The QRS axis is measured using the Bailey double tri-axis

This is the case from V7 to V9. V6 is a low side bypass, just like V5


It would be reduced. A normal PR is between 120 and 200 ms

It is normally between -30 and +90 degrees

A Q wave of amplitude corresponding to half of the QRS

It would be a Q wave of necrosis. A normal Q wave lasts less than 40 ms and makes less than a third of the QRS


An electric LVH can be found by the sign of Sokolov

A negative lateral T-wave may indicate severe LVH

Severe LVH induces total left axial deviation

Right ventricular hypertrophy cannot be seen on ECG

Several signs, including axial deviation of QRS greater than 110 degrees


Which of the following propositions are true about the ACFA?

There is a tremulation of the baseline with the presence of a P wave

There must be an absence of P wave to make the diagnosis of AF


Which of the following are left branch block signs?


Which of the following are true about atrial flutter?


Which of the following are signs of atrial flutter?


Which of the following describe ventricular tachycardia?


National stockpiles of medicines and vaccines are built up to address key threats

An "emerging risk" is defined as any risk that is both new and exponentially decreasing.

Cancers are the first type of emerging biological risk

Among biological risks, environmental risks and infectious diseases are at the forefront

The emergence of an infectious disease is a phenomenon that results from the interaction between three factors: the host, the biological agent and the environment.

Climate change has no scientifically recognized impact on the emergence of new epidemics

Environmental changes have a proven impact


Deforestation does not impact the emergence of diseases

The spread of Aedes albopictus was through the tyre trade

Emerging diseases cannot re-emerge by definition

The history of humanity has been punctuated by emerging infections (recent example of the HIV pandemic) or re-emerging infections (example of influenza pandemics or syphilis)

There will be no more emerging diseases by 2030 thanks to advances in medicine

Everything suggests that these emergence phenomena will continue, which justifies maintaining an effective health monitoring system.

Bioterrorism is defined as the use (or threat of use) of biological agents as a weapon, with a view to inducing disease or death in humans, animals and/or plants.


Concerning epidemiological monitoring and EIF:

A "biological agent" is naturally found in the environment

Under the term "biological agent", we include natural infectious agents (bacteria, viruses, parasites, fungi), the toxins they produce, but also genetically modified infectious agents

Health surveillance is carried out worldwide by WHO only

Health surveillance is carried out worldwide by the WHO, in Europe by the European Center for Diseases Prevention and Control (ECDC) and in France by the France Public Health Agency and its regional structures.

Any emergence of a new infectious agent is analyzed as potentially dangerous

According to the International Health Regulations, the DGS is responsible for reporting to WHO all health emergencies of international concern

Nearly 5 infectious agents have emerged in the last 50 years


Two-thirds of emerging diseases are zoonoses

Government plans have been developed and are regularly updated

Each health institution must develop, as part of the white plan, procedures allowing it to develop a dedicated circuit, premises and organization

The realization of full-scale exercises is forbidden in hospitals because the organization would be extremely complex

Carrying out full-scale exercises is useful

During national alerts, a definition of suspected cases developed and disseminated by the HAS

By the Directorate General of Health through the ARS


During a labyrinthine attack, standing and walking are impossible during vertiginous accesses

At a distance from the latter, walking is cautious and unstable with a lateral deviation from the walking line

When reaching the cerebellum, the standing person stands with his legs apart to widen his support polygon, with the arms in abduction and walking he progresses zigzagging and staggering, realizing the drunk gait

The parkinsonian gait is characterized by a walk with the trunk inclined forward, the limbs in slight extension with swinging of the arm preserved

The parkinsonian gait is characterized by walking with the trunk inclined forward, the limbs in slight flexion with loss of arm swing.

At a more advanced stage of Parkinson's disease, walking is done in small steps with foot rubbing and a decomposed U-turn.


What are the 4 etiologies to discuss first?

Not the same location most often. Many other clinical signs, such as fever or ictere, point to cholitis.

Always think about it in a woman of childbearing age


Which of these proposals can often cause acute pelvic pain?


The pain is usually very intense in case of torsion of appendix

A gradual onset points to IGH or acute appendicitis

Pain of brief evolution eliminates the possibility of a complication of an ovarian cyst

On the contrary, it points towards cystic origin

The time of onset of pain is of little importance in terms of diagnostic orientation

Pain topography can be relied upon to identify the organs involved

This is made very difficult/impossible by the mode of innervation of the pelvic organs.


The unilateral character is more in favor of an adnexal pathology

In case of upper genital infection, the pain is willingly diffused to the entire pelvis

Pain with lumbar irradiation should be sought as a priority for hepatic origin

An appendage torsion never radiates to the lumbar because of the mode of innervation of the tubes

Hypogastric and aortic plexus, so possible irradiation

– scapulalgia should be sought for intraperitoneal effusion


What does localized pelvic pain in the flanks remind you of?

Renal colic and pyelonephritis are to be evoked in front of a pain of the flanks, assessment to be completed by a BU and an ultrasound of the urinary tract


What are the etiologies of acute pelvic pain?


What are the diagnoses to be discussed in priority in front of acute pelvic pain in women?

The term salpingite is dropped in the latest edition of the CNOG


There is a link between endometriosis and ovarian cancer

False. There is no link (HAS 2017 recommendations). Therefore, there is no need to screen patients with endometriosis for ovarian cancer.

If there are no symptoms in a woman with endometriosis who is being treated, imaging should be done on an annual basis to monitor the progress of the lesions.

False. According to HAS, in the absence of symptoms, routine imaging monitoring of patients treated for endometriosis is not required.

The definition of endometriosis is histological: presence of endometritis glands or stroma outside the uterus

There is no need to seek endometriosis in cases of isolated dysmenorrhea controlled by hormonal contraception, without other painful symptoms or immediate pregnancy wishes

The "Endometriosis Health Profile-30" questionnaire and its short version "EHP-5", or the SF-36 questionnaire, are questionnaires assessing the quality of life of women with endometriosis


Regarding the epidemiology of prematurity:

Prematurity is defined as a birth occurring before 42 weeks of amenorrhea

Prematurity is defined as a birth occurring before 37 weeks of amenorrhea (AS) and from 22 SA of a child weighing at least 500 g

60% of neonatal mortality comes from children born before 30 weeks

The preterm birth rate is 0.7% for all births

The preterm birth rate is 7.4 per cent for all births and 6.6 per cent for live births due to a high proportion of preterm infants among stillbirths.

Among live births, the preterm birth rate is 6.6 per cent

About 75% of preterm births occur before 28 SA

About 10% of preterm deliveries occur before 28 weeks (extreme prematurity), 10 per cent occur before 28 to 31 weeks (severe prematurity) and 80% occur before 32 to 36 weeks (moderate prematurity)"


Extreme prematurity concerns births before 28 SA

Extreme prematurity < 28 SA. Severe prematurity < 32 SA. Moderate prematurity < 36 SA.

Severe prematurity is between 28 and 42 SA

A birth at 33 SA is moderate prematurity


Which of these proposals are possible causes of induced prematurity?


Which of these proposals are recognized risk factors for preterm birth?

Multiple pregnancy yes, with RR between 4 and 10


Spintaneous prematurity rarely occurs after spontaneous work with intact membranes

Spontaneous prematurity occurs after spontaneous labour with intact membranes (40–45%) or premature rupture of membranes (25–30%), while induced prematurity is most often induced for fetal or maternal pathology (30–35%)

Patients who have preterm rupture of membranes do not need induced delivery

Patients who have preterm rupture of membranes may also have an induced delivery if the condition of the newborn or mother requires induction of delivery or caesarean section.

Distilbene has been shown not to promote preterm births

In addition, the risk of OA would be multiplied by a factor ranging from 2 to 5 in case of in utero exposure to Distilbene®.

Cervico-isthmic gaping results in a late miscarriage at the end of the third trimester and with extremely algic and progressive uterine contractions

Clinically, it is accepted that it is in its typical form an event of sudden onset, unpredictable, little or no preceded by prior clinical cervical changes.

A history of conization increases the risk of preterm birth


In case of multiple pregnancy, the risk of prematurity is multiplied by 1.2

The rate of prematurity is 43%, a risk multiplied by 7 compared to single children

Twin pregnancies exclusively expose to the risk of moderate prematurity

Excess risk is observed for both moderate and severe prematurity

It may be the witness of an underlying fetal pathology (diabetes, fetal anemia by Rhesus alloimmunization or parvovirus B19 infection, fetal malformations or placental pathologies), idiopathic hydramnios remaining a diagnosis of elimination

Plana previa increases the risk of prematurity

It is associated with a 6 to 7 times increased risk of PA

Gestational vascular pathologies are mainly responsible for spontaneous prematurity

These pathologies are responsible for 25 to 30% of global prematurity and essentially induced prematurity"


Among these propsitions, which prevent prematurity:

Optimizing the balance of chronic diseases

Like diabetes, hypertension, asthma, etc."


Regarding intra-uterine growth retardation

A newborn is said to be small for gestational age if its birth weight is below the 50th percentile

A newborn is said to be small for gestational age (PAG) if its birth weight is below the 10th percentile

IUGR corresponds to a PAG and a break in the intrauterine growth curve

IUGR is said to be early if it appears before 35 SA

IUGR is said: • early if it appears in the 2nd trimester, versus late if it appears in the 3rd trimester

True IUGR is a purely intrauterine pathology that has no consequences after birth

Conversely, true IUGR is a pathology that exposes to complications: fetal death in utero, neonatal encephalopathy, abnormalities of psychomotor development"


Which of the following proposals are favored by prematurity?

True, prevented by antenatal corticosteroid therapy

The opposite: the persistence of the ductus arteriosus. It can be a source of pulmonary hyper-output (by aortopulmonary shunt at high pressure) and pulmonary arterial hypertension


The depot form of penicillins G/V is benzathine penicillin

The most common combination with amoxicillin is clavulanic acid


Penicillins V and G have a short half-life

The elimination of amoxicillin is done by urine at more than 70%

The diffusion is very good in the prostate


On which bacteria are penicillins A useful?


Any antibiotic therapy should be reassessed early

At 48-72h, it will take into account the efficacy, tolerance and possible bacteriological documentation

It is customary to reduce spectrum as soon as possible

Except in special cases, antibiotic therapy of more than 3 days is not justified

Most often does not exceed more than 10 days

There are treatments for only a minority of viruses

Antivirals eradicate the viral presence most often

Their purpose may be to control long-term viral replication.


Which of the following are true about vancomycin?

