appearance of new symptoms, the recurrence of old symptoms, or the worsening of pre-existing symptoms.


BMD measurement can be artificially increased by osteoarthritic injuries or vertebral fractures

In both sexes, the maximum BMD value is reached at the end of growth and corresponds to the peak of bone mass (between 20 and 30 years)

Bone loss is greater for trabecular tissue-rich skeletal sites

In humans, there is no age-related bone loss


Diabetes, especially poorly balanced, is particularly vulnerable to Staphylococcus aureus infections and surgical site infections

Infection of ascites fluid should be routinely investigated in cirrhotic patients

ƒƒ HIV: below 1500 CD4/mm3 lymphocytes, opportunistic infection should be systematically sought

Any fever returning from the tropics is malaria until proven otherwise and requires a diagnostic test (smear/thick drop or other)

It is most often not recommended to administer antibiotics as a diagnostic test


What are the conditions for male gamete donation?


Diagnosis of paroxysmal hemoglobinuria nocture is based on immunophenotyping of blood cells with overexpression of CD55 and CD59

Diagnosis is based on immunophenotyping of blood cells that shows defective expression of CD55 and CD59

Vitamin B12 deficiencies are most commonly caused by Biermer's anemia

In inflammatory anemia, serum iron is low and blood ferritin is low

Serum iron is low, blood ferritin normal or increased

Reticulocytes should be requested in front of newly discovered anemia, most often

Measurements of serum iron, blood ferritin, vitamin B12 and blood folate, when necessary, should be performed prior to treatment


Diuretics increase the elimination of sodium and water by the kidney

The diuretic action involves the inhibition of renal sodium reabsorption

The proximals, those of the loop, the thiazide and those of the cortical collecting tube

Proximal diuretics are indicated in hypertension tritement

Proximal diuretics are acetazolamide and mannitol. Both are not indicated in hypertension, nor in the edematous state

Acetazolamide is a carbonic anhydrase inhibitor


Regarding the epidemiology of disability in the world:

It is estimated that more than one million people live with a disability worldwide.

It is estimated that more than one billion people live with some form of disability, or about 15% of the world's population (based on population estimates for 2010).

The prevalence of disability is plummeting worldwide

This figure is higher than the previous WHO estimate, which dates back to the 1970s and suggested a proportion of around 10%

It is estimated that 15 million people have very severe functional difficulties worldwide.

The World Health Survey estimates that 110 million people (2.2%) have very severe functional difficulties, while the Global Burden of Disability Assessment indicates 190 million people (3.8%) with "severe disability" – equivalent to impairments caused by health problems such as quadriplegia, severe depression or blindness.

Worldwide, it is estimated that there are approximately 350,000 children with severe disabilities.

For the global burden of disease, disability in children (0–14 years) is also measured, and it is estimated to affect 95 million children (5.1%), of whom 13 million (0.7%) have a "severe disability".

In the coming years, disability will become an even greater concern due to the increase in its prevalence, which is explained by the aging of populations in particular.


Disability in France affects about 1% of the population over a lifetime

According to the HS survey, among men or women, one in ten people report being severely limited for at least 6 months in daily activities because of a health problem

Up to 40 years, 5% of French people say they are severely limited

One in four people at age 75 report being severely limited in their daily activities

Nearly 40% of people living in ordinary homes report living with a physical, sensory, intellectual or mental disability

All impairments lead to disability sooner or later

However, not all impairments present a disability: only a minority leads to a limitation of activity."


Regarding impairment and disability in France:

7.9% of population reports urinary or faecal incontinence

0.79% of the population reports urinary or faecal incontinence

15% of the population reports difficulties leaving home alone

Regarding motor activities, 5% of the population report difficulties leaving home alone and 1.8% to go up or down a floor

Overall, the older people get, the more difficult it is to perform the simple activities of daily living.

The most frequently used technical aids are those used for movement (cane, chair, etc.)

Having a disabling disability leads to difficulties in participating in social life


Between 100 and 120 ms, we are talking about incomplete BDBs.

