What are the recommended proportions of nutrients in a meal?

50% carbohydrates, 30% fat and 20% protein


Ischemic heart disease is the world's leading cause of death

In Europe, cardiovascular diseases are responsible for about 40% of deaths before the age of 75

Even imperfect CPR is always better than no CPR, even in children

See College Emergencies and Acute Failures, page 326

CPR should be initiated 30 seconds after loss of consciousness, in case the patient wakes up on his own

CPR should be initiated as early as possible and continued with the minimum of interruption by the first witness(ies) pending the arrival of specialized assistance

Any victim who is unconscious, not breathing or breathing abnormally, should be considered in CA


Regarding cardiopulmonary resuscitation and circulatory arrest:

The presence of agonic "gasps" at a frequency of 5-6/min can be misinterpreted as ventilatory movements

Taking the pulse at the carotid level is the most reliable method to confirm the absence of circulation

Taking the pulse (at the carotid level or any other site) is an unreliable method to confirm the absence of circulation, even for healthcare professionals, and is therefore no longer recommended for diagnosing CA.

There is no specific recommendation on the content or form of the alert to be given to the emergency services

In adults, the origin of CA is most often cardiac

The recommended optimal technique for chest compressions requires a frequency of at least 180/min

The recommended optimal technique for chest compressions requires a frequency of at least 100/min, with an amplitude of compressions of at least 5 cm in adults (not exceeding 6 cm), or at least one third of the anteroposterior diameter of the chest in infants and children


The number of chest compressions per minute during CPR is an important determinant of return to spontaneous circulatory activity (RACS) and survival without sequelae

Total chest relaxation after each compression must be ensured with an equal time between compression and relaxation

CPR plus mechanical ventilation is much more effective than CPR with chest compressions alone in the first 5 minutes

CPR by chest compressions alone is as eective as CPR plus artificial ventilation in the first minutes after the onset of non-traumatic and non-asphyxia CA in adults

Numerous and serious cases of transmission of viral diseases such as HIV have been reported during artificial ventilation, which requires the use of protective devices.

Very few cases have been reported. The use of simple protective devices can reduce the transmission of diseases, but in practice it is only recommended if the victim is known to be carrying a serious infection.

VF is the most common etiology among non-traumatic CA etiologies


Priority to defibrillation over CPR is confirmed

In hospitals, oxygen should be given as early as possible during CPR

Tracheal intubation is the gold standard technique for airway control

Pulmonary resuscitation is useless in hospital since a defibrillator is always present

You have to control the airway in less than 10 seconds

Once tracheal intubation is performed, chest compressions are continued continuously at a frequency of 100/minute, regardless of insuations which are performed at a frequency of 10/minute


Regarding specialized cardiovascular resuscitation:

Sternal punching should no longer be used to treat out-of-hospital KT

Sternal punching may be considered in a patient with atrial CA fibrillation

It may be considered in a patient with unstable ventricular tachycardia (TV) (including pulseless TV), occurring under the supervision of a specialized first aider, only if a defibrillator cannot be used immediately

Standard CPR allows coronary and cerebral perfusion equal to 100% of its physiological value

At best, standard CPR allows coronary and cerebral perfusion equal to 30% of its physiological value

The small-axis parasternal window is the one recommended in ETT to identify a reversible cause of CA

However, the performance of an ETT should not result in a prolonged interruption of the CPR, and the subcostal window, which seems to best meet this requirement, is the one recommended.

The recommended position for the electrodes is anterolateral, with a subclavicular electrode


Which of the following proposals are shockable rhythms?


Which of the following propositions are true about the person of trust?

Anyone around you can take on this role.

It has veto power over medical decisions

His role is to be consulted by the medical team if the patient is no longer able to clearly express his will

It is consulted when the patient is no longer able to clearly express his will


Palliative care is only for the sick patient

To the patient and all loved ones who need it

Palliative care is mandatory for patients at the end of life

They are proposed according to the context

Palliative care is contraindicated in children

Palliative care can only be introduced with the patient's consent when possible


Thus, the presence of bleeding during defecation is an alarm sign requiring a colorectal screening exploration

The treatment of hemorrhoidial thrombosis is based on the simple incision or excision of the thrombosed area that immediately relieves the patient when the patient is seen in the rapid aftermath of the constitution of the thrombosis

Hemorrhoid hemorrhages result in the emission of gleaming red blood in the immediate course of a defecatory episode usually mixed with the materials

Hemorrhoid hemorrhages They result in the emission of gleaming red blood in the immediate course of a defecatory episode usually not mixed with the materials

The presence of a permanent perianal swelling may be sequelale (marisque) but must evoke a benign associated condition (fistula, abscess) cancer

A manually reducible externalized procidence represents grade 3 hemorrhoids


The diagnosis of hemorrhoidal disease is based solely on the data of the interrogation and clinical examination

In case of isolated bleeding, the hemorrhoidal origin can be affirmed after ensuring that there is no other colo-rectal cause for the described bleeding (colonic endoscopy)

Drug treatment relies on antibiotics, transit retarders and local topicals

Drug treatment is based on hygiene-dietary rules, control of transit disorders and local topicals

Endoscopic techniques are reserved for patients suffering regularly from procidence or bleeding related to medium-sized hemorrhoids

The instrumental method that seems to offer the best benefit/risk ratio today is the elastic ligation.


Traditional surgical treatment of hemorrhoidal disease is based on excision and/or pedicle resection of vascular tissue and support of hemorrhoidal plexuses

Surgical treatment is usually offered after instrumental treatments have failed or because the anatomical disease is too severe.

Anoscopy should be done in all patients with hemorrhoidal symptomatology

The hemorrhoidal symptomatology remains very specific

The patient should be informed of the deleterious effects of long-term surgery as continence disorders.


Which of the following are true about hemorrhoids?

Treatment concerns only symptomatic forms

Non-symptomatic hemorrhoids are not treated +++

Hygyieno-dietary rules and endoscopic gestures (elastic ligation, photocoagulations, etc.). Surgery is really a last resort

An anoscopy should be done in any patient with hemorrhoidal symptomatology

The risk of recurrence after surgery is zero


Headaches perceived by the patient as recent and unusual ("acute") are by definition essential headaches

These are secondary headaches until proven otherwise and require emergency examinations

Headaches recognized by the patient as old and usual ("chronic") are usually primary headaches and are managed without urgency.

They can be paroxysmal (seizures) or permanent

Any recent change in an old and usual headache leads to suspicion of a secondary headache

Meningeal syndrome and intracranial hypertension syndrome are life-threatening emergencies


Concerning additional examinations of headaches and neuralgia:

Any recent and unusual headache should be considered secondary until proven otherwise.

In front of a first episode, the key examinations are brain imaging (CT and/or MRI), cerebral and/or cervical angiography (CT angiography, MRI-angiography) and lumbar puncture

In front of a first episode, the brain scan without injection looks for spontaneous hyperdensity (presence of blood)

Sections on the sinuses look for ethmoiditis

Ethmoiditis is technically sinusitis (but not the most common)

A CT scan without normal injection eliminates a cause of injury

A CT scan without normal injection does not rule out a lesional cause: CT scan is normal in 7% of subarachnoid hemorrhages after 24 hours, 30% of cerebral venous thrombosis, in almost all cervical artery dissections at the stage of local signs and in almost all meningitis


Brain MRI is more sensitive than CT scan for all parenchymal or pituitary lesions

T2 FLAIR coronal cervical MRI sections are needed to look for arterial dissection

Axial cervical MRI (T1 FAT-SAT) sections are needed to look for arterial dissection

MRI is the most common examination in emergencies

MRI often remains unavailable in emergency

The lumbar puncture does not highlight a hemorrhage

The lumbar puncture makes it possible to highlight a subarachnoid hemorrhage not visible in imaging (xantochromia) (but also meningitis and to measure the pressure of the cerebrospinal fluid (CSF) in search of intracranial hypertension)

PL is to be performed as a first-line treatment in case of suspected meningitis, after eliminating contraindications

Contraindications include suspicion of commitment or intracranial hypertension, too much blood fluidity


There are no contraindications to PL in case of emergency

Contraindications include local infection at the puncture site, severe hemostasis disorder, signs of intracranial hypertension with threat of engagement pointing to a lesion with mass effect. Imaging is therefore necessary when the lumbar puncture is performed for isolated headaches

In case of PL, the use of an atraumatic needle of the smallest possible caliber (25 G) minimizes the risk of headache by dural breach

An inflammatory syndrome can evoke Horton's disease or an infectious syndrome

Ophthalmological examination looks for bilateral papillary edema that is indicative of type 2 diabetes

Bilateral papillary edema = intracranial hypertension

Any sudden headache must suspect a vascular cause and in the first place a serious epistaxis

Suspect subarachnoid hemorrhage in the first place


Tension headaches can last from 30 minutes to 7 days

Cluster headaches can last between 3 and 14 days

Duration of the order of the hour: between 15 and 180 minutes in general

A migraine usually lasts between 4 and 72 hours

They are also unilateral, periorbital, frontal or temporal.

During a migraine, the headache is often accompanied by photo-phonophobia and nausea

Nausea can induce vomiting. In case of migraine with aura, we will also observe transient visual, sensory or language disorders, of progressive and successive installation, preceding or accompanying the headache


Which of these proposals can result in a normal non-injected CT scan?

Cerebral infarctions appear on CT scan after 3 hours

It is seen on a scanner without injection


Which of these proposals are visible on the non-injected scanner?

Brain infarctions give signs on CT scan after 3 hours


Any "explosive" headache with normal brain imaging requires a lumbar puncture to look for xanthochromia

An aneurysm-free SAH may correspond to reversible cerebral vasoconstriction syndrome (SVCR)

SAH (or subarachnoid hemorrhage) accounts for 10 to 30% of sudden headaches

Reversible Cerebral Vasoconstriction Syndrome (SVCR) is over-diagnosed

Underdiagnosed because it is a syndrome of recent description (2007)

SVCR accounts for 10 to 45% of "thunderclap" headaches


The restriction of participation expresses the impact in social life

The concept of incapacity has given way to the notion of restriction of participation

The inability to read is a restriction of participation

Loss of employment status due to impairment is a restriction of participation

An evaluation that is too difficult that puts the patient in check is useful to show him his limits

Absolutely useless and counterproductive! Evaluation must be conducted with tact and, above all, must be adapted


Which of these proposals are restrictions on participation?


Declarative memory engages explicit processes

Episodic memory refers to facts and knowledge

Episodic memory referring to experiences that fit into a spatial context

Episodic memory is that of 'where? when? how?'

