The most used are the visual analogue scale (EVA), the digital scale (EN) and the simple verbal scale (EVS)

EVA uses a graduation from 0 (no pain) to 10 (maximum bearable pain)

EVA uses a graduation from 0 (no pain) to 100 (maximum sustainable pain)

The EN rates pain from 0 (no pain) to 100 (maximum conceivable pain)

The EN scores pain from 0 (no pain) to 10 (maximum conceivable pain) and the EVS scores pain in 5 categories: 0 (no pain), 1 (low), 2 (moderate), 3 (intense), 4 (very intense), VAS rates pain from 0 to 100

Rating scales are not sufficient to assess chronic pain

These scales are insufficient for the assessment of chronic pain, which must take into account not only the intensity of the pain but all the dimensions of pain and its impact on quality of life.

The search for a neuropathic component to pain is essential

Neuropathic pain is to be sought, it testifies to the lesion of the somatosensory system and responds to a specific treatment involving in particular antidepressants and antiepileptics


The diagnosis of neuropathic pain is based on the use of specific scales (DN4, S-LANSS, NPQ), the most widely used in France is the DN4 questionnaire.

The DN4 questionnaire has 100 items to check

The DN4 questionnaire has 10 items to check

The DN4 questionnaire is completed by the patient

The practitioner questions the patient himself and completes the questionnaire

If the patient's DN4 score is greater than or equal to 4, the test is positive with significant sensitivity and specificity

The most frequent etiologies of neuropathic pain are radiculalgia (sciatica, cervicobrachial neuralgia), shingles or diabetes.


Chronic pain triggers a diagnostic approach that will clarify the presence of an underlying lesion

Acute pain triggers a diagnostic approach that will clarify the presence of an underlying lesion

Chronic pain corresponds to disease pain, i.e. a complex, biopsychosocial pathology

Inflammatory pain is often nocturnal pain (but nocturnal pain can also be of mechanical origin, for example in low back pain)

An inflammatory schedule pain is a pain that sets in in the second part of the night

The fibers that transmit the nociceptive message are fibers A and C


The modulation of nociceptive messages is subject to control systems of segmental and supraspinal origin

To assess pain, the diagnostic approach is based on the definition of the type of pain, knowledge of the mechanisms generating the pain and the intensity of the pain.

To determine the intensity of pain, multidimensional scales are used to estimate pain in a global way

To determine pain intensity, one-dimensional pain scales are used to estimate pain holistically.

the preferred scale is the numerical scale EN

The simple visual scale consists of 4 items, rated: 1: Low; 2: Moderate; 3: Intense; 4: Extremely intense

The simple visual scale consists of five items, rated: 0: Absent; 1: Low; 2: Moderate; 3: Intense; 4: Extremely intense


Pain is an unpleasant sensory and emotional experience, associated with, or described in terms of, present or potential tissue damage.

There are two main routes of transmission of somesthetic information: the lateral lemniscal system and the medial lemniscal system

There are two main routes of transmission of somesthetic information: the lemniscal system and the extralemniscal system

The lemniscal system corresponds to epicritical and proprioceptive sensitivities

The extralemniscal system corresponds to protopathic, nociceptive and thermal sensitivities


The neospinothalamic bundle rather connected to the Aδ fibers joins the ventro-postero-lateral nucleus of the thalamus before reaching the somatosensory cortex

The paleospinothalamic bundle rather connected to the C fibers joins the medial thalamus with a relay to the limbic structures and the frontal cortex

Diffuse inhibitory control of nociception-induced pain allows attention to be focused on the new painful area

Nociceptors can release neurotransmitters as well as substance P which has a vasodilating action and promotes the secretion of histamine, serotonin sensitizing neighboring nociceptors

It is neurogenic inflammation that causes primary hyperalgesia


NSAIDs act on the synthesis of prostaglandins by inhibiting the action of cyclooxygenase (COX)

Tissue damage leads to the secretion of analgesic substances such as opioid peptides

Serotonin (5-HT), dopamine and norepinephrine are largely involved in pain regulation by activating ascending neurons

Serotonin (5-HT), dopamine and norepinephrine are largely involved in pain regulation via descending inhibitory controls. This is the << gate control >>: they activate the A-alpha fibers which, in turn, inhibit the A-dela and C fibers (carriers of nociception) in the spinal cord.

The routes of transmission of the nociceptive message are lemniscal

What to remember The routes of transmission of the nociceptive message are extralemniscal


The main excitatory neurotransmitters of pain are adrenaline and corticosteroids glutamate, aspartate and substance P

These are glutamate, aspartate and substance P

It will be necessary to quickly determine the origin and nature in order to implement the appropriate treatment to remove the cause (if possible) and the complete disappearance of the pain.

In case of severe pain, a strong analgesic treatment, including strong opioid, is often useful

The pain is chronic if its duration is longer than 8 weeks

The pain is chronic if its duration is longer than 3 or 6 months

Chronic pain is a syndrome, multifactorial and complex, associating physical but also psychic, behavioral and social manifestations


Among these structures, at what level do the fibers of the lemniscale pathway decuss?

The fibers of the lemniscale pathway decuss at the buble, which is the lower part of the brainstem


Through which structures do the fibers of the lemniscale pathway pass?

These are sensory fibers (mainly Abeta) so they pass not the posterior horn of the spinal cord

They pass through the Ventro-Postero-Lateral nucleus of the thalamus

It is the post-central gyrus that is sensitive. The pre-central gyrus is motor


Which of these sensitivities are conveyed by extra-lemniscal routes?

There are three according to the College of Neurology: protopathic, nociception, thermal


The corpora cavernosa is an active vascular sponge consisting of smooth muscle cells surrounded by connective and elastic supporting tissue

Around the corpora cavernosa, the albuginea is a poorly stretched and resistant membrane

The albuginary muscle contracts rhythmically allowing the expulsion of semen during ejaculation

The bulbo-spongy muscle, which surrounds the initial part of the albuginea (= the bulb)

The glans is the terminal part of the corpus spongiosum that caps the distal end of the corpora cavernosa

The vascularization of the penis is largely anastomosed between the network of spongy arteries and dorsal arteries of the penis


Venous drainage is provided by a deep network

Pudendal veins flow into the external iliac veins

EMB drainage is through the internal iliac veins

Pro-erectile innervation comes from the orthosympatic system

Pro-erectile innervation comes from the parasympathetic system and NANC (non-adrenergic and non-cholinergic: essentially nitrergic [NO])

Pro-erectile innervation is of sacral origin S2-S4

In the flaccid state, adrenergic sympathetic innervation keeps the smooth muscle contracted limiting the opening of the sinusoid spaces


Age is an independent risk factor for erectile dysfunction

It is estimated that about 10% of couples have active sexuality by age 70.

ED is a sentinel symptom of cardiovascular disease and especially coronary artery disease

The prevalence of ED increases in comorbidities such as hypertension, diabetes, dyslipidemia and obesity

ED is an isolated sexual disorder, barring chance

There is a common association between ED and other sexual disorders


Which of these proposals are CMR substances (carcinogenic, mutagenic, reprotoxic)?


Which of these proposals are physical risks for pregnant women?


It is strictly forbidden to expose an unprotected pregnant woman to rubella

It is strictly forbidden to expose an unprotected pregnant woman to toxoplasmosis

Jackhammer work is not contraindicated in women before the 10th SA

Jackhammer work: generally forbidden to women, especially if they are pregnant.

Care shall be taken to ensure that exposure does not exceed 1 mSv if it is necessary for use

If she so requests, the pregnant woman or a woman who has given birth may request to move to a temporary day shift.


There is no legal obligation to declare the pregnancy to the employer

Declaring the pregnancy to the employer can lead to the implementation of optimized working conditions

A pregnant woman is not allowed to work for more than 5 consecutive days

The maximum working time is 40 hours/week at the beginning of pregnancy

From 6 months, the maximum weekly working time is 35 hours


If pregnancy leads to maladjustment to the position, dismissal is possible

No dismissal during pregnancy and maternity leave

Breastfeeding in the labour establishment is not possible

Maternity leave in its classic form is 24 weeks in total

The duration of maternity leave is: 6 weeks before the expected date of delivery and 10 weeks after

Maternity leave is extended in the event of multiple births


Psoriasis is an erythematosquamous dermatosis

Psoriasis is characterized by decelerated epidermal renewal and therefore hypoproliferation

Accelerated epidermal renewal with hyperproliferation and keratinocyte differentiation disorders

There is no genetic component that has been found until today

It involves, on a particular genetic terrain, complex interactions between the immune system, epidermal cells (keratinocytes) and vessels

The histopathological examination is mandatory to consider the diagnosis

Histopathological examination of a psoriatic lesion skin biopsy may be useful but is usually not necessary

The prevalence of psoriasis in the general population is about 2%


What is found during the histopathological examination?

An acanthosis is the thickening of the epidermis

Bacterial inflammatory infiltrates (often Staphylococcus aureus)


Many susceptibility genes have been identified

Some psoriasis in children begins as a result of nasopharyngeal infectious episodes

Infectious episodes have no impact on already established psoriasis

They can aggravate already known psoriasis

The occurrence or worsening of psoriasis during HIV infection is possible

Beta-blockers are an inducing or aggravating factor in psoriasis


Stopping systemic corticosteroids often stops psoriasis

Significant rebound possible or even development of severe forms (erythrodermic psoriasis, generalized pustular psoriasis) when stopping general corticosteroid therapy

Emotional shock has no impact on psoriasis

Possible role of emotional shock and trauma in triggering illness or flare-ups

Psychological stress could induce increased secretion of neurotransmitters with pro-inflammatory activity

Alcohol and tobacco are recognized factors of severity and therapeutic resistance

Overweight is a factor of resistance to treatment


The diagnosis of psoriasis is a pathological diagnosis

Skin biopsy is indicated only in case of diagnostic doubt in front of atypical lesions

The elementary lesion is a poorly limited tense bubble

The size of the lesions is always less than 5 mm

An AEG associated with elementary lesions strongly points to psoriasis

In the usual psoriasis, the general condition is not impaired


Failure to respect the rights and basic needs of the child

Refusal on the part of schooling in a classical school

Homeschooling is possible, legal and must be a respected choice

More common in cases of prematurity or disability


What are the risk factors for child maltreatment?


What are the risk factors for parental abuse?


What examinations are to be carried out in case of suspicion of abuse?

A hemostasis assessment is useless and only delays the real management

Eliminates a hemostasis disorder that can explain the lesions

Useless because would not explain common signs of abuse


With some exceptions, it is mainly a medico-legal emergency (see KB page 271)

The MIC is descriptive and photographs of the lesions must be attached

Administrative reporting is reserved for serious cases

Judicial reporting is reserved for serious cases

Shaken baby syndrome affects children under 1 year of age


The PMI service is under the Ministry of Social Welfare

Departmental service (this ministry does not exist)

The PMI is responsible for ensuring the health protection of mothers and children

The accompaniment is psychological and social


Which of the following are true for Gayet-Wernicke encephalopathy?