An rS or QS aspect in V1 signs a right branch block

T waves are generally positive in D1 in case of left BDB

An elevation of the ST sergment in V1 V2 V3 in the presence of a BDB signs ischemia

They are normal. Most often they do not exceed 1 mm

An exclusive R aspect in V6 signs a left BDB


The gait of hemiplegic is described as the mowing gait, the patient is forced to describe an arc of a circle with internal concavity due to contracture and paralysis of the lower limb

Intermittent motor deficit on spinal cord claudication leads to fatigability of the lower limbs when walking, associated with pain

Intermittent motor deficit on spinal cord claudication leads to painless fatigability of the lower limbs associated with pyramidal syndrome in the lower limbs that must be sought after walking the patient

A symptomatology of the upper limbs must be investigated for cervico-osteoarthritis myelopathy

During pseudobulbar syndromes and lacunar conditions in the elderly, the gait is carried out in small steps, the foot sliding on the ground with each step with an automatic arm flapping abolished

During pseudobulbar syndromes and lacunar conditions in the elderly, the gait is carried out in small steps, the foot sliding on the ground with each step with an automatic arm fluttering preserved

Posterior cord involvement leads to a heeling gait


A parkinsonism must investigate iatrogenic causes, including taking neuroleptics or related

Astasie-abasia is defined as standing instability with spontaneous retropulsion (astasia) and inability to walk

A waddling approach related to proximal deficit must make research a neurological pathology as a priority

A waddling approach related to proximal deficiency must seek a muscular pathology (myopathy), including metabolic, inflammatory or iatrogenic, and also osteomalacia

Careful walking is often encountered in the elderly, a cautious approach related to anxiety that appeared following falls and can lead to a real stasobasophobia

Falling is a common accident in the elderly: 30% of those over sixty-five and 50% of those over eighty fall at least once a year.


After seventy years, falling is the leading cause of accidental death

Among the traumatic complications of falls, fractures of the lower end of the femur are the most common

Among the traumatic complications of falls, fractures of the upper extremity of the femur are the most common

Even in the absence of trauma, the inability of the older person to get up is a poor prognosis

Falling in the elderly is a severe traumatic event regardless of the extent of the consequences of the trauma

Post-fall syndrome occurs in about one-third of falls


The lower ureters are innervated by the pelvic plexus

The uterine body is innervated by the aortic plexus

The proximal third of the fallopian tubes is innervated by the hypogastric plexus

The wide ligament is innervated by the pelvic plexus

The ovaries are innervated by the hypogastric plexus


They have the same mode of action as penicillins

Oral C3G has a bioavailability greater than 70%

Less than 50%. Digestive absorption is saturable

Urinary elimination in active form. For ceftriaxone, there is also biliary elimination


In all cases, computed tomography and MRI should include a triphasic study after intravenous injection of vascular contrast medium (at arterial, portal and late times)

In case of dilation of the intrahepatic bile ducts, cholangio-MRI makes it possible to visualize the bile ducts and to specify the cause

Cardiac ultrasound should be done to clarify the cause of evoked cardiac involvement due to dilation of the hepatic veins and inferior vena cava.

Liver puncture-biopsy It is essential when the combination of clinical, laboratory and imaging data does not establish the cause of hepatomegaly

It should cover focal lesions and at a point in the rest of the parenchyma, in case of homogeneous hepatomegaly

It should cover focal lesions and at one point in the rest of the parenchyma, in case of heterogeneous hepatomegaly


It is enshrined in legislation in France

It is mandatory following certain exhibitions

It is mandatory following exposure to asbestos

It allows the detection of acute pathologies with a short onset time

It will mainly intervene in the screening of chronic diseases with a long onset time

It is particularly useful for screening for occupational cancers


By involvement of the basal ganglia (preferential involvement). Other preferential disorders are the posterior arm of the inner capsule and the foot of the bridge (or protuberance)

Lacunar infarctions are part of macroangiopathies

Microangiopathies (involvement of the small arteries)

Deficiencies are caused by occlusion of a superficial arteriole on lipohyalinosis (local arterial disease)

The main risk factor for lipohyalinosis is smoking

The gaps are small infarcts more than 20 mm in diameter


A heart attack dating back less than 6 hours will be visible in sequence in broadcast.

Allows to visualize cerebral infarctions very early (a few minutes), in the form of systematized hyperintensity. It makes it possible to calculate the apparent diffusion coefficient (ADC) which is decreased (black) in case of cytotoxic edema.

The T2 FLAIR allows you to view strokes older than 4h30 and older.