It has no activity on gram-negative bacilli


Thrombocytopenia is a platelet count of less than 100 g / l regardless of age

Platelet depletion can lead to thrombotic syndrome

Severe thrombocytopenia causes infiltrated petechial purpura, sometimes associated with large hematomas

Purpura from thrombocytopenia is not infiltrated

The discovery of a purpura requires the prescription of a blood count

Look for signs of infection, anemia, liver disease, splenomegaly or lymphadenopathy


Signs of severity of hemorrhagic syndrome are those related to the existence of mucosal bleeding

These include: intraoral hemorrhagic bubbles, metrorrhagia, gingerage and epistaxis

Disseminated ecchymotic purpura, associated with significant mucosal hemorrhages, headache, neurological clinical signs, raises fears of the occurrence of a severe hemorrhagic syndrome

The three most feared locations are cerebral, mucosal and digestive

When severe bleeding is suspected, preventive treatment is essential, as bleeding is often spontaneous and unpredictable.

Indeed, bleeding is often spontaneous and unpredictable.

The presence of abnormal cells on the smear will suggest potentially malignant myelopathy

Vitamin B12 deficiency causes peripheral thrombocytopenia

Default medullary production plant. This is also the case for folate


When severe bleeding is suspected, preventive treatment is essential

Because the bleeding is then often spontaneous and unpredictable (especially cerebromeningeal hemorrhages)

Platelet concentrates have a very rapid efficacy in thrombocytopenia of central origin but more moderate and fleeting in thrombocytopenia of peripheral origin

Pseudothrombocytopenia may be related to EDTA

When there are no clinical signs, it is then necessary to repeat the sample on a dedicated tube

The risk of bleeding is major if the platelet count is less than 70 G / L

The risk of bleeding is major if the platelet count is less than 20 G / L

Osteomedullary biopsy is always prescribed when the myelogram is non-demonstrative

Most often, we don't even do a medullogram


Hepatomegaly is defined as an increase in liver volume

Hepatomegaly can be considered homogeneous or heterogeneous depending on the macroscopic appearance (palpation, examination of the section, or imaging examinations)

The liver is considered enlarged when its projection on the medioclavicular line is greater than 22 cm

The liver is considered enlarged when its projection on the medioclavicular line is greater than 12 cm

A mass of the right hypochondrium or epigastrium may be attached to hepatomegaly when it is mobile with breathing

Abdominal ultrasound makes it possible to specify the diagnsotic of hepatomegaly showing that the distance between the top of the time is of its lower edge, and the mid-clavicular line is greater than 12 cm


Most liver diseases can cause hepatomegaly

A cirrhotic liver is soft in consistency with a sharp lower edge

The clinical examination should look for hepatojugular reflux and systolic expansion of the liver

The clinical examination tries to find out if the liver is painful

To clarify the cause of heterogeneous hepatomegaly, contrast ultrasound, CT scan or MRI are often useful.


Malignant or benign liver tumors are the most common cause of heterogeneous hepatomegaly

Steatosis is cirrhosis are the most frequent legoses of homogenic hepatomeaglia

Liver biopsy cannot be performed transparientally when haemostasis disorders are present

In front of an abdominal mass the clinical examination makes it possible to eliminate among other things a fecal impaction, a bladder globe, a herenia

Liver biospsia can be echoguided or scannoguided


Which of the following is (are) correct?

Every year there are about 10,000 accidents at work (AT) in France

More than 620,000 TAs were recorded in 2014

Each year, TAs are responsible for more than 500 deaths in France

More than 500 deaths by AT in France each year

Occupational diseases are constantly increasing

About 2% of the population is exposed to a carcinogen through work

More than 13% of the French population is exposed

Very few notices of incapacity lead to dismissal

Unfortunately, far too many opinions still lead to dismissal


The state of health can never constitute a reason for dismissal

In case of incapacity and impossibility of redeployment, it may lead to dismissal

Medical incapacity is pronounced following a meeting between the patient, his manager at the workplace, and the doctor

Only the doctor can pronounce an incapacity, no consultation with a hierarchical superior is necessary

It can be total/restricted, definitive/temporary

There are 2 types of reclassification: upper and lower

There are 2 types of outplacements: internal or external

External redeployment calls on Pôle Emploi

This is the case with external redeployment


Adverse events associated with care are rare conditions

Important points Adverse events associated with care are frequent, costly pathologies, responsible for significant morbidity and mortality Nosocomial infection: any infection – neither present nor incubating at management – occurring in a health facility, more than 48 hours after admission

The delay is extended to 15 days post-surgery

This period is extended to 30 days in case of surgery

Healthcare-associated infections include nosocomial infections and infections associated with out-of-hospital care

Prevention is essential and hand hygiene with hydroalcoholic solutions is the main measure

Nosocomial infections never occur at RHAs

Some nosocomial infections require reporting to CPias and ARS (e.g. death related to nosocomial infection")


Healthcare-associated infections (HAIs) are home care infections

This term HAIs refers to infections that appear during or during the course of a patient's management (diagnostic, therapeutic, palliative, preventive or educational), if the infection was neither present nor incubated at the beginning of management.

Nosocomial infections (NOS) are those acquired at the patient's work

The term IN refers to infections acquired in health facilities: in practice, an infection is often considered nosocomial if it appears more than 48 hours after admission, but this period must be adapted to the incubation period of the disease

The definition of nosocomial infections in case of placement of foreign material is based on a period of 6 months

The definition of some NIs is based on longer delays: 30 days after surgery for surgical site infection 1 year in case of placement of foreign equipment

The 3 most frequently isolated microorganisms are Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae

Infectious agents responsible: Gram-negative bacilli in 60% of cases, Gram-positive cocci in 30% The 3 most frequently isolated microorganisms are Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa Fungi are becoming increasingly important in NIs

Overall, there is an increase in multidrug-resistant bacteria (MDR) and emerging "Highly Resistant" Bacteria (BHRe)


Regarding surgical site infections (ISO):

The most frequently encountered BMRs are extended-spectrum betalactamase-producing enterobacteriaceae (ESBL) and methicillin-resistant Staphylococcus aureus (MRSA).

eBHRs include carbapenemase-producing Enterococcus faecium and vancomycin-resistant Enterococcus faecium

The presence of local inflammatory signs requiring a resumption of the incision is a sign of infection of the surgical site

Signs of infection observed during re-surgery indicate surgical site infection

A period of one year following the placement of equipment (prosthesis or implant) is compatible with an infection of the surgical site


The diagnostic criteria for a nosocomial urinary tract infection are identical to those for a community urinary tract infection

Regression of infectious signs within 48 hours of catheter removal strongly suggests that the infection is catheter-related.

Treatment of a nosocomial infection is always probabilistic without adaptation

Reassessment and reduction of spectrum if possible upon receipt of bacteriological results

Surgical site infection requires specialized management

Catheter-related infection is treated by removing the catheter only

CATHETER-RELATED INFECTION Catheter removal + broad-spectrum antibiotic therapy secondarily adapted to susceptibility testing


Urinary colonizations should be treated with appropriate antibiotic therapy

NOSOCOMIAL URINARY TRACT INFECTION Colonizations should not be treated with antibiotics except in cases of pregnancy or planned urinary tract intervention

In case of urinary tract infection on probe, the bladder tube can be kept in place for 48 hours if antibiotic therapy works

Asepsis is the removal of dirt adhering to a tissue or surface

DEFINITIONS Asepsis: set of measures to prevent any introduction of infectious agents to inert or biological surfaces

Sterilization is the removal of dirt adhering to living tissue or an inert surface

Cleansing: removal of dirt adhering to living tissue or an inert surface"


Sterilization is the operation that aims to destroy all microorganisms of an object in a sustainable way on an inert medium

Decontamination and disinfection are synonymous

Decontamination: includes antisepsis and disinfection: temporary elimination of infectious agents

Mixing antiseptics of different nature makes it possible to broaden their spectrum

Rules for the use of antiseptics Avoid simultaneous or successive mixtures of products of different nature For antisepsis of healthy skin, the application of an antiseptic is always preceded by a deterioration phase

Chlorhexidine is contraindicated on the skin and reserved for mucous membranes

linen and instruments soiled with blood or any other product of human origin must be transported in leak-proof packaging


Alcoholic antiseptic should not be used in newborns

Chlorinated and iodine derivatives have a fairly reduced spectrum (centered on Gram-negative bacilli)

Manuporting is the main mode of cross-transmission of microorganisms

Hand hygiene is the most effective measure to significantly reduce the incidence rate of cross-transmission NIs by reducing transient skin flora by 99%

The friction of the hands must last at the mons 2mn30

Perform the friction of all areas until complete drying (= 30 seconds)"


Regarding the wearing of gloves and additional precautions:

Wearing gloves is advised to protect the patient from contact with the doctor's skin flora only

Hand hygiene should be performed before and after removing gloves

The gloves are worn for about 3 hours, they must be kept from beginning to end with the same patient

Change gloves between 2 treatments in the same patient, between 2 patients

Additional precautions are adapted to the modes of transmission of infections


Regarding additional hygiene precautions:

"Air" precautions are taken when only surfaces are contaminated

Droplet precautions are taken when the patient emits persistent infective particles into the air

Air precautions are taken when the patient emits infective particles that do not persist in the air

Contact precautions are taken when surfaces are contaminated

15-micrometre particles persist airborne

These are particles smaller than 5 micrometers."


Concerning additional hygiene precautions

This is the case: tuberculosis, measles and chickenpox

This is also the case for influenza, meningococcus, mycoplasma, rubella, mumps, Parvovirus B19 and RSV

Dificile clostidiodia requires contact precautions

This is also the case for eHRBs and BMRs, enteroviruses, RSV, scabies and pediculosis."


The patient uses a surgical mask for air and droplet precautions

Carriers apply standard precautions and apron in case of contact precautions

Hand washing with mild soap should precede hydroalcoholic friction

For Clostridioides difficile, conventional disinfectant detergents are sufficient for contact precautions

For Clostridioides difficile, conventional disinfectant detergents are not effective, use bleach as a disinfectant Protective isolation Protective measure to protect the immunocompromised patient (especially situations of prolonged neutropenia) from external contamination, avoiding contact with infectious agents

Limiting the indications for urinary catheters and their duration is useless

It is an asset in the fight against nosocomial infections."