Lactatemia has no relation to the severity of organ failure

Shock is responsible for organ failure(s) and elevated lactatemia (> 2 mmol/L) whose magnitude is proportional to the severity

Shock is defined by the combination of hypotension AND at least 1 organ failure

There are two types of shocks: hypovolemic and distributive

4 types of shock: hypovolemic, cardigenic, septic, anaphylactic


What is the dosage of volume expansion to prescribe in a child in hypovolemic shock?


Which of the following are possible indications for the implementation of palliative care in paediatrics?

This is not an indication according to the college

The entourage of a child who died suddenly and unexpectedly

True, like road accidents or stillbirths

Disabling mitochondrial metabolic diseases


Diagnosis is based on 2 to 3 pairs of well-filled blood cultures (10 mL), which must be performed before any antibiotic therapy

The incidence of bacteremia/fungal among hospitalized patients is 1%

A quarter of bacteremia/fungal infections are associated with signs of hemodynamic distress (sepsis, septic shock)

Blood cultures do not need to be particularly performed at peak fever, hypothermia and/or chills


Regarding bacteremia, sepsis and fungalemia

The bacteriology laboratory must be informed of the clinical context, and of the possible search for particular infectious agents in case of emocultures.

In endocarditis, blood cultures are incubated for 10 days (slow-growing microbe), hence the importance of notifying the laboratory of the search for endocarditis

Any foreign material must be suspected in the absence of any other obvious cause

Any bacteremia with sepsis is a therapeutic emergency

ƒƒ If a foreign material is at the origin of bacteremia, its removal is most often necessary sometimes urgently, to hope to obtain a cure


aureus are serious infections, by: ƒƒ high frequencyInfetions by s; AUREUS ARE serious infections due to the frequency of spetic metastasis

Any infection with S. aureus must therefore perform a complete clinical examination in search of secondary septic locations (heart, bone, ...) and must systematically perform an echocardiogram in search of endocarditis

Antibiotic therapy is usually IV monotherapy with penicillin M or cefazolin (SASM) or vancomycin or daptomycin (MRSA)

Initial dual therapy is often required in these infections

Initial dual therapy is only necessary in case of signs of severity (association with gentamicin) or suspicion of endocarditis on prosthetic valve (combination with gentamicin then rifampicin)

The persistence of positivity is blood cultures is in favor of the existence of secondary septic localizations or endovascular infection,


Diseases are organized by the International Classification of Diseases, currently in its version 5 (ICD 5)

A specific classification system for mental disorders has been defined by the American Psychiatric Association

Currently in its version 5, translated into French (DSM-5)

DSM-5 is more widely used than ICD-10 for clinical research in psychiatry

The DSM-5 allows the scoring of medical acts in psychiatry

The DSM-5 also refers to routine clinical practice, while ICD-10 remains the France reference for the rating of acts in hospitals.


A sign is an "objective" clinical observation

A symptom is a "subjective" experience described by the patient

A syndrome is a set of signs and symptoms forming a recognizable set

The psychiatric examination is essentially clinical

Semeiological analysis in psychiatry consists of exploring eight domains of the patient's lived experience and behaviour.


The evolution of the symptomatology over time unfortunately does not bring additional elements to the clinical reflection

Personal hygiene can be indicative of carelessness (with indifference and lack of care)

An amimic expression signs the disappearance of all mimicry

Discourse is the quality of language (lexical field, vocabulary, etc.)

Discourse is the association of language and thought


The form of speech can be altered in its continuity with inconsistencies

Fading is the gradual cessation of the patient's speech

The content of the speech is most often uninteresting

The content of the speech can find: delusions, worries and worries, obsessions, revivals and flashbacks, phobic ideas, ideas related to anticipatory anxiety, ideas related to mood (negative, devaluation, incurability etc.), ...


Anhedonia refers more specifically to the loss of the ability to experience pleasure

Increased mood is very rarely associated with hypertune

Hypertune is a hypersensitivity to context and atmosphere

Aboulie is to be distinguished from apragmatism (difficulty in initiating an action due to lack of planning)


The most common presentation of GEU is implantation on the ovary

The most frequent presentation is tubal pregnancy with implantation that begins in the tube: in its ampullary part in 75% of cases, isthmian in 20% of cases, or even pavilion for 3% of GEU

The rarest presentation of GEU is pavilion nesting

More rarely, implantation can occur in the interstitial part of the uterus, on the ovary or in the abdomen and exceptionally in the cervix (cervical pregnancy) or in a rudimentary uterine horn in case of malformed uterus

Heterotopic pregnancy is the coexistence of two simultaneous pregnancies: an intrauterine pregnancy and a GEU

The main risk factor for heterotopic pregnancy is advanced age

The main risk factor for the latter is medically assisted procreation

EMG is a relative non-life-threatening emergency most often

The GEU, when it is evolved, is therefore the very example of the vital emergency and remains a major cause of maternal mortality in the world."


Regarding the evolution and FDR of EMGs:

The incidence of EMGs has declined significantly in developed countries

The incidence of ectopic pregnancies has increased in developed countries, accounting for 2% of pregnancies in France

Morbidity and mortality has increased significantly in recent years

Morbidity and mortality has been significantly reduced thanks to the possibilities of early diagnosis and effective and less invasive treatments such as drug treatment or laparoscopy.

There are no demonstrated risk factors for GEU

The risk factors for GEU are therefore all factors altering tubal motility: • upper genital infections (IGH), endometriosis, tubal or abdominal surgery atcd, etc.

Tuberculosis may be a cause of damage to the tubal wall

Schistosomiasis may be a cause of tubal wall ateration


High maternal age is a risk factor for GEU

The intrauterine device leads to a relative risk of GEU of 0.3 and therefore makes it a protective factor

intrauterine device (risk relative to 3)

IVF patients cannot have a GEU because the injection is uterine

For these patients, we must think about heterotopic pregnancies

The diagnosis of GEU should be discussed in any woman of childbearing potential presenting to the emergency room for pelvic pain and/or metrorrhagia

In a woman of childbearing age who has pelvic pain, we can do without a clinical examination and do a pelvic ultrasound directly.

Clinical examination, pelvic ultrasound and plasma βHCG assay (not set = 0) should be performed"


Vaginal touch is always normal at Douglas' cul-de-sac

At the posterior vaginal cul-de-sac (Douglas), touch can cause sharp tenderness indicating peritoneal irritation related to hemoperitoneum

Uterine emptiness with normal βHCG is the main indirect sign of GEU

Uterine emptiness with βHCG greater than 1,500 IU/L is the main (indirect) sign of GEU

GEU is never visible on endovaginal ultrasound

The GEU may be visible on endovaginal ultrasound as a "laterouterine mass" (Figure 2

The laterouterine mass is exceptionally located on the side of the corpus luteum

In 90% of cases, the laterouterine mass is located on the side of the corpus luteum

The presence of blood in Morrison's space is a sign of a large hemoperitoneum


The BHCG test is urgently requested in any patient of childbearing age who presents pelvic signs

If βHCG is above 1,500 IU/L with uterine acuity on ultrasound, the diagnosis of GEU is very likely

βHCG less than 1,500 IU/L eliminates the diagnosis of GEU

In intrauterine pregnancy, BHCG levels remain stable from the first days of pregnancy

Indeed, in intrauterine pregnancy βHCG levels double in this time interval

In case of spontaneous miscarriage, BHCG remains stable for several weeks

In case of spontaneous miscarriage, they decrease"


What does the preoperative assessment of a patient suspected of GEU contain:


Which of these proposals are differential diagnoses of GEU in beta-HCG negative?


In GEU, βHCG levels show insufficient ascent or stagnate

In case of suspicion of GEU, the BHCG assay is to be completed by a preoperative assessment

A hemoCue® is to be performed if the patient has clinical or ultrasound signs of severity

If the mother's Rhesus is negative, the spouse's blood type should be requested for the prevention of alloimmunization (anti-D Ig)

The affirmation of the diagnosis of GEU goes through BHCG

If the patient presents clinical signs of severity and in case of diagnostic doubt, it is the emergency laparoscopy that will affirm the diagnosis"


Which of these criteria fall within the definition of surgical emergency in case of GEU?

3 criteria: hemodynamic instability, abdominal defense and hemoperitoneum on echo

From blood in Morrison's space to ultrasound


The presence of unsafe pain makes the diagnosis of surgical emergency

The presence of only one of these severity criteria defines surgical urgency: • hemodynamic instability, • hemoperitoneum on ultrasound and • abdominal defense

Surgical treatment is performed urgently after conditioning the patient with 2VPP and an infusion of macromolecules

Surgery is always the treatment for GEUs, even asymptomatic

If the patient is pauci or asymptomatic, surgery remains indicated if she refuses or if she has a contraindication to methotrexate treatment or if outpatient follow-up is difficult

Laparoscopy confirms the diagnosis and specifies the location of the pregnancy

Salpingectomy treatment is the gold standard in young patients

Conservative treatment or salpingotomy should always be preferred if it extracts the pregnancy and stops bleeding."


A postoperative βHCG assay is performed until negativation

If bleeding is too great, radical treatment (salpingectomy) is performed.

If the couple wishes to become pregnant, salpingectomy should be preferred so as not to alter fertility.

If the couple wishes a pregnancy, it is necessary to favor conservative treatment so as not to alter fertility

The risk of treatment failure with salpingotomy is about 65%

The risk of treatment failure with salpingotomy is about 6-15%

In case of asymptomatic GEU, drug therapy with methotrexate 1mg/kg may be considered


Regarding the non-surgical management of GEUs:

If the first injection fails, we go directly to surgical treatment

If this fails, a second injection of methotrexate or laparoscopy may be performed.

After an injection of methotrexate, it is normal to have abdominal pain, which should not lead to worry or to consult again

Finally, the patient must consult urgently in case of significant abdominal pain or discomfort because it occurs in rare cases a tubal rupture after injection of methotrexate with indication of emergency surgery

Given the seriousness of EOGs, therapeutic abstention is never a good solution

In some exceptional cases, if the patient is asymptomatic, the initial βHCG level is less than 1,000 IU / L and the kinetics of βHCG shows a progressive and constant decrease, therapeutic abstention can be discussed subject to good compliance of the patient (βHCG assay every 48 hours and clinical and ultrasound controls once a week)

The patient should be informed of the risk of failure of medical and surgical treatments

The patient's blood type is of no interest if the management is not surgical

It is necessary to remember to check the blood group of the patient in order to prevent if necessary the anti-D alloimmunization (not put = zero)"


Clinical triad of GEU: 1. Delayed menstruation (witness to pregnancy), 2. Metrorrhagia (witness of haematosalpinx secondary to erosion of tubal vessels), 3. Lateralized pelvic pain (but not necessarily on the GEU side)

Sometimes there may be the presence of a tusk that testifies to a hemoperitoneum

A lateoterine TR mass painful in 50% of cases.


