Regarding autonomy and dependence in the elderly, what are the exact proposal(s)?

A USLD is a residential service for chronic and disabling pathologies, and a UHR is a residential service for chronic and disabling psychiatric pathologies.

True, it includes an organization of several face-to-face aids

The SSIAD is a service combining personal assistance and administrative assistance

True, it also allows a reassessment of the aid plan to relieve caregivers physically and psychically

"Respite hospitalizations" are hospitalizations to allow caregivers to rest

False, this MCQ was important to know the classic APA criteria (>60 years, France > 3 months) but also to know the IRM grid. It goes from GIR 6 (autonomous) to GIR 1 (moribund) and the APA is given for GIR 1 to 4.

The APA (Personalized Autonomy Allowance) is available to people over 60 years old, living in France for at least 3 months, being classified in the GIR grid 2 to 6

True, three times true. Auxiliaries, remote alarm, carrying meals, housing development, protections, HDJ, temporary accommodation, nursing homes

The APA finances numerous physical, material and financial aids


Which of the following are possible allergens?

True. Allergens are proteins of animal or plant origin.

With some exceptions, carbohydrates (lactose in particular) and lipids are not allergenic.


At what apnea/hypopnea index threshold, are we talking about obstructive sleep apnea syndrome?

False, this is the apnea threshold for the child

False, this is the threshold of severity of sleep apnea


Which of the following propositions regarding obstructive sleep apnea syndrome is true?

True, OSA screening must be carried out in front of a risk terrain (cardiovascular comorbidities, cardiovascular risk factors, metabolic syndrome, respiratory pathologies) and / or revealing symptoms (snoring, pauses, suffocation, apnea, nocturia, anxio-depressive syndrome, daytime sleepiness ...)

Any obese patient with snoring should be referred for consultation or should perform nocturnal oximetry screening for sleep apnea syndrome

False, the Epworth score looks for daytime sleepiness. It is pathological when it is greater than 11

Epworth score looks for nocturnal symptoms of sleep apnea through interrogation elements

False, the screening is done by nocturnal oximetry (imagine it as a Holter of SaO2) and the diagnosis is done by ventilatory polygraphy or polysomnography

Screening for obstructive sleep apnea syndrome is done by nocturnal ventilatory polygraphy.

True, it is part of the comorbidities that may indicate bariatric surgery during a BMI >35 especially because its improvement in post-surgery is quite frequent

Obstructive sleep apnea syndrome may be an indication for bariatric surgery in case of BMI > 35

True, fatal risk to the patient due to drowsiness

Obstructive sleep apnea syndrome is a temporary contraindication to driving


What is the threshold of the Golde score defining intraalveolar hemorrhage?


Regarding febrile rashes, which of these propositions are true?

True, a fever in children is rarely greater than 5 days, Kawasaki syndrome is sought with cardiac ultrasound and CBC

A febrile rash of more than 5 days in children should be tested for Kawasaki syndrome

True, these two forms of rashes are called "large simulators", HIV and syphilis can mimic many dermatological pathologies ...

An atypical, poorly systematized rash in adults should be reminiscent of HIV or syphilis

False, it is an erythema called in "bellows" (bright red cheeks and edematous) and "gloves and socks" (red hands and feet edematous)

A so-called "cervical cache" erythema is found in Parvovirus B19 infection

True, this is scarlet fever caused by a Strepto A infection.

Of the most common febrile childhood rashes, only one is of bacterial origin

False, there is only one flare-up during measles with a start behind the ear and a downward path.

Unlike rubella, measles progresses in several outbreaks


Regarding pruritus, what are the exact proposal(s)?

True, it is to be distinguished from physiological pruritus which has no impact.

Pruritus is said to be pathological when it causes lesions or functional repercussions

False, a pruritus sine materia is a pruritus that does not have lesions except those caused by pruritus itself.

A pruritus sine materia is a pruritus that does not present lesions and therefore and is synonymous with physiological pruritus

False, nasty trap, but urticaria and psoriasis have dermatological lesions...

Causes of pruritus sine materia frequently include dysthyroidism, medications, parasitosis, hives, psoriasis, cholestasis and hemopathies.

The assessment of pruritus sine materia includes: NFS, CRP, Iono, BR, BH, TSH, HIV/HBV/HCV, abdominal ultrasound, chest X-ray

False, we will favor topical treatments and if only the pruritus is too intense we can use antihistamines

Benzodiazepines are the treatment of choice to soothe the patient to avoid pruritus


Luke Marcheciel is a newborn baby who was born 24 hours ago. While you take the time to reread the letters and you have entrusted the clinical examination of the baby to your outpatient, he comes back proud because he thinks he has diagnosed a hemangioma! Suspicious, you congratulate him, but question his diagnosis. What elements of the clinical picture or examination will refute your external hypothesis?

True, a hemangioma usually only sets in after several weeks of life, unlike the vascular malformation that is present from birth.

False, color has no impact on the diagnosis.

True, a hemangioma is flexible, soft and has no pulsations or internal heat. Unlike vascular malformation

True, varicose veins and vascular malformations are characteristic of congenital malformations

False, vascular malformation remains stable, unlike hemangioma


During your Saturday standby, you go to your MPR department and you meet Mrs. Jeanne Dorian, 67 years old, who is gradually recovering from her stroke that occurred 1 month ago. She tells you that if the resumption of walking is gradual, she still has a lot of trouble grasping her glass of water with her right hand which is "paralyzed". She wonders how she will be able to play the violin with such a weak hand... Link the impact of the disability with the examples from the statement.

Difficulty grasping the glass of water = Activity limitation

Stop playing the violin = Restriction of participation

Difficulty grasping the glass of water = Impairment

Stop playing the violin = Activity limitation


Regarding cutaneous-mucosal infections with Candida, what are the exact proposal(s)?

True, this kind of infection is very common

A perlèche is an intertrigo of the labial commissure, which may be of fungal origin

True, this semiological finesse is important to distinguish the two causes and allow an adapted antifungal treatment

Unlike dermatophytes, nail candidiasis has centrifugal extension and perionyxis

False, it is necessary to know what is typical of candidiasis (under breast, abdominal fold, intergluteal) and dermatophyte (inguinal)

An intertrigo of the inguinal folds is classic of candida infections

False, one of the most important points of candidiasis is its physiological presence in the digestive and vaginal mucous membranes

In front of an infection, vaginosis type, a positive Candida sample signs vaginal candidiasis

Topical antifungals are mainly based on fluconazole or amphotericin B


Regarding autoimmune bullous dermatoses which of these propositions are true?

The most common autoimmune bullous dermatosis in France is bullous pemphigoid

True, which makes it can be confused with Behcet's disease or Cowden syndrome (do not remember Cowden syndrome)

Clinically, pemphigus can present only through mouth or genital ulcerations.

False, indeed it is necessary to make several samples, but because there will be one that will be unfixed (for histological analysis) and one that will be fixed to highlight the areas of fixation of antibodies.

It is essential to take several samples during the biopsy, with the main purpose of allowing a second opinion in case of diagnostic doubt

True, these are also the same complications as pressure ulcers if you notice well.

The main complications of autoimmune bullous dermatoses are infections, hypothermia, dehydration and undernutrition.

False, it has been shown for years, that local corticosteroid therapy has a similar effectiveness for fewer adverse effects

The standard of care is based on systemic corticosteroid therapy


Which of the following proposals may be present in a child with autism spectrum disorder?

When parents smile at their child, the child does not smile at them. This is a very early sign of autism.

Children have difficulty accessing implicit and figurative language

These are the difficulties in having reciprocal exchanges. The child will also have remarks that are focused on his own interests and does not take into account the point of life or the words of the interlocutor to register in a turn of turn (social clumsiness).

Conversations tend to be focused on the patient's interests

The child has a lot of difficulty making friends. In addition, they are often not very interested in social relationships with peers (lack of social motivation).

The child has facilities to make friends


Which of the following propositions regarding bipolar disorder is true?

True, hence sometimes the notion of bipolar disorder type III, manic disorders induced by antidepressants etc ...

Although a distinction is usually made between type I and type II bipolar disorder, there are bipolar disorders that do not fit into this classification.

True, this is THE prodrome to know in the bipolar patient

A manic crisis should be evoked in front of a bipolar patient, with recent insomnia without fatigue

False, on the contrary, the fact that he is not "paralyzed" by depression, will promote the passage to the act

In front of a patient with manic syndrome, it is useless to look for suicidal thoughts, since he presents an elation of mood

False, treatment will be implemented remotely, once bipolar disorder is diagnosed and differential diagnoses have been ruled out.

In front of a maniacal patient in the emergency room, lithium treatment must be initiated without delay, because of its long half-life and narrow therapeutic range.

Monitoring of lithium in chronic treatment is based in particular on TSH, urea and annual serum creatinine


Regarding comorbidities with other neurodevelopmental disorders. Which of the following are true?

30% of children with ASD have an intellectual disability

20% of children with ASD have attention deficit hyperactivity disorder

20% of children have oral language acquisition disorders

10% of children with autism spectrum disorder will have epilepsy at some point in their lives


Which of the following are risk factors for postpartum mental disorders?


Among the following proposals, which additional examinations are part of the assessment to look for differential diagnoses of pervasive developmental disorders?

Only to make the diagnosis of associated disease. Epilepsy is not a differential diagnosis.

Search for differential diagnoses and also associated diagnoses

These are scores to make the positive diagnosis. The ADI-R is a semi-structured interview with parents, which examines the current symptomatology as well as the developmental history of the child. ADOS is a semi-structured observation of the child's symptomatology.

These diagnostic tests are useful for diagnosing ASD syndromes, not for finding a differential diagnosis.

Neurological, genetic, metabolic and brain MRI assessments


True, at the maneuver we can observe a fall behind the head up to 2 months of age

The pull-and-sit maneuver is used to evaluate the holding of the head

False, at 4 months, he sits with support. At 8 months only, without support

From 4 months, the child must sit without support

True, walking alone can be observed from 9 to 18 months.

True, reflex from bending the fingers to stimulating the palms of the hands or feet

The reflex grasping is a reflex of the newborn

False, she becomes a volunteer around 4-5 months. At 9 months the child can manipulate with 2 hands and also appears the thumb clamp index

The grip becomes voluntary from 9 months


Regarding the schooling of patients with ASD, which are true?

The type of schooling adapted to the child will depend on the level of severity of ASD, the impact
functional disorder and associated neurodevelopmental disorders and parental choice.