Regarding urinary tract infections and urinary catheters:

For neurological bladders, indwelling catheterization is preferred

Adverse Events Associated with Care (HIAC) Prefer multi-day survey to indwelling survey for neurological bladders

Measuring the voiding residue by ultrasound (bladder scan) rather than by round-trip sampling is a preventive measure for HIAs

Systematically changing the bladder tube (e.g. 1 time every 3 days) helps limit urinal infections

No systematic change of the bladder tube

Urinary catheters are only changed if they leak

Change if it malfunctions (obstruction, leakage ...) or in case of proven tissue infection after 24 h of effective antibiotic therapy (allows to place the 'clean' probe in an environment with lower inoculum, in the presence of antibiotics)

Epidemiological and microbiological monitoring of urinary tract infections to detect epidemic phenomena is important


Overall, there is an increase in multi-resistant bacteria

The most frequently encountered BMRs are extended-spectrum betalactamase-producing enterobacteriaceae

The term IN refers to infections acquired in health care facilities

The definition of certain NIs is based on longer deadlines

Mushrooms are taking an increasing place in NIs


Dysphonia (or hoarseness) is a purely objective alteration of the sound support of speech resulting in the isolated or combined impairment of the three acoustic parameters of the voice which are pitch, intensity and timbre

Dysphonia (or hoarseness) is an objective or subjective alteration of the sound support

The voice is a sound produced by the vocal cords under the influence of exhaled air

The larynx is an element of the upper airway

Phonation requires the abduction of the vocal cords and the maintenance of subglottic pressure

Hypophonia during acute or chronic respiratory failure is a type of dysphonia

It is an alteration of the voice related to a defect of respiratory capacity so not a dysphonia


Teachers, lawyers, amateur or professional singers are more exposed to functional voice disorders

Dyspnea or associated dysphagia indicates an extensive lesion beyond the vocal cords

Ultrasound is the basic examination to be performed in front of a dysphonia whose evolution is not quickly favorable

The laryngoscopic examination is the basic examination to be performed in front of a dysphonia whose evolution is not quickly favorable

Only the dynamic CT scan in a conscious patient can obtain precise information on the mobility of the larynx and vocal cords


Dysphagia and a curtain sign are seen in facial nerve paralysis

Velopharyngeal paralysis should be sought by nasal regurgitation and open rhinolalia in particular

Sensory signs are often very marked on the face

The sensory signs are not very marked: hypoaesthesia or hemianesthesia of the pharynx and veil on a limited area

Involvement of the accessory nerve XI (also called "spinal") internal results in paralysis of the wings of the nose

Involvement of the accessory nerve XI (also called "spinal") internal results in velopalatine paralysis

Stroboscopy allows you to visualize abnormalities of the pharynx

It allows, by the decomposition of the vibratory movement of the vocal cords, to visualize an anomaly localized at the level of the mucosa of the vocal cord (synechia, fibrous scar, beginning tumor)


Laryngeal electromyography is useless and is reserved as a last resort for dysphonia more than 6 months of evolution

It confirms peripheral neurogenic syndromes (vocal cord paralysis), neuromuscular junction syndromes (myasthenic syndromes) and dystonic syndromes (spasmodic dysphonia)

The phoniatric examination consists of recording lip movements to assess a neurological cause

It consists, in addition to the laryngoscopic examination, in the realization of a voice recording and a study of the objective parameters of the voice

The reference imaging examination is ultrasound

CT scan or magnetic resonance imaging are the two useful tests for etiological diagnosis

In unilateral paralysis of the pneumogastric nerve, the voice is typically blown or bitonale

In Dysphonia by velopalatine paralysis, the voice is hoarse, deep and more intense

In unilateral paralysis, functional signs are reduced to a minimum: nasal voice, discrete swallowing disorders, fluids tending to flow back through the nose


73 years (70 years for men, 76 years for women)

The incidence is 150,000 patients per year

Stroke is the leading cause of acquired motor disability in adults in France

Stroke is the leading cause of death in men

First cause of death in women, third leading cause of death in men


Regarding the main clinical manifestations of cerebral infarctions according to arterial territories:

The anterior circulation includes the opthalmic artery, the anterior cerebral artery and the middle cerebral artery.

Involvement of the anterior cerebral artery can result in a predominantly brachiofacial motor deficit.

Predominantly crural. Involvement of the middle (sylvian) cerebral artery results in a predominantly brachiofacial motor deficit.

Involvement of the vertebrobasilar territory can give Wallenberg syndrome.

Via an attiente of the PICA (branch of the vertebral artery)

In the superficial sylvian artery of the minor hemisphere, there may be motor aphasia and Broca's fluent.

Doubly false. It is an attack of the major hemisphere that will give Broca's aphasia. Broca's aphasia is motor and not fluent.

Involvement of the anterior choroidal artery causes a syndrome of 3 H: hemiplegia, hemianesthesia and lateral hemianopsia homolateral to arterial occlusion.


Regarding infarction of the territory of the middle cerebral artery (Sylvian artery):

A total sylvian cerebral infarction combines signs of superficial and deep cerebral infarction, but also a combined deviation of the head and eyes on the contralateral side to the lesion.

The conjugated deviation of the head and eyes goes towards the lesion. Everything else in the statement is true.

When the minor hemisphere is affected in superficial sylvian cerebral infarction, it is Anton-Babinksi syndrome.

This syndrome includes anosognosia, hemiasomatognosia and hemineglect.

Deep sylvian cerebral infarction corresponds to an attack of the internal capsule, which causes a proportional massive hemiplegia.

Hemiplegia is proportional because all pyramidal fibers pass through the inner capsule. There will therefore be no coral or brachiofacial predominance at the clinic.

There may be a homonymous lateral hemianopsia during a superficial sylvian cerebral infarction.

Caution: HLH is also present during damage to the posterior cerebral artery

Involvement of the minor hemisphere can cause anosognosia (non-recognition of the disorder), hemiasomatognosia (non-recognition of the paralyzed hemibody) and hemineglect


Regarding infarction of the territory of the anterior cerebral artery:

There is predominantly brachiofacial hemiplegia.

Coral predominance (involvement of the paracentral lobule)

There may be ideomotor apraxia of the hand

There may be a frontal syndrome (adynamia, dysexecutive syndrome)

During unilateral and complete involvement of the anterior cerebral artery, there is an akinetic mutism

This would be true in the event of a bilateral infringement.

The anterior cerebral artery and the sylvian artery can be affected at the same time

Possible in the context of thrombosis of the termination of the internal carotid artery ("carotid T")


Regarding infarctions of the arteries vascularizing the brainstem:

An alternate syndrome is defined by involvement of a cranial nerve on the side of the lesion and involvement of a long (sensory or motor) contralateral pathway to the lesion

Alternating syndromes are secondary to ischemic brainstem involvement

The most common alternate syndrome is protuberantial infarction

Wallenberg syndrome or infarction of the lateral part of the medulla elongata

The "locked-in syndrome" is caused by a bilateral infarction of the foot of the bridge (or protuberance)

The only possible movement during a "locked-in syndrome" is a horizontal movement of the eyes

Brainstem infarctions are caused by damage to the vascularization of the posterior cerebral artery or basilar trunk


It is an infarction of the lateral part of the medulla elongata (retrobulbar), by occlusion of the artery of the lateral dimple of the medulla elongata (from the posteroinferior cerebellar artery)

There may be a feeling of dizziness, balance problems and posterior headaches

On the side of the lesion, there will be damage to the spinothalamic bundle which causes thermoalgic anesthesia of the hemibody sparing the face

Alternate syndrome is defined as involvement of a cranial nerve on the side of the lesion and involvement of a long, sensory or motor pathway, contralateral to the injury. The spino-thalamic bundle is a long pathway, so there will be contralateral involvement to the lesion

On the side of the lesion, there will be: Claude Bernard-Horner syndrome (involvement of a sympathetic pathway), cerebellar hemisyndrome (involvement of the inferior cerebellar peduncle), vestibular syndrome with rotational nystagmus (involvement of VIII), phonation and swallowing disorders with paralysis of the hemiveil and hemipharynx (involvement of nerves IX and X) and anesthesia of the hemiface (involvement of the descending root of the V).

Wallenberg syndrome is also called alternate sensory syndrome


The multideficiency condition caused by the multiplication of small deep infarcts can cause:

A pseudobulbar syndrome = damage to the central motor neurons of the corticobulbar pyramidal bundles


Regarding the dissection of the cervico-encephalic arteries:

This is the essential sign of dissection, to look for in front of any infarction of the young subject (periorbital headache on carotid dissection, posterior on vertebral dissection)

There may be Claude Bernard-Horner syndrome

By pericarotid sympathetic plexus involvement (myosis, ptosis and enophthalmos)

There may be paralysis of the lower cranial nerves (IX, X, XI)

They travel along the internal carotid arer in the posterior subparotid space

By perception of the acceleration of blood flow in the intrapetrous carotid artery

The symptomatology associates an inconstant triad: neck pain / headache, local signs homolateral to dissection, and ischemic signs


80% of strokes are ischemic and 20% are hemorrhagic

Horton's disease can cause ischemic stroke

Horton's disease is a vasculitis of the large vessels, mainly affecting the encephalic vessels

Ischemic strokes caused by cardiac embolism are more common than strokes caused by atherosclerosis

Atherosclerosis is the leading cause of ischemic stroke (30% of ischemic strokes). Heart emboli cause about 20% of ischemic strokes.

In 50% of ischemic strokes, the etiology is unknown

A dissection of the cervicoencephalic arteries should be sought during an ischemic stroke in young subjects

Always look for a traumatic cause, chronic hypertension or pathology of the arteries (connective tissue disease such as Ehlers-Danlos disease, fibromuscular dysplasia)


The territories most frequently affected in microangiopathy associated with chronic hypertension, causing intraparenchymal hemorrhage, are:

The 3 most frequent locations are, in order of frequency: capsulothalamic, capsulolenticular and cerebellar


What is the leading cause of lobar intraparenchymal hemorrhage in the elderly?


Which are MRI sequences that are part of the emergency protocol for a stroke less than 6 hours old?

Allows to visualize any intraparenchymal hemorrhagic lesion

Angio-MR sequence (MRA) performed without injection of contrast medium, for the study of the branches of the Willis polygon and the visualization of a possible arterial occlusion.

Visualization of a hypoperfused area: the subtraction between infusion and diffusion makes it possible to identify the area of penumbra where the lesions are potentially reversible under treatment. On the other hand, it is not mandatory in the management of a heart attack less than 6 hours old.

Visualizes cerebral infarction very early in the form of systematized hyperintensity


Regarding the control of blood pressure in the acute phase of a stroke:

It is necessary to add an IV antihypertensive treatment (nicardipine type) if the BP > 140/90 mmHg in a cerebral infarction.

The blood pressure surge is physiological in front of a stroke, to ensure adequate perfusion of the brain. Antihypertensive drugs should be introduced only when the BP > 220/120 mmHg for cerebral infarction.

Following treatment with thrombolysis or endovascular thrombectomy, blood pressure below 185/110 mmHg must be maintained.