The memory of a birthday meal that took place with such protagonists will bring procedural memory into play

Semantic memory refers to facts and knowledge


Which of these proposals are causes of mental disability?

Cognitive disability (cf. College of Psychiatry page 565: mental disabilities are from birth)

Mental disability: begins in adolescence or adulthood, progressive, possible or even essential drug treatments.

Mental disability: early onset from birth, stable, infrequent medical care


According to the WHO, an IQ of 58 corresponds to:

Mild mental retardation: between 55 and 70 IQ points

Severe mental retardation: between 20 and 34 IQ points


From which cell does Reed Stenberg's cell derive?

Let's remember that a platelet is not a cell. It is a fragment of the Megakaryocyte


A lymph node biopsy in a 26-year-old woman, with no history, who has supradiaphragmatic lymphadenopathy, shows a lymph node architecture modified by broad bands of fibrosis delimiting cell nodules. Binucleolate giant cells of CD20-, CD30+, CD15+ phenotype are identified.

Which of the following are true?

This description is in favor of the diagnosis of diffuse large cell malignant B-cell lymphoma

Hodgkin lymphoma (phenotype corresponds to Hodgkin cells and binucleolate giant cells correspond to Reed-Sternberg cells)

CD20- phenotype supports T-cell lymphoma

Binucleolate giant cells correspond to Sternberg cells

This description is typical of Hodgkin lymphoma of the "mixed cellularity" subtype.

Scleronodular (because clears the lymph node architecture and has wide bands of fibrosis)

EBV virus expression can be found in 20% of cases


A PET-CT scan regains intense hyperfixation of right jugulo-carotid lymphadenopathy and an anterior mediastinal mass, without other hypermetabolism.

Which of the following is Ann Arbor Stadium?

True, 2 lymph node areas affected on the same side of the diaphragm


Which of the following are characteristics of the Hodgkin cell?


Renal failure is found in about 50% of symptomatic cases

Fanconi syndrome is a distal tubulopathy

Fanconi syndrome is proximal tubulopathy


A woman may have ovulatory cycles without periods

For example in case of absence of uterus

The presence of menstruation affirms the presence of ovulatory cycles

It is possible to have anovulatory cycles with menstruation

The only physiological circumstance of amenorrhea is menopause

Primary amenorrhea is defined as the absence of menarche at age 12

Secondary amenorrhea is defined by stopping menstruation for more than 3 months without previous irregularities


Among these proposals, which are signs of accompaniment of primary amenorrhea that must be specified during questioning?

Not an interesting sign in this context, although it can orient in specific cases


Regarding the interrogation in case of primary amenorrhea:

Infectious pathologies such as meningitis are to be specified during questioning

A history of appendicitis is important to specify

Inguinal hernia cures are not relevant given their location in the iliac fossa

Very important because can affect the ovaries

Corticosteroid therapy can cause primary amenorrhea

The interrogation must go back to the circumstances of pregnancy and childbirth


Regarding the gynecological examination:

Gynecological examination is performed with empty bladder

Inspection of the vulva makes it possible to specify the degree of hair

As well as the appearance of the labia, the size of the clitoris, etc.

The appearance of the labia minora and labia majora does not matter

It is inspected and provides interesting information

The classification of pubertal stages is Turner's

Speculum examination can detect the presence of the uterine tubes


Among these proposals, which are signs of hyperandrogenism?

Especially if it goes down on the thighs


The first test to order in case of secondary amenorrhea is the LH/FSH to rule out pituitary adenoma

This is the plasma assay of βHCG in order to eliminate a pregnancy

The objective of the first examinations is to find the exact cause of amenorrhea

The first objective is to specify the level of amenorrhea, not its exact pathophysiology

Menothermic corube is required in all women

It is performed if secondary sexual characteristics are developed

The menothermic curve must be carried out over 1 month

Ovulation occurs at the highest point of the temperature curve

Ovulation occurs at the lowest point of the menothermic curve before the temperature rises (thermal shift of about 0.5 °C)


Radiography of the hand helps define bone age

It is prescribed in case of impubertism + primary amenorrhea

Sesamoid of the thumb appears for a bone age of 16 years

The involvement is ovarian in case of low FSH and high LH

The involvement is ovarian in case of elevated FSH

After checking the integrity of the genitals, the progestin test is offered as a first-line


Secondary amenorrhea is much more common than primary amenorrhea

The first cause of primary amenorrhea is the impermeable hymen

In front of a primary amenorrhea, the first examinations are the assay of FSH and prolactin, in particular

As well as hand X-ray and pelvic ultrasound

In case of secondary amenorrhea, a progestogen test is performed as a first-line

ATTENTION, we first eliminate a pregnancy

Turner syndrome is an important etiology of primary amenorrhea without secondary sex characteristics


Regarding psychiatric care without consent:

There are two distinct constraint procedures

By decision of the Prefect or at the request of a third party

They may be practised by decision of the Prefect.

They can be practiced at the request of a third party (=SDRE)

There are 5 conditions that can motivate them

2: mental disorders that make consent impossible and a condition requiring immediate care


Concerning the admission procedure under ordinary law:

3 documents: 2 medical certificates and 1 application for admission from a third party

Medical certificates must be made by psychiatrists

Verification of the patient's identity is carried out by the intake officer

By the director of the institution prior to any admission of the patient

Medical certificates must be less than 15 days old

Or if it can justify the existence of relationships with the patient that make him act in his interest


The pigmented appearance of the areola is strengthened during pregnancy

During pregnancy, the areola loses its sensitivity to tactile stimulation

It is more sensitive to tactile stimulation

During pregnancy, the areola completely loses its thermal sensitivity

Davatange sensitive to thermal stimulation

Montgomery's glands participate in the secretion of an odorous liquid

The odorous liquid is a powerful olfactory landmark for the newborn


The areola is a cone in the center of the nipple

It is of course the opposite: the nipple is a small cone in the center of the areola that contains many smooth muscle fibers and at its top, many pores to release milk

The mammary gland is composed of two lobes on the left and three on the right

Let's not confuse with the lung: the mammary gland consists of about fifteen lobes on the right and left

Each lobe behaves like an independent gland with its own excretory duct

The milk ducts have a very sinuous path and open at the top of the nipple through the pores

More than half of the mammary gland is 3 cm from the base of the nipple


Prolactin has a negative lactogenic action

Prolactin has a positive lactogenic action!

Feeding causes elevated prolactin and oxytocin

Breast milk only has a nutritional function for the child

Breast milk has two main functions: nutritious and immunological

Its composition and quantity are constant over time but there is a small interindividual variation

Its composition and quantity are variable: water and trace elements, high lactose content, low casein but rich in soluble proteins (α-lactoglobulins), etc. Also, there is a modification of content from the 15th day to go towards a higher fat composition

The first breastfeedings are composed of 99% lactose

The first breastfeedings are composed of collostrum, a substance rich in IgA, glycoproteins, oligosaccharides, immune cells and low in fat


There is a change from the 15th day in transition milk increasingly rich in fat

Breastfeeding has little effect on immunity

It brings to the newborn passive immunity against certain infections

The composition of milk is common to all mammals and falls within the definition of these

Milk is a species-specific substance, each with milk of different content

Breast milk is translucent and relatively low in vitamin D

Infant formula is obtained by processing beef milk

Infant formula is obtained by processing cow's milk. The boeur being the male, it does not produce milk


Among these proposals, which are a contraindication to breastfeeding:

Synthetic antithyoids taken by the mother


Artificial breastfeeding is in every way equivalent to breastfeeding

Artificial breastfeeding does not have the immunoprotective function of breastfeeding because it is derived from cow's milk while the immunological elements are species-specific.

Breastfeeding should not begin before 12 p.m. postpartum

It is advisable to breastfeed immediately, if possible in the labor room

It usually takes one feeding every 12 to 24 hours at the beginning

Far too long! Every 2 to 3 hours at the beginning

Prohibiting smoking during breastfeeding is necessary

The only complication of breastfeeding is engorgement


Which of the following proposals designate the advantages of growing up milk over cow's milk?

Growing up milk has about half as much protein as cow's milk


Which of the following are the benefits of breastfeeding?

It is adapted to the nutritional needs of the newborn

It is deficient in vitamin K. If it is exclusive, vitamin K 2mg PO should be supplemented at 1 month (after routine supplementation at birth)


Most pregnancies are normal and can be managed by a doctor or midwife

For these pregnancies without a risk situation or a low level of risk (follow-up A of the HAS), the management is medical and psycho-social with a screening and prevention approach.

Pregnancy monitoring aims to assess the only fetal risk of developing diseases

Pregnancy monitoring aims throughout pregnancy to assess fetal and maternal risk in order to prevent, screen, diagnose and manage by specialized teams abnormal situations detected

Pregnancy monitoring is the responsibility of a medical gynecologist

Pregnancy monitoring is a team effort that combines: medical and psycho-social problems

Pregnancy monitoring requires the collaboration of all specialists involved


Regarding pregnancy monitoring and the choice of maternity:

Pregnancy monitoring can call on the services of PMI (maternal and child protection), CAF, psychologists, dieticians, etc.

Pregnancy monitoring includes 9 consultations per pregnancy covered 100% by the Health Insurance

There are two consultations per month between the 5th and 7th month normally scheduled

From the 7th month, it is preferable that it is the team that will ensure the birth that does the surveillance

Expectant parents always turn to the maternity wards of their choice


Level I maternity wards account for 80% of maternity wards

The three types of maternity are: • Level I maternity wards (49% of maternity wards): − management of low-risk pregnancies

Level 1 maternity wards have neonatal units with fewer than 6 beds

Level II maternity wards are intended for high-risk deliveries

Level 2a maternity wards have a neonatal intensive care unit

these maternity wards have: − a neonatal unit (level II a) (23%)

49% of maternity hospitals in France have a neonatal intensive care unit


Which of these proposals refer to the objectives of the first pregnancy consultation?

Making the diagnosis of pregnancy exclusively clinically

Determine clinical term via ultrasound only

Talking about screening for trismia risk 13


23% of maternity hospitals in France are level 3

Level 3 maternity wards have a neonatal resuscitation unit within a CH with an adult resuscitation unit

The first consultation of the pregnancy follow-up must take place in the first month of pregnancy

The first consultation of the pregnancy follow-up takes place before 3 months of pregnancy (the HAS in its recommendations of 2007 proposes two consultations in the 1st trimester one to 10 SA and one before 15 SA), the Health Insurance reimburses one at 100%

The diagnosis of pregnancy is based on the clinic and complementary examinations most often

The vaginal touch shows the increase in volume of the uterus which thickens from front to back giving a spherical shape


Which of these additional tests can be used to diagnose pregnancy?