The children have an ordinary schooling, but there will be adjustments. The Personalized Support Project (PAP) and the Personalized Schooling Project (PPS) specify the arrangements that should allow schooling in an ordinary environment. Some patients will therefore be able to benefit from a School Life Assistant (AVS) when they have learning difficulties or difficulties with autonomy.

Patients with mild ASD without another neurodevelopmental disorder
associated, and with a slight functional impact, have schooling in an ordinary environment, and will have no accommodation.

Patients with mild ASD, another associated neurodevelopmental disorder (for example, mild intellectual disability), and with mild or moderate functional impact will be enrolled in ULIS (Localized Units for Inclusive Education) classes.

Patients with moderate to severe ASD and another associated neurodevelopmental disorder (e.g., moderate intellectual disability), and with moderate or severe functional impact: IME orientation.

The statement is true, except for the PAP. Simple school arrangements made by the PAP do not need notification to the MDPH: the project is only validated by the school doctor.

The implementation of school facilities (PAP, PPS, AVS) and school orientations (ULIS, IME) always require notification from the MDPH, which requires the drafting of a reasoned medical certificate.


Regarding the links between pain and mental health, what are the exact proposition(s)?

True, it is quite logical, psychic pain leads to physical pain and vice versa

Patients with a characterized depressive episode more often have chronic pain complaints and vice versa

True, the pathophysiological cause/consequence is more difficult to pin down, but it does exist...

A fibromyalgia patient has a higher risk of developing bipolar disorder than a person without chronic pain

False, the urgency is the chest pain here that must quickly perform an ECG

In front of a patient in the emergency room having a panic attack, who complains of chest pain at the same time, the urgency is to calm the patient by words or by a benzodiazepine

False, the schizophrenic patient feels the pain but does not recognize it and cannot express it clearly

The schizophrenic patient develops anesthesia to pain, which explains why he expresses it less because he feels it less

True, a bit like the schizophrenic patient, he has trouble expressing his pain clearly and therefore the pain is to be sought!

Children with autism spectrum disorder may exhibit withdrawal, aggression or mutilation behaviours in the face of pain


Regarding somatoform disorders, which of these propositions are true?

True, like any psychiatric illness. A child of a depressed parent is more likely to develop depression. Same with somatoform disorder

There is polygenic genetic transmission of somatoform disorders

True, extremely frequent. Any doctor will face this situation at some point.

Among the functional signs often expressed in somatoform disorders, we readily find chest and abdominal pain

False, it is an entire part of it. It is the erroneous belief of being overweight or obese.

Dysmorphophobia is not part of somatoform disorders

False, somatoform disorder is a diagnosis of elimination. Just because a patient has psychiatric disorders doesn't mean they can't have a heart attack or stroke!

Faced with a physical complaint in a patient with multiple psychiatric history, it is necessary to know how to quickly evoke somatoform disorders

False, the patient is convinced that he has a medical pathology, and the perpetuation of negative examinations only reinforces his certainty (the idea that his disease is not known to doctors, is not diagnosable etc ...)

It is often recommended to multiply additional examinations and medical opinions in front of a somatoform disorder, to reassure the patient


Concerning mental disorders in the elderly, which of the following propositions are true?

True, these units are frequently found in geriatric clusters.

The management of patients with chronic psychiatric disorders or psychiatric manifestations of neurodegenerative pathologies can be done in U.C.C (cognitive-behavioral units)

Schizophrenia in the elderly will manifest itself by a predominance of negative symptoms and disorganization and a lesser presence of positive symptoms

False, usually we find delusions of persecution or misidentification

In the psychiatric manifestations of neurodegenerative diseases we will find delusional ideas of grandeur or megalomania

False, usually we start at half dose, to avoid the main side effects

To prescribe psychotropic drugs in the elderly, we start at the same dose as in adults, but we increase the doses more gradually.

True, benzodiazepine abuse and addiction is extremely common in the general population.

A memory complaint may be related to chronic addiction to benzodiazepines


What are the additional examinations of acute non-serious pyelonephritis without risk of complications probably diagnosed?

If PNA severe or at risk of complication


Which of the following propositions concerning pre-eclampsia are true?

False, in 4 to 12% of pre-eclampsia. Pre-eclampsia affects 3 to 10% of pregnancies.

HELLP syndrome occurs in 4 to 12% of pregnancies

Immediate hospitalization is indicated before the discovery of pre-eclampsia

In front of any visual abnormality it is necessary to make a fundus in search of hypertensive complications.

True, others are acute fatty liver disease (SHAG), HUS or thrombotic thrombocytopenic purpura (TTP)

One of the differential diagnoses of pre-eclampsia is thrombotic microangiopathy.

False, it is only necessary to undertake a vascular filling when a risk of hypovolemia is predictable. Overfilling can precipitate the occurrence of an OAP.

Vascular filling of patients with pre-eclampsia is essential.


Regarding fractures of the upper end of the femur. Which of the following are true?

The typical deformation is in Shortening, Internal Rotation, Adduction.

The trochanterian massif is mainly trabecular bone.

The little trochanter is the insertion site of the gluteus medius

The great trochanter is the insertion site of the Psoas

During a pertrochanteric fracture, there is a risk of osteonecrosis of the femoral head.


Regarding superior femoral epiphysiolysis. Which of the following proposition(s) are true?

It is the second cause of hip lameness during the pubertal period, after osteoarticular infection.

There are two forms: the stable form and the unstable form

It is a growing cartilage disease of unknown cause.


Among the main germs found in children, we find which germ at what age?

Kingella kingae in children from 6 months to 4 years

Staphylococcus aureus is the majority in children with sickle cell disease

Pneumococcus is the most common germ in children from 6 months to 4 years

Staphyloccocus aureus is the majority in children over 4 years of age

E. coli and group B streptococcus are the majority in infants less than 3 months of age


Which one(s) is part of the systematic assessment in the face of a suspicion of acute osteoarticular infection in children?

Ultrasound of the affected joint, often comparative

False. It is the best test for diagnosing IOA (more sensitive and specific than bone scan), but it is not indicated systematically.


Which of the following refer to muscles innervated by the median nerve?

Extension is provided by the radial nerve


Which of the following propositions refer to muscles of the hypothenar compartment?

True, all the muscles mentioned in these propositions are innervated by the ulnar nerve


Which of the following are muscles innervated by the ulnar nerve?


It is the evolution of a buttonhole finger

It reflects the chronic involvement of the IPD extender

It reflects chronic involvement of the IPD flexor

It reflects chronic involvement of the PPI extender


Which of the following are true about Zenker's diverticulum?

Nasofibroscopy regains the sign of the tide 🌊


Which hepatitis virus(s) is/are usually asymptomatic in the acute phase?


What is the lifetime prevalence of hemorrhoids?


Regarding hernia, what are the exact answer(s)?

It is the passage of abdominal contents through a natural orifice

True, in front of the coral and umbilical

25% of the child's hernias are congenital


Which of the following are possible complications of H. pylori infection?

Acute viral gastritis without chronicity


Which of the following are true for irritable bowel syndrome (IBS)?

Absent at night, predominates in the morning and post-prandial

Yes, we can have both (typical pain + <3 bowel movements per week)

There are no organic abnormalities of the intestine


Which of the following is one or more of the potential cause(s) of hepatomegaly?


How does the incidence of lithiasis change with age?

It was necessary to find 4 distractors 😂


Which of the following are the providers of diarrhoea?

True, it is one of the most common treatments for diarrhea^^

True, so important that it can go so far as to require stopping the treatment

True, it is an antimetabolic (the lining of the intestine is renewed very quickly)


Which of the following are anti-emetic drugs?

6 effects: anxiolytics, hypnotics, anti-convulsants, orexigen, muscle relaxants, amnesiacs

True, it is used in particular to counter the adverse effects of chemotherapy


Which of the following are signs of dehydration?


Which of the following are tests to request in the face of suspicion of Crohn's disease?

Gastro-duodenal endoscopy + systematic staged biopsies

Colonoscopy + biopsies if macroscopic abnormalities

True, Essential to assess hail. The 3 systematic examinations are: endoscopy + ileocolonoscopy + entero-MRI. Biopsy is done anywhere it can :)


Which of the following are possible etiologies of cirrhosis?


Never chronic hepatitis (but acute hepatitis possible)


Which of the following are causes of primitive achalasia?


Which of the following are true for gastroduodenal endoscopy in duodenal ulcer?

True, clinical signs, even typical, are not enough

It is essential for the positive diagnosis of ulcer

Duodenal ulcers never degenerate into cancers

In case of hemorrhage, Forrest's classification can be used

Systematic search for Helicobacter pylori

It allows the systematic search for CMV infection


Regarding sigmoid diverticulosis and acute diverticulitis what are the exact proposal(s)?

True, you have to enjoy as much as you can 🎉

These pathologies are very rare before the age of 30

Not since the last recommendation in 2017. It is indicated in case of non-response to symptomatic treatment or in case of signs of severity

Antibiotic treatment in uncomplicated diverticulitis is routine

Unnecessary ultrasound. We make the diagnosis on the bio and the angioscan

Diagnosis of diverticulitis is based on ultrasound

Bristol scale = stool 💩 consistency. We are talking here about the Hinchey classification

Bristol scale classifies complicated diverticulitis

True, risk of perforation and peritonitis

Active diverticulitis contraindicates colonoscopy


Which of the following are complications of cholecystectomy?

Complication of unoperated cholecystitis


Which of the following propositions are true about physiological jaundice in newborns?

False, it appears only after 24 hours of life (free interval)

The neuronal toxicity threshold is 340 micromoles/litre


Which of the following are classic signs of cholitis?


Which of the following are among the following proposals for complicated diverticulitis?


Which of the following proposals are features of unranged hernia?

True, impulsive = extensive = no strangulation


Up to what age is loperamide contraindicated?

True. It is contraindicated before 2 years. Some adapted presentations are valid between 2 and 8 years.


Which of the following are criteria of severity leading to the treatment of uncomplicated sigmoid diverticulitis with antibiotics?

Tachycardia is not a criterion of severity (unless really high)


Which of the following are etiologies of brown urine jaundice?


Which of the following are recognized risk factors for ulcers?

True, several causes including PPIs, H. Pylori, autoimmune, ...


Which of the following are included in the treatment of uncomplicated diverticulitis?

Antibiotic therapy if symptomatic treatment failure

Laparoscopy explorer if pain persists for > 10 days


Which of the following are true for the treatment of GERD without esophagitis that occurs less than once a week?