Which of the following proposals are part of the pre-therapeutic assessment of methotrexate?

True, thrombocytopenia and leukopenia possible under methotrexate

Not for the assessment of methotrexate treatment, but it should be done for the assessment of the impact of the GEU in case of bleeding

True. Hepatic failure is a contraindication

True. Renal failure is a contraindication

True, frequent vomiting or diarrhea in methotrexate treatment


Regarding medical treatment with methotrexate for GEU. Which of the following are true?

It is an antimetabolite treatment of nucleic acids

True. Specifically, it is a folic acid antagonist that inhibits folic acid reduction and tissue cell proliferation.

Methotrexate is most often injected into the GEU, directly into the tube, under ultrasound or laparoscopic control.

The injection is mainly done in one dose intramuscularly. This technique is rarely used for methotrexate

It is recommended if the β-HCG level is > 5000 IU/L

It is recommended if the hematosalpinx is < 4 cm

It is possible as a first-line treatment in an obese grade 2 woman with a haematosalpinx > 4 cm


Regarding complementary examinations in the GEU, which proposal(s) are true?

The β-HCG doubles every 48 hours in a normal pregnancy. In GEU, the kinetics of β-HCG stagnate, have insufficient elevation or fall.

If the β-HCG is negative, the diagnosis of GEU can be ruled out with certainty.

In front of any abdominal pain in women of childbearing age, it is necessary to dose the β-HCG to eliminate a GEU.

Subcortical reflex. Just like malaria and fever after a blah blah...

Pelvic ultrasound is not systematic in the diagnosis of GEU.

Pelvic ultrasound is systematic in the diagnosis of GEU. She looks for direct and indirect signs of GEU.

Diagnostic laparoscopy is sometimes indicated in case of doubtful diagnosis in a symptomatic patient.


It takes place only in the uterine cavity.

It can take place anywhere: in the fallopian tube, in the uterine cavity, and even in the ovary (very rare).

No, it takes place 7 days after fertilization. Fertilization occurs at 2 SA, so implantation occurs at 3 SA.

Implantation is the fact that the embryo implants in the uterine cavity.

It takes place 7 days after fertilization.

More rarely, implantation may occur in the interstitial part of the uterus, on the ovary or in the abdomen and exceptionally in the cervix.


Heterotopic pregnancy is the coexistence of two simultaneous pregnancies

Specifically, it is having a GEU and an intrauterine pregnancy at the same time.

Ectopic pregnancy is the implantation of the egg outside the uterus

During a GEU, the most frequent location of implantation is at the isthmian level.

At the ampullary level: 70% (the most frequent). At the isthmian level: 20%.

The main risk factor for heterotypic pregnancy is medically assisted reproduction.

The incidence of ectopic pregnancies has increased in developed countries, accounting for 15% of pregnancies in France


Premenstrual syndrome (PMS) is an extremely rare functional discomfort

It is the most frequently reported functional impairment by women (30-40%)

PMS is a set of clinical signs of interest to the genital tract, appearing in the days before menstruation to disappear at the beginning or during menstruation

It is a set of benign manifestations that can interest all devices, and whose only common point is their cyclical nature, appearing in the days before menstruation to disappear at the beginning or during menstruation

The evolution of PMS is punctuated by the events of psycho-affective life and episodes of genital life

Several treatments exist, more or less effective

The pathophysiology is poorly known but interstitial tissue edema seems to play a role


Regarding the management of premenstrual syndrome (PMS)

There are three main signs: breast, abdomino-pelvic and psychic

The elimination of psychoactive substances such as coffee are part of the treatment

Diuretics have no place in therapeutic management

They are useful in case of predominant edema

Synthetic progestogens are useful in the management of

In case of isolated mastodynia, local progesterone preparations can be used


Selective serotonin reuptake inhibitors (SSRIs) are effective on premenstrual, physical and emotional symptoms

Anxiolytics are not recommended systematically, especially because of the risk of tolerance and dependence

PMS is common and affects 30-40% of women

The three main clinical components are: headache, fatigue and somnolence

Premenstrual syndrome is common (30–40%). The three main clinical components are: mastodynia, abdominal bloating and mood disorders. The diagnosis is clinical: appearance of symptoms in the premenstrual period.


Which of the following proposals designate antibiotics with good diffusion in the bone?

True. Antibiotics with good bone diffusion = fluoroquinolone, rifampicin, fusidic acid, clindamycin, cyclins


Which of the following are antibiotics with good diffusion in the bone?

True, FRACC (because they shatter bone): Fluoroquinolones, Rifampicin, Fusidic acid, Cyclines, Clindamycin


Which of the following propositions are true about spondylodiscitis?

It is the most common osteoarticular infection (IOA)

The lymphatic pathway is most often involved

It is the blood-borne route that is the most common


Cardiovascular diseases are the leading cause of death worldwide

Cardiovascular mortality is steadily increasing in France.

Plateau phase / slight decrease (progress in management and prevention)

There is an ongoing epidemiological transition in developing countries, with an increase in the prevalence and incidence of atheromatous diseases

In particular because of the lack of prevention and management of risk factors

Variations in CV disease prevalence are less related to environmental and lifestyle factors than to genetic differences

These variations are more related to environmental factors and lifestyle.

In France, CV diseases cause one in three deaths


There is a difference in incidence between the sexes, which decreases with age

The prevalence of cardiovascular disease increases with the age of the population

Significant risk from age 50 in men/age 60 in women

CV mortality is higher in Southern Europe than in Northern Europe

Higher mortality in North/Western Europe (non-Mediterranean diet)

The increase in the thickness of the wall by increasing the volume of the plates is associated with an increase in the diameter of the vessel

In order to compensate (initially) for the reduction in light gauge


Atheroma can also alter the parietal structure of the vessel and destroy the extracellular matrix, which can promote the formation of an aneurysm

Among others at the level of the abdominal aorta

Treatment of high blood pressure helps prevent the development of atheroma

By reducing the mechanical stresses applied to enfothelium

Atheroma develops mainly near turbulent arterial flows: ostium, bifurcation, mechanical stress zone

Atheroma affects large and medium arteries : mainly the aorta and its branches

Atheromatous plaques lead to a tendency to vasoconstriction and vascular spasm

Remodeling prevents the passage and action of NO


Predisposing factors for atherosclerosis include obesity, physical inactivity, stress and psychosocial conditions.

Polyatheromatous disease is an atheromatous involvement of at least two different arterial territories

Atheromatous involvement may or may not be symptomatic

Frequent associations require screening for lesions of other arterial territories, whenever an atheromatous lesion is discovered

Minimum work-up: clinical (including BP), ECG, IPS measurement, EAL, fasting blood glucose

The atheromatous localization most frequently associated with coronary involvement are the arteries of the lower limbs (PAD)

Strong association with coronary artery disease PAD


Hand-shoulder syndrome is typical after stroke

2 types. Type 2 is associated with nerve damage, unlike type 1

The evolution of type 1 CRPS is spontaneously favorable in 10% of cases

In 90% of cases, but the evolution lasts several months


Trophic disorders and aponeurotic retractions may be observed in CRPS type 1

The pain is constant in CRPS: it is intermittent with inflammatory rhythm

The pain is continuous, disproportionate to the triggering event

CRPS is never seen in young people under the age of 20

CRPS is possible at any age, but remains exceptional in adolescents and children

The pathophysiology of CRPS includes neurological dysfunction of the peripheral, medullary and cerebral nervous systems

The most common triggers of CRPS1 are central neurological disorders


CRPS associated with pregnancy mainly affects the shoulder

The severity of CRPS 1 is proportional to the severity of the triggering factor

The diagnosis is made according to the Budapest criteria

Criteria of pain, various sensory symptoms, vasomotors, sudomotor players, trophic (...) and exclusion of differential diagnoses

Typically, in post-traumatic, CRPS is composed of two phases

3 phases: inflammatory hot phase, pure dystrophic cold phase and atrophic phase (in practice, these three phases are rarely found)


The joint space is the site of erosions in advanced forms

Clinical diagnosis, and low specificity of MRI (17% according to the college of MPR)

No biological abnormalities, except due to the trigger. In any case, a biological inflammatory syndrome must seek a differential diagnosis.

MRI can be normal, without questioning the diagnosis

MRI is the gold standard exam but it is not systematic

This is indeed the reference examination, and no imaging is systematic: the diagnosis is clinical, the complementary examinations aim to exclude differential diagnoses and are guided by the clinic


Regarding the management of CRPS type 1:

The only curative treatment that has been shown to be effective in CRPS1 is vitamin C

It is the only preventive treatment that has been shown to be effective.

Analgesics are an effective curative treatment

It is symptomatic treatment, not curative. In addition, drug treatments are not very effective in CRPS, although they are necessary.

Occupational therapy is indicated as a first-line treatment in case of upper limb involvement

Total rest is indicated during the hot phase

Rest must be kept to a minimum: rehabilitation is started as early as possible

Bisphosphonates have an early indication in severe forms or to treat signs of neurogenic inflammation

In IV/PO. Neurogenic signs of inflammation include pain and neuropathic sensory signs.


The majority of acute meningitis and meningoencephalitis are infectious by contamination of the CSF with an infectious agent

Meningeal syndrome is characterized by the inconsistent association of the triad of headache, vomiting and meningeal stiffness

A meningeal syndrome should be evoked in front of a whiny child, presenting cries on mobilization (skin hyperesthesia), behavioral changes, unusual drowsiness interspersed with periods of agitation

Abnormal tension of the fontanel can be found in case of meningeal syndrome of the infant

In children, clinical signs may be more crude with an infectious syndrome often in the background


Regarding meningitis and meningoencephalitis:

In adult bacterial meningitis, 95% of patients have at least two of the following signs: headache, fever, stiff neck, impaired alertness

However, diagnosis is more difficult at extreme ages.

Bone marrow aspiration is the key test to confirm the diagnosis of meningitis

Lumbar puncture (LP) is the key test to confirm the diagnosis of meningitis

An EEG showing a slow trace with diffuse periodic slow waves is in favor of encephalitis

Herpetic meningoencephalitis is a diagnostic and therapeutic emergency because there is a risk of serious sequelae

Normal CSF, including HSV PCR examination, early in the disease does not exclude the diagnosis of herpetic meningoencephalitis.

HSV PCR in CSF can be negative for up to 4 days and should be repeated if clinically suspected.


Cerebrospinal fluid (CSF) analysis can tell the difference between meningitis and meningoencephalitis

Droplet precautions should be instituted until meningococcal meningitis has been ruled out and/or during the first 24 hours of antibiotic therapy.