In front of intraparenchymal hemorrhage, the target BP is < 140/90 mmHg

Increased BP may worsen intraparenchymal hemorrhage

High blood pressure should be routinely treated > 140/90 mmHg in front of stroke

It is necessary to respect the blood pressure surge in front of an ischemic stroke


The drug for thrombolysis IV is rt-PA (Recombinant Tissue-Plasminogen Activator, Alteplase)

It can only be introduced if the stroke schedule is known and is less than 4:30 a.m.

Warning: it is possible to introduce it if there is a FLAIR-diffusion mismatch in MRI on a stroke of indeterminate schedule

Especially in patients treated with ACE inhibitors

It induces a high risk of cerebral hemorrhage and gastric hemorrhage

Target blood pressure after IV thrombolysis is 220/120 mmHg


Regarding the antagonization of anticoagulants in case of intraparenchymal hemorrhage:

Under VKA, PPSB and vitamin K should be administered urgently, at doses independent of the patient's weight

Under dabigatran, it is necessary to add its antidose which is idarucizumab

Reminder: Dabigatran is the only AOD that has an antidote

Oral anti-Xa may benefit from a specific antidote

PPSB or FEIBA must be administered urgently

When bleeding on antiplatelet agents, platelets can be transfused

It is possible to add LMWH at isocoagulant dose (in the absence of contraindications) 24 hours after the onset of intraparenchymal hemorrhage

LMWH or intermittent pneumatic back pressure (standard of care to prevent thromboembolic complications in intracerebral haemorrhage)


Among these proposals, which are principles of organ donation:

The donation must be made safely for both parties"


The law establishes the principle of inviolability (respect for the body) and non-patrimoniality (free donation) of the human body

Bioethics laws allow the removal of organs and tissues for therapeutic purposes in order to perform transplants and save lives

The state of brain death corresponds to the irreversible and isolated destruction of all intracranial nerve centers following complete brain circulatory arrest

The diagnosis of brain death is clinical

The diagnosis of brain death includes a clinical aspect and the use of confirmation by a paraclinical examination having medico-legal value in the context of a possible organ donation

There is no additional test to be done to diagnose a state of brain death

The paraclinical examinations to arm the diagnosis of brain death state are either two electroencephalograms (EEG) performed four hours apart under maximum amplification, or cerebral angiography (arteriography of the four cerebral vascular axes or cerebral angiography of easier realization)"


The report of brain death must be signed by a doctor

The report of brain death is signed by two doctors

In case of death with "heart stopped", the report must be signed by a doctor

Consent to organ removal is no longer revocable when the donor enters the hospital

Consent to organ or tissue removal may be revoked at any time

Patients diagnosed with brain death (EM) are the main potential organ and tissue donors

It may be decided not to remove certain organs if the patient had expressed this wish during his lifetime.


Regarding consent or refusal of organ donation

The first kidney transplants were performed in the 1960s and 1970s while the first heart was successfully transplanted in 1967 (Professor Barnard in Cape Town)

The principle of inviolability of the human body means that an individual does not sell his body

Consent The principle of inviolability of the human body means that an individual cannot be compelled to suffer harm to his or her body.

In France, the law specifies that organ or tissue removal may be carried out only if the deceased person has not made known his refusal during his lifetime (art.

Any elderly adult may register on the national register of refusals of organ removal

Anyone over the age of thirteen can register or unsubscribe confidentially on this register

In the case of an oral expression of the refusal, the medical team will ask the relatives to specify the circumstances and to sign the transcript that will be made in writing.


Which communicable diseases are urgently detected in the donor?

CMV, VRB, Syphilis, Toxoplasmosis, HIV1 and 2, HTLV1 and 2, HBV and HCV


Which of these reflexes can persist even in the event of brain death?

It is a brainstem reflex. Patients in EME (brain death state) are in areactive mydriasis

This is the abduction or adduction of the arm after nociceptive stimulation


Diagnosis of brain death The diagnosis of ME is primarily clinical but must be confirmed by a paraclinical examination

Brain angio-CT is more used than arteriography to confirm an EME

Cerebral angio-CT is currently the most common examination performed

CT angiography is not recommended because it is less specific than arteriography.

It is a fast and minimally invasive technique with a protocol defined by the French Society of Neuroradiology, Radiology and the ABM

The angioscanner is mainly done at portal time to visualize the sinuses

It is performed at least 6 hours after the clinical diagnosis of ME and includes 4 series of acquisitions, 3 successive and identical after the injection of contrast medium, and a last 60 seconds after the start of the injection

CT angiography requires an average blood pressure greater than 65 mmHg


Concerning the sampling in case of EME or stopped heart

The diagnosis of ME is established at the end of the paraclinical examination whose time of realization signs the time of death of the patient

The report of encephalic death must be drawn up and signed by 2 doctors not belonging to the transplant services

Organ harvesting procedure can begin as soon as brain death is suspected

Once this diagnosis is established, the procedure of organ and tissue removal can be initiated while the organs and tissues are maintained in survival through resuscitation.

If the heart stops, this organ may be considered to transplant a recipient in need.

The deceased donor with heart arrested (corpse) 52 Only tissue samples (corneas and skin) are possible in this context

For heart-stamped donors, we can do without respect for consent

Tissue samples are subject to the same legislation as in the case of EM concerning the rules of health safety and consent (search for the non-opposition of the donor on the RNR and with relatives)"


Isolated tubular proteinurias are very common after age 75

They are rare and most often accompany Fanconi syndrome

Microalbuminuria is specific for glomerular involvement when the patient is diabetic

Microalbuminuria is an independent marker of high cardiovascular risk

Orthostatic proteinuria occurs during puberty

Orthostatic proteinuria requires MRI centered on the hypothalamic-pituitary area

Orthostatic proteinuria does not require any additional examination


Regarding vascular thrombosis and coagulation abnormalities in nephrotic syndrome:

Thrombosis concerns only the arterial territory

Venous thrombosis of the renal veins and cerebral venous sinuses may occur

There is increased urinary loss of procoagulant factors

There is an increased synthesis of procoagulant factors (antithrombin III, Protein S ...)

Antithrombin III and Prot S are anticoag factors. True if Factor V, VIII, fibrinogen ...)

Anticoagulant therapy is prescribed if albumin is < 30 g/L


Which of the following are secondary causes of nephrotic syndrome? :


At the biospy of a nephrotic syndrome, we can find:

Extramembranous granular deposits of IgG and C3 without cell proliferation

Rare that Berger's disease presents with nephrotic syndrome, svt hematuric syndrome


Which of the following proposals would be in favor of extracellular hyperhydration?


Which of the following propositions concerning physiological proteinuria is or are true?

Especially low molecular weight proteins (< 70kDa)

It is composed mainly of low molecular weight proteins

It may be associated with orthostatic hematuria

No physiologically orthostatic hematuria


Regarding general information on chronic kidney disease (CKD) and end-stage renal disease (ESRD):

Chronic renal failure is defined by the irreversible decrease in glomerular filtration rate

The only treatment for end-stage renal disease is kidney transplantation

And/or extrarenal purification (hemodialysis or peritoneal dialysis)

End-stage renal disease is more common in men than in women

The leading cause of end-stage renal disease is chronic interstitial nephropathy

It is vascular and hypertensive nephropathy (25%), followed closely by diabetic nephropathy (22%)


Among these proposals, which are arguments of chronic kidney disease:

CT = Scanner. They are often without impact on the kidney

By active vitamin D deficiency due to the absence of renal hydroxylation (in position 1. As a reminder, hepatic hydroxylation is in position 25)

Default production of erythropoietin. It is often normocytic and normochromic, as well as well tolerated because of progressive installation.

Generally without impact on the renal parenchyma, unless they are pyelonephritis

Kidneys with a major axis of less than 10 cm on ultrasound

A decrease in the size of the kidneys is a morphological criterion"


In some tubulopathies, the diagnosis of CKD is based on the existence of blood ion abnormalities

The GFR can only be estimated by formulas

GFR can be measured by measuring the clearance of exogenous tracers filtered as such by the kidney (such as inulin)

The Cockcroft and Gault formula is the most accurate for assessing GFR from creatitinemia

It is much less accurate than MDRD, and CKD-PPE when GFR is greater than 60. But it is calculable without a computer, so potentially requested for examination

The deadline to declare kidney disease as chronic is 3 months

They are differentiated by the GFR: >=90, 60, 45, 30, <15


The incidence of terminal IR is 1200 patients per million inhabitants in metropolitan France

There are areas where there are almost as many transplant patients as hemodialysis patients

An RCM can only be established after three months of GFR decline

Below 3 months, we can not talk about MRC

CKD is accompanied by metabolic alkalosis with increased bicarbonates

Metabolic acidosis is observed by decreased acid filtration

Significantly reduced kidneys are an anamnestic criterion for CKD


Which of these proposals are expected complications of IRC?

By decreasing acid filtration, and is aggravated by protein catabolism. There are therapeutic proposals: bicarbonates, Vichy water...

Normochrome normocytic aregenerative anemia

It is secondary to the decrease in serum calcium (itself due to the deficiency of hydroxylation of 25-OH-VitamineD by the kidney)


It is often asymptomatic, but in case of a gout attack, treatment is necessary

Is aimed at a blood pressure control with a BP < 140/90mmHg in case of albuminuria < 30g / 24h

Small trap: take a good look at the units... (sorry)

IEC and ARA2 are so-called "nephroprotective" treatments


Which of the following propositions regarding dyalsis and transplantation are true?

Hemodialysis is the most frequently used replacement technique in France

Hemodialysis is based on two types of transfers: conductive and dynamic.

2 types of exchanges: diffusion and convection

Peritoneal dialysis is performed at home and is better tolerated hemodynamically

Peritoneal dialysis is a time-limited technique

True, mainly because of the alteration of the peritoneum which is a membrane that fibrosis by force

Kidney transplantation provides a better life expectancy than dyalsis


Which of the following propositions on kidney transplantation are true?