Not in the first intention. This is the case if GERD happens more than once a week


Which of the following propositions are true about primitive achalasia?

Manometry is the exam of choice for a positive diagnosis


What is the treatment of choice for primary biliary cirrhosis?


Which of the following are risk factors for chronic pancreatitis?


Regarding the incidence of gastric ulcer in developed countries:

It is not a DO disease but epidemiological studies can be done on all diseases

It is not calculable because it is not a reportable 😏 disease


If chronic pancreatitis is suspected, what is the imaging test to perform as a first-line treatment?

No longer done (useless in this indication)


Which of the following should be avoided in case of celiac disease?


Which of the following are recommended vaccines for splenectomized?


What is the PNN threshold that defines an infected ascites fluid? (mm3)


Which of the following propositions are true about Gilbert's disease?

It is a disease with genetic polymorphism

It is an unconjugated bilirubin jaundice


What test can determine whether GERD is acidic or non-acidic?


Mallory Weiss syndrome corresponds to a rupture of:


What does bimuthea quadritherapy contain?

Non-bismutheic therapy: amoxicillin, curative PPI, metronidazole, clarithromycin/levfloxacin


What is the estimated survival of 1 year for Child Pugh C?


Which of the following are true for antibiotic treatment of uncomplicated sigmoid diverticulitis?

After failure of symptomatic treatment (or in case of signs of severity)

Second-line therapy is fluoroquinolones (or C3Gs) combined with metronidazole

Antibiotic treatment lasts less than 7 days

True, this is most often the case (oral treatment)

Treatment can be done on an outpatient basis


What time corresponds to the venous time on the injected scanner?


Which of the following are ultrasound signs of lithiatic cholecystitis?

Increased pain when passing the ultrasound probe

Hypodensity representing the calculation


Which of the following are indications for gastroduodenal endoscopy in GERD?

False, on the other hand newly discovered asthma (contemporary with GERD may be an extradigestive sign)


Which of the following are signs of hepatic encephalopathy?


Which of the following are signs of portal hypertension?


Which of the following are true about vomiting during pregnancy?

They are physiological in the second trimester

They disappear spontaneously during pregnancy

Pre-eclampsia may be accompanied by vomiting


Which of the following propositions are true regarding chemical trauma?

True, they penetrate longer and deeper into the eye

Basic chemical burns are more serious than acid burns

it is the Roper-Hall classification that is used

The ASA classification is suitable for burns of chemical origin

The classification ranges from grade I to grade IV, with grade I being the best prognosis

True with absence of limbic ischemia and corneal opacity

Grade I is for pure epithelial involvement


In what structure is the origin of the optic nerve inserted?


Which of the following proposals are pathological in 1-year-olds?


Which of the following are possible infectious causes of prenatal hearing loss?

Mnemonic medium: TORCH (Toxoplasmosis, Mumps, Rubella, CMV, HSV)

Infection of the mother with toxoplasmosis


Which of the following propositions designate the nerve on which the palpebral occlusion depends?

IV nerve, innervates the superior oblique

Nerve VI, innervates the external/lateral right

Nerve III, innervates the upper right, the medial right, the lower right and the inferior oblique


What is the interval for mild hearing loss?

light = PAM between 21 and 40 dB; mean = PAM between 41 and 70 dB; severe = PAM between 71 and 90 dB; deep = PAM ≥ 90 dB; total (cophosis) = PAM ≥ 120 dB.


What is the field of action of the superior oblique muscle?


It is a question of sphericity, not depth, the refraction of the eye differs according to the plane in which the incident rays are located.


What is the field of action of the inferior oblique muscle?


Which of the following are true for congenital hip dislocation (CHL)?

Ultrasound (if risk factor or suspicion)

Low radiation hip X-ray is the first-line additional examination in case of suspicion of LCH

Adduction limitation is a clinical sign of CHL

Limb length asymmetry is a clinical sign of CHL


Which of the following proposals are correct and expected for a 3-month-old child born at term?


This is the size of the newborn. The expected PC is 35 cm

At birth, the expected head circumference (CP) is 50 cm

This is the newborn's PC. The expected size is 50 cm

At 4 years old, the child measures about 1m25


Which of the following proposals suggest pathological strabismus?

According to the COUF: "It should be remembered that strabismus is never normal and that any child with strabismus must benefit from a rapid specialized examination. This assertion must be qualified in the baby less than 3 months in whom an intermittent deviation can be tolerated."

The child's strabismus is only a symptom. Any strabismus must seek an underlying organic pathology.

Convergent and intermittent strabismus require simple monitoring at the beginning


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


What is the formula for estimating the expected head circumference during the first year of life?


What is the interval of profound hearing loss?


Which of the following are true for genu varum at 1 year?

It justifies a bilateral F+P radiological assessment

It corresponds to a normal evolutionary phase of the growing skeleton in most cases


Which of the following are drugs that decrease the secretion of aqueous humor?

They increase the elimination of aqueous humor


Which of the following are risk factors for hearing impairment?


Which of the following propositions are true about AEPs?

They do not allow it, it is one of their limits. Other limitations: profound deafness hinders the interpretation of latency curves, and the ranges explored concern only the treble

They allow a frequency by frequency study

True, by studying the latencies and conduction delays of the five peaks: I (cochlea), II (auditory nerve), III, IV, V (brainstem)

They have topographic value in sensorineural hearing loss

High frequencies, this is one of their limits

It is an objective examination, to be used especially in infants or non-cooperating patients


Which of the following are functions of the outer 👂 ear?

Amplification of conversational frequencies

No role of the outer ear in balance. This is the case of the inner ear


Which of the following are true about the parotid gland?

There are three main salivary glands: parotid, submandibular, sublingual 😊

It is one of the two main salivary glands

Steno Canal. Wharton's duct is the duct of the submandibular gland

Its excretory canal is the Wharton Canal

It is the most common site of salivary lithiasis


Regarding the salivary glands, which of the following propositions, which is/are true?

False, if the excretory duct of the parotid gland is indeed the Steno duct, it is blocked at the level of the homolateral upper 2nd molar (namely)

The excretory duct of the parotid gland is the Steno duct and it plugs at the sublingual wattle.

False, do not confuse the sublingual glands (two small glands under the floor of the mouth) and the accessory salivary glands (there is, indeed, a multitude)

There are multitudes of sublingual glands (about a thousand)

True, these are the two main pathologies to master.

While viral sialitis mainly affects the parotid glands, lithiasic sialitis mainly affects the submandibular glands

False, it is pleomorphic adenoma, and it is a benign 😅 tumor

The most common tumor of the parotid is a malignant 😱 tumor

True, a low risk, but sufficient to indicate surgery for any pleomorphic adenoma.

Pleomorphic adenoma has a risk of cancerization


Which of the following propositions are true about acoumetry?

It is a qualitative measure of hearing (we have no number, the answer is a yes/no)

It can be performed at the patient's bedside

True, i.e. the patient hears less well in air conduction than in bone conduction (which is not normal)

Rinne's test is negative in case of conductive hearing loss

Weber's test consists of placing the tuning fork on the vertex

The Weber is non-lateralized in case of left unilateral transmission hearing loss


Which of the following suggestions can guide you towards right otosclerosis?

Weber on the right because right transmission deafness

Tonal audiometry regains right-sided one-sided conductive hearing loss


Which of the following propositions are true for pleiomorphic adenoma?


Management is exclusively drug (antimitotics)


Which of the following are true about salivary lithiasis?

Glandular swelling is often per-prandial

They are most common in the submandibular gland

MRI is often needed to confirm lithiasis

Dental panoramic imaging is first-line imaging


Regarding the salivary glands among the following propositions, which one is/are true?

True, it is the same radiological semiology for all lithiasis: hyperechoic with posterior umbral cone. This is the case of renal lithiasis and cholelithiasis too 😊

The first-line examination for lithiatic sialois is ultrasound to demonstrate hyperechogenicity with posterior shadow cone

False, they are rare! But this risk of sequelar orchitis is the main justification for mumps 😏 vaccination

Viral sialitis is formidable because it frequently leads to sequelar 😱 orchitis.

True, parotid involvement is found in Heerfordt and Mikulicz 🤓 syndromes

Bilateral chronic parotid sialosis should suggest sarcoidosis

False, a biopsy of the salivary glands ACCESSORIES (the famous BGSA)

Sjögren's syndrome, a bilateral chronic sialosis, is diagnosed by a biopsy of the main salivary glands

True, this is an exception in the tumor family...

Malignant parotid tumors are most often painful


In chronic inflammatory enterocolopathies, classically, peripheral involvement evolves parallel to digestive involvement, unlike axial involvement which evolves on its own account.

Physical activity and physiotherapy are essential to reduce the progression of ankylosis in a bad position

In ankylosing spondylitis, physiotherapy is not essential

The syndesmophyte is an ossification of a vertebral enthesis, specific to spondyloarthritis, unlike enthesophytes which can be the result of mechanical overloads

Syndesmophyte is not specific for Spondyloarthritis

At least 2 NSAIDs should be tried successively over a total of 4 weeks before concluding that they have failed.

After 4 weeks of treatment with the same NSAID without results, it can be concluded that the treatment has failed and it is then necessary to move on to background treatments

Fiessinger-Leroy-Reiter syndrome is the most complete form of reactive arthritis, defined by the urethritis-conjunctivitis triad-arthritis.


Regarding coxarthrosis, what are the exact proposal(s)?

True, congenital hip dislocation and other dysplasias lead to early coxarthrosis

A coxarthrosis of the young subject must seek a history of hip dysplasia

False, it is the coxodynias, which can give projected pain in the knee

Differential diagnoses include classical projected gonarthrosis

False, it is the internal rotation that will lead to a functional limitation of the joint.

The clinical examination will look for a limitation of external rotation, the first clinical sign of the functional limitation of the joint

True, to put it simply, the covers are what allow the good mechanics of the joint

The front X-ray and the false profile of Lequesne look for insufficient coverage of the VCE (external cover of the roof of the acetula) and the VCA (anterior coverage of the femoral head)

True, be careful not to forget the hygiene-dietary rules (regular walking, possibly cane in contra-lateral, weight loss if obesity ...)

First-line treatment is based on conventional level 1 analgesics and rehabilitation by physiotherapy


Which of the following proposition(s) is or is true?

An effusion of a joint is always the translation of intra-articular suffering

MRI is the exam of choice to quickly confirm or rule out joint effusion

True. Sternoclavicular involvement should be investigated for SAPHO syndrome.