Faced with clinical suspicion, lumbar puncture (LP) is the key examination, to be performed urgently

Taking antiplatelet agents does not contraindicate PL

On the other hand, taking anticoagulants is a contraindication.

Venous glucose is performed concomitantly with the PL for a correct interpretation of glycorachia


The macroscopic aspect of the CSF provides a 1st etiological information: if it is cloudy on the different tubes, it evokes elevated leukocytorachia and therefore purulent meningitis

Antibiotic therapy should be initiated prior to PL if purpura fulminans is suspected

Probabilistic treatment of a bacterial meningitis chart is dominated by IV C3G and that of an encephalitis chart by amoxicillin-aciclovir

In case of purpura fulminans, it is essential to make an IV or IM injection of ceftriaxone pre-hospital

In case of meningococcal meningitis, antibiotic prophylaxis of contact subjects (± vaccination) and case reporting are essential.


The pia mater is directly attached to the bone

It is the most in-depth layer, directly covering the central nervous system.

The arachnoid is the middle layer, between the dura mater (attached to the bone) and the pia mater (acolated to the CNS).

The dura mater directly covers the brain and spinal cord

The arachnoid and pia mater form leptomeninge


It is contained in the subarachnoid space (between the arachnoid and the pia mater, that is, between the two leptomeninges).

The study of the contents of the CSF by lumbar puncture, together with clinical examination, allows the diagnosis of meningitis

The study of the contents of CSF by lumbar puncture, together with clinical examination, allows the diagnosis of meningoencephalitis

The majority of acute meningitis and meningoencephalitis are infectious by contamination of the CSF with an infectious agent

An increase in lactates is suggestive of a bacterial infection

Suggestive of bacteria: hyperproteinrachia, hypoglycorachia (relative to blood glucose), hyperlactatemia, nuclei elements > 1000 (with PNN) and cloudy CSF.


Brudzinski's sign corresponds to an involuntary flexion of the lower limbs following the anterior forced flexion of the neck

This is a sign that can accompany meningeal syndrome

Kernig's sign is an inability to sit without bending the knees and painful resistance to full extension of the lower limb when the thigh is flexed.

In a patient with meningeal syndrome, live ROT may be found

In a patient with meningeal syndrome, hypoaesthesia of the lower limbs may be found

Rather, diffuse cutaneous hyperesthesia is found.

The meningitic line of Trousseau corresponds to the fact that the drawing of a line on the skin with a foam tip reveals a line first white, which then reddens and disappears late


These signs and symptoms, which are part of encephalitic syndrome, include:

To varying degrees, from simple drowsiness to deep coma

Part of meningeal syndrome (inflammation of the meninges) and not encephalitic syndrome (inflammation of the brain)

For example, motor deficit, cranial pair paralysis, aphasia, abnormal movements

Meningeal syndrome (inflammation of the meninges) and not encephalitic syndrome (inflammation of the brain) are part of.


Purpura fulminans is defined by the presence of at least 1 necrotic or ecchymotic element greater than 3mm

The 2 germs most often involved in purpura fulminans are meningococcal and pneumococcus.

CSF should always be collected before antibiotics are introduced in front of purpura fulminans

When managing purpura fulminans pre-hospital, antibiotics should be given before CSF is collected.

It is necessary to administer 1g of C3G IV or IM

Meningococcal is a gram-positive diplococcus

Gram-negative diplococcus. The gram-positive diploma is a pneumococcus.


The 2 diagnoses to evoke are infectious meningitis and subarachnoid hemorrhage

This is the triad of meningeal stiffness + headache (with photophonophobia) + jet vomiting

Kernig's sign corresponds to an involuntary flexion of the hip and knee in response to a forced flexion of the neck

Brudzinski's sign corresponds to painful resistance to full knee extension when the hip is flexed

Meningeal stiffness is a contracture of the paravertebral muscles in response to pain


Are signs of severity during meningitis / meningoencephalitis:


Are the antibiotic (s) authorized before a purpura fulminans

There are only 3 antibiotics allowed: ceftriaxone, cefotaxime and amoxicillin


What are the situations where a lumbar puncture is not done before starting the treatment of meningitis?

On the other hand, in hospital it is necessary to do blood cultures before antibiotic treatment. In out-of-hospital blood cultures, blood cultures are not done.

If the transfer to the hospital is less than 120 minutes

More than 90 minutes (120 minutes is for SCA ST+)

No longer a contraindication if isolated


Regarding the CSF of purulent meningitis

NN> 50% = purulent meningitis; lymphocytes > 50% = clear fluid meningitis

This is glycorachia in normal CSF. In purulent meningitis, glycorachia is < 0.4 x blood glucose (very specific for a bacterial cause)

On direct examination, we will always find gram-positive cocci

There are two bacteria that are most often involved: meningococcal (gram-negative diplococcus) and pneumococcus (gram-positive diplococcus). These are encapsulated bacteria.


Etiologies causing glycorachia < 0.4 x blood glucose with clear fluid meningitis:

The causes of glycorachia < 0.4 x blood glucose with clear fluid CSF are: listeria, tuberculosis, cryptococcus and carcinomatous meningitis


What germs give normoglycorachic lymphocytic meningitis?

Hypoglycorachic lymphocytic meningitis, hypoglycorachic purulent meningitis, or hypoglycorachic variegated meningitis

Spirochetes (lyme, syphilis and leptospirosis)


It is the leading cause of purulent meningitis in all age groups.

Meningococcal disease is most often involved in 15- to 24-year-olds. Pneumococcus is most often involved in other age groups. Meningococcal is transferred by close relation and by saliva, I let you use your imagination;)

20% of pneumococci have a change in PLP target

They are therefore resistant to penicillins (amoxicillin). We therefore use C3G as a first line because we want to cover resistant germs in the face of a potentially very serious infection.

Pneumococcal infection is promoted by a meningeal breach

Always look for a notion of head trauma during interrogation.

Complement protein deficiency promotes pneumococcal purulent meningitis

In a subject with pneumococcal meningitis or sepsis, it is necessary to look for a complement protein deficiency

There is often a carriage of pneumococcus at the ENT level


Regarding the latency time of a meningococcal infection:

It is for this reason that the definition of the contact case is anyone who has had a contact of < 1m for > 1h for the last 10 days. These contact cases should be treated with antibiotic prophylaxis and vaccination to eradicate meningococcal carriage.


Which of the following are situations where a brain scan must be performed before the lumbar puncture?

Glasgow less than 12 (from Glasgow = 11)


What is the main pathogen responsible for primary purulent meningitis in young immunocompetent adults?


Which of the following proposals are found in a normal CSL?

Glycorachia < 2/3 of venous blood glucose

Glycorachia >2/3 of venous blood glucose

A direct gram-negative staining examination


Which of these responsibilities lead to a sanction of the doctor?

3 types of responsibilities can lead to a sanction of the doctor: criminal, ordinal and disciplinary

Leads to compensation to the patient but not to a sanction to the physician

Leads to compensation for the patient but not to a sanction for the doctor."


Which of these proposals are reprehensible from a criminal point of view?

The conscience clause makes it possible not to perform an abortion but obliges the practitioner to re-direct the patient to a colleague who will receive her within a reasonable time.


Which of these proposals refer to an exemption from medical liability?

Whether the doctor is in clinical practice or not does not exempt medical liability in all cases (non-assistance to a person in danger for example)

Alteration of the doctor's consciousness

Does not allow an exemption from medical liability"


Before which court is a contravention judged?


In the event of a complaint, the Public Prosecutor's Office must prove:

The correlation between physician's fault and patient harm

The Public Prosecutor's Office is represented by the Public Prosecutor


Criminal law is the application of the rules contained in the Penal Code

Criminal liability is based on fault (not error)

The Penal Code defines 2 types of offences: misdemeanours and crimes

The Penal Code defines 3 types of offenses: Contraventions (rare in the medical field), Misdemeanors and Crimes

The dismissal is decided by the gendarme receiving the complaint

The Prosecutor decides on the Republic: If it is necessary to continue (If the case of investigations, request expert opinions ...) the prosecution, or if there is no need is not in a state to be judged, the investigating judge intervenes to expedite

If one of the 2 parties is not satisfied with the judgment, he can appeal the decision


The limitation period for contraventions is:

Be careful, there has been a reform of the limitation periods. It is now: 1 year for misdemeanors, 6 years for misdemeanors, and 20 years for general crimes.

For general crimes (30 years for serious crimes such as terrorism)


The statute of limitations for misdemeanours is:


The statute of limitations for general crimes is:


The Code of Medical Ethics provides for the rights and duties of physicians towards their patients but also towards their colleagues.

This code is itself inserted into the Public Health Code (Articles R. 4127-1 to R. 4127112)

Disciplinary misconduct occurs when the physician's conduct undermines the interests governing the profession

There is a list of sets of possible disciplinary offences

No list (as in the Penal Code) can therefore cover all disciplinary offences.

Medical malpractice may be subject to both the ordinal jurisdiction and the ordinary courts


Among these proposals, what are the penalties incurred during a disciplinary sanction decided by the Order of Physicians

Permanent prohibition to practise in a given region


Regarding the fundamentals of medical liability

The Civil Code governs the liability of doctors practising in private practice

Civil liability is demonstrated by the existence of a fault of the doctor and a prejudice for the patient

Civil liability is based on the existence of a fault of a damage of a causal link (or damage) between the 2, link that will have to be proven by the victim A distinction is made between:

Patient dissatisfaction often stems from a lack of communication with the doctor

The physician is no longer the one who makes decisions alone that he imposes on the patient

The distinction between major tort and contractual nature is important


Lymphadenopathy is an enlargement of more than 1 cm of a lymph node (or node)

Infectious etiologies are the most common, followed by cancers and lymphomas

All lymph node areas should be examined to determine whether it is localized lymphadenopathy or polyadenopathy, as the diagnostic approach is different

TRUE. In the case of polyadenopathy, a blood count should be performed to look for acute leukemia, CLL or mononucleosis syndrome

Any lymphadenopathy whose diagnosis is not quickly specified justifies a cytopuncture, or even a biopsy or surgical excision for analysis

TRUE. Cytopuncture is the examination of choice in single lymphadenopathy. For poly-adenopathy, if the blood count is not sufficient, lymph node biopsy is preferred

Non-infectious lymphadenopathy is mainly represented by hematological malignancies (lymphomas, leukemias) and cancer metastases.


Additional examinations are indicated in case of:

Lymphadenopathy is said to be voluminous if > 2 cm. Conf College of Infectiology

Lack of etiology at the end of the clinical examination

TRUE. It is a hard lymphadenopathy that will rather direct to cancer


Which of the following proposals point to cancerous lymphadenopathy?