Induction therapy may be anti-lymphocyte serum, rituximab or corticosteroids

Ciclosporin and tacrolimus are calcineurin inhibitors

Belatacept selectively blocks the interaction of CD80/CD86 antigen-presenting cells with the CD28 molecule of the T cell


Palpitations are an abnormal perception of normal or abnormal heartbeats

These are objective disorders that may or may not indicate a cardiac abnormality

Subjective disorders with or without cardiac abnormality

The diagnosis is made mainly during the interrogation

Look for other symptoms that would immediately change management, such as chest pain, loss of consciousness/syncope, dyspnea


Routine biological tests (ionogram, CBC, blood alcohol level, troponinemia, β-HCG, TSH in particular) are necessary in front of palpitations

Extrasystoles are not a pathological element in themselves, but are a clue to look for underlying heart disease or extracardiac pathology

Isolated extrasystoles may explain palpitations


Common causes of extrasystoles include alcoholization, lung disease, bronchial neoplasia, hyperthyroidism, electrolyte abnormalities, pregnancy

Cardiac neurosis can cause palpitations but remains a diagnosis of elimination, sometimes self-maintained by management or iterative consultations

The diagnosis of cardiac neurosis is based on a strictly normal ECG at the time of palpitations, often obtained through long-term monitoring

Palpitations are a banal symptom that disappears behind a possible more serious symptom such as syncope, chest pain or dyspnea

The primary objective of management is to rule out signs of severity related to terrain, poor hemodynamic tolerance or immediate registration of ventricular rhythm disorder


Once the immediate emergency is managed, the next two objectives are the search for heart disease or extracardiac disease and electrocardiographic documentation

Simultaneous ECG documentation of symptoms leads to the notion of electroclinical correlation

Electroclinical correlation may require in order of increasing complexity, standard ECG, Holter 24–96 hours, ambulatory monitoring 21 days, endocavitary electrophysiological study and implantable monitor

The final diagnosis may be limited to sinus tachycardia or extrasystoles whose extracardiac causes must be known.

Among the rhythm disorders responsible for palpitations, atrial fibrillation and flutter are the most common with following junctional tachycardia


It often has a triphase presentation: appearance, plateau, disappearance

Collaboration with parents is essential for good care

It's one of the situations where you have to include them

The first step in management is pain assessment

Therapy differs from adults and is specific to children

The therapeutic principles are close to those of adults

There is a specific MA for use in paediatrics


From what age a pain self-assessment can be proposed


From what age a pain self-assessment is reliable


Which of the following propositions concerning pain in children are true?

Tramadol is indicated in pediatrics for severe pain from the age of 3 years

Paracetamol is indicated in case of neuropathic pain

False, pain by excess of nociception especially. For neuropathic pain, amitryptilline (antidepressant) or gabapentin (antiepileptic) are used in MA

The dosage of paracetamol in children is 60 mg / kg / day in 4 doses

Paracetamol is contraindicated in newborns

Codeine is possible from the age of 12 (unless contraindicated)


Which of the following can be used in a 2-year-old child?

True, always a hetero-evaluation before 4 years

Reliable self-assessment from 6 years old

Validated self-report scale in adults and the elderly with difficulty using VAS, EN or EVS, e.g. in patients with verbalization difficulties


The occurrence of a disability or chronic disease in children is a relatively common situation in France

Cerebral palsy is the leading cause of motor disability

Cerebral palsy is related to a brain injury that occurred in the antenatal or perinatal period

The main risk factor for cerebral palsy is genetic deficiency

The main risk factor for cerebral palsy is prematurity

trisomy 21 and fetal alcohol syndrome (FAS) are the leading cause of mental retardation, respectively hereditary and non-hereditary


Regarding the generalities of disability in children:

Multiple disability is a severe disability associated with severe and long-term impairment with severe or profound mental retardation.

Over-disability is the addition of secondary impairments or behavioural disorders to a pre-existing disability

The child's disabilities are always congenital

Can be acquired: trauma, iatrogenic, etc.

The child is a developing being! It is not an adult in miniature

The goal of rehabilitation care is to correct the disabling lesion

The goal of rehabilitation care is to assess and limit the consequences of this lesion and to stimulate the development of the child (brain plasticity)


Concerning the management of disability in children:

The care of a disabled child must be centered around the medical and psychological

It must be comprehensive: medically, psychologically, academically and socially.

The role of the team is to care for the child and reassure the family

The role of the team is to support, inform and guide them

The doctor specialized in PKD receives the child in his private practice and refers to the hospital if problem

The doctor specialized in PKD receives the child during outpatient and/or multidisciplinary consultations in the hospital and in medico-educational structures (SESSAD, CAMPS, IEM, IME)

The MDPH must provide unique access to the rights and benefits of persons with disabilities and their families


Regarding the general diagnosis of dyspnea:

Acute dyspnea is an emergency until proven otherwise

Inspiratory dyspnea indicates cardiac involvement

Orthopnea is a strong sign of heart failure

Wheezing dyspnea is pathognomonic of asthma

May also sign COPD or heart failure in the elderly

A pulmonary embolism is rarely expressed by isolated dyspnea


This is different. Dyspnea = SUBJECTIVE discomfort with breathing

Smoking is a key criterion of interrogation

Dyspnea is respiratory discomfort for a level of activity that do not normally cause discomfort

Dyspnea and tachypnea are mutually exclusive

Often associated, but to differentiate semiologically

Involuntary respiratory control is found in the brainstem


Inspiratory dyspnea with horn signs bronchial pathology

Antepnea is a dyspnea that appears when the patient is leaning forward

Cyanosis and sweating are signs of acute respiratory distress

A bradypnea corresponds to a FR < 10/min


Harzer's sign is a sign of acute right ventricular failure

Dyspnea with prolonged inspiratory time signs obstruction of the VAS

Right heart failure can cause obstruction of the VAS

3 etiologies: foreign body, angioedema, laryngitis


A prolongation of the expiratory time evokes a pathology of the VAS

Wheezing and sibilants sign bronchial involvement

Asthma attack is the first etiology of dyspnea with inspiratory prolongation in the elderly

We think especially in the allergic young subject during an expiratory elongation with hissing and sibilants

A context of bed rest reinforces the suspicion of PE

Foamy coughs and sputum point to a cardiac cause


Normal auscultation eliminates the diagnosis of PE

Hoover's sign is a sign of chronic respiratory failure

Pursed lip breathing is a sign of heart failure

Anginal pain leads to a heart abnormality

Quantifying dyspnea in chronic situations is useless

This makes it possible to evaluate the evolution and impact of the care


What is the norm of Respiratory Rate (per minute) in a 2-month-old child?


What is the standard respiratory rate (per minute) in a 6-year-old child?


Any suspicion of malaria is a diagnostic and therapeutic emergency

See item in the latest edition of the college

Diagnosis is based on the combination of a sensitive technique (thick drop or molecular biology) on a thin blood smear

Only Plasmodium falciparum species (> 90% of accesses) can cause severe malaria attacks

The presence of signs of severity requires transfer to intensive care

Artesunate IV is the standard of care for severe malaria, with quinine used only if artesunate is not immediately available


Artemisinin-based combinations are indicated as a 1st line in uncomplicated Plasmodium spp. import malaria

Vector control personal protection measures should be explained to any traveller travelling to malaria-endemic areas

In France, the HAS publishes annual health recommendations for travellers for health professionals.

Malaria is a protozoosis caused by a haematozoan of the genus Plasmodium

2 plasmodial species pathogenic to humans


The vector of malaria is the male anopheles

Anopheles does not make noise and its bite is painless

Manifestations of malaria are due to erythrocyte schizogonia

The severity of manifestations depends on the species of Plasmodium, parasitemia and host immunity

The clinical manifestations of malaria are mainly those of aregenerative anaemia

The clinical manifestations of malaria are essentially those of hemolytic anemia: fever, chills (hemolysis releases a pyrogenic substance), progressing by access, interspersed with periods of clinical remission


Sub-Saharan Africa is the source of 90% of global cases, mostly due to P. knowlesi

Approximately 4,000 cases of imported malaria per year are reported in France

Antimalarial chemoprophylaxis, even if taken correctly, does not completely eliminate the risk

Any fever during a stay in a malaria-endemic area should evoke the diagnosis of malaria

Malaria attacks of Plasmodium falciparum can occur from 7 days after the first exposure in endemic areas and up to 3 months after leaving this area


Any fever returning from a tropical stay is malaria until proven otherwise.

The annual incidence is about 4000 in France

Malaria is caused by gram-positive bacteria

It is rare (less than 1%). It is Plasmodium falciparum the most common (> 90%)

The incubation period can be up to 3 months


Which of the following are signs or symptoms of malaria?


Which of the following propositions are true for first-line treatments for malaria?

Without vomiting: Dihydroartemisinin-Piperaquine PO

Without vomiting: Artemether-Lumefantrine PO

Treatment of severe malaria (with or without vomiting)

Clindamycin combines with IV Quinine for the treatment of single bouts with vomiting


Which of the following are biological signs that lead us to consider the case as severe malaria?

True, a malaria attack in a pregnant 🤰 woman should be managed as a severe ⚠ malaria attack.


What type of anaemia can be observed in malaria?


True. Third (J1 J3 J5 J7 J9 etc) for falciparum, vivax and oval. Fourth (J1 J4 J7 J11 etc) for malaria. Every 24h for knowlesii.

It is almost constant and is not a sign of gravity

Thin blood smear - thick drop is done at febrile peaks only

As a matter of urgency, never wait for a feverish peak.

The thick drop allows the identification of the species

The thick drop allows the positive diagnosis of malaria. It is the thin blood smear that allows the identification of the species.

The thin blood smear is used to measure parasitmeia


Which of the following proposals about malaria are true?

It is a reportable disease in all circumstances.

Any fever on return from an endemic country should evoke the diagnosis.

The incubation period for the Falciparum strain varies between a minimum of one week and 3 years.

False
Between one week and 3 months maximum

The manifestations of malaria are due to the hepatic merozoite form.

The manifestations of malaria are due to the erythrocyte schizogony form.

Antimalarial chemoprophylaxis protects 100% against malaria.

False, it does not completely eliminate the risk of infection even if properly followed.


Which of the following proposals regarding malaria treatment are true?

Artenimol-piperaquine is the first-line treatment for pregnant women in the 1st trimester

False, it is contraindicated in the 1st trimester, like all artemisinin derivatives

The Artemether-lumefantrine prescription requires the performance of an ECG beforehand.

True
It causes QT prolongation, like all artemisinin derivatives

In case of complicated form with vomiting administration of IV Quinine is the first-line treatment

False
This is true in uncomplicated forms
In severe forms the first-line treatment is Artesunate IV

Administration of artesunate requires haematological monitoring one month after discontinuation of treatment

Doxycycline is the treatment of choice for pregnant women in the first trimester

False!!
Contraindicated in pregnant women


Which of the following proposals regarding malaria prophylaxis are true?

Artenimol-piperaquine should be started on the first day of stay and continued one week after

False
It is not indicated for prophylaxis

Mefloquine should be started 10 days before stay and continued 3 weeks after

Mefloquine should be taken daily at the same time throughout the stay

Atovaquone-Proguanil must be started on the first day of stay and continued 10 years after

It is necessary to warn the traveler that any fever within 3 months of returning from an endemic area must be consulted urgently to look for Malaria

True
The incubation period of Falciparum can be up to 3 months


A negative blood smear eliminates the diagnosis of malaria.