The diffusion sequences and T2 FLAIR may show a mismatch allowing an establishment of endovascular revascularization beyond the 6th hour.

The T2* sequence makes it possible to visualize any intraparenchymal ischemic lesion

T2* makes it possible to visualize fresh blood, so it allows to visualize an intraparenchymal hemorrhage

A FLAIR-diffusion mismatch reflects an ischemia probably dating from less than 4h30


IV thrombolysis is beneficial when applied up to 6 hours after the onset of infarction

Thrombectomy is possible on distal thrombi

Only proximal thrombus. Mechanically speaking, it is impossible to reach distal thrombi.

Mechanical thrombectomy is possible after 6 hours if there is clinical-radiological mismatch and/or diffusion-perfusion mismatch

After thrombolysis, aspirin therapy should be initiated, in the absence of contraindications.

The patient must be initially positioned in the supine position with a straightening of the head at 30 °


If the potential donor is a minor or an incapable adult, the consent of each of the holders of parental authority or legal representative is required

It is important to inform your loved ones of your decision regarding organ and tissue harvesting

The principle of non-patrimoniality of the body is enshrined in the law

Organ and tissue donation is free of charge and cannot be marketed, unless agreed at the discretion of both parties.

As a result, organ and tissue donation is free of charge and cannot be marketed.

The Civil Code and the Public Health Code define the rule of anonymity that applies to all donations on deceased donors but not to living donors


Regarding the epidemiology and EME of organ donation

The purpose of anonymity is to limit any pressure or conflict of interest on the potential donor or recipient restricting his or her free consent.

The Public Health Code prohibits "advertising for organ donation for the benefit of a specific person or for the benefit of a specific institution or organization"

Currently, 1,500,000 people die each year in France

Definition and etiologies Currently, 500,000 people die per year in France of which about 4,000 (0.85%) in EM in an intensive care facility

The state of brain death (EME) results from the "irreversible and isolated destruction of all intracranial nerve centers (cortex and brainstem) following complete brain circulatory arrest"

Brain destruction suppresses central respiration control, as well as regulation of circulatory, thermal, and endocrine homeostasis


Regarding the basics of renal physiology:

The proximal tubule reabsorbs the vast majority of physiologically filtered proteins

In the normal state, only proteins below 600 kD are filtered

Kappa light chains are not freely filtered in the physiological state

Under physiological conditions, the amount of albumin present in the urine is less than 15-30 mg/d

See item in the latest edition (8°) of the college p.115

Urinary creatinine excretion in an adult is approximately 1 g/d


Abundant hematuria may interfere with the interpretation of proteinuria on BU

Microscopic hematuria causes abundant proteinuria due to hemolysis of RBCs

This is the case of macroscopic hematuria only

ECBU enables qualitative study of proteinuria

This is the case of urinary protein electrophoresis

Glomerular proteinuria is said to be selective if it consists of more than 80% albumin

Tubular proteinurias are a sign of proximal tubular reabsorption disorder


Concerning the management of disability in children:

The child's project is exclusively therapeutic and medical

The child's project is threefold: therapeutic (medical, paramedical...), educational (schooling), social (family, life activities, environment, home care, compensation...)

We must detect the causes of over-disability

The therapeutic objective will be to manage the pain and the medical consequences of the disability

The therapeutic objective is to prevent or treat these so-called neuro-orthopedic disorders

The schooling to be considered in the first place is ordinary schooling

The long-term goal is to bring the child into adulthood towards a completely normal life project.

The long-term goal is to bring the child into adulthood towards a personalized project of independent living in an optimal medical-surgical, cognitive and psychic situation.


The Borg scale quantifies dyspnea in acute situations

This is the case for the MRC. The Borg scale is a subjective verbal scale between 0 and 10

The scale for chronic dyspnea is modified CKD

Stage 0 indicates a total absence of dyspnea

Shortness of breath only for significant effort

Stage 3 CKD refers to shortness of breath at rest


Which of the following are criteria for hospitalization in a patient with malaria? (DO NOT check the severity criteria if you see 🤭🙈 any)

True
It is a digestive disorder that makes oral treatment impossible.

False. Parasitemia > 2%. Be careful not to confuse hospitalization criteria with severity criteria.

False. Creatinemia>150 μmol/l. Be careful not to confuse hospitalization criteria with severity criteria.