Size greater than 2cm in inguinal region


Which of the following are possible causes of inflammatory lymphadenopathy?


Light propagates in a straight line in space, but when it encounters a surface separating two transparent media of different index, its direction changes: this phenomenon of deflection is called refraction

Light rays pass through refractive surfaces and refractive media, the whole of which constitutes the dioptric apparatus of the eye.

The two most important refractive elements of the eye are the cornea (on average 42 diopters) and the lens (about 20 diopters)

The total convergence power of the eye is about 12 diopters

The eye is therefore a complex optical system composed of several diopters, whose total convergence power is about 60 diopters.

In the optically normal or emmetropic eye, parallel rays focus on the retina, spontaneously giving a clear image.


In hyperopia, the image of an object located at infinity is not formed on the retina and it is therefore seen blurred

Myopia and hyperopia are so-called punctiform ametropia

Myopia and hyperopia are so-called spherical ametropia, the optical anomaly being the same regardless of the plane in which the light ray is located

The punctum remotum is defined by the closest point that the eye can see clearly without accommodating

The punctum remotum is defined by the farthest point that the eye can see clearly without accommodating (to infinity for the emmetropic eye)

The main ametropias are glaucoma and AMD

The main ametropias are myopia, hyperopia and astigmatism

In hyperopia, the image is formed virtually behind the retina


Appears at the same time as other ametropia

In myopia, the refraction of the eye is not the same depending on the plane in which the incident rays are located.

Visual acuity (VA) is the discriminating power of the eye

VA is one of the functional parameters (along with color vision and contrast vision) specific to the macula.

Distance VA is measured with the Menetrier scale

The VA from afar is measured with scales, the most used in France is that of Monoyer (1875), graduated in tenths


The lens is suspended inside the globe by a set of fibers constituting an elastic ligament, the zonule.

When the zonule contracts, it increases the convergence power of the lens

The amplitude of accommodation is defined by the difference in the dioptric power of the eye in distance and near vision

Symptoms of presbyopia usually begin to appear in patients after the age of 80

Presbyopia is responsible for a decrease in visual acuity in distance vision such as hyperopia

Presbyopia is responsible for decreased visual acuity in near vision


Presbyopia must be compensated by the addition of a correction consisting of convex spherical glasses

at age 60: frequent addition of 3 diopters

In a healthy and emmetropic subject, VA is spontaneously satisfactory

In a refractive anomaly, the VA can be improved by wearing an optical correction


It is an inflammation of the ileocecal appendix of unpredictable course (inflammation, abscess, perforation)

There is no anatomo-clinical parallelism

In the face of abdominal pain, no clinical signs or symptoms (including fever or apyrexia) have sufficient individual diagnostic value to confirm or exclude a diagnosis of appendicitis (HAS, strong agreement)

Ultrasound is the preferred examination in children, young subjects, women of childbearing age

The non-visualization of the appendix on ultrasound does not exclude appendicitis


As soon as complicated appendicitis is suspected, the CT scan then becomes the first-line examination.

The CT scan must be performed within 24 hours with clinical signs of severity or occurring on fragile ground

The examination must be carried out within 4 hours with clinical signs of severity or occurring on fragile ground, and within 24 hours for suspicions of uncomplicated appendicitis

The appendicular abscess is suspected before: a tusk that may extend to the right flank and hypogestrium, general signs marked with a fever above 38.5 ° C, and transit disorders suggestive of occlusion

The appendicular plastron is marked by persistent pain, fever and biological inflammatory syndrome.

Appendicitis can be immediately revealed in the form of peritonitis


Intussusception of the infant should be discussed in case of abdominal pain with vomiting

In children, right base pneumonitis is a differential diagnosis that can be expressed by abdominal pain in a febrile context

In adults celiac disease should be evoked on recurrent abdominal pain, diarrhea and scannographic data

Crohn's disease should be discussed on recurrent abdominal pain, diarrhea and scannographic data

A right colonic tumor and other causes of febrile occlusion should be evoked in the elderly

Treatment of acute appendicitis is surgical


Treatment is based on appendectomy within 2 hours in case of uncomplicated acute appendicitis

The operating time includes an exploration of the peritoneal cavity and the realization of bacteriological samples

The surgical piece must be sent to pathology

In case of peritonitis or suspicion of gangrenous appendicitis, surgery is indicated urgently, combined with antibiotic therapy

Water-electrolyte rehydration in case of complication is necessary


Its risk is the progression to perforation and peritonitis which is life-threatening.

Acute appendicitis is the most common surgical emergency in France

The majority of cases of acute appendicitis occur in women over 40 years of age

The majority of cases occur in adolescents and young adults between the 2nd and 3rd decade with a male predominance

The incidence of perforation is 70 to 80% in children and 30% in the elderly

The typical pain of appendicitis begins in the left iliac fossa

Starts right in the right iliac fossa (FID) and gradually increases in intensity over the first 24 hours


Palpation regains pain caused or maximum IDF defense at the rovsing point

The NFS shows polynuclear hyperleukocytosis (> 10,000/mm3) (80% of cases)

A negative urine strip eliminates a urinary tract infection

β-HCG are dosed in women of childbearing potential to rule out the possibility of an ectopic pregnancy

Ultrasound is preferred as a first-line approach in women


The abdominal CT scan has become the reference complementary examination for any abdominal emergency in case of diagnostic doubt, due to a positive predictive value close to 100%

The abdominal CT scan has become the reference complementary examination for any abdominal emergency in case of diagnostic doubt, due to a negative predictive value close to 100% – that is, the visualization of a normal appendix on the CT scan eliminates the diagnosis of appendicitis

CT scan is indicated as a first-line test in the elderly

On imaging, the diagnosis is based on an increase in size of the appendix and its wall, an infiltration of the fat of the mesoappendage and the possible presence of stercolith

In front of abdominal pain suggestive of appendicitis, the concomitant absence of a defense in the right iliac fossa, a leukocytosis greater than 10 × 10^9 cells / L and a CRP greater than 8 mg / L makes the diagnosis of acute appendicitis unlikely

In the face of abdominal pain suggestive of appendicitis, the combination of a defense in the right iliac fossa, leukocytosis greater than 10 × 109 cells / L and a CRP greater than 8 mg / L in young men makes the diagnosis of acute appendicitis very likely


In the face of abdominal pain, no biological parameter (leukocytes, PNN, CRP) has an individual diagnostic value high enough to confirm or exclude a diagnosis of appendicitis

In case of pelvic appendicitis the pains are localized to the left hypogastric region

The pains, localized to the right hypogastric region, are in the foreground, most often associated with a febricle

In case of subhepatic appendicitis the symptoms are those of acute cholecystitis: pain of the right hypochondrium, fever and defense

The patient sometimes has an analgesic position in psoitis in case of subhepatic appendicitis

In case of meso celiac appendicitis the appendix is located in the middle of a digestive loop and its inflammation is at the origin of a more or less important reflex ileus in a febrile context


In France, the reservoir of the disease is in adults and the elderly

The reference identification technique is immunostaining

Fluoroquinolones are the basis of curative antibiotic therapy and antibiotic prophylaxis

Macrolides are the basis of curative antibiotic therapy and antibiotic prophylaxis

Bordetella pertussisest is a gram postive cocci

Bordetella pertussis = pertussis agent, gram-negative bacillus


Transmission is strictly human-to-human, airborne.

The attack rate is high (75%) in case of close and repeated contact

Transmission is mainly intra-family and intra-community

Children are the reservoir of contamination in the world

Infant mortality is high (malnutrition, respiratory complications)


Maternal antibodies do not protect the infant from disease (apart from vaccination during pregnancy, not recommended in France)

the adult form is atypical, readily attenuated by residual immunity

Main symptom is cough organized in paroxysmal fits with difficulty of inspiratory recovery or chronic spasmodic cough

There is hyperlymphocytosis at the NFS often > 10 G / L, suggestive, but inconstant


ƒƒ ACE inhibitors can cause prolonged coughing

While stereotyped 3-phase evolution is common in unvaccinated infants, it is not always identifiable in adults.

There is an Ineffectiveness of treatment on symptoms when prescribed in the fifths phase

The alternative if contraindication macrolides is cotrimoxazole for 14 days


It is always the expression of intra-articular suffering

Physiological joint fluid has a nutritious function for cartilage

The diagnosis of joint effusion is always clinical

For the shoulder and hip, the diagnosis is mainly ultrasound or radiological

A patellar shock at the knee signs an effusion

MRI is the exam of choice to objectify an effusion in the deep joints

Rather ultrasound in this case of use. MRI does not provide additional information (except in the case of hemarthrosis).


Regarding the diagnosis of joint effusion

Involvement of the proximal and distal interphalangeal joints and respect for metacarpophalangeal refers to rheumatoid arthritis

Towards digital osteoarthritis. There is respect for distal interphalangeal in rheumatoid arthritis

MRI can identify the etiology of effusion in most cases

Arthritis with a digestive infection 2 weeks ago suggests septic arthritis

Reactive arthritis (absence of germs in the joint)

Hygroma = Bursitis. This is an attack of the periarticular structures

Viral arthritis is typically polyarticular


However, a joint puncture is contraindicated in this case to avoid joint contamination.

Hip pain should evoke a knee injury, by projection of pain.

It's the opposite: a hip injury can be depressed by gonalgia

The diagnosis of rheumatoid arthritis can only be made after 6 weeks of evolution

During a joint puncture, biochemical analysis is systematic


Non-febrile seizures require EEG 🧠 exploration within a week

Febrile seizures require a lumbar puncture if the age is less than 9 months 👶

The most common cause is epilepsy-absence

The most common cause is hyperthermic seizure

Simple seizures recur in 20 to 30% of cases

Cerebral thrombophlebitis are rare causes of seizures 🤕


What is the annual incidence per 100,000 inhabitants of acute leukaemia?


Leukemias are the most common cancers in children


Which of these proposals are etiological factors for leukemia?

Especially in case of immunosuppression (in transplant recipients for example)


Regarding the different forms of leukemia:

Monoblastic AML is accompanied by frank hyperleukocytosis

Post-chemotherapy AML does not typically find karyotype abnormalities

ALL with Philadelphia chromosome finds a translocation 11;14

There is a translocation 9;22 (BCR ABL). Translocation 11;14 is a factor in good prognosis for multiple myeloma

Burkitt's ALL may be accompanied by tumor lysis syndrome

Most acute leukemias are rapidly fatal without treatment


Which of the following are causes of thrombocytosis?

Does not have this effect, it is not integrated by the marrow


Which of the following are classic ways of revealing acute leukemia?


Which of the following are factors in poor prognosis for AML?


Which of the following are causes of pancytopenia?

Medullary invasion of clonal proliferation


Regarding promyelocytic myeloid leukemia (AML 3), which propositions are true?