Ultrasound of the uterus. Pregnancy is then visible only from 5 SA and cardiac activity from 5.5 SA on vaginal ultrasound


Regarding the duration of a normal pregnancy:

Fetal heart sounds can be heard by the fetal Doppler apparatus at the end of the 1st month

Fetal heart sounds (BDC) can be heard with the fetal Doppler machine at the end of the 3rd month (sound signal heard at the 10th SA, sometimes as early as the 9th)

The duration of pregnancy varies between 280 and 290 days

The duration of pregnancy varies between 40SA and 41.3SA

The average length of pregnancy is 284 days


Among these proposals, which designate a cranio-caudal length in the standards:


Among these proposals, which designate tests not recommended in patients during pregnancy?


Concerning the course of a non-pathological pregnancy

For a woman who has a regular 28-day cycle and a last menstrual period on January 1, the beginning of pregnancy is January 14 and the expected term is August 14.

For a woman who has a regular 28-day cycle and a last period on January 1, the beginning of pregnancy is January 14 and the term is October 14.

In case of IVF, the date of pregnancy is the date on which the sounds of the heart are observed with Doppler, minus 3 months

In case of IVF, the date of onset of pregnancy is defined by the date of puncture (professional agreement)

Ultrasound dating is based on the antero-posterior length of the fetus

To reduce the risk of prolonged pregnancy, the CNGOF in its 2011 CPR recommends ultrasound dating of early pregnancy using ultrasound measurement of craniocaudal length, which ideally should be done between 11 and 13.6 SA (CCL between 45–84 mm): • CCL at 11 SA = 45 mm

Interrogation alone will define the mode of obstetric monitoring


Which of these proposals are oligatory biological examinations during normal pregnancy?

Not if there are written results that allow immunity to be considered acquired


Regarding the follow-up of type B pregnancy

In type B follow-up, regular follow-up can be done by an authorized midwife

Regular follow-up should be provided by an obstetrician gynecologist

If the patient does not have a complete blood group card, a double determination is mandatory

Screening for syphilis TPHA-VDRL is mandatory in all cases

Rubella serology is mandatory in all cases


Concerning the follow-up of non-pathological pregnancy

Irregular antibody testing (IAR) is mandatory in all cases

The search for antibodies A and B is mandatory

excluding antibodies to A and B antigens

Toxoplasma serology is repeated every month from the 2nd prenatal examination in all cases

Toxoplasma serology is repeated monthly from the 2nd prenatal examination if immunity is not acquired

The search for albuminuria is to be done at the 3rd and 6th month only

The search for albuminuria is to be done every month during pregnancy

Obstetric ultrasound is a mandatory examination

Obstetrical ultrasound is not a mandatory examination but it is necessary for a good obstetrical follow-up


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

The responsibility for whether or not to prescribe a rehabilitation program rests with the physician

The realization of rehabilitation is a prerequisite for the establishment of a

The legislation distinguishes 84 rehabilitation professions

Seven: masseurskinesitherapists, occupational therapists, speech therapists, psychomotor therapists, orthoptists, pedicures-podiatrists and dieticians

There are 13 different rehabilitation programs that are chosen for each patient according to their situation

The rehabilitation program is adapted and personalized for each patient

A rehabilitation programme must be followed by the evaluation of results; involving the doctor and paramedics


Simple rehabilitation programs involve the collaboration of the doctor regardless of his specialty and a medical assistant, physiotherapist or speech therapist mainly

Complex rehabilitation programs require the collaboration of MPR and several rehabilitation auxiliaries

Treatment of urinary incontinence in women requires complex rehabilitation

1st line treatment of UI in women: rehabilitation and treatment of contributing factors

The overall goals of rehabilitation can be anatomical or functional recovery, maintenance or compensation for a disability.

Edema and trophic disorders are indications for massage physiotherapy


It is necessary to distinguish true hypercalcemia, with elevation of ionized calcium from false hypercalcemia by increase in the protein-bound fraction

Hyperalbuminemia, by severe dehydration for example, leads to an increase in total calcium, but without an increase in ionized calcium

The assessment of hypercalcemia must therefore include an ionized calcium assay or an albuminemia assay

Severe or rapid onset hypercalcemia is accompanied by general signs, digestive disorders and often confusing neuropsychic manifestations

Signs of hypercalcemia are very specific


Neuro-psychic signs are common (memory problems, depression or anxiety)

Digestive disorders (anorexia, nausea and vomiting) are common when serum calcium is > 2 mmol / L

Digestive disorders Anorexia, nausea and vomiting are common when serum calcium is > 3 mmol/L

Hypercalcemia leads to a decrease in QT space and rhythm disorders

Chronic hypercalcemia can lead to renal lithiasis and chronic renal failure

Calcemia is regulated by two hormones: parathyroid hormone (PTH) and vitamin D, which control digestive calcium absorption, bone formation and renal excretion.


10 to 20% of cancer patients will have at least one episode of hypercalcemia during the course of their disease

Primary hyperparathyroidism results in 20% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands

Primary hyperparathyroidism results in 80% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands

Parathyroid carcinoma (malignant form of primary hyperparathyroidism) is exceptional (< 1%) and is accompanied by severe hypercalcemia (> 3.5 mmol / L) poorly tolerated

Parathyroid adenoma mainly affects women after 40 years

Primary hyperparathyroidism can be the consequence of chronic lithium intake


Which of the following are ECG signs of hypercalcemia?


Which of the following are signs related to hypercalcemia?


Ionized serum calcium varies between 1.15 and 1.3 mmol/L

The determination of ionized calcium can be disturbed by pH and phosphate

Calcium homeostasis is essentially based on three key organs (intestine, kidney and bone) and two regulatory hormones.

Digestive inputs are regulated by active vitamin D, also known as calcidiol (25-[OH]-vitamin D2), which promotes calcium absorption

The active vitamin D is calcitriol (1,25-[OH]2-vitamin D3)

Urinary excretion is regulated by renal reabsorption in the distal tubule which is promoted by PTH


PTH is the key hormone that supports serum calcium

PTH then stimulates the distal renal tubular reabsorption of calcium, the conversion by 1α-hydroxylase, of 25-OH-vitamin D3 into active vitamin D

Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 6 mmol/L or an ionized serum calcium greater than 1.5 mmol/L

Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 2.6 mmol/L or an ionized serum calcium greater than 1.35 mmol/L

The discovery of hypercalcemia requires a second confirmatory test, without delaying treatment if there are threatening signs

It is estimated that 40% of hypercalcemias are asymptomatic and incidentally discovered.


Chronic hypercalcemia is often complicated by phosphate lithiasis or calcium oxalate (renal colic, hematuria or urinary tract infection), nephrocalcinosis, obstructive renal failure

Acute hypercalcemia is a medical emergency with a risk of death from heart rhythm disorders

An emergency ECG should be performed to look for rhythm disorders (tachycardia, QT shortening, early onset T waves) because there is a risk of ventricular fibrillation and sudden death.

The discovery of malignant hypercalcemia requires hospitalization to carry out emergency treatment

Calcitonin should be given urgently in acute hypercalcaemia

It includes the following measures:Calcitonin no longer has a place in the treatment of hypercalcemia


Most heart conditions if not detected or treated in time can lead to heart failure

HF is a syndrome that can be defined as the combination of symptoms and signs associated with cardiac dysfunction

The diagnosis of HF is, in most cases, easy to make

Relatively difficult generally. In doubtful cases, the clinical response favorable to appropriate treatment (diuretic) may be an argument in favor of the diagnosis

It is estimated that the prevalence of heart failure in the general population is between 15 and 20% in France

That would be far too much. It is estimated that the prevalence of heart failure in the general population is between 1 and 2%

The average age of diagnosis in Europe is around 40 years


Population aging explains why the prevalence of HF tends to increase

Ejection fraction is the most widely used parameter to characterize diastolic function

In case of cardiac dysfunction, the body will react by bringing into play a number of compensatory mechanisms

Tachycardia under the dependence of the activation of the parasympathetic system helps to maintain cardiac output

Tachycardia is dependent on the activation of the (ortho)sympathetic system. It helps maintain cardiac output (DC = VES × HR)

Vasoconstriction in response to activation of the sympathetic system and renin angiotensin system helps maintain perfusion pressure


Exertional angina is often indicative of the disease

It is rather the dyspnea of effort that reveals the disease. There is rarely angina at the beginning of the disease

The degree of effort at which dyspnea appears makes it possible to quantify the functional tolerance of the disease

In severe or end-stage heart failure, respiratory disorders such as Cheynes-Stokes breathing sleep apnea syndrome may be observed.

Apart from an acute flare-up of the disease, the physical examination of the heart failure is often quite rich (dyspnea, pallor, edema, etc.)

Apart from an acute flare-up of the disease, the physical examination of heart failure is often quite poor, especially when HF is treated and controlled.

At the cardiac level, palpation sometimes makes it possible to note a spike shock deviated at the top and right, related to left ventricular dilation

In case of dilation of the LV, the tip shock is deflected at the bottom and left, in the axis of the heart


At a very advanced stage, heart failure can be accompanied by an alternating pulse, oliguria, muscle wasting, sometimes achieving a real cachectic state.

Cheynes-Stokes dyspnea is sometimes noted in patients with heart failure during sleep

Especially in cases of severe or terminal HF

ECG is low contributory to the diagnosis of heart failure

The existence of a branch block in particular left (duration of the QRS > 120 ms), is an important element to take into account given the current therapeutic implications

It is essential to appreciate the pleuropulmonary impact


BNP or NT-proBNP can help in the diagnosis of heart failure, with good positive predictive value.

BNP or NT-proBNP can help in the diagnosis of heart failure, with a good negative predictive value; thus, normal values of BNP (< 100 pg/mL) or NT-proBNP (< 125 pg/mL) make the diagnosis of heart failure very unlikely in the presence of acute dyspnea with a good negative predictive value

There are values of BNP/NT-proBNP for which the diagnosis is uncertain, the interpretation must imperatively take into account the clinical data

Transthoracic echocardiography (ETT) coupled with Doppler is the essential key test in case of suspected heart failure

Coronary angiography is a key test for suspected primary heart failure

Coronary angiography is usually offered in case of impaired systolic function (decreased ejection fraction [EF]) to rule out coronary artery disease.