SAPHO syndrome includes synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis

Digital osteoarthritis affects the proximal and distal interphalangeal joints with respect for the metacarpophalangeal joints

Thrombocytopenia at 70 G / L contraindicates joint puncture


Which of the following proposals corresponds to the first-line management of inflammatory spondyloarthritis?

NSAIDs in the absence of contraindications

No MA for spondyloarthritis (except psoriatic arthritis)


Which of the following are elements indicating urgent neurosurgical management?


Which of the following are found in an inflammatory joint puncture fluid?


Which of the following proposals can lead to a disco-radicular conflict in case of lumbo-cruralgia L4?

True, foraminal or extraforaminal -> touches the first digit (here L4)

foraminal or extraforaminal -> touches the first digit (here L3)

True, median or paramedian -> touches the second digit (here L4)

True, median or paramedian -> touches the second digit (here L5)


You perform a knee puncture. The liquid returns purulent. On direct examination, gram-positive cocci are observed in clusters. Which germ is most likely to be involved?

Rather found in case of infection associated with care (catheter, tube, etc.). But, indeed, it is a gram cocci + in clusters (this is the case of all staphylococcus).


How to treat latent tuberculosis before starting biotherapy?

Rifampicin + Isoniazid + Ethambutol + Pyrazynamide for 3 months

It is the same treatment as tuberculosis disease

Possible treatment 3 weeks after the end of well-conducted TB treatment

Biotherapy is contraindicated for life because of the risk of tuberculosis reactivation


Dactylitis is an inflammatory condition of the entire finger or toe

In young adults. Forms with late onset (after 45 years) are rare

The majority of cases of spondyloarthropathy begin in the elderly

In spondyloarthritis, all entheses can be affected, but enthesitis preferentially sits in the upper limbs

The sacroiliitis results in the appearance of pain of the buttock of schedule most often inflammatory

Entheses are the bony insertions of tendons, ligaments, capsules and fascia.


Which of the following is the score assessing spondyloarthritis activity?

Score assessing the functional impact (there is an F in it) of spondyloarthritis (AS for Ankylosing Spondylitis)


Which of the following propositions, is/are true?

Local anesthesia can be performed urgently or programmed by any doctor, regardless of his specialty

There are 2 loco-regional anesthesia techniques: perimedullary (around the spinal cord) or peripheral (around the nerve)

The anesthesia consultation must be done at least 3 days before surgery

The pre-anesthetic visit must be done a maximum of 24 hours before surgery

True, written consent is only required for certain specific acts: genetic research, clinical trial, organ removal, tissues, cells from living persons, gamete donation and use, sterilization, abortion.

Oral consent is sufficient for anesthesia during surgery outside of emergency situations


Which of the following are complications of anti-TNF-alpha therapy?

True, dermatological consultation 1x/year

True, annual influenza and pneumococcal vaccination + discontinuation of therapy in case of infection


False! Red flag, in the first place eliminate an organic cause.

In front of back pain, the most likely cause is a static disorder, an X-ray face + profile of the dorsolumbar spine is sufficient

The search for an indolent or pauci-symptomatic "sausage" toe is also very important, justifying the careful examination of patients' feet.

In conventional radio, the different evolutionary stages of enthesopathy are 3 in number.

In the context of spondyloarthritis, there may be anterior acute uveitis, non-granulomatous in most cases, often pauci-symptomatic but sometimes severe.

False, MRI has no contribution to the diagnosis, if the sacroiliitis is visible on radiography.

In case of sacroiliitis on conventional radio, MRI may have an interest to confirm the diagnosis


Which of the following proposals correspond to the management of common (non-symptomatic) low back pain without red flag, neither deficit nor hyperalgic?

Analgesics level I and II according to the EVA

Nonsteroidal anti-inflammatory drugs in the absence of contraindications, suitable for pain


According to the French vaccination schedule in force since 2018, the MMR vaccination schedule recommended in France includes:

2 doses of primary vaccination at 2 and 4 months

The dose at 16-18 months is not a booster, but a catch-up. It is part of the basic vaccination schedule


Which of the following are true about Syphilis?

The infection is said to be late if it is more than a month old

The chancre testifies to the replication of treponema at the front door


With regard to tetanus, at what age are vaccinations associated with diphtheria and poliomyelitis done?


You are following Jean-Paul. He is 75 years old and has type 2 diabetes. He tells you he hasn't had a vaccination in a very long time and asks you which ones he should do. Your answers:

True, reminders at 6 years, 11-13 years, 25 years, 45 years, 65 years, 75 years and then every 10 years

True. Diabetic = immunocompromised = antipneumococcus + antiinfluenza


What are the hospitalization criteria for a non-serious NAP?

3 reasons: signs of severity, hyperalgic form, non-observant patient

Doubts about the patient's ability to adhere to antibiotic treatment

The presence of bacteremia (when tested) does not change management

The intensity of the fever without other argument of sepsis, and without particular terrain, is not in itself an indication of hospitalization

Especially an argument to look for a favoring factor


Mr. X brings you his 2-year-old son for a fever. "He's not like usual, he's all grumpy," he explains. You notice when you undress the child a necrotic-looking purpura appeared in the morning. What is the course of action?

You contact the SAMU for a medical transfer to the nearest hospital

You immediately perform an injection of parenteral C3G IM or IV

Purpura fulminans = immediate life-threatening emergency, requiring urgent parenteral C3G antibiotic therapy and resuscitation

You prescribe symptomatic treatment with paracetamol and ask to see the child again the next day

You send the child to perform a biology at the local laboratory

You ask the father to take his child to the emergency room right away


Regarding menorrhagia and metrorrhagia, which of these propositions are true?

False, we talk about menorrhagia when the Higham score is >100

We talk about menorrhagia when the Higham score is >200

True, these are the main consequences of bleeding.

In the face of bleeding of gynecological origin it is essential to assess tolerance by looking for signs of shock and anemia

False, the main causes of bleeding in the 3rd trimester of pregnancy are placenta previa and retroplacental hematoma

In front of a hemorrhage of the 3rd trimester of pregnancy, the main causes of metrorrhagia to evoke are late miscarriage and ectropion

False, pelvic ultrasound is performed as a first-line procedure, easier to access and practice than pelvic MRI

In the event of genital bleeding, the complementary first-line examinations are BHCG, CBC and pelvic MRI

False, any gynecological bleeding is cancer of the BODY of the uterus until proven otherwise (the endometrium is the cause of gynecological bleeding and is in the uterus not on the cervix)

Any postmenopausal gynecological bleeding is cervical cancer until proven otherwise.


Which of the following proposals are routinely included in the blotting paper biological newborn screening test?


Which of the following proposals are part of the ASD assessment?

For the assessment of IQ, adaptive behaviour (e.g. Vineland scale) and attentional abilities

For the evaluation of verbal and non-verbal language and language pragmatics

Look for epilepsy (present in 20% of ASD)

Systematics for the diagnosis of syndromic forms of ASD


Which of the following are true about the baby blues?

It must be treated with SSRIs for 6 weeks

Patients do not understand their symptoms ("I have everything to be happy")

It can be very transient and last only a few hours (College of Gynecological)


True
Think that PC as weight starts with 35 it helps :).

The average parameters of birth of a term newborn are a weight of 3500g, a height of 50cm and a PC at 35cm.

FALSE
It is doubled at 4 months of life.

The birth weight of a child is doubled at 1 year.

During the first trimester of life, an infant is expected to take 25g per day.

False
Definition of a statural growth anomaly
- Size< -2 DS according to the curves of the general population.
- And/or size< -1.5 SD relative to genetic target size
- And/or slowing down (or breaking the growth rate) (< 4cm per year after 4 years)

A child with a height of -1.5 DS, has a delay in stature.

True
Important to know how to calculate. We must be careful because sometimes we can know a statural delay if we rely only on the "raw" size, with for example a child at -0.8 DS, which is absolutely normal if we look at that, but if there is a high parental target size, let's admit +2 DS, it will be late (because 2.8 DS difference).
Hence the importance of the 3 criteria in the definition.

To calculate the genetic target height of a boy, it is necessary to: (Mother's height + father's height)/2 +6.5


In the case of intentional violence, what is the threshold of days modifying the classification of the offence?

True. Below ➡ police court ticket ➡. Above ➡ misdemeanor ➡ criminal court

Three months. This is the case for unintentional violence


The prevalence of ASD is 1% and the sex ratio is 4:1 in favour of boys

Like all neurodevelopmental disorders, ASD has a multifactorial origin

That's why we talk about autism spectrum disorders.

There is significant clinical heterogeneity of ASD

Heterogeneity is related to the severity of symptoms in the 2 clinical areas of ASD as well as the presence of comorbidities with other neurodevelopmental disorders

No, there are children who have a normal IQ (> 70). This is called Asperger's syndrome.

All children with autism spectrum disorder have a mental disability


Which of these propositions are true among bipolar disorder?

False, bipolar disorder usually appears between 15 and 25 years but it is often diagnosed at more than 30 years ...

Bipolar disorder is a disorder that appears around the age of 30

False, a bipolar disorder type 1 is diagnosed by the presence of a manic episode +/- a depressive episode! (We cannot talk about bipolar disorder if there is only one depressive episode...)

Bipolar disorder type 1 is diagnosed by the presence of a manic episode or a characterized depressive episode.

False, the semiology of a hypomanic syndrome being more frustrating, to speak of a bipolar disorder it is necessary the association of one or more hypomanic episodes and one or more depressive episodes

Bipolar disorder type 2 is diagnosed by the presence of one or more hypomanic episodes

True, lithium is one of the rare cases of the use of a metal as a medicine in medicine.

Treatment of choice for bipolar disorder uses metal-based medication

Cognitive remediation is a psychological rehabilitation technique


Regarding benzodiazepine addiction, which of the following propositions, which one or which are true?

True, these are the main actions of treatments

Benzodiazepines are anxiolytic, hypnotic, amnesiac, anticonvulsant and muscle relaxant drugs

True, this is why there is an addiction to benzodiazepines.

Benzodiazepines are part of the treatments with tolerance and withdrawal

True, the main cause of benzodiazepine addiction is "automatic" prescription renewal.

When prescribing a benzodiazepine, it should always be considered that it is only a temporary treatment, and should be discontinued.

False, we never put more than one benzodiazepine.