A t(9;22) translocation is often found at the karyotype

t(15;17)
The translocation t(9;22) corresponds to the Philadelphia chromosome found in 2 pathologies: ALL with Philadelphia chromosome and CML with Philadelphia chromosome

Its treatment is based on ATRA (all-trans retinoid acid)

True, 5-year relapse-free survival of 80%

False. It is in monoblastic myeloid leukemia (AML5)

Pancytopenia is often found on a blood count


Regarding monoblastic leukemia (AML5). Which of the following are true?

False. DICD is often associated with promyelocyte leukemia (AML3)

True. Leukemides are a cutaneous localization of blasts.

There is often a meningeal involvement which justifies prophylaxis.

It often includes leukostasis syndrome, which can cause acute respiratory distress, impaired consciousness and epilepsy through damage to the pulmonary and cerebral capillaries.

Leukostasis syndrome is common in monoblastic leukemia. It appears when there is hyperleucytosis > 100 G / L


Which of the following are tests to clarify the diagnosis of acute leukemia?

True, performed on spinal cord puncture but can also be performed on circulating blasts

True, indispensable: allows to affirm leukemia and to type it

Molecular biology analysis of bone marrow cells


Which additional examination(s) are systematically part of the assessment of complications of acute leukaemia?

False. PL is systematic even in the absence of signs of call of meningeal invasion only in case of ALL, monoblastic LA and hyperleukocyte LA (hematic college 3rd edition)

True. Necessary for the review of the DIC.

True. To look for tumor lysis syndrome. The amount of LDH is proportional to lysis syndrome.

True. It is necessary to look for a secondary localization of blasts.

False. It is useless unless spinal aspiration is impossible or unless there is a suspicion of associated myelofibrosis.


A myelogram would show what abnormalities in acute myeloid leukemia?

True. These are small red sticks that are specific to AML

False. By definition, acute leukemia present ≥ 20% of bone marrow blasts

Positive myeloperoxidase enzyme activity

Small and medium-sized blasts are suggestive of ALL


Which of the following proposals, which, independently of others, can the diagnosis of acute leukaemia be affirmed?

Immunophenotyping of circulating lymphocytes

True, it is the only examination that can confirm the diagnosis


The eyelids, upper and lower, have the essential role of protecting the eyeball

They are composed of an anterior plane and a posterior plane

The posterior plane is tarsoconjunctival

The conjunctiva is reflected at the conjunctival cul-de-sac and then lines the eyeball (bulbar conjunctiva)


The eyelids contain Durkeim's glands that secrete lipids used in tears.

Tears are eliminated either by evaporation or by drainage to the nose through the excretory tear ducts.

The two tear points, lower and upper, are visible on the free edges in the vicinity of the inner canthus

Insufficient secretion does not lead to any particular symptom

Insufficient secretion can lead to dry ocular syndrome

The palpebral closure is provided by the orbicular muscle of the eyelids innervated by the trigeminal

The palpebral closure is provided by the orbicular muscle of the eyelids innervated by the VII (facial nerve)


The opening of the eyelids is related to the levator muscle of the upper eyelid, innervated by the III (common ocular motor)

The stye is a boil of the free edge of the eyelid centered on a pilosebaceous follicle of the eyelash

The stye corresponds to a parasitic infection

It corresponds to a bacterial infection, most often Staphylococcus aureus, of the pilosebaceous follicle

The stye is painless almost systematically

It develops within a few days and can lead to sharp pain.

Treatment of stye is purely symptomatic pending spontaneous healing

Treatment consists of eye drops or antibiotic ointment for 8 days


Chalazion is an inflammatory granuloma developed on a meibomian gland

Chalazon is a bacterial infection, most commonly due to Staphylococcus aureus

Most of the time, there is no infection and the secretions contained in the chalazion are purely sebaceous

Chalazon presents clinically as a painful swelling of the eyelid most often

Chalazon heals in 3 to 5 days of antibiotic therapy

It can evolve over a longer period than stye, up to several weeks

First-line treatment is the application of local corticosteroid ointment combined with eyelid care


In Chalazion, if corticosteroids are not effective, antibiotics are prescribed

If this treatment is not effective and if the chalazion progresses to the encystement, it is sometimes necessary to make an incision of the meibomian gland under local anesthesia.

Incising the Meibomian gland then allows, with a scalpel, to incise the chalazion to express the sebum

In case of surgery, the gland is left without suture and antiseptic eye drops are prescribed for 8 days

Surgery is contraindicated in case of anti-thrombotic treatment

No big ships at all. The most common complication is low bleeding that usually breaks away within minutes by simple compression.

Entropion is the tilting of the eyelid towards the conjunctiva


Entropion can lead to a chronic red and painful eye

Senile entropion is the tilting from the lower eyelid to the eyeball, resulting in friction of the eyelashes on the conjunctiva and cornea.

Senile ectropion is linked to sagging skin tissue

Watery eyes eliminate diagnosis of ectropion

It can lead to corneal exposure and tearing by rocking of the lower tear point which then no longer collects tears, and consequently a red and chronic painful eye

Ptosis is an involuntary, unexplained and permanent miosis

The ptosis is defined by a too low position of the free edge of the upper eyelid, the ptosis can be:


Purpura is an elementary lesion of the skin or mucous membrane by extravasation of blood into the dermis or chorion.

Purpura is a flat or infiltrated lesion that does not fade with vitropression

The three semiological forms of a purpura: petechiae, ecchymosis, vibicies

Purpura disappears spontaneously without sequelae

It is difficult to distinguish it from telangectasias not both fading to vitropression

with possible • Elementary lesions possibly associated • Macules, papules, more rarely nodules


Purpura should always suggest invasive meningococcal infection

Hospitalization is urgently provided if extensive and/or necrotic purpura

Meningococcal is the most frequently involved germ

There is a systemic picture in the foreground with sepsis severe beremic ± septic shock ± disorders of consciousness

In children the picture is crude, petechiae of rapid onset, deceptive infectious syndrome with little fever, sometimes drome hypothermia)


In case of a platelet count > 100,000/mm3 thrombocytopenia is not attributable in purpura, it is necessary to look for another cause (thrombosis, vasculitis)

Purpura fulminans requires immediate antiobiotic treatment and urgent management in an intensive care unit

A platelet count must be done in front of all purpura to rule out thrombotic origin

A platelet count below 40000/mm3 indicates the imputability of thrombocytopenia in purpura

In case of major thrombocytopenia or DIC, the prognosis is determined by the risk of visceral haemorrhage, especially meningeal hemorrhage


There are two main types of purpura: thrombocytopenic purpura and vascular purpura

Thrombocytopenic purpura is petechial (lesions < 3 mm) and/or ecchymotic, not infiltrated

Vascular purpura is petechial, infiltrated, sometimes necrotic or ecchymotic

Any febrile purpura justifies emergency hospitalization and the implementation of additional precautions Droplets until the elimination of a (meningococcus)

The presence of at least one ecchymotic element ≥ 3 cm and / or necrotic evokes purpura fulminans and justifies the pre-hospital administration in extreme urgency of a first injection of injectable 3rd generation cephalosporin

The presence of contagiousness minus an ecchymotic element ≥ 3 mm


Any purpura associated with fever requires hospitalization

Purpura fulminans requires pre-hospital therapeutic management (antibiotic therapy) in extreme urgency

Any extensive thrombocytopenic purpura indicates a bleeding risk

Purpura is an extravasation of red blood cells in the superficial dermis entering tahes that do not fade with vitropression.

The presence of at least one ecchymotic element ≥ 3 mm and/or necrotic is a sign of severity


Purpura in adults and children is of central origin rarely, or of peripheral origin most often

There are 3 mechanisms of peripheral thrombocytopenia on a pathophysiological level: destruction (most frequent), consumption (DIC), sequestration (hypersplenism)

Hepatitis B and C cause vascular purpura

EBV, CMV viruses cause thrombocytopenic purpura

Hematopoietic tuberculosis causes thrombocytopenic cental purpura


Regarding myelodysplastic syndrome, which propositions are true?

It is most often idiopathic, in about 85% of cases

Clonal involvement involves peripheral hematopoietic stem cells


Which of these proposals are possible causes of myelodysplastic syndrome?

There are many genetic causes: trisomy 21, Fanconi anemia, Kostmann's neutropenia, neurofibromatosis.


Which of these genetic diseases can cause myelodysplastic syndrome?

Is not a genetic disease and does not cause myelodysplastic syndrome. It is a bullous dermatosis of drug etiology, characterized by acute necrosis of the epidermis over the entire height of the mucous body.

The genetic causes listed in the college are: trisomy 21, Fanconi anemia, Kostmann's neutropenia, neurofibromatosis.


Regarding additional examinations in the context of myelodysplastic syndrome, which proposals are true?

The blood count shows anemia in most cases

The blood count may also show thrombocytopenia and leukopenia predominant on the PNN

In case of monocytosis > 0.5g / L, we speak of CMML (Chronic Myelomonocytic Leukemia)

We talk about CMML during monocytosis > 1g / L

Myelogram shows poor marrow in 90% of cases

In about 80% of cases, the marrow is rich or normal, which raises suspicions of spinal cord abortion.

Anemia is macrocytic most often. It can be normocytic.


Which of these proposals are recognized treatments in case of low risk?

It is the first-line treatment in case of high risk

The risk of transition to acute myeloid leukemia is 30% and the impact of anemia can be significant.


Which of the following are true for secondary acute leukemias?

The prognosis is unchanged from that of the myelodysplasia that precedes it

Allogeneic hematopoietic stem cell transplantation is a curative treatment

Lack of remission after induction is a poor prognosis criterion


Which of the following proposals promote the onset of myelodysplastic syndrome?

The FDRs are: previous chemotherapy, previous radiotherapy, toxic intake, acquired hematopathy, genetic causes (trisomy 21 or Fanconi anemia for example)


Which of these proposals are part of the three stages of carcinogenesis?


Which cancers predispose to BRCA1 or BRCA2 mutations?


It is assumed to be vastly underestimated

4 to 8.5% of cancers are of occupational origin

The majority of occupational cancers compensated in France are linked to previous exposure to asbestos

Secondary prevention is to be prioritized


Mesothelioma is the most represented cancer

Occupational exposures to carcinogens are more common in women

All occupational cancers are recognized as such

Exposure to wood dust should be accompanied by an ENT examination and naso-fibroscopy regularly

Prevention and follow-up stops at retirement

Post-occupational supervision must be provided by the doctor chosen by the insured person


Which of these proposals are proto-oncogenes?


Which of these proposals are anti-oncogenes?


R0 means that the quality of resection is not determined

R0 status refers to a resection with healthy margins

Surgery is a marginal therapy compared to chemotherapy

Surgery is still the first-line management in most non-metastatic cancers (breast, lung, liver, colon, skin, etc.)