Ischemic heart disease is the leading cause of heart failure.


Pulmonary arterial hypertension is defined as a mean PAP greater than 25 mmHg

Normal cardiac output is 5 L/min, cardiac index is 3 L/min/m2

All heart conditions can lead to heart failure

High blood pressure is also an important factor or cofactor in heart failure

Dilated cardiomyopathies (DCM) are defined by damage to the heart muscle that results in dilation and decreased LV ejection fraction.


All left valvular heart disease can be complicated by heart failure (mitral or aortic insufficiency, mitral or aortic stricture)

Ventricular or supraventricular rhythm or conduction disorders can cause heart failure

Pulmonary oedema in a young migrant, especially if it is associated with atrial fibrillation, should suggest the diagnosis of rheumatic valvular disease, especially mitral valve disease.

mortality remains high in heart failure, averaging 50% at five years but can reach up to 40-50% per year in severe heart failure (NYHA IV)


HF is considered the leading cause of hospitalization after age 65

Hospitalization for cardiac decompensation is always a severity factor

Heart failure can be accompanied by anemia, iron deficiency, sleep apnea syndrome

Prevention of heart failure begins with management of cardiovascular risk factors

The success of treatment depends closely on the patient's education and understanding of the disease.


Which of the following are true about the NT proBNP?

Faced with acute dyspnea, he directs to a cardiac origin

It is a prognostic marker of heart failure

It is increased in case of heart failure


Which of the following are early complications of triple-chamber defibrillator implantation?


The incidence of epilepsy is higher in children and after 60 years

About 1% of epilepsies begin before the age of 5

About 50% of epilepsies begin before the age of 10

EEG during juvenile myoclonus is characterized by generalized, bilateral, symmetrical and synchronous polyspikes-waves

EEG during the typical absence is characterized by a generalized, bilateral, symmetrical and synchronous paroxysmal discharge of wave-peaks at 3 Hz, abruptly beginning and ending, of a few seconds, interrupting normal background activity

Disorders of consciousness during focal seizures do not have a precise localizing value


When faced with an epileptic seizure in a known epileptic, it is necessary to do a brain imaging in first line

No. Antiepileptic drugs must be dosed as a first-line measure.

The most common cause of seizures in an epileptic is lack of sleep

It is the lack of adherence, hence the fact of dosing antiepileptics in the first-line assessment in the known epileptic

Prevalence is about 1% in the general population

In 50% of cases, no cause of the seizure is found

The tonic phase of a tonic-clonic seizure lasts 30 seconds

It lasts 10 to 20 seconds. The clonic phase lasts about 30 seconds.


Mental confusion persisting for more than 15 minutes


Which of these proposals are suggestive of an epileptic seizure?

Recovery is slow, often in transport to the hospital. Confusion can last a long time

Often due to the fall and does not portend the character of the crisis

Fever is a criterion of severity of the seizure, but is not in itself an element pointing to an epileptic seizure


These are two different syndromes, although their clinical impact is close

It is characterized by generalized EEG discharge

Wave peaks usually have a frequency of 3hz


Regarding treatments in a woman of childbearing potential:

In patients of childbearing potential, enzyme inducer treatments are preferred to be avoided

They decrease the effectiveness of oral contraception

Levetiracetam does not present an over-risk of malformation compared to the general population

Valproic acid should not be prescribed to a woman of childbearing age

Oxcarbazepine is contraindicated in Wilson's disease

It is contraindicated in case of porphyria


Among these anti-epileptic molecules, which are also indicated for bipolar disorders?

Broad-spectrum molecule whose main EI is asthenia. The route of elimination is renal and has a half-life between 7 and 11 hours.

Also indicated in bipolar disorder, lamotrigine is a broad-spectrum anti-epileptic whose main AE is to aggravate myoclonus, Lyell's syndrome, insomnia and headache. Its elimination pathway is hepatic (it is an enzyme inhibitor) and has a half-life of about 1 day (25 hours)

Narrow-spectrum anti-epileptic drugs with hyponatremia, rash, dizziness, and diplopia as main ARs. Its elimination pathway is mixed (hepatic and renal). It is an enzyme inducer

Broad-spectrum anti-epileptic drugs with urolithiasis and weight loss as AEs. It is also used in migraines (not in bipolar disorder)

Absolutely contraindicated in women of childbearing age. This question is based on this table: https://www.cen-neurologie.fr/sites/www.cen-neurologie.fr/files/files/capture_decran_2019-12-19_a_14.41.14.png


Which of the following proposals regarding electroencephalogram (EEG) are true?

An epileptic seizure is a clinical manifestation of the hyperactivity of a group of cortical and/or subcortical neurons

A normal EEG rules out an epileptic cause

During epileptic seizures, we can find at the EEG paroxysmal activities of the poly-peak wave (PPO) type.

EEG may reveal paroxysmal intercritical activities

EEG abnormalities can be activated by sleep deprivation


Regarding gastroesophageal reflux disease or GERD

Gastroesophageal reflux refers to the passage through the cardia of gastric contents into the esophagus

The key element of the RGP is the failure of the anti-reflux barrier forged by the lower esophageal sphincter (SIO) and the diaphragm

The combination of pyrosis acid regurgitations are almost pathognomonic of GERD


Regarding epidemiology in the general population, which propositions are true?

10% of people describe a pyrosis at least weekly

60% of people are subject to monthly GERD

No data in the college on monthly frequency

2 to 5% of people experience GERD a daily pyrosis


Which of the following refers to the main mechanism of GERD in very young infants?

Inappropriate and transient relaxations of ORS

True, with 5-second episodes of relaxation ≥ independent of swallowing


Which of the following proposals are part of the management of simple gastroesophageal reflux disease in small children?

Reassure parents about the benignity of regurgitation

Putting the child to bed in the supine position

Never advise this is a high risk factor for sudden infant death syndrome.
According to the college, the inclination of the cradle (proclive) as well as the eviction of passive smoking have no proven effectiveness.

This is not at all a contraindication to breastfeeding, which is on the contrary advisable.
If hygiene-dietary rules are not enough, it is possible to express milk and thicken it.


Which of the following are possible treatments for simple gastroesophageal reflux disease in a bottle-fed infant?

Alginates and other esophageal dressings are a controversial adjuvant measure of efficacy, especially in infants

They have an antisecretory action acids. They are therefore only effective in case of acid reflux only. They have no effectiveness on regurgitation and are not used in simple GERD.

Contraindicated in children under 18 years of age because risk of extrapyramidal syndrome.


Which of the following are complications of GERD?


It is a chronic inflammation of the pancreas resulting in progressive fibrosis of the pancreatic parenchyma

Chronic pancreatitis first affects exocrine tissue, then endocrine tissue

• At the initial stage, the disease is characterized by outbreaks of acute pancreatitis, and by chronic pain that represent the main clinical translation of the disease

• Prevalence of about 1/1,000,000 inhabitants in Western countries


Excessive alcohol consumption is the cause of the majority of chronic pancreatitis (CP) in the West

Tobacco is a risk factor present in more than 80% of cases

Hypercalcemia is a rare cause of chronic pancreatitis

hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 30 years

hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 15 years

Transfixing epigastric pain relieved by alcohol intake is a main sign of chronic pancreatitis


A pseudocyst is a fluid collection containing either pure, clear pancreatic juice or liquefied pancreatic necrosis.

A pseudocyst: • complicates 20 to 40% of PCs; • can form as a result of an acute flare-up (necrosis) or by ductal retention (clear liquid); • may remain stable, regress or become complicated: compression of a neighborhood organ (bile duct, duodenum, splenoportal axis), (resulting in a pancreatic abscess), hemorrhage or rupture in a nearby hollow organ or in the peritoneal cavity or in a serous (pleura, peritoneum)

Stenosis of the main bile duct most often results in anicteric cholestasis

Digestive bleeding occurs in 10% of chronic pancreatitis

During CP, exocrine pancreatic insufficiency occurs almost inevitably after an average of ten years of evolution


Chronic pancreatitis is a chronic inflammation of the pancreas that results in the death of the patient in the majority of cases

Migration of a gallstone into the wirsung is the main cause of chronic pancreatitis

The main cause of CP is acute pancreatia

Stenosis of the main bile duct is a cause of CP

Diabetes mellitus is one of the complications of chronic pancreatitis

Pain management in a specialized unit is essential


Concerning reasoning and decision in medicine

The medical decision precedes the decision

It is the medical reasoning that precedes the decision

The decision engages the responsibility of the doctor

The diagnostic approach corresponds to choosing the best therapy for the patient

The therapeutic approach corresponds to the fastest and most effective way to arrive at the diagnosis

The medical decision engages the responsibility of the hospital

The medical decision engages the responsibility of the one who makes it, therefore the doctor"


From the clinical signs will be built the diagnostic approach

Following the clinical interrogation, the doctor develops hypotheses based on his physiopathological clinical knowledge, in particular

Diagnostic hypotheses should always be verified by examinations such as imaging or biology.

These hypotheses will have to be verified by a guided clinical examination and possibly additional examinations

The choice of a complementary diagnostic (or therapeutic) examination must always be justified

The doctor is the one who makes the diagnosis


If there is a diagnosis, the doctor must assess its seriousness

When the diagnosis is made, the doctor should always propose a curative treatment if it exists

Situations where the proposal of a curative treatment is not a solution

The doctor usually has to inform the patient about his illness

When the main symptom does not correspond to any disease, the doctor should dismiss his patient and not prescribe anything

The doctor must try to find the motivation of the request for consultation for two reasons: to avoid medical nomadism and the prescription of unnecessary check-ups

Incidentalomas are a type of medical error

This is the detection of abnormalities unrelated to the main symptomatology"


Diagnosed pathologies should always be treated

Only when the benefit/risk balance is in favor and the treatment is the patient's will

There are 5 possible reasonings that dictate the decision to treat

There are 3: analog reasoning, pharmacological reasoning, and evidence-based reasoning.

Automatic reasoning is very common in internal medicine

It is common in medicines where the speed of action is important (eg emergency medicine, resuscitation, etc.)

Habit reasoning is an analogical type of reasoning

Reasoning by dictated behaviour is evidence-based


Medical knowledge has slowed down in recent years (few major discoveries)

The number of publications reaches peaks year after year, with great discoveries such as artificial intelligence, hepatitis and HIV treatments, CRISPR-Cas9, etc.