For the management of anxiety, a maximum of two anxiolytics can be combined, one short-lived and one long-lived

True, abrupt withdrawal increases the risk of physical withdrawal syndrome.

A gradual cessation is preferred to a sudden withdrawal.


Which of the following are genetic or metabolic diseases causing autism spectrum disorder?

Rett syndrome is a genetic disease. The disease causes a severe and comprehensive disorder of the development of the central nervous system, occurring only in girls. It results in multiple disabilities with intellectual disability and motor disability, which are often severe. (Source: https://www.orpha.net/data/patho/Pub/fr/Rett-FRfrPub91.pdf)

Autonomic recessive genetic disease linked to a deficiency of phenylalanine hydroxylase, an enzyme that allows the transformation of phenylalanine into Tyrolean. It is responsible, in the absence of treatment, for severe psychomotor retardation. The disease is screened for blood (Guthrie) on Day 3 by measuring phenylalanine.

Trisomy 21 is not in itself a genetic cause of ASD, but is an associated risk factor. 3% of children with trisomy 21 have ASD (p. 154 8th edition of the College of Pediatrics)


Which of the following proposals should be acquired at 2 months?


The Tanner classification evaluates the appearance of secondary sex characteristics for monitoring the pubertal evolution of girls and boys.

True Hence the boys who often make small in middle school compared to girls 1) their puberty begins physiologically + late, 2) the statural acceleration begins at a later stage of puberty.

The acceleration of the rate of stature growth begins at the first signs of puberty in girls (S2) and staggered in boys (G3) and rises up to 8 to 10 cm per year.

The appearance of the sesamoid of the thumb is contemporary with the onset of puberty, at a bone age of 11 years in girls and 13 years in boys.

The appearance of the sesamoid of the thumb means that the growth of the child is almost complete.

Bone maturation in children can be assessed by bone age, which is obtained by taking an X-ray of the left hand and wrist from the front.

Wrong, it's the other way around. Early puberty is defined as breast development in girls before the age of 8 and in boys testicular development before the age of 9.                          Puberty physio in girls 8-13 years, 9-14 years in boys.

Precocious puberty is defined as breast development in girls before the age of 9 and in boys testicular development before the age of 8.


Which of the following are teratogenic drugs?

False. A pregnant woman with lupus can continue to take her background treatment.

True. All ACE inhibitors and angiotensin II receptor antagonists (sartans) are contraindicated in the 2nd and 3rd trimesters of pregnancy. They are not contraindicated in the first trimester, but it is not advisable to maintain them during pregnancy.

True. Effective contraception should be initiated during this acne treatment, and maintained 4 weeks after stopping treatment.


You have in hospitalization in infectious disease Mrs. Bouvier, Pamela, 76 years old, who has a febrile heart murmur newly appeared for 1 week, poorly tolerated. Although you suspect infective endocarditis, blood cultures persist in coming back negative, and yet you have not initiated any antibiotic therapy 😑. You then think about the causes of negative blood culture endocarditis, what are they? 😏

True, the causes of negative blood culture endocarditis are: Whipple, Bartonella, Brucella, Coxiella, Chlamydia, H.A.C.E.K. but also Legionella, Mycoplasma, Rickettsia, Aspergillus, etc....

Bacterial endocarditis of the H.A.C.E.K. group


Which of the following are true for the diagnosis of infective endocarditis? 🤯

CT angiography is the first-line examination

The ETO is very often done as a second intention, after the ETT

ETO is only needed in case of negative 🤷 ♂ angioscan

Not always, it is not found in 10% of cases ➡ bacteria of the HACCEK group (slow growing), prior antibiotic therapy, etc. In all cases, blood cultures must be repeated several times 😋

True, they contraindicate thrombolysis in stroke

The presence of two major criteria (ultrasound + blood culture) make it possible to make the diagnosis of infective endocarditis


Which bacteria are most common in infective endocarditis? 🙌

Gram-negative cocci that lead to ear and upper and lower respiratory tract infections

This is not the most common. This germ often has a digestive origin (➡ perform a colonoscopy)


The germ mostly found is Staphylococcus aureus

The right heart is more often affected than the left 💔 heart

IV addiction is an important risk factor for endocarditis of the right heart

True, risk of rupture of mycotic aneurysm

IV thrombolysis in stroke is contraindicated (relatively) in case of a history of AE


Which of the following are true about fungal endocarditis?

It is often necessary to combine surgical treatment with medical treatment

IV addiction is an important risk factor


What is the procedure to take in case of dental avulsion in a patient who has had infective endocarditis and proven allergy to amoxicillin?

Sound familiar? 😋 This is the prophylaxis of pneumocytosis in immunocompromised 😉 people

Prolonged antibiotic prophylaxis with bactrim 3x per week

2g of amoxicillin 1 hour before the gesture


Which of the following are major criteria in infective endocarditis?


Which of the following are signs or symptoms of infective endocarditis?

True, always think about it in front of a prolonged fever! 🚨

Cerebral mycotic aneurysms (these are fake aneurysms eh)


Which of the following are true for Libman-Sacks endocarditis?

True, a bit of history 🧐 (from Wikipedia we admit 😇)

The lesions were described by Emanuel Libman and Benjamin Sacks in 1924.


Which heart diseases are at high risk of developing infective endocarditis? 🤔

True, hence the need for antibiotic prophylaxis in case of invasive dental procedure


What is the mortality rate of fungal endocarditis? 🍄

Surgical treatment should be discussed concomitantly with medical treatment

More reserved prognosis (mortality rate of bacterial AEs around 20%)

The prognosis is better than that of bacterial endocarditis


Which of the following proposals can result in blood culture negative endocarditis?


What is the procedure to take in case of dental avulsion in a patient who has had infective endocarditis?

This is the case in prophylaxis of pneumocytosis in immunocompromised people

True, indicated in case of infective endocarditis, cyanogenic heart disease or new valve. If allergy: clindamycin

2g of amoxicillin 1 day after the gesture

Too long, I remind you that beta-lactam have a short lifespan (we made a fairly complete topo on insta, you can find it on the storys on the front page)

1g of amoxicillin 1 week before the gesture


Which of the following diseases are notifiable diseases?

True, it is a notifiable disease because it is necessary to identify the food source to limit the risk of epidemic

True, it is a reportable disease because it is necessary to identify the environmental source to limit the risk of epidemic.

True since 2021 due to the implantation of this virus in the on of Europe (this is also the case for the tick-borne encephalitis virus which has become the 3rd cause in France of encephalitis)

True, like almost all arbroviruses (Dengue, Yellow fever, Zika)

False, invasive meningococcal invasions are reportable


In front of bronchiolitis of the child, what are the criteria of severity?

False, it has been changed it is an age of less than 8 weeks

Difficulties of living conditions, precariousness

False, it has been changed it is below 92%

False, it is severe signs of struggle that count!


What is the first-line treatment for Treponema pallidum infection?


While visiting with your favourite outpatient in the infectious diseases department, you go to the room of Mrs. Solitaire, 55, who has gram-negative bacillus bacteremia. Your external will ask you if there is a need to do further examinations to look for a secondary location of bacteremia. You answer him that no, this is not the case here, but that there are certain germs for which it is necessary in case of bacteremia to systematically look for a secondary location or an endovascular relay. What are these germs?

False, we do not systematically look for a secondary location to this germ

True, there is a very significant risk of Staphylococcus aureus endocarditis, which requires a transthoracic ultrasound

True, a candida fungemia must be sought for cardio and ocular localization and requires a transthoracic ultrasound and fundus

False, we do not systematically look for a secondary location of this germ


Which of the following are viruses against which vaccines exist?


What is the first-line treatment for Chlamydia trachomatis infection?

True, replaced azithromycin as first-line treatment


While you are an outpatient in your general medicine department, the nurse approaches you by telling you that Mrs. King, Elektra, 55 years old, admitted for 8 days for biological inflammatory syndrome, has a fever of 38.2 ° C.  Not knowing where to start you will see your intern who tells you to apply the rule of P, which makes it easy to look for nosocomial fevers. What are the "Ps" that are part of it?

True, the 5P rule is not to know for the ECN but it seems essential to me for your internships. The 5 Ps are Pee (Urinary Tract Infection), Lung (Pneumonitis), Skin (Erysipelas), Phlebitis (DVT) and Peripheral Puncture (Catheter)


Which of the following are true about influenza vaccination?

Immunity appears 10-15 days after vaccination


Which of the following are true about BCG vaccination?

True, it is a M. bovis attenuated in its pathogenicity

It is mandatory in a child born in a country with a high tuberculosis endemic

It is mandatory in a child with a family history of tuberculosis

True, due to a risk of vaccine disease, as with all live attenuated vaccines

It is contraindicated in case of cellular immunosuppression


Which of the following are true about HPV?

Infection is asymptomatic most of the time

The treatment of condylomas is based, depending on their size and location, on the use of laser, local treatments (especially imiquimod) or surgery

Treatment of warts is based on antivirals such as acyclovir

Bivalent vaccine is preferred in most cases

The HAS recommended in December 2019 to vaccinate all boys with the same vaccination schedule as in girls: two doses of Gardasil 9 vaccine (M0-M6) in 11-14 years old and catch-up in 15-19 year olds with 3 doses (M0-M2-M6). This recommendation has been in effect since January 1, 2021.

Vaccination of boys and girls is recommended


Regarding measles, which of the following proposition(s) is true?

The period of contagiousness extends from 5 days before to 5 days after the rash

True, these are the white/bluish rashes on the inner side of the cheek appearing at the 36th hour of the fever and persisting until the rash.

The maculopapular exanthema is itchy and begins behind the ears

Biological confirmation can be done by PCR or serology in blood or saliva

The disease leads to eviction from the community up to 15 days after the eruption


Which of the following are criteria for classifying pyelonephritis as at risk?

Age > 75 (or >65 with +2 Fried criteria), Urinary tree abnormality, pregnancy, IR or severe DI, male sex


With regard to acute fever, which of the following propositions, are true?

False, naughty trap, but to emphasize the importance of qSOFA, easy to perform and of which 2 of the 3 items among the following allows to define a serious sepsis (FR greater than or equal to 22, acute impairment of higher functions, TAs less than or equal to 100mmHg)

In the emergency room, an assessment of the potential severity of the fever can be made via the SOFA

True, let's particularly insist on dehydration especially on fragile grounds (elderly)

The main complications of fever itself are dehydration, decompensation of comorbidities and neurological disorders.

True, this is the great fear of gynecologists and attending physicians.