Oncology is a medical specialty. The surgery is done by the surgeon of the organ concerned

R2 status refers to resections in which margins are macroscopically invaded.


p means that it is an anatomopathological observation

Thanks to ultrasound, as the name suggests.

Almost all types of cancer have a TNM grade

TNM cannot, without definition, be measured after neoadjuvant chemotherapy


The cTNM classification is clinical or radiological

The pTNM classification is anatomo-pathological.

The most reliable classification is the usTNM

This is pTNM. Histological evidence is often the most accurate

M0: no distant metastasis. M1: distant metastasis(s)


Which of these proposals corresponds to a WHO 2 stage?

A person bedridden less than half of his time

A person who is autonomous but cannot work

A person who is permanently bedridden or in a chair

This is stage 4. It is then totally dependent

It is capable of activity comparable to that before the disease


Before age 80, upper gastrointestinal bleeding is more common in men

Lower bleeding accounts for 40% of gastrointestinal bleeding

Lower bleeding accounts for 20% of gastrointestinal bleeding

Lower gastrointestinal bleeding is more common in women

The most common cause of upper gastrointestinal bleeding is peptic ulcer disease.

Lower gastrointestinal bleeding is of hail origin in more than 80% of cases

Lower gastrointestinal hemorrhages are most often of colo-rectal or origin


The risk of ulcerative complications is multiplied by 3 to 4 in patients on NSAIDs and that of fatal ulcer complications by a factor of 7 to 8

Gastrointestinal bleeding-related deaths increase in patients treated with NSAIDs

Some risk factors further increase the risk of bleeding complications with NSAIDs such as age > to 65 years, excessive alcohol consumption

Compared to non-selective NSAIDs, anti-COX-2 drugs reduce the risk of serious gastrointestinal events (bleeding, perforations, strictures) by 50%.

The risk of digestive toxicity of aspirin is dose-independent

The risk of digestive toxicity of aspirin increases with dose


Aspirin has high-dose antiplatelet effects

Aspirin has low-dose antiplatelet effects

There would be in patients treated with serotonergics a blockade of the reuptake of serotonin by platelets inducing a disorder of primary hemostasis

Helicobacter pylori infection is an independent risk factor for ulcerative upper gastrointestinal bleeding

Mortality from upper gastrointestinal bleeding is 1-3%

Mortality from upper gastrointestinal bleeding is 3-10%

Haemorrhage-related mortality is constantly increasing


In front of a hematemesis and a melena the origin of the bleeding is usually upstream of the right colonic angle

Rectorrhage is usually a sign of lower gastrointestinal bleeding

In front of a hemorrhagic shock without externalization of blood it is necessary to evoke in principle a digestive hemorrhage, especially of the upper digestive tract

The amount of externalized bloody fluid is a reliable outcome

To assess the immediate severity of bleeding, the amount of externalised bloody fluid is a poor outcome. Pay attention to signs of shock.

Hemodynamic impact assessment is the best way to assess the immediate severity of bleeding


They are considered by definition high when the lesion is located upstream of the Treitz angle (duodenum-jejunum junction), and low downstream of this zone.

The incidence of high HD is estimated at 100 to 150/100,000 per year

The incidence remains high despite therapeutic progress on HD-generating pathologies, due to the aging of the population and the greater use of NSAIDs & anti-thrombotics

Mallory-Weiss syndrome is a tear of the mucosa in the cardia following iterative vomiting

Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or tobacco.

Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or alcohol


Hemobilia is a common cause associating high HD, biliary pain and jaundice

Hemophilia is a rare cause combining high HD, biliary pain and jaundice

The risk of HD occurring in patients with cirrhosis is the same regardless of the severity of the cirrhosis

The risk of HD in patients with cirrhosis increases with severity of cirrhosis

The intensity of clinical signs depends on how quickly the bleeding builds

In subjects with cirrhosis, the pulse should be interpreted according to the intake of beta-blockers, the presence of a withdrawal syndrome in case of alcoholism, and the existence of a possible associated infection

The active nature of the hemorrhage is assessed by the evolution of hemodynamic parameters under filling, and possibly by repeated gastric lavages.


Initial hematocrit is an excellent reflection of blood loss

Initial hematocrit is not a good reflection of blood loss, until physiological hemodilution or vascular filling has occurred.

Upper GI endoscopy is the key examination

Endoscopy should be performed best in the first 24 hours after the onset of bleeding because the early examination improves diagnostic performance

The time to perform a gastro-duodenal endoscopy is 6 hours in case of associated cirrhosis

This period is 12 hours in case of associated cirrhosis

The endoscopy procedure is possibly preceded by an injection of gentamycin 250 mg IV route in the 30 minutes preceding the examination.

Possibly preceded by an injection of erythromycin 250 mg IV route (unless contraindicated, QT prolongation on ECG) within 30 minutes prior to examination


Endoscopy is performed as soon as possible when high active HD is suspected

It affirms the cause of bleeding in 90% of cases, assesses the risk of bleeding recurrence, and allows possible hemostatic treatment

Sometimes the CT scan is indicated in case of severe HD (abundant externalization and hemodynamic impact) and: – high HD presumption but FOGD not available immediately, – or suspicion of aorto-duodenal fistula

Mortality from PH-related hemorrhages is about 20%, while mortality from ulcerative bleeding is about 5%.

Hemorrhagic recurrence is an independent severity factor


Prognostic factors for high HD in general are related to the abundance of bleeding, its active nature and the terrain

For ulcerative hemorrhages, the endoscopic appearance of the ulcer is assessed by Forrest's classification

Adherent clots (IIb) are at intermediate risk of recurrence

Ulcers with pigmented spots (Ic) or clean bottom (III) are at low risk of bleeding

Ulcers with pigmented spots (IIc) or clean bottom (III) are at low risk of bleeding

Three quarters of HDs stop spontaneously


Early postprandial chest pain points to gastroesophageal reflux disease or peptic ulcer disease

Gastroesophageal reflux disease or angina. A peptic ulcer is rather associated with a late postprandial doulor

Chest pain yielding to trinitrine in less than 3 minutes may suggest pericarditis

By lowering the parietal tension and friction

In the case of pericarditis, pain is triggered by anteflexion

A normal intercritical ECG eliminates the diagnosis of acute coronary syndrome

Caution: a normal intercritical ECG does not eliminate the diagnosis, and a left branch block should be considered as an equivalent of SCA with ST segment elevation. Ischemia in the territory of the circumflex artery can be electrically mute!

A paradoxical pulse, i.e. decreased on inspiration, is a sign of hemodynamic gravity


ST elevation associated with PQ undershift suggests left ventricle aneurysm

In pulmonary pain associated with dyspnea, an elevation of a pulmonary cupola on chest X-ray suggests a pulmonary embolism

Cardiomegaly symmetrical on chest X-ray suggests left heart failure

A pericardial effusion. Cardiomegaly of left heart failure is asymmetric

A negative troponin assay should be systematically repeated

Only in case of chest pain that started less than 6 hours ago


Chest pain with dyspnea and normal chest x-ray must necessarily evoke the diagnosis of aortic dissection

On blood gas, a hypoxemia hypocapnia combination characterizes a shunt effect

Pulmonary embolism must then be systematically evoked

Arterial gas is systematically indicated in front of chest pain

Only in case of arterial oxygen saturation <95%, brady^nea or tachypnea

A T1 T4 negative T wave on ECG characterizes ischemia of the right ventricle

Sign seen among others in the massive EP, reflecting a suffering of the right heart

Because of the pulmonary infarction they cause. Proximal PE is rather associated with inaugural shock


Dissection of the descending aorta is associated with a risk of tamponade and shock

This concerns the dissection of the ascending aorta

The first risk factor for aortic dissection is high blood pressure

Faced with a suspicion of acute pericarditis, echocardiography and troponin testing should be performed

In case of chest pain, pericarditis is a diagnosis of elimination

Benign cause: serious causes must first be eliminated

Cardiomegaly with a "carafe" appearance on X-ray raises fears of aortic dissection


The DAILY/STANFORD classification is the reference classification for aortic dissection

Infectious pneumonia is constantly accompanied by chest pain

Only in case of parietal contact (the pleura is innervated, but not the pulmonary parenchyma)

Some severe pulmonary arterial hypertension gives anginal pain

By ischemic suffering of the right ventricle

Chest pain may be due to vesicular lithiasis

Tietze syndrome is a form of tracheobronchitis associated with chest pain

Parietal pain of the chondrocostal or sternoclavicular joint


Chest pain caused by pericarditis is not influenced by breathing

Extremely common (1/4 of chest pain in the emergency room), they remain however a diagnosis of elimination

Absence of effusion on transthoracic echocardiography excludes diagnosis of pericarditis

Esophageal spasm may be associated with anginal pain yielding to nitrates

A pneumothorax is to be evoked in case of chest pain with signs of severity

Pneumothorax suffocating. Other etiologies to be mentioned in priority in case of signs of severity: ACS, massive PE, tamponade, aortic dissection


Which of the following are blood tests to be performed urgently (after drug management)? (one or more expected answers)


After an injection of IM adrenaline, symptoms persist. How often should the adrenaline injection be repeated?


What is the preferred route to introduce adrenaline?


What type of reaction causes anaphylaxis, according to the classification of Gell and Coombs?


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

True, with mucocutaneous signs, arterial hypotension and unusual tachycardia, bronchial hyperresponsiveness (cough, ventilatory difficulty)

Severe life-threatening multi-organ disease

Cardiocirculatory inefficiency and respiratory arrest


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

True, requiring cardiopulmonary resuscitation maneuvers


Which cells degranulate massively during anaphylaxis?

False, anaphylaxis is a reaction of innate immunity


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

True, erythema, urticaria, with or without angioneurotic edema


Irritable bowel syndrome (IBS), a preferable designation to functional colopathy, is one of the first reasons for consultation in gastroenterology

IBS is defined by the coexistence of chronic abdominal pain and fluctuating transit disorders (constipation, diarrhea, alternation of both).