EBM is a conscientious use of the best current evidence from basic biological research

According to the Public Health KB, EBM is the use of clinical research data (not basic research)

4 steps: question formulation, literature review, outcome assessment and application to the patient

Literature review must follow PICO criteria

The PICO criteria concern the formulation of the question (Patient, Intervention, Comparator and Outcome)

Patient decision making (step 4) should be based on the patient's experience

As well as patient preferences and available resources"


Among these proposals, which are not components of the HBS:

The 3 components of HBS according to the KB of Public Health and the Cochrane French Centre: Clinical expertise, patient preferences and research data


Regarding the levels of evidence of the HAS:

Level 1 = Grade A = established scientific pereuve

Grade C corresponds to Level 3 and Level 4

Level 2 is that of scientific presumption

Level 3 is a low level of scientific evidence


Regarding the levels and grades of proof of the HAS:

High-powered randomized controlled trials are grade C

Grade A = Level 1 = scientifically established evidence

Grade B = Level 2 = Scientific presumption

Low-powered randomized controlled trials are grade B

As well as cohort studies, and well-conducted non-randomized controlled studies

Retrospective studies are grade C and level 3

Only case-control studies are level 3. Retrospective studies are Grade C and Level 4


The collegiate procedure may be requested by:

4 possibilities: the doctor, the family/relatives, the person of trust and the patient himself by his advance directives


Most often, it is triggered by the person of trust

By the doctor most often (cf. KB Public Health, page 35)

Only the opinions of doctors are taken into account

The entire healthcare team, the support person, etc.

The final opinion is taken by the family

The procedure is notified in the medical record

An external doctor is called in as a consultant


Which of the following proposals regarding cryptorchidism is (are) accurate?

Cryptorchidism describes an abnormal location of the testicle

Hernia / cryptorchidism association is not uncommon

Cryptorchidism is bilateral in 75% of cases

The origin of cryptorchidism is genetic most often

The scrotal migration phase is testosterone-dependent

While the intra-abdominal migration phase would be dependent on the hormone INSL3


At full-term birth, a penis smaller than 4 cm is a micropenis

Micropenis (penis < 2 cm in a term newborn)

Hormonal exploration is considered if cryptochidism persists at the end of puberty

It must be taken care of well before, from birth to find the etiology and the impact

When cryptorchidism is bilateral, the urgency is to eliminate an abnormality of the enzyme block type 21-hydroxylase

The most common abnormality of normal karyotype sexual development is the 21-hydroxylase block.

A 17-hydroxyprogesterone assay allows screening for congenital hyperplasia of the spleen

17-hydroxyprogesterone assay allows screening for congenital adrenal hyperplasia


Regarding cryptorchidism and anorchidism:

AMH testing can assess the existence of testicular functional tissue

Ultrasound can detect Müllerian derivatives if the cryptorchidism is bilateral

Anorchidism is rare and affects only one in 40 newborns

Anorchidism is much rarer and its pathophysiology is poorly understood

Surgical exploration in case of anorchidism makes it possible to look for the testicles in the abdominal area

Surgical exploration is, most often, not useful


Cryptorchidism is a call sign of a hypogodatrophic pathology that is a diagnostic emergency in the newborn

Cryptorchidism is a developmental anomaly very often found in polymalformative syndromes

There is a risk of ischemic necrosis by traction of the vascular pedicle during surgical lowering of the gonad

Two-step surgical lowering reduces the risk of necrosis

Surgical management must wait until puberty

The first consultation with a pediatric surgeon should ideally take place within the first six months of life.


In front of cryptorchidism in adults, hormonal exploration looks for type 1 diabetes

We look for hypogonadism (FSH, LH, total testosterone assay)

The determination of hCG is indicated in front of a testicular mass

A spermogram is performed to look for azoospermia or oligospermia

Testicular microlithiasis is indicative of malignant pathology

Their number greater than five should encourage vigilance given their frequent association with malignant testicular lesions.

Any cryptorchidism requires early endocrine exploration


According to a 2018 HAS care relevance report, it is preferable to perform this surgery between 6 and 12 months (spermatogenesis optimization). However, surgery should not be performed before the age of 6 months (apart from an inguinal hernia cure) because the testicle can descend spontaneously during the first months of life.

Cryptorchidism surgery patients in childhood do not need special follow-up

They must be monitored and reviewed at puberty to assess the impact on gonadal functions

Cryptorchidism may be associated with infertility

The search for cryptorchid atcd is essential during infertility consultations. It can also be associated with hypogonadism.

The relative risk of testicular cancer is zero with cryportchidism

Cryptorchidism increases RR of testicular cancer

Gynecomastia accompanying cryptorchidism points instead to hormonal dysregulation


Amyloidosis is a set of diseases characterized by extracellular tissue deposits of insoluble, fibrillar proteins, organized in folded, antiparallel beta sheets

The diagnosis of amyloidosis is histological

By biopsy of an affected organ, or, due to the dissemination of deposits, by biopsy of subcutaneous fat or accessory salivary glands

In amyloidosis, a normally insoluble protein will become soluble and form extracellular aggregates.

In amyloidosis, a normally soluble protein will become insoluble and form extracellular aggregates organized into folded, antiparallel beta sheets (amylose deposits or amyloid substance)

Some amyloidosis are acquired diseases, others are hereditary (amyloidosis by mutated transthyretin ATTR deposits)

Amyloidosis deposits are composed of 95% fibrillar proteins, and 5% glycoproteins


The biochemical nature of the amyloid fibrillar protein gives the name of the type of amyloidosis (example: amyloidosis type AL = immunoglobulin light chain)

Example: amyloidosis type AL = immunoglobulin light chain

Many proteins can cause amyloidosis deposits

Serum amyloid protein in AA amyloidosis, Ig light chains in AL amyloidosis, e.g.

The histological aspect varies according to the type of amyloidosis

Regardless of the type of amyloidosis, the histological appearance is the same: fibrils in beta-pleated sheets. They are highlighted by the Congo Red, and are birefringents to polarized light

These extracellular deposits may affect only one organ (localized amyloidosis as a single mass) or several organs (generalized amyloidosis which can be life-threatening)

They can also affect several organs (generalized amyloidosis which can be life-threatening)

The organs preferentially affected depend on the type of amyloidosis

AL amyloidosis: renal (65%), cardiac (61%), and in about 20% of cases hepatic, neurological, soft tissue or digestive system involvement. AA amyloidosis: mainly renal and hepatic damage


Kidney damage results in proteinuria, nephrotic syndrome, and renal failure

There is, classically, neither HTA nor hematuria

In case of suspicion of amyloidosis, a sample is sent to the laboratory, fixed in formalin for inclusion in paraffin for the detection of deposits, accompanied by a second sample sent fresh to be frozen for the typing of deposits

Deep rectal biopsies have a sensitivity of about 80%

They highlight gastrointestinal involvement of AL amyloidosis

Accessory salivary gland biopsies have a sensitivity of 80-85%

In case of amyloidosis, transparietal liver biopsy has a very high diagnostic interest

Frankly no interest. A blood enzyme assay is sufficient (greater increase in PAL than GGT). No cytolysis (normal TGO and TGP) and no jaundice (except in very rare cases, poor prognosis)


Regarding the skin involvement of AL amyloidosis:

They sit preferentially at the level of the legs

The preferred seat is the trunk and face

They may be accompanied by the sign of the shoulder pads


Regarding renal involvement of AL amyloidosis:

Renal failure appears in about half of cases

Kidney damage is very common: in more than 70% of cases (according to the College of Internal Medicine)

Proteinuria is mainly composed of light chains

Proteinuria is part of a glomerular syndrome (in a third of cases). It is therefore mainly composed of albumin and relatively abundant.


It is present in 10% of patients at diagnosis

It is present in 60% of patients at diagnosis

Cardiac involvement is the major prognostic factor

It is manifested by ischemic cardiomyopathy

It is a restrictive hypertrophic cardiomyopathy

It evolves towards adiastolia: the heart can no longer relax

It progresses to restrictive heart failure


What is the organ with the most severe prognosis?

True, mortality from amyloidosis is largely linked to cardiac involvement (restrictive cardiomyopathy). The appearance is brilliant in ultrasound. There is a QS V1-V3 microvoltage on the ECG.


The Medical Psychological Centre (CMP) is the pivotal structure of the sector

The Medical and Psychological Centres (CMP) offer outpatient care

Liberal psychiatrists are very much in touch with the actors of general medicine

Multidisciplinary health homes are time-full hospitalization structures

Ambulatory. We also talk about a multi-professional health home.

The financing of the health care system is provided by health insurance


Health insurance is based on a logic of compensation for illness

In general, health insurance guarantees the reimbursement of care provided as part of the "Coordinated Care Pathway".

In case of consultation with a medical specialist, the maximum reimbursement rate is guaranteed to the insured if the pathology is serious

If he is referred by his "attending physician"

A patient between 16 and 25 years of age can consult a psychiatry without losing the usual rate of reimbursement

The use of the psychiatric care system is declining sharply


Regarding the organization of psychiatric care in France:

The prevalence of mental disorders in the general population in France is about 3%

The fight against stigmatization of people with psychiatric disorders is still relevant

The HSPT law of 2009 provides for the creation of ARS responsible for defining new health territories relevant to fight against health inequalities.

Psychiatry is the only medical discipline that can provide care without the consent of the person

The different types of care without consent can only be provided by public structures

The different types of care without consent (full inpatient or outpatient) are most often provided by public psychiatric services, but some private institutions may also provide this type of care.


Sequential care occurs after the CMP for the follow-up of the compensated patient

Part-time therapeutic reception centres (CATTP) provide therapeutic and occupational activities

Full-time hospitalization corresponds to "traditional" hospitalization within the hospital (24 hours a day), during the acute phase of the disease

The after-care centers are very short-stay units to ensure the compensation of the disease in 48 hours

After-care centres are medium-stay units, transitional units between hospital and return home

Care aims to limit disability and support the return to independence


The most used care structure in child psychiatry is the HDJ

The most widely used care structure in child psychiatry is the CMP


Multidisciplinary structure (doctors, nurses, social workers, psychologists, ...) public.

They allow hospital care of decompensated patients

The reimbursement of consultations is made within 72 hours


Regarding the epidemiology of the impact of mental disorders:

Mental disorders account for 15% of disabilities

Mental disorders cause more disability than cardiovascular disease

Mental disorders cause more disability than cancers

About 2% of the French population suffers from mental disorders

Mental disorders account for 30% of life days lost through preventable mortality or disability


There are three main somatoform disorders

The distinction between somatoform disorder and psychosomatic disorder is clearly identified and clinically important

The distinction between somatoform disorder and psychosomatic disorder is not always easy and repeated changes in nosographic classifications have contributed to the confusion.