Any fever with flu-like illness in pregnant women should be tested for blood culture listerias.

False, it is often in these cases a urinary colonization, it is necessary to know how to look for clinical signs and urinary functional signs

A positive ECBU in a febrile elderly should lead to the offer of antibiotic treatment

True. For once, very tricky painting and already seen in internship

A fever in children with abdominal pain and vomiting may indicate pneumonia


Regarding acute community lung disease, which of these propositions are true?

False, in ambulatory the ONLY necessary examination is chest X-ray

During an outpatient consultation at the general practice, additional examinations are limited to chest radiography and minimal inflammatory blood test (CBC, CRP)

False, ECBC should be prescribed in case of productive cough because they make it very easy to identify germs

In standard hospitalization, the biological assessment to identify the infecting germ is mainly based on blood cultures, the yield of ECBC being low, the latter are no longer widely used

The reference antibiotic for pneumococcal pneumonitis is Amoxicillin

False, it is recalled here that legionellosis is an infection that is transmitted from the environment (here infected water networks) to humans, but that there is no human-to-human transmission.

When legionellosis is suspected, in addition to mandatory reporting, the patient should be isolated in a room with additional "droplet" type protection.

True, this is the main complication to look for

In case of dyspnea or febrile desaturation or reascent after the start of antibiotic therapy, a chest X-ray should be done to look for pleural effusion


With regard to whooping cough, which of the following propositions, which one or which are true?

False, it's a gram bacillus -! Remember that cocci gram + it is staphylococcal / pneumococcus / enterococcal / streptococcus, bacillus gram + it is Listeria, Cocci gram _ it is meningococcal and gonococcal and the rest or almost it is bacillus gram -!

Bordetella Pertussis is a small gram+ bacillus

False! Big trap that I often got screwed on SIDES, whooping cough usually does NOT give a fever.

Pertussis can be confused with CoVID 19 infection or with viral pneumonitis because of symptomatology functional signs ENT-fever-cough-muscle pain

True, one of the only indications for nasal PCR after CoVID and influenza

The diagnosis of pertussis is made by nasal swab PCR

False, pertussis is a notifiable disease in clustered/nosocomial cases

True, it is the strategy of cocooning consisting in vaccinating the entourage of infants not yet vaccinated (vaccination starting at 2 months of life) in order to reduce the risk of potentially serious pertussis in the infant.

Although boosters after age 25 are not mandatory, there is an infant protection strategy based on vaccinating adults and the elderly in preparation for pregnancy.


Genital ulcers are mainly due to: (2 responses)

non-sexual acquiring urinary tract infection


You receive in general medical consultation, the young Jeppe, 16 years old, who comes to see you because he has just changed partners, and that his new partner has told him about the screenings of "STDs". You decide to prescribe the standard screening, what tests do you do?

True, followed by a VDRL only in case of positivity.

Automated Qualitative Treponemal Test (EIA or ELISA)

False. Hepatitis B screening is based on HBsAg, HBcAg and HBsAc.

True, it is one of the two valid methods to look for local infections (gonococcus, chlamydia) in humans.

Urethral swab self-sampling to be brought to the laboratory for Gonococcus and Chlamydia PCR.

Collection of the first urinary stream for Gonococcus and Chlamydia PCR.


You are a general practitioner in office and you receive in consultation Mr Kananga, type 2 diabetic for 40 years who has a superinfected plantar perforating disease. As a result, you explain that he will require hospitalization to assess his infection, with specialized care. But what will this support entail?

True, plantar perforating disease arises from a combination of neuropathy and arterial disease.

An evaluation of the vascular trunks with at least one IPS and at most an Echo-Doppler of the lower limbs

True, the plantar perforating disease signs an imbalance of diabetes, so it is necessary to evaluate the biological impact.

A reassessment of diabetes balance by fasting blood glucose and HbA1c

False, the superficial sample would only show the saprophytic bacteria of the skin, it requires a deep sample, even surgical

Bacteriological sampling of the wound by swab

Local management with discharge of the foot and debridage of the wound

Reassessment of tetanus vaccination status


Which of the following propositions are true about syphilitic chancre?

Associated with one or more lymphadenopathy(s), most often inguinal(s) (depending on the site of the chancre), NOT inflammatory(s) 😬

It is accompanied by lymphadenopathy (often inguinal) inflammatory


In the northern hemisphere, influenza is rare in winter

Some coronaviruses can infect patients returning from the Arabian Peninsula

Diagnosis of certainty of coronavirus infections is impossible

PCRs are available for most respiratory viruses

True, especially in the elderly or immunocompromised

These respiratory infections can be life-threatening


In case of late syphilis, the IM injection of penicillin G in the form of delay should be repeated:


With regard to Community infectious spondylodiscitis, which of the following proposals are correct?

S. aureus spondylodiscite indicates a probable dermal origin of the infection

True, like ANY involvement of the spine, it is necessary to look for a lesional syndrome (radiculalgia ...) and / or under lesional (urine retention, pyramidal irritation ...)

If spondylodiscitis is suspected, always look for signs of spinal cord compression.

False, it's the opposite, tell yourself that infectious lesions in 99% of cases are hyper T2 and hypo T1 on MRI

Signs of spondylodiscite on MRI are T1 hypersignal and T2 hyposignal

First-line antibiotic therapy is based on IV vancomycin

False, it is only an analgesic immobilization and it is associated with rehabilitation from the first day

Immobilization is necessary at the beginning of treatment to avoid creating a vertebral fracture


What are the additional examinations of acute non-serious pyelonephritis with risk of complications probably diagnosed?

If second episode of a non-serious ANP without risk of complication (or hyperalgic form)


Urethritis and cervicitis are mainly due to: (2 responses)


What are the additional tests for a severe acute pyelonephritis probably a diagnosis?


With regard to the salpigites, which of these proposals are correct?

True, salpingitis causes lateralized pelvic pain.

Appendicitis, appendix torsion and ectopic pregnancy are the main differential diagnoses of salpingitis

True, by definition, one STI always calls for another.

Salpingitis is an indication to look for local and general STIs

Pelvic ultrasound can highlight pyosalpinx

Salpingitis is treated first-line with Metronidazole monotherapy

True, violin string syndrome, sequelae of chamydia in the liver capsule

Complications of salpingitis include Fitz High Curtis syndrome


Which of the following are ophthalmological manifestations of secondary syphilis?

Only two etiologies to remember for NEC: Sarcoidosis and MS


Which of the following are true about neurosyphilis?

It can be present at all stages of the disease

Early neurosyphilis can be expressed as meningitis

posterior radiculocord syndrome found in TARDIVE neurosyphilis

Early neurosyphilis can be expressed in the form of tabes

Late neurosyphilis can be expressed as dementia

Early neurosyphilis can manifest as memory problems


What is (are) the possible complication(s) of chickenpox in children?


You are a general practitioner in the countryside. On a beautiful Saturday morning (where you work, because you are motivated and passionate about your job 🔥🚀❤❤), Mrs. Carrière, 32, brings you her son. A very energetic little boy of 13 months, he has had a temperature of 40 ° C for 48 hours. He is grumpy and has vomited 3 times 🤮. On clinical examination he presents axial hypotonia and the fontanelle is bulging. What diagnoses do you mention in view of these elements?

Does not explain the fever (you may have a fever, but not a fever at 40)


Which of the following propositions are true about the hamartochondrome?

Often easy diagnosis on pathognomonic CT data of "popcorn" appearance, combining calcifications and fat densities

The spiculated nodule appearance is pathognomonic 🤔

Not mandatory in front of the popcorn appearance and the absence of malignancy criteria

True, note that histological verification (not excision) is desirable


You are a doctor of the ARS and you are dispatched to the sausage fair of Bourg en Bresse Peyronnas, in front of a strong suspicion of Collective Food Poisoning (at least 30 cases). On the road, you remember in mind which samples you are going to make... What are they?

False, canteens/catering places are obliged to keep control food, in case all food is eaten

In case all the food has already been eaten, you can not take a sample from the food

True, this is the only indication to vomiting sampling that you need to know for ECN

Vomiting sampling of symptomatic persons

Stool collection from symptomatic individuals

False, it's not up to you to do the hygiene surveys of the place!

Sampling at storage and refregiration sites


During which diseases are ENT involvement observed (rhinitis, sinusitis, nasal polyposis)?

Eosinophilic granulomatosis with polyangiitis

Rather a pulmonary involvement type of intraalveolar hemorrhage


Which of the following are true for periarteritis nodosa?

In periarteritis nodosa, ANCA is ALWAYS negative

C-ANCA are relatively susceptible to this disease

It can cause vascular nephropathy (malignant nephroangiosclerosis) without glomerulonephritis

Puncture renal biopsy is contraindicated

There is necrotizing vasculitis of medium-sized vessels


Which of the following are true for IgA vasculitis?

It is also called Henoch Schonlein Syndrome

It mainly affects children but remains possible in adults

It mainly affects men over 50 years of age


Which of the following are true about Takayasu's disease?

It affects large arteries: aorta and its main branches, with a predilection for the carotid territory and subkeyboard

It affects the vessels of the microcirculation

Especially women under 50 (++ different with Horton)

It mainly affects men under 50 years of age

We can find vascular murmurs and an abolition of the pulse

We can find a tensional asymmetry and limp of the limbs


Which of the following are true about Kawasaki disease?

It mainly affects children from 1 to 15 years old

It is a febrile adenocutaneous-mucosal syndrome

A palmo-plantar desquamation, often late (the only Kawasaki I saw had no peeling at all but you have to remember what is in the college!)


Which of the following propositions are true regarding the anatomical pathology expression of giant cell arteritis (Horton's disease)?

Essentially mononuclear inflammatory infiltrate

It is the INTERNAL elastic limiting that is destroyed (much less solid than the external elastic limiting)

Destruction of the external elastic limiter

They are found in Goodpasture's disease (vasculitis of microvessels)


Which of the following proposals are common features of the 3 ANCA small vessel vasculitis?

Not microscopic polyangiitis (the term "granulomatous" is not found in the name of this vasculitis)

Glomerulonephritis is rapidly progressive (GNRP)


Which of the following proposals are vasculitis concerning the large vessels (aorta and main collaterals)?

Field: subject willingly elderly, >50 years old

Anti-MBG antibody vasculitis concerning capillaries


Which of the following are true regarding the diagnosis of Granumolatosis with Polyangiitis (Wegener)?