This condition does not engage the prognosis but considerably alters the quality of life of patients and has a strong medico-economic impact

The prevalence of IBS in the general population ranges from 40 to 50% in all countries of the world

The prevalence of IBS in the general population ranges from 10 to 15% in all countries of the world

There is a female predominance, 70% of consultants are women


There is visceral hypersensitivity in at least 60% of patients

Regular exposure to stressful events are factors associated with greater severity of symptoms

Abdominal pain is the main symptom of IBS and the main reason for consultation

An colscopy should be performed in front of a family history of cancer or colorectal adenomas

An age > 40 years (in the absence of a complete colonoscopy since the onset of symptoms) is an indication for colonoscopy

Age > 50 years (in the absence of a complete colonoscopy since onset of symptoms)


Resistance to symptomatic treatment or recent change in symptoms are incdications for colonoscopy

The presence of warning signs such as overt digestive bleeding or weight loss are indications for colonoscopy

Abdominal bloating is the second main reason for consultation

Bloating may be aggravated transiently by the emission of gas and/or stool

It can be improved transiently by the emission of gases and/or stool


Normal bilirubinemia is less than 20 μmol/L

Jaundice occurs when bilirubinemia exceeds 60 μmol/L

Jaundice occurs when bilirubinemia exceeds 40 μmol/L

A light jaundice, or beginner, is visible next to the ocular sclera, the lightest place of the integuments

In healthy subjects, bilirubin circulates in plasma in 2 forms

In healthy subjects, plasma total bilirubin is almost exclusively represented by unconjugated bilirubin


The main causes of conjugated bilirubin jaundice are hyperhemolysis and dyserythropoiesis

These are causes of unconjugated bilirubin jaundice (also the case of decreased activity of bilirubin glucuronide transferase)

Urine is normal in colour in case of unconjugated bilirubin jaundice (free)

Gilbert's syndrome is a totally benign and very common condition linked to partial glycuronyl transferase deficiency.

Crigler-Najjar syndrome is an exceptional, often very serious condition due to an absence or collapse of glucuronyl transferase activity.

Crigler-Najjar syndrome is inherited genetically in an autosomal dominant manner

It is transmitted genetically in an autosomal recessive manner


Cholestasis is the most common mechanism of conjugated bilirubin jaundice

Cholestasis is defined by decreased bile secretion

Cholestasis is mainly manifested by a concomitant increase in serum alkaline phosphatase and γ-GT

Isolated elevation of γ-GT or alkaline phosphatases does not indicate cholestasis

Small bile duct involvement must be diffuse to result in jaundice


The CIF was adopted by the European Union in 2002 and enshrined in French law.

ICF allows for a holistic approach to all aspects of a disease

The ICF applies only to children and the elderly


Depending on the person's life project, a compensation plan is developed that translates into a disability compensation benefit (PCH)

The ICF model distinguishes between two levels of disease expression: functional and social.

4 levels: lesional, clinical, functional and social

Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss


Activity refers to the execution of a task in everyday life

Personal factors include age, gender and physical condition

Impairment refers to the inability to perform an action

Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss

In practice, the most common impairments that cause functional limitations are neurological and musculoskeletal impairments.

A limitation of joint amplitudes can be quantified in degrees using a goniometer


What is the prevalence of overweight in France?

The prevalence of overweight (BMI between 25 and 30) is about 35% in France


Which of these proposals are complications of adult obesity?

With hypopnea index greater than or equal to 5 (severe if greater than or equal to 30)

In this particular case, it is rather a protective factor.


Among these proposals, which indicate the carrying out of additional examinations in an overweight minor?

The presence of a family history of diabetes

The presence of a family history of dyslipidemia


Which of these proposals are the causes of secondary obesity?

Primary adrenal insufficiency. It results in hypotension and hyperpigmentation and can be complicated by acute adrenal insufficiency with cardiovascular collapse.

A genetic disease of the development of the olfactory system characterized by the association of hypogonadotrophic hypogonadism due to gonadotropin-releasing hormone deficiency (GnRH) and anosmia or hyposmia.


Which of the following are complications of obesity?

Restrictive ventilatory disorder rather!


Obesity is defined as a BMI > 25kg/m squared

BMI > 25 -> Overweight
BMI > 30 -> Obesity

First-line treatment is dominated by anorectic molecules

False, they are not indicated in the medical care (attention!). Lifestyle change and hygiene-dietary rules are the first-line measures.

Treatment can be surgical in case of grade 3 obesity

True especially with a bypass or a sleeve-gastrectomy!

Treatment may be surgical in cases of grade 2 obesity under certain conditions

Android obesity is more at cardiovascular risk than gynoid obesity


Regarding the clinical diagnosis of myasthenia gravis:

The diagnosis of myasthenia gravis must be evoked in front of fluctuating sensory-motor signs from the age of 40

The diagnosis of myasthenia gravis should be evoked in front of exclusively muscular signs and symptoms

Only the muscles directly put into action during the effort are at the origin of the symptoms

The symptoms may be related to muscles directly activated during the effort or to remote muscles not directly involved in the effort.

The only symptom is muscle weakness of the limbs


Regarding the positive diagnosis of myasthenia gravis:

Unilateral ptosis should suspect myasthenia gravis of the eye and palpebral muscles

Damage to the eye muscles cannot result in diplopia

Diplopia possible, most often intermittent

Damage to the bulbar innervation muscles induces, among other things, swallowing, phonation and chewing disorders

Myasthenia gravis affects only the proximal muscles

The involvement predominates on the proximal muscles, but can more rarely affect the distal musculature also

The Barré event is normally held 2 min 30


Regarding pathologies associated with myasthenia gravis:

The diagnostic sensitivity of the ENMG is 98%

When myasthenia gravis is diagnosed, a CT scan or chest MRI should be prescribed to explore the thymic compartment for thymic hyperplasia or thymoma.

Thymic hyperplasia is found in 90% of myasthenia gravis cases

Thymomas can be mild or malignant and need to be operated on

Thymic hyperplasia corresponds to a macroscopically normal thymus but microscopically characterized by a proliferation of germinal follicles with a clear center


Which of the following are symptoms or signs of early generalized myasthenia gravis?

Cranial nerves are respected in myasthenia gravis

True, it is a sign of severity (like dyspnea and dysphonia)

No amyotrophy because it is a non-total damage to the neuromuscular junction. Amyotrophy is observed in motor deficits by damage to the second motor neuron. Be careful ⚠, in myasthenia gravis in the late stage, when they are severe and chronic, selective muscular atrophy can be seen.

True, this is the Dropped-Head Syndrome 😌. It is also seen in amyotrophic lateral sclerosis.


Which of the following propositions are true for the first-line management of generalized myasthenia gravis?

Treatment with pyridostigmine-type anticholinesterase

A background treatment with corticosteroid therapy

Third line (after pyridostigmine and thymectomy)

A remission of the list of contraindicated drugs

Benzodiazepine have a muscle relaxant effect that contraindicate them in myasthenia gravis


Which of the following proposals about electroneuromyogram (ENMG) are true?

True. This is the case for all examinations whose sensitivity is less than 100%

It can objectify a decrement after repetitive stimulation at 3 Hz

True, otherwise we come across a differential diagnosis (demyelinating pathology such as polyradiculoneuropathies)

It is most often associated with motor evoked potentials

Sensitivity increases in clinically healthy territories


It is a pathology that affects the neuromuscular junction


Myasthenia gravis is linked to a pre-synaptic block of the neuromuscular junction

Myasthenia gravis is related to a postsynaptic block of the neuromuscular junction

True since this concerns acetylcholine receptors

Myasthenia gravis usually begins after an infection

This is the case of Guillain-Barré syndrome (acute inflammatory polyradiculoneuritis)

Myasthenia gravis is an autoimmune disease


Which of the following are myasthenia gravis abnormalities that can be seen in a chest CT scan?

Not seen on chest CT scan + is not associated with myasthenia gravis


Which of the following are additional tests for myasthenia gravis?

True. They have a sensitivity of about 80%, and are very specific.

True, we are looking for a decrement to repetitive stimulation at 3 Hz

True, looking for thymoma or thymic hyperplasia


In what proportion of myasthenia gravis is associated thymic hyperplasia found?


Which of the following proposals are in favor of a cholinergic crisis?

Rather, a miosis is found in parasympathetic hyperactivation

Rather, they are found in myasthenic seizures.


What is the minimum percentage decrease in the amplitude of the muscle evoked potential necessary to evoke a decrement at the ENMG?

True. A decrement at the ENMG is significant if it is greater than or equal to 10%


Which of the following are signs or symptoms of myasthenia gravis?


In what proportion of myasthenia gravis is an associated thymoma?


Which of these patients have an HbA1c goal of 7% or less?

Seniors whose life expectancy is considered satisfactory

Newly diagnosed T2DM with life expectancy >15 years and no history


Which of these patients have an HbA1c goal of 6.5% or less?

With fasting blood glucose levels< 0.95 g / L and 2h post prandial < 1.20 g / L

Target <= 8% (patient categories with advanced cardiovascular complications)


Which of these patients have an HbA1c goal of 8% or less?

Objective< 9% and/or pre-prandial capillary blood glucose between 1 and 2 g/L

Patients with microvascular complications

Myocardial infarction with heart failure

Group of patients with a history of advanced macrovascular complications

Moderate CKD: target <= 7%. Severe or terminal CKD: target <= 8%


What are the goals of a type 2 diabetic patient during pregnancy?

Postprandial blood glucose levels <= 1.25 g/L

Postprandial blood glucose levels at two hours < 1.20 g/L

There is no goal or monitoring of nighttime blood glucose


NPH insulins are intermediate-acting insulins

Insulins are contraindicated during pregnancy

Metformin is the only antidiabetic drug to lose weight

Insulin doses are less than 1 U/kg most often

Insulins are preferred to metformin in case of pregnancy or breastfeeding


Which of the following are possible causes of polyuro-polydipsic syndrome?

True, hyper-filtration due to high pressure


Regarding the paediatric peculiarities of diabetes, which proposals are true?

An acanthosis nigricans is a peculiarity of T1D

An acanthosis nigricans and a polycystic ovary syndrome should suspect insulin resistance and in particular T2DM (rare ++ in T1D)

Vaginal yeast infections should suggest T2DM

HbA1c ≥ 8.5% is a diagnostic criterion for T2DM

False, the diagnosis of T2DM is made on venous blood glucose

The presence of autoantibodies does not rule out the presence of T2DM

The presence of autoantibodies eliminates the presence of T2DM and points to T1D

Drug therapies that have marketing authorisation for T2DM in children are sulphonylureas and insulin.

Drug therapies that have MAiD in the treatment of T2DM in children are metformin and insulin


The finding of a blood glucose > 2.5 g / L must make a urine strip in search of ketone bodies.

Among the complications of ketoacidosis, cerebral edema has a mortality of 25%.

Regarding the management of cerebral edema complicating ketoacidosis, it is essential to confirm its presence by a brain scan before starting treatments.

If clinical suspicion:
1. 30% decrease infusion rate
2. Mannitol injection 20%
3. Elevation of the patient's head
4. Brain scan in a stable child on mannitol

Neuroglucopenic syndrome occurs quickly for blood glucose levels < 0.7 g / L in diabetics.

Blood glucose < 0.7 g/L: Neurovegetative SD ++
< 0.54 g/L: Neuroglucopenic Sd ++

In a diabetic child who is unconscious during hypoglycemia, it is recommended as a first line to inject him with Glucagon.

Glucagon 0.5 mg if < 25Kg / 1 mg if > 25 Kg