False
A negative blood smear and a RDT (rapid diagnostic test) rule out the diagnosis.

A negative epiasse drip examination eliminates the diagnosis.

A positive blood smear and a positive Rapid Diagnostic Test (RDT) are sufficient to make the diagnosis.

The epiasse drop examination requires expertise on the part of the biologist.

A negative RDT allows him to eliminate the diagnosis of malaria.

False, it takes a negative RDT + a negative blood smear to rule out the diagnosis.


The diagnosis of primary hypothyroidism is based primarily on TSH testing

If TSH is elevated, free T3 measurement measures the severity of secretory deficiency

It is the dosage of free T4 that is carried out

Free thyroxine is dosed rather than total T4 because the latter is subject to multiple physiological variations

Normal free T4 indicates frustrated hypothyroidism

TSH is very elevated in subclinical hypothyroidism


Which of the following is (are) correct?

Low free T4 and increased TSH indicate overt hypothyroidism

Primary hypothyroidism is the most common

The diagnosis of hypothyroidism is often late because of the highly variable symptoms and clinical signs

Currently, by the generalization of the TSH assay (systematic assessment or asthenia), the diagnosis is most often early, made at the stage of crude hypothyroidism where only TSH is increased.

A single moderately increased TSH assay makes it possible to make the diagnosis

A single moderately increased TSH assay is not sufficient to make the diagnosis of hypothyroidism and therefore justify treatment.

Thyroid-impaired insufficiency constitutes less than 5% of hypothyroidism


Thyrotropic insufficiency is very rarely part of a pituitary pathology context

On the contrary, this is almost always the case

T4L is always low in thyrotropic pathology

A slightly elevated TSH (but less than 10-12 mIU/L) and a low T4L suggest rather a primitive involvement

In this case, TSH is immunoreactive but biologically inactive and contrasts with low T4L. This painting evokes hypothalamic involvement

The diagnosis of thyrotropic insufficiency is based on the determination of the T4L-T3L couple

Rather on the dosage of the T4L-TSH couple

The semeiology of hypothyroidism depends on its depth, age and origin


Crude hypothyroidism is the most common form nowadays

Crude hypothyroidism, called subclinical, is the most common form, it is grouped into 3 categories according to the risk of conversion to overt hypothyroidism

Carotinosis can be observed by decreased transformation of carotene into vitamin A

Dry, flaky skin is symptomatic of thyrotoxycosis

Axillary depilation is promoted by hypothyroidism


Hair is dry and brittle in overt hypothyroidism

Laryngeal involvement can result in a hoarse voice

Eustachian tube involvement is possible in hypothyroidism

Involvement of the Eustachian tube can induce hearing loss

Tendonitis is very rarely due directly to hypothyroidism

Arthralgia, myalgia and cramps are more often seen

Deep primary hypothyroidism can cause hyperploactinemia


Which of the following are the signs and symptoms found in hypothyroidism?


Which of the following are true about Hashimoto's thyroiditis?

Anti-TPO positive antibodies.
If they are negative (rare), we dose the anti-Tg that are positive.

It is the most common cause of hypothyroidism in women ♀

It can be part of autoimmune polyendocrinopathy

True, when it is associated with other autoimmune disorders such as vitiligo, celiac disease, Biermer's anemia, then pNEM2 must be suspected.


The lifetime prevalence of panic attacks is 3-5%


Which of the following are possible treatments for panic attacks or acute anxiety attacks?

Room with very loud rock music to distract the patient

Systematic measures: calming, reassurance, breathing control


Which of the following are observational studies?

Not all, there may be human intervention

True, this is an analytical observational study


Which of the following are scientific journals with an impact factor >10 😏?

As French-language newspapers are rarely cited by the international community (which speaks mainly English), their impact factor remains limited 😕

IF of 0.08. Remember especially the major journals: NEMJ, Lancet, Nature, Science, PNAS, etc.


Which of the following are true about relative risk?

It measures the association between an exposure factor and the event under study

It corresponds to the Odds Ratio (OR) in cohort studies

Prospective cohort studies measure risk ratios (RRs). In case-control studies, an Odds Ratio (OR) is measured

A relative risk strictly less than 1 is a protective factor

A relative risk greater than 1 is a protective factor

Relative risk is a parameter that is measured in real life at the individual level

It is a parameter that is calculated in prospective studies


Which of the following are risk factors for prosthesis infection?


Minor and moderate deficits are the most numerous and include ametropia or refractive disorders

Strabismus does not affect children under 8 years of age

Several thousand children under the age of 8 are affected by strabismus

Severe deficits are very rare in children

It is estimated that 15 to 20% of children under 6 years of age have a visual abnormality


50% of children who have strabima are at risk of developing amblyopia if not treated promptly

Screening for visual disorders in children is a public health problem

During the first weeks of life, light reflexes testify to visual sensitivity

The photomotor reflex develops from 2 months

The photomotor reflex is present from birth but it is slow and of low amplitude


Regarding the development of the vision:

The preferential look is developed around the third month

Eye-head-hand coordination appears at week 5

Eye-head-hand coordination appears around the 4th-5th month

The convergence reflex and the fixation reflex appear in the third month

First week: light reflex, photomotor reflex

The pursuit reflex is established around the age of 6 months

2nd–4th week: continuation reflex established around 2 months of age


Week 4–12: fusion reflex, binocular coordination

The vision of forms is formed around the third month

From 2 years old: measurable visual acuity

A first antenatal screening is performed by ultrasound during pregnancy


At what age is the eye tracking reflex established?

True, according to the new College of Pediatrics (2021)


At what age does we achieve 10/10th visual acuity?

True, according to the new College of Pediatrics (2021). 1 year: visual acuity at 4/10th, 2 years: visual acuity at 6/10th, 4 years: visual acuity at 10/10th. (Note that the old frame of reference gives the age of 6 years for visual acuity at 10/10th.)


The diagnosis is essentially clinical, but can be supported by molecular biology

See item in the latest edition of the college

There is no specific treatment and prevention is based on vaccination of adults

It is an acute non-contagious viral infection

Acute, contagious, most often mild viral infection


Testicular involvement is most often bilateral

Sequellar testicular atrophy is present in 50% of cases but sterility is rare

The eviction of the case is not mandatory and there is no specific measure to be taken vis-à-vis the contact subjects


Which of the following are true about mumps?

The neurological manifestation may be bacterial meningitis

Viral meningitis since mumps is caused by an RNA virus

The neurological manifestation is common (>25% of mumps cases)

Mumps puts you at risk for Guillain-Barré syndrome


With regard to mumps, what are the exact proposals?

Possible clinical pictures include: erythematous angina, mumps parotitis, acute pancreatitis, orchitis and purulent meningitis

False, mumps gives meningitis which is usually not very symptomatic with few sequelae. Pancreatitis is benign (edematous pancreatitis)

Vaccination is important despite the existence of antiviral treatment

False, there is no specific treatment. The main treatment is preventive by vaccination

Preventive treatment consists of 2 vaccinations at 12 and 16-18 months with the MMR vaccine

True, this is not a reminder. The second injection increases the responder rate.

The purpose of vaccination is to prevent complications of infection such as: testicular atrophy, sterility, deafness, encephalitis

True, especially testicular atrophy is present in 50% of orchites


What is the incubation period for mumps?

This is the incubation period of scarlet fever

This is the incubation period of measles

This is the incubation period of whooping cough

The incubation period is almost zero (a few hours)

RNA viruses take time to replicate in enough cells to give a clinical picture


Which of the following is true about mumps?


Regarding the Basics of Childbirth: Normal Childbirth

The work is composed of two stages: cervical dilation and delivery

The 4 stages of labour: cervical dilation, descent of presentation into the pelvic canal, delivery, return to normal

Dilation of the cervix conditions vaginal delivery

Contraception should be discussed and offered postpartum during the maternity stay

Childbirth requires the passage of two obstacles: the cervix and the perineum

Childbirth requires the passage of three obstacles: • the cervix: closed during pregnancy, it expands under the influence of uterine contractions • the pelvis: crossing this rigid parade requires constant adaptation of the different parts of the fetus to the container • the perineum: its crossing constitutes expulsion

Expulsion occurs under the influence of uterine contractions reinforced by maternal abdominal thrust


Regarding the Anatomy of the Obstetric Pelvic Duct: Normal Childbirth

The pelvic girdle consists of 3 bony pieces

A Maternal pelvis 1 Bone pelvis The pelvic girdle is a symmetrical osteoarticular ring consisting of 4 bony parts and 4 joints: • the 4 bony pieces are: − the 2 coxal bones, − the sacrum, − the coccyx

The 4 joints of the pelvis are very mobile

The pelvic girdle has the shape of a funnel with a large lower base the large abdominal cavity with the pelvis through the lower strait (DI)

The pelvic girdle has the shape of a funnel with a large upper base that communicates the large abdominal cavity with the pelvis through the upper strait (SD)

The lower orifice consists of all the middle and lower straits

The upper strait is also called the Demelin "engagement cylinder"


Regarding the Anatomy of the Pelvis in Women: Normal childbirth

The promontory overlooks the pubic symphysis 8-9.5 cm

Note that the axis of the DS is oblique backwards and upwards

It should be noted that the axis of the DS is oblique backwards and downwards: it aims at the sacrococcygeal line spacing.

The axis of the DS targets sacrococcygeal space

The circular section of the pelvic excavation is 18cm anteroposterior

Its circular section is of constant diameter at the level of all planes (about 12 cm)

The middle strait (MD) is an oblique plane passing through the two sciatic spines.