It is the only vasculitis that has ANCA type c (anti-proteinase 3)

ANCA are directed against the PR3 protein

Biopsy finds granulomatous pauci-immune necrotizing vasculitis

Direct immunofluorescence on the biopsy piece is negative


Which of the following propositions are true about Behçet's disease?

It occurs mainly in men from the Mediterranean Basin (Turkey++), the Middle East (Turkey) or the Far East.

Behçet's disease begins around the age of 30

Diagnosis cannot be made before the age of 50

It combines oral and genital aphthosis, posterior uveitis, and sometimes joint, digestive, cardiac and / or cerebral damage

Bipolar aphthosis with oral and genital involvement


Which of the following are true about microscopic polyangiitis?

It is the only vasculitis of ANCA small vessels that is non-granulomatous. The other two (Granulomatosis with Polyangiitis, and Eosinophilic granulomatous with Polyangiitis) are granulomatous, as their name suggests. Remember: often, EVERYTHING is in the name 😅

The only vasculitis where c-ANCA is found is granulomatous with polyangiitis (Wegener)

Glomerulonephritis and pulmonary capillaritis are common


Which of the following propositions are true about chronic atrophic polychondritis?

Like Behçet's disease and Cogan syndrome, it affects vessels of all sizes.

It is a vasculitis that affects only small vessels

It is an "exceptional" disease from an epidemiological point of view

It is an inflammation of the cartilages of the ears and nose, aortic valves, aorta and trachea

This is the description of Cogan syndrome, a vasculitis affecting vessels of all caliber (very rare)

It is a non-syphilitic interstitial keratitis and audio-vestibular involvement


It affects large arteries: aorta and its main branches. She has a predilection for the carotid territory and subkeyboard

It affects the vessels of the microcirculation

It mainly affects men under 50 years of age

We can find vascular murmurs and an abolition of the pulse

We can find a tensional asymmetry and limp of the limbs


Which of the following propositions are true for a 42-year-old woman with a pathogenic BRAC1 mutation in remission from breast cancer?

True. Bilateral appendectomy to be offered from age 40 for BRCA1 and age 45 for BRCA2

True, the relevance of ultrasound is left to the discretion of the radiologist

Breast monitoring is done by annual mammography for life, associated or not with an ultrasound (excluding mammectomy)

True, no genetic testing in miners (unless there is immediate medical necessity, which is not the case for BRCA mutations)

Genetic tests in offspring will be offered after they reach the age of majority

The risk of digestive cancer is higher than in the general population

He should have been offered a bilateral mastectomy from the age of majority.


Which of the following are breast cancer risk factors?

False. There is no longer an over-risk of breast cancer when the pill was stopped more than 10 years ago

The use of the estrogen-progestin pill 15 years ago

False. It is protective (decrease in the duration of hormonal impregnation)

Late age at first pregnancy (> 30 years)


Regarding the epidemiology of breast cancer, which of the following propositions are true?

False. About 58,000 cases per year (we must retain about 54,000 - 58,000 as an order of magnitude, this figure changes depending on the sources). It is the most common cancer AND the deadliest in women.

There are 78,000 new cases of breast cancer in France per year

It is the 2nd most common cancer in France, all sexes combined

True. It is the deadliest cancer in women.

Breast cancer causes 12,000 deaths per year in France

False. The 5-year survival rate is 87% and 76% at 10 years. It is a cancer with a high survival rate thanks to mass screening that allows early detection of cancers (at stage N0)

1 in 5 women will develop breast cancer in her lifetime


Regarding the BI-RADS classification of the ACR, which ones are true?

False. ACR 0 means that further investigation is required. ACR 1 means that the mammogram is normal.

ACR 3 means that the anomaly is probably benign but requires short-term monitoring (3 or 6 months)

False. ACR 6 means that there is histological evidence of certainty of the malignancy of the lesion.

ACR 6 means that there is an abnormality suggestive of cancer

ACR 4 means that there is an undetermined or suspicious anomaly

ACR 5 means that there is an abnormality very suggestive of cancer


Lymphatic drainage of the breast is done to which site(s)?

True. Lymphatic drainage occurs to 3 main sites: axillary caval nodes, upper and subclavicular lymph nodes, and internal mammary chain nodes.

The lymph nodes of the external breast chain

The lymph nodes of the internal breast chain

False. It is a left supraclavicular lymph node, but it mainly drains the digestive system and is suggestive of digestive cancer (e.g. pancreas, colon).


Which of the following are genetic mutation(s) that can cause breast cancer?

True. It is also a syndrome that causes childhood cancer.

True. The mutation causes breast and ovarian cancer.

False. It causes, among other things, colon, endometrial and ovarian cancers.


An ultrasound found an 18mm lesion in the right breast. On clinical examination, you do not find any skin involvement and the lymph node areas are perfectly free. No clinical signs elsewhere. What is the TNM classification of this lesion?

Mx because we did not make an extension assessment

True. T1c more precisely (between 1 and 2 cm)


Which of the following is the most common histological form of breast cancer?


Which of the following are true for giant cell arteritis (Horton's disease)?

It occurs in subjects over 65 years of age

It predilection affects the carotid and vertebral territory (including the temporal artery)

This is a NOIIA in giant cell arteritis. NORB is found in Multiple Sclerosis

Pseudo-rhizomelic arthritis is often associated


Regarding epilepsy-Absence of the child. Which of the following are true?

Treatment is usually stopped after puberty

Attentional disorders are a common comorbidity to always look for in children with this syndrome.


Concerning centrotemporal peak epilepsy (CTEP) in children. Which of the following are true?

True: Oral area, with hypersalivation, speech stoppage, hemifacial clonia, paresthesias of the tongue and gums.

The beginning is focal: central opercular

No: before 15 years, and beginning of the syndrome usually around 10 years

The prognosis is pretty good, with a cure before 10 years


Are multi-daily absences >10/d, favored by hypopnea

EEG is characterized by bursts of synchronous generalized polyspike-wave discharges at 3cycles / minute

It is an epileptic syndrome with a good prognosis, very pharmacosensitive (80%)


Which of the following are criteria for lumbar puncture during a febrile seizure in children?

no, but it is a criterion for complex febrile seizure <6MONTHS

Bulging of the fontanel and anomaly of the tone


Which of the following are true about febrile seizures?

No, a febrile seizure is by definition <5 years.

A febrile seizure > 15min in a 6-year-old child is complex

True: psychomotor delay = complex crisis

A generalized febrile seizure of 5 minutes, without post-critical deficit, with normal neurological examination in a 2-year-old child who has just acquired standing with supports is a complex febrile crisis and justifies hospitalization.

A generalized febrile attack of 12 minutes with a fever at 41 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires a lumbar puncture.

No because > 1 year, <15min, generalized

A generalized febrile seizure of 14 minutes with a fever at 42 ° C, in a 4-year-old child without post-critical deficit, without any particular history, with a normal neurological examination is a complex febrile seizure.


Regarding occupational health, what are the exact proposal(s)?

True, it makes sense. We will determine if a disease is of occupational cause if the disease occurs after exposure (chronological criterion) and if the lesions are semiologically compatible with exposure (semiological criterion)

The imputability between disease and exposure is justified by chronological and semiological criteria

False, it is by far the musculoskeletal disorders (carpal tunnel, meniscal involvement)

The most common occupational diseases are occupational cancers

True, completely! Some workers such as health professionals can contract these pathologies as a result of their work, so it is very clearly occupational ⚒ diseases!

Tuberculosis or viral hepatitis can be considered occupational diseases

For job retention, the occupational physician may set up job changes, job adjustments or professional reclassifications.

True, if he is dismissed, it will be during the resumption visit that takes place after the resumption of work

An employee cannot be dismissed during a work stoppage


Regarding the follow-up visit in occupational medicine, which of these proposals is/are true?

Wrong, it's the pre-resumption visit that!

The follow-up visit is requested by the general practitioner, the patient or the medical officer of the health insurance

True, it is done from a work stoppage for more than 1 month, so this is the case

The follow-up visit is carried out at the end of a pregnancy/maternity leave

True, this is the purpose of the takeover visit

The follow-up visit decides whether or not the employee is fit

The resumption visit is done within 8 days of the resumption of work by the employee

When transferring to another position in the company, in case of job adaptation, the salary remains the same for a period of 3 months


Regarding orthopedic treatment, which proposals are true?

Consolidation of fractures is faster in small children

The average duration of consolidation is shorter for epiphyseal detachments

This is the case for diaphyseal fractures

The consolidation of metaphyseal fractures is equivalent to that of adults

Duration valid for a diaphyseal fracture in a child over 5 years of age (equivalent to adults)

Fractures of the 2 bones of the forearm must be immobilized 90 days

Analgesic immobilization, non-systematic, between 0 and 21 days

A lump of butter fracture must be immobilized on average 45 days


Which of the following are systematic additional reviews for INM? (based on HAS, 2009)


Which of the following propositions are true regarding unexpected infant death?

This is, according to the HAs, any "death occurring suddenly in an infant under 2 years of age when nothing in his known history could have predicted"

Deaths that remain unexplained are grouped under the term unexplained IMN.

In France, approximately 500 infants under 2 years of age die unexpectedly annually

It is most often an infant aged between 2 and 4 months

This is most often an infant between 20 and 24 months of age.

The supine sleeping position is a risk factor for MIN

The supine sleeping position is a protective factor of MIN


Which of the following are/are risk factors for unexpected infant death?

It is absolutely necessary to avoid the supine position

Soft mattresses and duvets/blankets should be avoided


Which of the following are true about pancreatic pain?

It sits mainly in epigastrium (possibly hypochondrium)

It sits in the umbilical region most often

It is transfixing (radiates to the back)

This is the case of the pain of the uclera. Pancreatic pain is aggravated by the meal, which can cause a fear of eating and therefore malnutrition


What is the threshold of days below which abdominal pain is considered acute?


Which of the following are endocrinological (and therefore non-digestive) etiologies of abdominal pain?

It is indeed a cause of abdominal pain (always do an ECG) but it is cardiac (not endocrinological, see statement). trap, I grant 💩 you


True. To see it in pictures: https://upload.wikimedia.org/wikipedia/commons/thumb/5/57/Stomach-fr.svg/1200px-Stomach-fr.svg.png

That was a tough question, sorry! In addition, it is clearly not mandatory to know, so do not worry if you can not retain 😉 it


Which of the following are germs that can cause acute gastritis?