The prevalence of somatoform disorders is around 0.1% in adults in the general population

The prevalence of somatoform disorders is difficult to identify and depends on diagnostic tools and context: it is probably in the range of 5 to 10% for all somatoform disorders in the general adult population (and much more so in a population of medical consultants)

Somatization disorder typically begins in late adolescence or young adulthood, at any age for conversion disorder and pain disorder

The ratio by sex is 2:1, with a more frequent presence in women


The prevalence of suicide attempts is a function of the depressive psychiatric comorbidity to be systematically sought

The association of multiple polymorphic and long-lasting functional complaints has been called Lighter syndrome

Symptoms and signs do not respect the anatomical organization of the central or peripheral nervous system in conversion disorder

In the case of the painful symptom, it is pain whose intensity must be evaluated by a visual analogue scale

We speak of acute painful symptoms if the duration is less than 6 months


A prolonged fever is defined as a temperature above 38°C for more than 3 weeks.

10% of prolonged fevers remain without identified etiology, and then require patient monitoring

The temperature is taken, at best, just after the meal

The temperature is taken away from meals and after 20 minutes of rest

The axillary or oral routes are usually used and the measured temperature must be increased by 2°C to obtain the core temperature.

The axillary or oral tract is usually used: the measured temperature must be increased by 0.5°C to obtain the core temperature

The drugs mainly involved in prolonged fivres are antibiotics (ßlactams, rifampicin ...), antiepileptics and antiarrhythmics

Iatrogenic etiology is one of the elimination diagnoses


It will be necessary to look for a dental or sinus focus

Malignant diseases are responsible for 20 to 30% of prolonged fevers

"HORTON's disease is the most common immunoinflammatory cause"

In case of drug cause, fever usually occurs between 7 and 28 days after the introduction of a new treatment

Hypereosinophilia is present in only 20% of drug-induced fever cases


What is the threshold for defining the prolonged nature of a fever?

True. A prolonged fever is defined as a body temperature above 38.3 degrees Celsius for more than three weeks.


Regarding the inflammatory reaction in general:

Inflammatory diseases are the leading cause of death

It is the third leading cause of global mortality, after cancer (1) and cardiovascular disease (2)

About 30% of hospitalized patients have a general inflammatory reaction

Inflammatory diseases are often accompanied by AEG

The 4 clinical signs of inflammation are: redness, warmth, pain, effusion

The 4 cardinal signs are rougueur, pain, edema and heat

Hypotermia eliminates the possibility of an inflammatory reaction

Some inflammatory diseases are accompanied by a body temperature < 36 degrees Celsius


Which molecules are classically increased during an inflammatory reaction?

Albumin is decreased. This is clearly seen in protein electrophoresis


What can be the causes of a normal ESR inflammatory syndrome?

Renal failure increases ESR (even without inflammatory syndrome)

Polyclonal hypergammaglobulinemia increases ESR, even in the absence of an inflammatory syndrome


Which of these proposals concerning cardiovascular prevention are true?

A risk factor is a clinical or biological element associated with an increased risk of developing a disease, with a causal relationship between the factor and the disease.

In the case of a statistical association without a causal relationship, we speak of a risk marker

Removal or reduction of a risk marker does not change the course of a disease

A risk marker is not causally linked to the disease

Framingham study estimates cardiovascular mortality at 10 years

Risk of cardiovascular events, not mortality

In individual prevention, the effect of a prevention program is all the greater the higher the risk of the disease

Aspirin is systematically indicated for secondary prevention of cardiovascular risk

After a vascular event, the risk is considered very high, aspirin has a benefit


An absolute risk makes it possible to estimate the risk of an event in an individual over time

While relative risk allows for comparison

Absolute cardiovascular deaths lower in women than in men

The absolute number of cardiovascular deaths is higher in women (54%), but before age 65 the cardiovascular mortality of men is 3 to 4 times higher than that of women

The SCORE depends among other things on the LDLc level

The SCORE is valid for any adult under 65 years of age

The SCORE is valid between 40 and 65 years only

Dairy products are associated with increased cardiovascular risk


Smoking lowers LDL-cholesterol levels and increases HDL-cholesterol levels

Lowering of HDL-cholesterol levels and increased oxidation of LDL-cholesterol, which participates in atherogenesis

SCORE tends to underestimate cardiovascular risk in desocialized patients

Sleep apnea syndrome increases cardiovascular risk by 70%

Erectile dysfunction is a cardiovascular risk factor


The share attributable to smoking in the occurrence of myocardial infarction is all the more important the younger the subjects

The risk of developing an abdominal aortic aneurysm is significantly increased in smokers

A high cardiovascular risk corresponds to a SCORE of 5-10%

Elevated fibrinogen is associated with coronary cardiovascular excess risk

High blood pressure exposes more to cerebrovascular risk than coronary risk


Dyslipidemia is a minor cardiovascular risk factor

An EAL includes a determination of TG, LDLc and HDLc

LDLc is calculated, according to Friedewald's formula

Hypercholesterolemia is mainly due to too high intakes of unsaturated fatty acids

The diagnosis of hypertension is made on a single measurement when the blood pressure is greater than 180/60 mmHg

The diagnosis of hypertension should not be made on a single measurement

A normal EAL should be rechecked at 5 years in the absence of an intercurrent event


The ambulatory measurement of blood pressure (MAPA) eliminates a "white coat" effect related to the presence of the doctor

A screening EAL is recommended for an 85-year-old smoker

A 45-year-old type 1 diabetic with no other cardiovascular risk factors or organ damage has a moderate cardiovascular risk

Abdominal obesity is an indispensable criterion in the diagnosis of metabolic syndrome

It is no longer an indispensable criterion

About 20 million French people are overweight, including 6 million obese


Which of the following are non-modifiable cardiovascular risk factors?

Modifiable because it can be taken care of and made sure that it is no longer a risk factor

Non-pharmacological and pharmacological management


Which of the following designate situations in which the SCORE table is not usable?


Which of the following proposals fall within the scope of metabolic syndrome?


A rise in cortisol levels can precipitate or maintain delirium

It is believed that the cholinergic system is largely involved

It corresponds to acute and severe brain dysfunction

It is responsible for an increase in morbidity and mortality in the following year.


Which of these proposals are part of the DSM-V diagnostic criteria?

It is the decrease in the ability to lead, focus, support and shift attention.

The installation is on a short time, from a few hours to a few days

It is necessary to highlight a break with the previous state

In particular through the interrogation of a relative

No biological criteria. The diagnosis is purely clinical


Regarding 5-FU, which propositions are true?

It is an analogue of pyrmidines (bases C, T and U)

It is an inhibitor of topoisomerases type II

Toposiomerase type 2 inhibitors are etoposide and anthracycline


Which of these proposals is, or are, type 2 topoisomerase inhibitors?

It is an antimetabolic (analogue of pyramidin)


Which of these propositions is, or is, or is, true with respect to platinum salts?

The three platinum salts are: cisplatin, oxaliplatin and carboplatin

These compounds are DNA alkylating agents

Cisplatin has renal toxicity that may cause acute tubular necrosis


Which of these proposals are, or are, expected adverse effects of hydroxyurea?

Hydroxyurea is a myelosupressor: penias can be observed (leukopenia, thrombocytopenia, or even macrocytic anemia)


Which of these proposals are, or are, folic antimetabolics?

It is a pyrimide antimetabolic, along with gemcitabine


Which of these proposals are, or are, stabilizers of the spindle?


Which of the following are true about Denosumab?


Platinum salts block chromosome depolymerization

This is the case with depolymerase inhibitors (taxanes such as Paclitaxel)

Platinum salts cause adducts with DNA inhibiting its replication

This is the case of Tecans (irinotecan and topotecan)

Platinum salts inhibit the action of topoisomerase II

This is the case for anthracyclines and etoposide


Which of the following are the toxicities of platinum salts?

This is the case of 5-FU (coronary spasm) and anthracyclines (dilated cardiomyopathy)


Which of the following are recommended before starting Denosumab therapy?

True, in front of the risk of hypercalcemia


Which of the following are complications of an autologous transplant?


Anthracyclines have cumulative cardiac toxicity

Trastuzumab poses risk of myocardial toxicity

Anti-pyrimides are topoisomerase inhibitors


Which of the following are true for bentuximab?

False, this is the case of Jakavi for example

There is a risk of peripheral neuropathy


Which of the following proposals regarding the adverse effects of brain radiotherapy are true?

True, due to transient diffuse demyelination


Which of these proposals make it possible to study isolated cells?

Biopsies of solid tumours extract tissue, not isolated cells.

Biopsy of a gastric tumor induced by H. Pylori

While the BOM makes it possible to study the fabric


Among these colorations, which one or which ones make it possible to highlight Iron?

It makes it possible to highlight the iron fixed in hemosiderin colored blue by Prussian blue; The nuclei are highlighted by nuclear red.

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

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


Which of these stains can highlight lipids?

Sudan dyes are synthetic dyes characterized by a nitrogen group. Their main property is to be soluble in hydrocarbons, oils, fats and waxes, which are then colored.

It is the dye used to highlight Acid-Alcohol-Resistant Bacilli (tuberculosis bacilli)


Genital bleeding is a very rare reason for consultation in general practice

The main etiology is urinary tract infection

2 main etiologies: hormonal dysfunctions + pregnancy

Pregnancy is a leading cause of genital bleeding

The essential complementary examination is the LH/FSH assay

They are therefore not limited to uterine haemorrhages


A distinction is made between vulvar hemorrhages, vaginal hemorrhages and cervical hemorrhages

These are the three subtypes of hemorrhages

In case of suspicion of adenomyosis, MRI is indicated

Postmenopausal endometrial cancer should be suspected

Upper genital hemorrhage originates from the cervix

This would be a lower genital hemorrhage. High = hutterine cavity externalized by the cervix

The duration of normal menstruation is between 3 and 6 days

Normal abundance is between 50 and 80 mL


Regarding abnormal bleeding during menstruation:

Conventionally the periods are more abundant the first 3 days and less abundant thereafter

Normal period blood is coagulable, like venous blood

Rules with anomalies of duration and abundance

The prevalence of menometrorrhagia is around 1% in the general population


Functional metrorrhagia are due to endometrial alteration

Often caused by an imbalance in the estrogen-progestin balance

Organic bleeding affects the cervix most often

Uterine, tubal or ovarian pathology. Bleeding from the cervix is part of lower genital bleeding

The causes of menoage and metrorrhagia are often intertwined

Genital bleeding is not limited to uterine hemorrhages

They are due to a permanent or temporary alteration of the endometrium caused by a hormonal imbalance of the estrogen-progestin balance


Biotherapies have existed for a hundred years

Biotherapies are molecules taken from the human body and injected in large quantities into sick people

They are substances produced and purified from the use of living organisms for the purpose of treating diseases

Background treatments are opposed to symptomatic treatments

DMARDs are Drug Modifing the Activity of the Rheumatic Disease

Synthetic and biological DMARDs are separated


A distinction is made between original bDMARDs (boDMARDs) and biosimilar bDMARDs (bsDMARDs)

Biosimilars are copies of the original molecules but require the same technology to produce them.