Regarding the Concerning the generalities about normal childbirth: normal childbirth

The lower strait (ID) is the lower opening of the pelvic canal

The posterior surface of the lower strait corresponds to the 2 ischia and the tip of the coccyx

The soft pelvis corresponds to Douglas's uterus, bladder and cul-de-sac

2 Soft pelvis It consists of: • the vagina • the pelvi-perineal diaphragm: musculotendinous hammock which includes: − a deep plane: fibers of the levator of the anus, ischiococcygeal muscles and large sacrosciatic ligament, − a superficial plane: muscles of the superficial perineum

The curled up fetus is amalgamated with a cube with 4 poles

1 Fetal head The fetal head has an ovoid shape with the small end corresponding to the chin and the large end to the occiput (Figure 30

The anterior fontannelle is called bregma


Regarding the Concerning the pregnant uterus: normal childbirth

The posterior fontanelle is called bregma

The pregnant uterus consists of 3 parts: the body, the lower segment and the cervix

The uterine body, in late pregnancy, has the shape of an ovoid with a large upper end

The axis of the body of the uterus in late pregnancy is always craniocaudal

Its axis depends on the tone of the anterior abdominal wall

In the frontal plane, the uterus is often tilted to the right side


Concerning the basics of normal childbirth

At the level of the inner circular layer, the fibers retract to erase the lumen of the vessels in order to reduce the hemorrhage of normal delivery (live ligatures)

At the level of the plexiform layer, the retraction of the fibers erases the lumen of the vessels, which has the effect of reducing the hemorrhage of normal delivery: this is the phenomenon of living ligatures

Uterine contraction is the driving force of childbirth

The mechanical study of uterine contraction requires expensive and rare electrophysiology equipment

1 Means of study The mechanical study of UC is commonly used in obstetrics thanks to monitors that allow simultaneous recordings of fetal heart rate and uterine contractions: • external tomography allows

External tocography makes it possible to note the duration of uterine contractions thanks to an intravenous sensor

Internal tocography provides basic tone and intrauterine pressure


These questions may seem tedious, but these measures are worth knowing according to the College

Sternodorsal diameter or bi-acromial diameter after settlement


This diameter is not reduced by compaction. It is 8 cm

Sorry for these questions, but these measures are to be known according to the college :/

This is the sterno-dorsal distance as well as the bi-acromial distance after settlement


Sorry for these questions, but these measures are to be known according to the college :/. 8 cm is the bi-iliac diameter


Bi-trochanterian diameter. Sorry for these questions, but these measures are to be known according to the college :/

This distance can be reduced by settlement


Which of the following proposals is/are a risk factor for postpartum haemorrhage?

Very fast or too prolonged work is a ToR


Regarding plasters, which proposals are true?

There are two types of plasters: circular and gutter

Pain = problem = systematic removal of the cast for complete clinical examination

Conventionally, the cast contains the fractured limb and the underlying joint only

Conventionally, the fingers of the hand are left free


What are the delays in radiographic control of plaster?

The deadlines mentioned by the college of orthopedics are: J2, J8, J21 and J45


What are the two main etiologies of paresthesias under plaster?


Which of the following are frequently found in DRESS syndrome?


Regarding pain in a patient suffering from a psychiatric pathology:

The tools used to measure pain are specific to psychiatry

There is no specific tool in psychiatry to measure pain

Dental pain is often directly related to psychiatric pathology

No direct link, but an indirect link: psychiatric pathology -> poor hygiene -> no dental care -> dental pain


The placebo effect has no place in therapy

The placebo effect is accompanied by the release of endogenous opioids

There is an addictive risk if taken care of morphine


Anxious manifestations make you forget the pain

It concerns 10% of the general population on the time of life

Everyone went through periods of acute pain


It is defined for a duration greater than 1 week

No, but often depressive symptoms. In addition, the psychiatric reference framework explains that about 50% of bipolar patients have a pain syndrome, mainly neck pain, back pain and arthralgia.

The flagship treatment is long-term paracetamol

Not at all (beware of the risk of addiction): it is a multidisciplinary care based on medicamental and non-drug therapies that must be put in place


The average age of reporting a bladder tumour is around 60 years

Bladder tumours affect both men and women

Deaths caused by bladder tumors account for 3% of cancer deaths

The main risk factor is alcohol consumption

It can be recognized as an occupational disease


Which of these proposals are factors that promote squamous cell carcinomas?

Be careful, it promotes urothelial carcinoma (see the Medline, part "trap to avoid", on page 424)

Not cited as a risk factor for bladder tumours

Especially in endemic areas in the Middle East and especially in Egypt

Be careful, they promote urothelial carcinoma (see the Medline, part "trap to avoid", page 424)


Regarding the diagnosis of bladder tumors:

Hematuria is often terminal or even total

In case of hematuria, clots can be found

Unlike hematuria of nephrological origin


It will perform a cytological examination infondi via cystoscopy, after verification by the ECBU

Urinary cytology has excellent negative predictive value (NPV)

Cytology has excellent positive predictive value


Follow-up includes regular endoscopic check-ups

In 90% of cases, bladder tumours present immediately as a bladder tumour that infiltrates the IMTV muscle.

Survival of patients with MITV is greater than 90% at 5 years

The main risks of a NMITV are recidivism in the form of one or more MINTVs

The urothelium covers the entire urinary tract


The normal testicle is formed by seminiferous tubules, contained in lobules

Seminiferous tubules contain four types of cells

Germ cells and Sertoli cells are the two most important cell types

Sperm are produced in the seminiferous tubules

The Leydig cells that produce sperm are present in the stroma


Which of the following propositions are true?

Non-germline tumours include gonadal stromal tumours

The Doppler ultrasound makes it possible to define the lymph node and metastatic status of the patient on which the TNM stage of the disease will depend

Staging of metastatic forms according to the IGCCCG classification

Diagnosis is based on ultrasound which makes it possible to highlight hyperechoic areas

More generally, the presence of grade 3 microcalcifications in a patient with gonadal dysgenesis syndrome warrants periodic clinical and ultrasound monitoring.


Which of the following are the side effects of cisplatin?

This is the case of etoposide (inhibitor of topoisomerase type II)

Especially anthracyclines, docetaxel, 5FU and capecitabine


Which of the following are non-germline tumors?

Non-seminoma germ cell tumours, AFP synthesis

Non-seminoma germ cell tumours, hCG synthesis


Which of the following propositions are true about the extension balance?

The PET-CT has no place in the initial assessment.

Scrotal MRI should be performed to better characterize the mass

False: scrotal MRI does not provide a decisive element to the local assessment.

Bone scintigraphy is performed at the point of clinical call

The CT-TAP is the reference exam for the extension assessment

Brain imaging should be performed in case of extranodal metastatic disease


Which of the following should be put in place before taking cisplatin?


Which of the following proposals must be made before the treatment is implemented?

Presentation of the file in Multidisciplinary Consultation Meeting (RCP)

Proposal of a gamete collection to CECOS

Diagnostic announcement according to the recommended modalities


Which of the following are germ cell tumours?


Which of the following serum tumor markers are relevant in germ cell tumors of the testicle?


At what stage is the invasion of the spermatic cord established?

Tumor limited to the testicle and epididymis WITHOUT vascular invasion

Tumor limited to the testicle and epididymis WITH vascular invasion OR with invasion of the tunica vaginal

No T5. The maximum is T4 (invasion of the scrotum)


Which of the following are risk factors for germline testicular tumors?


Regarding venous thrombosis and pulmonary embolism

Pulmonary embolism (PE) is most often a complication of deep vein thrombosis (DVT)

PE causes 5,000 to 10,000 deaths per year in France

PE results in an initial dead space and then a shunt effect by redistribution of blood flow and secondary bronchoconstriction

As a reminder: shunt effect = unventilated infused, and dead space = ventilated not infused

PE results in a picture of hypercapnic hypoxemia with ventilatory alkalosis

Hypocapnic hypoxemia (by hyperventilation, normocapnia in COPD), with ventilatory alkalosis

The hemodynamic consequences of PE (increased cardiac work by increased afterload) appear for obstruction >50-60% of pulmonary circulation

For obstruction >30%. If the obstruction is >50-60%, cardiogenic shock (drop in cardiac output and hypotension) = acute pulmonary heart is feared


About venous thromboembolic disease (VTE)

For the diagnosis of DVT, D-Dimer should be age-appropriate

Age adjustment only in the case of PE and if elderly patient

D-Dimer have a PPV (positive predictive value) of 99% for PE and proximal DVT

A VPN (negative predictive value) of 99%: in case of negativity and low clinical probability, the diagnosis is excluded

In a patient suffering from cancer and faced with a suspicion of PE, a CT angiography will be requested immediately regardless of the clinical probability

DDimers have no value in the case of cancer (false positive)

On ECG, an S1Q3 associated with a right axial deviation and a right branch block is specific to pulmonary embolism.

Signs of suffering of the right heart, they can evoke PE but are not specific

In case of high clinical probability, a negative CT angiography does not exclude pulmonary embolism

This is an indication for ventilation/perfusion scan or arteriography


In case of superficial venous thrombosis, Doppler ultrasound of the lower limbs is essential

In case of distal DVT or spontaneous superficial venous thrombosis, 6 weeks of anticoagulant therapy is recommended

In PE, a cardiac ultrasound may show direct signs, such as a non-enlarged hypokinetic dilated right ventricle

This is an indirect sign (acute pulmonary heart)

In PE, pulmonary angiography is particularly recommended in case of thrombi in the right atrium

Severe PE is defined as a SBP <90 mmHg or a decrease in SBP of 20mmHg for more than 10 minutes

STEP <90mmHg or drop of 40mmHg for more than 15 minutes


In PE, the early onset of basithoracic pleural pain accompanied by a dry cough should suggest pulmonary infarction

In case of surgery <3 months and prescription of LMWH, an NFS is recommended in the pretherapeutic workup, then 2 times a week for 1 month, then 1 time per week

Indications for NFS monitoring in LMWH: chir/trauma <3 months, UFH/LMWH <6 months, significant comorbidity at risk

The PESI score assesses the risk of developing a chronic pulmonary heart

In PE in an 81-year-old patient with cancer and SBP at 85 mmHg, right ventricle ultrasound dysfunction and elevated BNP biomarkers: PE is of intermediate severity

In severe PE, LMWH should be initiated as soon as possible in the absence of severe renal impairment

LMWH is contraindicated in severe PE. UFH is indicated in combination with fibrinolysis


Which of these proposals fall within the scope of calculating the Geneva score?

65 years, as often in cardiology (it is at this age that it is considered a cardiovascular risk factor)

Neither alcohol, tobacco nor diabetes are recognized risk factors for DVT (Deep Vein Thrombosis) or PE (Pulmonary Embolism)


From what Geneva score do we do without D-Dimer and do we do a CT injected directly?

A Geneva score greater than or equal to 11 requires the performance of a chest CT angiography


From what Wells score do we do without D-Dimer and do we do a Doppler ultrasound of the lower limbs directly?

A Wells score greater than or equal to 3 is strong. It requires the realization of a venous Doppler ultrasound of the lower limbs


D-dimer are specific products of fibrin degradation formed under plasmin action

The management of Deep Vein Thrombosis (DVT) is done in cardiovascular service only

Well-tolerated DVTs can be managed on an outpatient basis

A PESI score greater than or equal to 1 is intermediate

A BP (Systolic Blood Pressure) less than 90 mmHg classifies a PE as high risk

The objective, in case of an intermediate PESI score, will be to dissolve the clot

Management with DOAC (direct oral anticoagulants) aims to prevent the appearance of new clots. DOACs, like VKAs or antiaggregants, are not thrombolytics.