True, then progresses to chronic gastritis

Not per se, but induced immunosuppression promotes infection/reactivation by/of HSV and CMV


What is the sex ratio for gastric ulcer?


In the case of a gastric ulcer, treatment with curative PPI lasts for:

True. 6 weeks of curative PPIs in addition to Helicobacter Pylori treatment


Among the following proposals, which are techniques that could be used for the detection of H. Pylori?

True, reference technique to control post-treatment disappearance

Cytobacteriological examination of sputum (ECBC)


Which of the following are true about gastritis?

Lymphocytic gastritis is often asymptomatic

True, as well as gastritis under PPI and gastritis due to H. Pylori. These are the three causes of atrophiing gastritis.

Autoimmune gastritis can progress to atrophy

Autoimmune gastritis mainly affects children

All gastritis is at risk of degeneration

Granulomatous gastritis has no risk of malignant transformation


Which of the following propositions are true about labialveolar clefts?

They are due to a defect of fusion of the buds of the face in the 1st trimester of pregnancy

They are due to a defect of fusion of the buds of the face in the 2nd trimester of pregnancy

Failure to merge the buds of the face in the 1st trimester

They are due to a defect of fusion of the neural crest in the 3rd trimester of pregnancy

True, no involvement of the bony palate and veil in the lip and alveolar cleft


Which of the following propositions are true regarding the total cleft lip-alveolo-palate?


You receive in your general practice Mr. Emiliano Largo, 75 years old, who has just returned from a consultation with an ophthalmologist. He admits, a little embarrassed, that he did not understand what the ophthalmologist told him and that he had understood, however, that he will have cataract surgery on his right eye. You decide to do some therapeutic education. Which of the following proposition(s) are true?

False, cataract may be very common, it is a pathology of the lens. The aging of the lens will result more in presbyopia (lack of accommodation that will disrupt near vision)

Cataract is a physiological aging of the lens, linked to a clouding of the latter

True, these are quite characteristic and frequent signs of cataracts (hemeralopia = twilight vision disorder)

Apart from decreased visual acuity, cataracts can be characterized by hemeralopia and yellowing of colors.

False, the examination with the slit lamp allows the diagnosis of cataract and specifies its topography, so it makes it possible to distinguish nuclear cataract, posterior subcapsular, cortical or total

The slit lamp examination distinguishes a primary or secondary cataract

False, this seemingly vicious trap between ultrasound in mode A and B makes it possible to return to an important point and misunderstood by students. Mode A ultrasound is a "profile" ultrasound that measures the axile length of the eye while mode B ultrasound is a frontal ultrasound that will explore "the fundus" of the eye and look for foreign bodies or retinal detachment.

Before surgery by phacoemulsification of the lens, certain additional examinations are performed: ultrasound mode B and keratometry

False, if the most common complication is this one, the most formidable is endophthalmitis!

If secondary clouding of the lens is the most common complication, the most formidable complication is retinal detachment


In your acute geriatric department, you have been hospitalized for a few hours Mr Traveylan, Alec, 88 years old, for acute pneumonia, of viral origin, related to CoVID 19, which led to a decompensation of his chronic heart disease. You ask your outpatient to summarize the overall care of the patient according to the Bouchon model or 1+2+3. Link the right number to the right pathology(s):

True, the 1 in the Bouchon model corresponds to physiological aging

True, the n°2 corresponds to chronic pathologies

True, the n°3 corresponds to the decompensating factor


Regarding the two types of possible health follow-ups in occupational health, which of the following proposals are accurate?

False, hiring and periodic visits must be made by the occupational physician. The nurse can make intermediate visits

The follow-up of an employee in a position at risk may include periodic follow-up visits by an occupational nurse

Periodic follow-up visits shall be carried out at least every two years

False, for non-at-risk employees, there is no certificate of aptitude

For employees in non-high-risk positions, the recruitment examination issues a certificate of suitability for employment

The prevention information visit is done periodically at least every 5 years

True, if he is not at risk, all mandatory visits can be made by an intern or a nurse

An employee will not necessarily see the occupational physician in his professional life


True, this is part of the non-exhaustive list of roles of the occupational health service.

The occupational health service has as its action the prevention of the consumption of toxic substances at work

The occupational health service has as its action the prevention of sexual and moral harassment

False, naughty trap, there are no psychomotor and occupational therapists ...

The occupational health service may consist of nurses, psychologists, psychomotor therapists and occupational therapists.

True, double secret characteristic of the profession

The occupational physician is bound by medical and professional secrecy

True, 2021 College of Occupational Medicine Update

The role of the occupational physician is only preventive


Regarding accidents at work and occupational diseases, what are the possible benefits received by the employee?

False, cash benefit = compensation (think of cash as "pay in cash")

False, nothing to see it is the great war invalids / great war maimed


Which of the following are possible causes of ptosis?

Levator muscle of the eyelid = oculomotor nerve III


Which of the following suggests a rapid test in consultation that can support the diagnosis of myasthenia gravis in case of ptosis?

Test indicated when a patient suffers from ocular paralysis (and not ptosis). It consists of a graphic recording of ocular motor skills in different positions of the gaze.

True, ptosis decreases after several seconds

Useless for myasthenia gravis, not in consultation

Unnecessary and unchanged/normal in myasthenia gravis


Regarding facial paralysis, which of the following propositions, which one or which are true?

False, the definition here corresponds to peripheral facial paralysis. We must not forget that we can have central facial paralysis, which corresponds to an attack of the central nervous system.

Facial paralysis corresponds to distal involvement of nerve VII

True, unlike a central facial paralysis where we will have a predominant lower facial involvement.

Peripheral facial paralysis is characterized by upper and lower involvement of the face

True, to have seen him in internship it is all the more bluffing. The eyes open we will have an asymmetry sometimes minimal, and the sign of Charles Bell can be revealed entirely at the closing of the eyes.

The sign of Charles Bell is revealed or increased when a patient is asked to close his eyes

False, it is done on the healthy side. To help you remember tell you that it is the VII (motor nerve) that is abolished, so you have "no muscle" to stretch the mouth on the healthy side. But do not panic, I still confuse today the affected side ...

Deviation of the mouth in unilateral peripheral facial paralysis occurs on the paralyzed side

True, it is the main cause of facial paralysis, but you have to think about all the other causes too.

Facial paralysis "a frigore" is the most common cause of facial paralysis and is characterized by restoration without sequelae in about 90-95% of cases


Regarding tamoxifen, which statement(s) are correct?

False. In premenopausal women. In postmenopausal women, anti-aromatases are indicated (Anastrozole, Letrozole)

Tamoxifen is indicated in postmenopausal women with hormone receptor positive

True. Tamoxifen increases the risk of endometrial cancer.

In case of bleeding during tamoxifen treatment, endometrial cancer should always be ruled out and diagnostic hysteroscopy with biopsy curettage performed.

Tamoxifen is prescribed for a period of 5 years

True. Effective contraception is indicated.

Tamoxifen is linked to an over-risk of thromboembolic complications


Which of the following are true about Lyme disease?

True, and more specifically borreliosis (infectious diseases caused by bacteria carried and transmitted to humans by ticks or lice)

True, the best way to remember it is to pronounce it (no I'm kidding)


Which of the following propositions, is (are) true regarding fat embolism?

True. CLINICAL diagnosis above all and not paraclinical that will guide. If you ever miss the clinic, the fundus will allow a retrospective diagnosis

The diagnosis is primarily clinical and is based on the discovery of hyperthermia, sinus tachycardia and polypnea a few hours after a limb fracture

False. In addition there is only hypoxemia that is almost constant

The diagnosis is primarily paraclinical and based on the discovery of thrombocytopenia, hemolytic anemia and arterial hypoxemia.

True. It can be used to make a retrospective diagnosis when clinical manifestations have been missed.

The fundus can find retinal hemorrhages, cottony nodules and retinal edema

True! These manifestations are fickle, however.

The Gurd triad is based on the association of lesional pulmonary edema + neuro-psychic manifestations + petechiae of the trunk and mucous membranes

True! HEMODYNAMICS to be monitored extremely rigorously in the context of (poly)trauma. Fat embolism was the subject of an entire question at ECNI 2021. All this information can be found in the latest college of anesthesia resuscitation p344: https://www.cnear.fr/dfasm

Preventive treatment is based on immobilization of fracture foci, maintenance of good hemodynamics and the fight against pain


You receive in your acute geriatric department Mr. Dominique Greene, 89 years old, who comes for a classic fall care. You wonder what systematic assessment you are going to make and you note possible examinations / supports. What reviews will you NOT incorporate into your systematic review?

True, the fall assessment is as follows: Reassessment of the prescription, Evaluation of autonomy and functional independence by ADL and IADL/////NFS, CRP, Ionogram, Vitamin D, Blood glucose, Renal work, Liver test, CPK, Troponin, +/- TSH, Albumin, ////ECG, IPS, Orthostatic hypotension test, +/- ETT, Holter ECG, Brain imaging if call point


Among the following proposals, which examination(s) of unscrambling for etiological purposes must / must imperatively be carried out in front of any acute renal failure?

useful only if parenchymal cause (eliminate pre-renal and post-renal cause before)


Which of the following proposals concerning the therapeutic management of a polytrauma patient are true?

True, A=Airway, B=Breathing, C=Circulation, D=Disability, E=Environment and ensures no source of potential instability is forgotten

Treatment of vital distress follows sequence A, B, C, D, E

Stage E (Environment) mainly involves the fight against hypothermia

Stage D (Disability) focuses on neurological examination

The volume of blood lost during the first 6 hours post-traumatic of a femur fracture can reach 2000 mL

False, hypocalcemia that results from the dilution and presence of citrate in PSL (calcium chelator)

A massive transfusion exposes to the risk of hypercalcemia


Which of the following are causes of dysphonia with normal and mobile vocal cords?

It is not dysphonia (differential diagnosis), hypophonia is observed


Which of the following are recommendations for pregnant women who are not immune to toxoplasmosis?

There is no vaccine against toxoplasmosis


Which of the following can cause lesional esophageal dysphagia?

Non-lesional dysphagia: perprandial retrosternal pain


Which of the following proposals designate types of orthotics?

True: reduced pain and deformities at rest


Which of the following proposals correspond to a situation where a doctor can prescribe off-label? 😱

I kindly remind you that general medicine is a specialty. 😇😇

At the request of the specialist when you are a generalist


Which of the following are confusogenic molecules due to their anticholinergic activity?

No anticholinergic action. However, it can participate in dehydrating the patient (cause of confusion)