The boDMARD are cheaper than the bsDMARDs


The tsDMARDs are the targeted synthetic DMARDs

The bsDMARDs are the biological original DMARDs

There are twelve biotherapies that have a MA in chronic inflammatory rheumatism and autoimmune diseases

The prescription of biomedicines is governed by an initial hospital prescription (PIH)

The first-line prescription in osteoarthritis is methotrexate


Regarding the indications for targeted therapies:

If contraindications to methotrexate in RA are prescribed.

In RA, it is generally advisable to combine biotherapy with DMARD

Secukinumab has MA for ankylosing spondylitis

Secukinumab has MA only in ankylosing spondylitis


What are the indications for phenotyped red blood cells?

Unless at risk of repetitive transfusions


Which of these substances can cause secondary Raynaud's syndrome?

Class III antiarrhythmic according to the Vaughan-Williams classification. It delays the repolarization of the heart cell and extends the refractory period of the latter homogeneously. It has no significant effect on vasoconstriction of finger arteries.

It is the beta-blockers that cause peripheral vasoconstriction

ACE inhibitors (which then reduce the production of angiotensin II) do not have significant effects on the arteries of the hands

calcium channel blockers, such as nifedipine or amlodipine, reduce the number of seizures and decrease their severity through their vasodilator effect


Which of these proposals concerning Raynaud's syndrome is true?

The syncopal phase begins the phenomenon

During the syncopal phase, the fingers are red

The syncopal phase is accompanied by cutaneous hyperesthesia

Rather, there is cutaneous hypoaesthesia


Raynaud's phenomenon is the most common acrosyndrome.

Acrosyndromes may be accompanied by trophic disorders

Scleroderma may accompany Raynaud's phenomenon

Raynaud's disease is the only etiology of Raynaud's phenomenon

Raynaud's phenomenon can have many etiologies: Rayaud's disease, scleroderma, Leo Burger, ...

Essential acrocyanosis finds hot and painful extremities

In essential acrocyanosis, the extremities are purple, cold, clammy and painless.


Which of these proposals are acrosyndromes?

Skin lesions after exposure to cold and/or moisture


It is also called Thromboangiitis Obliterans

It is characterized by segmental and inflammatory obliteration of medium and small vessels

The role of tobacco appears essential in the initiation and clinical aggravation of the disease.

It is benign and does not require further examination

An underlying immunological cause or thrombophilia (inflammatory or immunological assessment for ANCA, antiphospholipid antibodies, or antinuclear antibodies) must be ruled out and imaging tests are often required

Calcium channel blockers are proposed as a first-line treatment

There is currently no specific treatment for Buerger's disease. Only smoking cessation has been shown to be effective


The basics of autosomal dominant polycystic kidney disease (ADPKD):

Autosomal dominant polycystic kidney disease has a prevalence of 1/1,000 in the general population

It causes about 60-80% of end-stage renal failure

The leading cause of ESRD is hypertensive nephropathy. ADPKD is responsible for 8-10% of IRTs

Transmission of the disease occurs in an autosomal dominant manner

The gene concerned is located on the Y chromosome

It is either chromosome 16 (for PKD1) or chromosome 4 (for PKD2)


It's the opposite: the frequency of PKD1 is 85%

About 5% of patients have a de novo mutation

Abdominal ultrasound can evoke the diagnosis

The diagnosis is most often made from the age of 60, when renal failure becomes terminal

It is usually in young adults (hypertension, abdominal thinker, etc.)

After the age of 40, the presence of less than 2 cysts excludes the disease


Ultrasound has a higher sensitivity than CT scan

Cysts are multiple and bilateral most often

Cysts are responsible for compression and progressive fibrosis of the non-cystic renal parenchyma

ADPKD is therefore glomerular nephropathy


The exact characterization of the mutation in question is essential

Being a polygenic disease, with relatively independent management of the type of mutation, accurate genetic analysis is both complex and unnecessary

The mode of transmission concerns gonosomes

Chromosome 4 (PKAD 2) and 16 (PKAD 1) mostly

It requires a family tree for the identification and monitoring of relatives

It is linked to de novo mutations in 90% of cases


What are the symptoms possibly caused by autosomal dominant polycystic kidney disease?


Regarding the conscriptive cerebrity aneurysms of PKAD:

The prevalence of cerebral aneurysms is 40% in case of confirmed PKAD

8%, or 16% in case of family history of aneurysm. In the general population, the prevalence is 1.5%

They sit preferentially within the Willis polygon

Screening angio-MRI should be offered before age 50 to first-degree relatives of PKRAD patients who have ruptured a cerebral aneurysm


A brain aneurysm should be routinely tested for by MRI angiography in all patients with ADPKD

False. Only if a patient has a 1st degree family history of brain aneurysm, or if the patient is doing a risky job (e.g. airline pilot)

In a family with ADPKD, an unaffected person does not transmit the disease

About 5% of patients have a de novo mutation, i.e. one not transmitted by a parent

When faced with the diagnosis of ADPKD, it is not currently indicated to identify the genetic mutation in families, except in special cases

If a mother with ADPKD wishes to have a child, she can have genetic counselling and pre-implantation diagnosis.

False. This is not provided for in the ADRP


In what circumstances(ies) can the diagnosis of ADKDP be affirmed?

6 cysts per kidney in a subject over 60 years of age

1 cyst on the right kidney and 2 cysts on the left kidney in a 45-year-old subject

False. It takes ≥ 2 cysts / kidney between 40 and 60 years to make the diagnosis.

4 cysts per kidney in a 63-year-old subject

False. It is necessary ≥ 5 cysts / kidney from 60 years

1 cyst on the left kidney and 2 cysts on the right kidney in a 33-year-old subject

True. ≥ 3 uni- or bilateral cysts if the subject is under 40 years of age.

5 cysts on the right kidney and 4 cysts on the left kidney in a 69-year-old subject


A patient under 18 years of age with a parent with ADPKD should be screened by abdominal ultrasound

False. No screening of minors. Abdominal ultrasound will be done after 18 years

In a patient under 18 years of age with a parent with ADPKDP, paediatric follow-up with annual monitoring of hypertension is required.

Renal involvement is secondary to the progressive development of multiple cysts in both kidneys, responsible for compression and progressive fibrosis of the non-cystic renal parenchyma.

Cysts are developed only at the expense of the distal renal tubules

False. Cysts are developed at the expense of any renal tubule

The growth of cysts results from a proliferation of the cells lining the cysts, and a secretion of fluid by these same cells


In front of a patient affected by ADPKD and who has macroscopic hematuria without fever, it is necessary to evoke what diagnosis(s)?


Which of the following proposals may be present in a patient with ADPKD?


Regarding the management of intracystic infections. Which of the following are true?

If ECBU does not show bacteria, the diagnosis of a kidney cyst infection may be rejected

False. ECBU is often sterile because the bacteria are in the cyst.

Dual therapy with C3G + amikacin is recommended

False. Fluoroquinolone + Cotrimoxazole 3 to weeks

It is necessary to systematically puncture the cyst to evacuate its contents

False. A puncture of the cyst will be done when there is a persistence of fever > 7 days under dual antibiotic therapy

A PET scanner is systematically recommended

False. The PET scanner can be done in case of failure of antibiotic therapy


Generalized oedema is the consequence of extracellular hyperhydration

An anasarca corresponds to edema of the lower limbs that do not disappear after 3 months

It is the association of generalized edema and effusions of serous

Generalized edema is not accompanied by ochre dermatitis

A venous obstacle can only involve generalized edema

The formation of edema requires increased purification of salt by the kidneys

On the contrary, sodium and water retention is observed by the kidneys


The increase in capillary hydrostatic pressure corresponds to an increase in Starling force

Areas with minimal capillary hydrostatic pressure are deck zones.

The capillary hydrostatic pressure is, on the contrary, maximum in the detached zones. This is why edema is formed preferentially in these areas (lower limbs when the patient is in an upright position, lower back when he is in a horizontal position)

The amount of sodium contained in the human body determines the extracellular volume

The regulation of the body's sodium capital is carried out by the liver

True hypervolemia is sodium retention by the kidney


Regarding the etiologies of edema and their clinical signs:

In heart failure, antinatriuretic systems are stimulated and reabsorb sodium and water

The increase in blood volume following the positive sodium and fluid balance increases filling pressures and improves cardiac function

True hypovolemia is observed in hepatic cirrhosis

It is an effective hypovolemia that is due to the sequestration of blood in the splanchnic territory

Clinical signs begin to be frank from 100 mL of edema

They are frank when they exceed 3% of body weight (2L at least)

Generalized edema is white, soft, painful and does not take the bucket

They are bilateral, symmetrical, declivated, white, soft, painless, taking the bucket


Regular weighing of a patient is the best parameter to evaluate the effectiveness of the treatment put in place

Edema has no clear consequences on the biological balance

Hemodilution and decreased hematocrit and protein are observed

Natriueresis is preserved in the phase of constitution of edema

Chronic or acute viral hepatitis can cause edema


An increase in capillary hydrostatic pressure


A 50-year-old patient consults for edema of the lower limbs. The balance sheet finds a hypertension, an albuminemia at 20 g / L, a proteinemia at 50 g / L, a natremia at 120 mmol / L. BU: 3 cross of prot, a cross of red blood cells, no leukocyte. The patient presents:

Natremia reflection of the intraCR sector

Nephrotic SD: Proteinuria + Hypoabuminemia. Impure because hematuria and HTA.


The quality of care and the health system is a real public health issue

Health system evaluation structures were created very late. The first (ANDEM) was created in 1989.