Which of these proposals can elevate D-Dimers?


The determination of D-dimer has an excellent negative predictive value in ambulatory patients for whom the clinical probability of diagnosis of DVT/PE is not high.

The so-called "antiphospholipid" antibodies are specific for complexes associating anionic phospholipids and proteins which may be β2-glycoprotein I

APS (Anti-Phospholipid Syndrome) is linked to ANCA vasculitis

Many antibodies
antiphospholipids may be present transiently and are non-thrombogenic


Which of these factors and proteins are involved in mutations that can cause VTE?

4 proteins and factors to know: Protein C, Protein S, Factor III and Factor V


Which of the following identifies the most common germ in urinary tract infections?


Which of the following are mandatory examinations in case of suspicion of severe acute pyelonephritis?

Useless if you do not think you have to transfuse (this is the general case)

We prefer the uroscanner from the outset

True, before administration of antibiotic therapy (C3G IV + Aminoside IV)


Which of the following are the probabilistic first-line treatments for severe acute pyelonephritis?

True, it is the aminoglycoside that is preferred


Which of the following propositions concerning simple acute cystitis are true?

The diagnosis of simple acute cystitis does not require the realization of a urine strip in the young woman

ECBU is not necessary in young women without comorbidities

First-line treatment is Fosfomycin-tromitamol as a single dose

Macroscopic hematuria is a sign of severity

False
It is not a sign of the severity of the infection


What is the significant threshold of bacteriuria in humans (with notable exceptions)?

True. 10^3 in all cases EXCEPT atypical Enterobacteriaceae (other than E. coli, Enterobacteriaceae, etc.) in women (in this case, the threshold is 10^4)

This threshold is allowed for atypical enterobacteriaceae in women


What is the threshold of significant bacteriuria in women for E. coli?

True. 10^3 all the time, except in the case of atypical enterobacteriaceae (other than E. coli, enterobacteriaceae, etc.) in women (threshold of 10^4)


Renal aging is the consequence of intrinsic genetic and extrinsic mechanisms, related to environmental factors and comorbidities

Renal aging concerns only endocrine functions

It concerns all the functions of the kidneys: elimination of waste and toxins, homeostasis, endocrine functions

Renal ageing is accompanied by 'physiological' proteinuria

Renal aging is not accompanied by proteinuria or significant hematuria

The finding of proteinuria is always pathological, regardless of age

There are transient and physiological proteinuria (orthostatic, effort ...)

Age-related structural and functional renal changes do not have significant consequences in normal situations

But they limit the capacity for self-regulation, thus increasing the risk of occurrence of an IRA


Regarding the renal physiology of the elderly:

The determination of serum creatinine gives a poor reflection of renal function in the elderly and overestimates the severity of renal failure

It most often leads to underestimation of the severity of renal failure

The GFR value should be estimated by the CKD-PPE formulas rather than by the MDRD formula which is not very precise after 75 years.

The GFR value should be estimated by the CKD-PPE or MDRD formulas rather than by the Cockcroft formula, which is imprecise after age 75 and should no longer be used.

A plasma creatinine value > 135 μmol/L may indicate severe chronic renal failure (stage IV) in the elderly

The decrease in GFR is continuous and of the order of 10 ml / min and per year from adulthood

Aging is accompanied from adulthood, without threshold effect, by a decrease in the glomerular filtration rate of the order of 0.7ml / min / year

Water-electrolyte disorders are common in the elderly because the adaptive capacities of the kidney are quickly exceeded


Osmolar intakes tend to decrease with age

Body composition changes, with a lower percentage of fat mass and an increase in water volume

Lower percentage of total water and a higher percentage of body fat

Hyponatremia increases the risk of falls

The incidence of acute renal failure increases exponentially with age

Rapidly progressive glomerulonephritis syndrome is an urgent indication for renal biopsy


Age does not increase the rate of progression of chronic kidney disease

Renal failure alters the pharmacokinetics of all drugs

Not all but a lot, and you have to be careful!

Contraindications to dialysis management should be discussed on a case-by-case basis

The occurrence of certain pathologies may lead to consider the cessation of extrarenal purification

Kidney transplantation cannot be performed after age 75

Must be prosposed if necessary up to 85 years according to the HAS


What is the threshold of red blood cells per mm3 for which we speak of microscopic hematuria?

The threshold is 10 GR/mm3 or 10 to the power of 4 red blood cells per mL


Regarding renal aging, which proposal(s) is/are accurate?

Albuminuria is physiological as long as it remains moderate

Microscopic hematuria is physiological after 80 years

The GFR decrease, from the age of 40, is 10 points per year

The decrease in GFR from the age of 40 is 10 points per decade, or 1 point per year about

The decrease in GFR observed with age is about 0.7 per year

The best formula for estimating GFR is the Cockcroft-Gault in the elderly


What are the exact suggestions regarding kidney size?

The size of the kidneys remains the same from the age of 20

The size of the kidneys decreases with age, at the expense of the cortex, which remain regular (no notches, no cysts, etc.)

The kidneys increase in size with age physiologically

There is a decrease in the size of the kidneys at the expense of the parenchyma

The decrease in kidney size is at the expense of the cortex

The cortex remains regular in physiological situation


Regarding renal aging, which proposals are accurate?

The CKD-Épi formula is preferred to the Cockcroft-Gault formula to estimate the GFR

It decreases due to the decrease in muscle mass, which can mask kidney failure.

Creatinineuria decreases due to the decrease in GFR with age

It is increased by the decrease in GFR, it is decreased by the loss of muscle mass

The feeling of thirst is decreased with age

The dilution capacity of urine is increased with age, which increases the risk of dehydration

The dilution capacity of urine is decreased in the elderly


GFR decreases by about 0.7 ml/min/1m73² per year

GFR decreases by about 10 ml/min/1m73² per decade from age 40

The renin angiotensin aldosterone system is potentiated by aging

The decrease in the size of the kidneys occurs in the cortex

Chronic kidney disease progresses faster and faster with age

The MRC continues its course without being impacted by age


Treatment of fibroids is mainly medicated

The essential complementary examination is pelvic ultrasound

Tumor markers are to be measured in second line possibly


The 3 most common pelvic swellings are uterine fibroid, ovarian cyst and pregnancy

Always think about pregnancy in a woman during genital activity

The bHCG test is unnecessary in women taking contraception

Uterine fibroids are most often mucous when palpable

The uterine fibroid, when palpable, is most often subserous (types 5,6,7 according to the FIGO classification) or interstitial (types 3,4)

1-2% of women over the age of 35 have uterine fibroids

It is the most common tumor of the uterus: 20 to 30% of women over 35 years of age have it

Fibroids are extremely painful most often


Menorrhagia is the main telltale sign of uterine fibroids

Rules are increased in duration and abundance

In menorrhagia indicative of fibroids, menstruation is increased in abundance but not in duration

The Huntigton score specifies the number of diaper changes per day

The number of exchanges per day = Higham score

Sometimes endometrial hyperplasia is associated with fibroids

Dysmenorrhea is a sign eliminating the diagnosis of fibroid

It may be related to a fibroid of the cervix or isthmus interfering with the evacuation of menstrual flow.


A submucosal fibroid is very rarely hemorrhagic

A submucosal fibroid is often responsible for significant bleeding (especially if an IUD is present), which can lead to hyposideremic microcytic anemia

Subserous fibroids rarely cause bleeding

This is also the case with interstitial fibroids.

Hyperplasia and nerve compression of a fibroid is the main cause of pain in fibroids

Complications are multiple during pregnancy, often minor and low impact once pregnancy has set in.

Adenomyosis is a very common cause of pelvic tumours

They are rarely the cause of a pelvic tumor because the uterus is rarely palpable (does not exceed one x2 in size)


Endometrial cancer is a common cause of palpable pelvic tumours

This is actually a very rare cause, which is then often an endocavitary tumor with cervical stenosis and intrauterine retention.

Functional ovarian cysts are the most common of a woman's pelvic swellings during genital activity

Follicular cysts or lutein cysts (of the corpus luteum) whose regression is most often spontaneous

70% of ovarian tumours are malignant or borderline

20% of ovarian tumours are malignant or borderline, and the risk of cancer increases with age


The symptomatology of ovarian cysts is very specific: swelling, cyclical pain and menometrorrhagia

There is no specific symptomatology of ovarian cysts

Ovarian cyst is symptomatic in 10% of cases

In more than 50% of cases, the ovarian cyst is latent, and is discovered by incidentaloma

Sometimes the ovarian cyst is discovered during a complication

Acute pelvic pain from a cyst complication is mild and cyclical

It is a thunderclap in a serene sky not yielding and amplifying

Abdominal-pelvic pain begins abruptly from one second to the next and does not give way, getting worse.


Regarding complications of ovarian cysts

In case of torsion, surgery is urgently needed to untwist the ovary or appendix and remove the cyst

Hysterectomy is preferred in young women to ensure 100% survival

It is necessary to be conservative in young women, even in case of late gesture and even if the appearance of the ovary is worrying

Intracystic hemorrhage often occurs in organ cysts

A tusk is found in one of the two iliac fossa in case of intracystic hemorrhage

The cul de sac homolateral to pain is filled

Peritoneal effusion associated with intracystic hemorrhage is rare and indicates the severity and urgency of management

It is common to observe an associated peritoneal effusion


Regarding the consultation in a woman with a very painful pelvic swelling:

Vaginal touch guides the diagnosis and is often very contributory

It is the essential examination because it helps to guide the diagnosis but it is often not very contributory because of the pain (see statement)

A uterus globally enlarged in volume most often corresponds to one or more interstitial fibroids

The clinical examination is emptied bladder

So as not to have a bladder globe that would trap us

Laterouterine masses in young women are always dependent on the uterus

Not at all, they can be independent if they interest the ovary for example

Transparietal and transvaginal pelvic ultrasound is the additional examination to be requested first


Solid swellings most often correspond to ovarian cancers

Solid swellings most often correspond to uterine fibroids and ultrasound specifies their size, number and location

Cancer masses are rarely large enough to give pelvic masses

In case of a supposedly benign cyst, a cystectomy or appendectomy is performed depending on the age

Therapeutic abstention is promoted in case of asymptomatic fibroid less than 25 cm


What is the FIGO classification of an intramural uterine fibroid in contact with the endometrium?

Intramural interstitial fibroid (no contact with the endometrium)

Intracavitary pedunculated submucosal fibroma


What is the FIGO classification of a pedunculated subserous uterine fibroid?

Intramural interstitial in contact with the endometrium