The HAS (Haute Autorité de Santé) was created in 1946

2004. She is the descendant of ANAES (1996), herself who comes from ANDEM (1989)

The quality approach is inspired by the world of industry and services


Quality of care is an approach that must allow:

To guarantee him the best care (not necessarily cure)

Have a minimum cost for acceptable results

Have a minimum cost for the best result (concept of efficiency)

To bring the best satisfaction to the stakeholders (patients and caregivers)


Concerning the generalities of the quality approach

The France was very early in the field of quality approach with many institutions created in the 19th century

The France has been slow to set up evaluation structures: ANDEM in 1989 (National Agency for the Development of Medical Evaluation), which became ANAES in 1996 (National Agency for Accreditation and Evaluation in Health), then HAS in 2004 (High Authority for Health)

The formalization of a "quality approach", inspired by the world of industry and services, gradually developed in France, after having imposed itself in Anglo-Saxon countries.

Quality is the set of properties of a product that make it last over time

Set of properties and characteristics of a product or product that give it service the ability to satisfy expressed or implicit needs (ISO 8402)

Quality assurance is the set of actions necessary to give the appropriate confidence that a product or service will meet the requirements

The quality approach is the set of actions to satisfy customers and users.


Which of these proposals are indicators of quality and safety of care?

It is an indicator. It does not validate one.


Regarding quality and safety of care indicators:

3 types: structure indicator, process indicator, result indicator

Cross-cutting themes and specialty themes"


Each hospital has the obligation to have a quality department with a quality manager.

The continuous quality improvement approach is symbolized by the Demin wheel

A quality and safety of care indicator is a tool for tracking the costs of safety procedures

Tool for measuring a state of health, one or the practical occurrence of an event, which makes it possible to evaluate in a valid and reliable way the quality of care and its variations in time and space

The scope of application of quality indicators is limited to peripheral CHU and CHU with more than 200 employees

Public and private health institutions by the HAS: IPAQSS program (Indicators for the Improvement of Quality and Safety Management of Care)

The HAS regularly informs the ARS of the commitment and progress of the establishments in the certification procedure.


Regarding the certification process for healthcare facilities

The interface document must be sent 3 weeks before sending the quality account

Sent by the establishment to the HAS in the 6 months preceding the sending of the Quality Account (i.e. 12 months before the visit)

The HAS chooses a visit date for certification and has the legal obligation to respect it

The HAS may postpone the certification visit if important points of patient safety management are not fulfilled by the institution, after analysis of the interface document

The method of analysis of the quality account is chosen and specific to each institution: it is not imposed by the HAS.

The HAS has the sole role of visiting the establishment and issuing (or not) the certification based on it only

It carries out a quality control of the Quality Account: it can request additional information

The visiting experts are appointed by the HAS


Regarding the different levels of certification:

Certification with improvement recommendation is valid for 3 years

The decision to suspend certification requires a follow-up visit within 6 months

A new decision will be rendered at the end of this follow-up visit

Simple certification is valid for 4 years

Certification with improvement obligations requires the sending of a quality account 12 months before the visit


The HAS makes the decision to certify or not an establishment after analyzing the recommendations of the CREDO

The certification report is confidential and the health institution is prohibited from disseminating it

The institution must: ensure the widest possible dissemination of the certification report (CME, CDU ...) make available to the public the results of the quality and safety of care indicators

The institution's welcome booklet for inpatients must include information on the results of the various procedures for assessing the quality of care.

The HAS website must not contain hospital certification reports

The HAS publishes the certifications and the various reports on its website

The accreditation of doctors is implemented by the HAS


Which of these specialties are subject to accreditation?

Obstrical ultrasound, gynecology-obstetrics, surgeries, anesthesia-resuscitation, intensive care and interventional specialties


Crohn's disease can affect all segments of the digestive tract, most commonly the terminal ileum, colon and anus.

Crohn's disease can start at any age but its peak frequency is between 20 and 30 years

To make the diagnosis, it is necessary to perform an eso-gastro-duodenal endoscopy and an ileocolonoscopy with biopsies of the injured areas but also macroscopically healthy areas

The endoscopic lesions of Crohn's disease are very specific

The endoscopic lesions of Crohn's disease are not specific

Lesions extend into the digestive tract without leaving gaps of healthy mucosa

Intervals of healthy mucosa are possible,


Among the characteristics of ulcerative colitis:

It is absent: there is no involvement of the anus in UC

The colonic extension can reach, at most, the cecum

There are healthy mucosa intervals between lesions

Lesions do not leave a healthy mucosa gap


Regarding the etiologies of progressive visual acuity decreases:

Cataract is a clouding of the vitreous humor

The topography of cataract clouding is always peripheral

It can be nuclear (central), cortical (peripheral) or posterior

Chronic open-angle glaucoma is immediately symptomatic

Long asymptomatic, unlike angle-closure glaucoma

The most common hereditary maculopathy is Stargardt's disease

Retinopathy pigmentosa concerns batônnets in priority

Sometimes the damage can extend to the cones and lead to complete blindness.


Which of the following are part of the posterior segment?

It is on this fibrous support shell that the oculomotor muscles are inserted. It is also in its posterior part that the optic nerve is inserted.


Which of the following proposals are transparent environments of the eye?

3 transparent media: vitreous body, aqueous humor, crystalline


Which of the following proposals are part of the previous segment?


An ulcer is defined as a loss of substance from the gastric or duodenal wall deeply affecting the muscular.

Gastric or duodenal ulcers (UGD) result from the imbalance between chlorhydropeptic aggression and defense mechanisms (mucosal barrier) at a specific point in the mucosa

H. pylori is a gram-positive cocci that resists gastric acidity thanks to its urease activity and colonizes the surface of the gastric mucosa

H. pylori infection is most often acquired in childhood by the oral-oral or faecal-oral route

Most often, gastritis with HP does not get complicated


Selective NSAIDs (coxibs) that inhibit COX-2 by preserving COX-1 activity reduce the risk of ulcerative complications

They do not eliminate this risk but reduce it, in fact

Zolliger ellison syndrome should be evoked in case of multiple or recurrent ulcers, which are often complicated

"Stress" or psychological factors have no demonstrated role in the pathophysiology of ulcer

The incidence of DMUs has increased in developed countries over the past 3 decades

The incidence of GDU has declined in developed countries over the past 3 decades in line with the decline in gastric H-infection.

Duodenal ulcer is less common than gastric ulcer before age 55


The mortality rate for ulcerative complications is about 10%

The typical ulcer syndrome is an association of epigastric pain, without irradiation, punctuated by meals with a free interval of 1 to 3 hours, type of cramp or painful hunger, calmed by taking food or antacids.

This is the classic definition. Beware, however, of atypical syndromes

Physical examination is normal in the absence of complications

Upper GI endoscopy allows to visualize the upper digestive tract up to the second duodenum and to perform biopsies

Gastrodudenal endoscopy is the key diagnostic test


Gastric ulcer is at risk of cancerization

NSAIDs are responsible for one-third of ulcer complications

Duodenal ulcer requires systematic healing control

The eradication treatment of H. pylori is based on antibiotics only, for 10 to 14 days depending on the chosen protocol

Antibiotics + PPI +/bismuth salts according to protocol


Which of the following are true for Helicobacter pylori?

It is a risk factor for gastric carcinoma (in case of gastric atrophy)

Also called Endobrachyoesophagus
Risk factors tend to be overweight or chronic GERD


It is a risk factor for the occurrence of duodenal ulcer

It is contracted most often in childhood

100% of Helicobacter pyloria infections progress to gastritis

True, according to Figure 9.2 of the 4th edition of the HGE College


Regarding genital bleeding in the 1st trimester:

Genital bleeding complicates about 25% of pregnancies

A molar pregnancy is a very rare cause of 1st trimester hemorrhage

Cervical cancer is a very rare cause of 1st trimester hemorrhage

The vaginal examination makes it possible to check the permeability of the cervix and the possible presence of a laterouterine mass

The vaginal touch makes it possible to appreciate the condition of the cervix, the uterine volume, the appendages. TRUE

Genital bleeding of the first trimester is frequent, it does not require additional examination

Any genital bleeding in a pregnant woman should be explored. The main complementary examinations are: • plasma assay of 'hCG in case of doubt about the state of pregnancy, an endovaginal ultrasound and a urine strip. A blood test will be performed in case of significant hemorrhage with hemodynamic impact.


Which of these signs is (are) in favor of spontaneous abortion?

A disappearance of sympathetic signs of pregnancy

Dark blood hemorrhages without clots or debris

Light red blood, abundant, with clots and debris


The presence of an intrauterine device is in favor of a GEU

If pregnant in a woman with an IUD, it is more likely to be a GEU. However, the IUD is not recognized as an ELT FDR. TRUE

A very large uterus is a clinical sign in favor of a GEU

In case of GEU, the uterus is smaller than the expected volume in case of intrauterine pregnancy.

There is a loose and open collar in case of GEU

In case of GEU, the cervix will be rather toned and closed

The presence of a painless laterouterine mass is a clinical sign in favor of a GEU

The inconstant laterouterine mass (the GEU) will typically be painful, pain may be caused in the lateral or posterior cul-de-sac (signs of peritoneal irritation)

A well-centered intrauterine egg sac in the uterine cavity points to a normal pregnancy.

Be careful, the "pseudo-bag" is to be distinguished from the gestational sac. Unlike the gestational sac, the pseudo-sac is centered in the cavity and without trophoblastic crown (unlike the gestational sac which is lateralized and with a peripheral hypoechoic area): it is often a blood clot
in the uterine cavity, in the process of expulsion, which can be found on ultrasound in case of GEU. Pseudo-sac is common and can lead to a misdiagnosis.


Trophoblastic disease or molar pregnancy is exceptional in the West, more common in Southeast Asia. It results from an abnormality of fertilization and is characterized by abnormal trophoblastic proliferation without possible normal embryonic development.

A molar pregnancy results in a uterus that is smaller than gestational age would like.

On ultrasound: the uterus is larger than the management age would like. It is occupied by a heterogeneous, flaky mass, containing multiple small vesicles. The ovaries are large, polycystic

Ultrasound finds no ocular cavity or visible embryo in case of trophoblastic disease.

Indeed, there can be no embryonic development in case of trophoblastic disease. TRUE

The diagnosis of molar pregnancy is ultrasound

The diagnosis evoked on ultrasound requires aspiration under ultrasound control with systematic histopathological examination

Molar pregnancy is accompanied by very intense sympathetic signs of pregnancy, as well as very high hCG levels. Treatment consists of aspiration of endouterine contents under GA, and monitoring of the correct decrease in hCG levels over time. In the absence of decay, invasive mole or cholangiocarcinoma (chemotherapy treatment) may be feared.