Regarding preeclampsia, which of the following are true?

True. Cf. 2020 CNGOF Recommendations. It is routinely put on to prevent complications of eclampsia.

IV magnesium sulfate is indicated in all pregnant women with severe pre-eclampsia with at least 1 severity endpoint

HELLP syndrome is frequently associated with DIC.

The anti-hypertensive recommended in first line in front of severe hypertension in pre-eclampsia is labetolol

True. First-line treatment: labetolol. Second-line therapy: calcium channel blocker (nicardipian) or uradipil, as monotherapy or in combination.

In case of contraindication or failure of first-line antihypertensive therapy, the second-line antihypertensive drug for severe hypertension in pre-eclampsia is a calcium channel blocker (nicardipine) or uradipil

False. This is a difference with hypertension in adults and hypertension in pregnant women. In adults, it is ≥ 180 mmHg PAS and/or ≥ 110 mmHg PAD. In pregnant women, it is ≥ 160 mmHg PAS and / or ≥ 110 mmHg PAD.

Severe hypertension during pregnancy is defined as SBP ≥ 180 and/or PAD ≥ 110 mmHg


The direct toxicity of a drug is dose-dependent 💊

Digestive absorption of drugs is age-dependent 👴

The hepatic first-pass effect is decreased in the elderly 🧓

Most are not ➡ always checked on the CRAT website

Albuminemia increases during pregnancy 🤰


True. Between 5 and 60 minutes for each symptom

Symptoms of migraine aura last less than an hour

Tension ⚡ headaches have nothing to do with high blood pressure.

Headaches due to drug abuse may be due to paracetamol

This is the case of cluster headache. For tension headaches, it is amitriptyline

The background treatment for tension headaches is verapamil

Oxygen therapy is part of the treatment of cluster headache crisis


Which of the following proposals for pre-eclampsia are criteria for severity?

True. Defined by mechanical hemolysis (schizocytes, LDH ≤ 600 IU/L, total bilirubin ≥ 12mg/L), hepatic cytolysis (AST≥70 IU/L) and thrombocytopenia (≤100 G/L)

False, nephrotic syndrome with proteinuria ≥5g/24h


Mr. Idaho, Duncan, 35 years old, comes to see you in your office because he would like to be recognized for his chronic lumbosciatica related to his profession, in occupational disease. Which of the following means qualify for recognition as an occupational disease?

False, the presumption of imputability applies to accidents at work and not to occupational diseases. Attention, classic trap in MCQ.

True, if the disease corresponds to the picture (physical injuries, delay etc ...) there is no need for additional evidence

False, the occupational physician cannot certify the occupational disease, just with a certificate

Certificate from the occupational physician certifying the occupational origin of the disease

True, the CRRMP allows to debate cases that do not fit completely in the tables or being outside the tables, overall, they will study in detail the links between illness and work and grant or not the disease as occupational or not.

Recognition of the file before the Regional Committee for the Recognition of Occupational Diseases (CRRMP)

Pathology that started during labour and persisted for more than 5 years


Which of the following are contraindications to transparietal PBH?

True, these are the 4 contraindications mentioned in the college 😉


Which of the following are true for macrophage activation syndrome (SAM)?


Which of the following propositions are true about ALD?

Each ALD has a fixed term, at the end of which renewal can be requested

It is usually requested by the attending physician

Only for care related to the pathology in question

It offers the right to 100% coverage for all care

It makes it possible to free oneself from mutual insurance companies


How many loose/watery stools per day are we talking about diarrhea?

True, diarhea if > 3 watery/soft stools per day


Which of the following are causes of extrahepatic jaundice?


Which of the following are signs and/or symptoms of UC?

The diagnosis is made on a bundle of arguments


A "green wood" fracture is a fracture where part of the cortical of the bone is ruptured, and the other side of the cortical is continuous.

A fracture in "lump of butter" results from a torsional mechanism

Traumatology is the second leading cause of death between 1 year and 19 years

The occurrence of a fracture in an infant who does not move must give rise to suspicion of abuse.

True. The water density of the child's bone gives it greater plasticity.

Fractures made of green wood and lump of butter are specific to the child


What is the main property of dobutamine?

True, increased strength of
contraction. Continuous infusion with the self-pushing syringe

No effect on the conduction velocity of nerve impulses of myocardial muscle fibers


Which of the following are signs of hepatocellular insufficiency?


Which of the following are true about migraines?

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

Migraine with typical aura involves visual, sensory or language disorders of gradual and successive installation

Sensory disorders are most common in migraines with aura

auras can change over the course of life

Auras are always the same throughout life

Episodic migraine lasts less than 25 days a month


Which of the following are true for pellagreal encephalopathy?


The dynamic muscle replacement orthosis is a corrective orthosis

Canes and wheelchairs are external technical aids

The stabilization orthosis allows the maintenance of activity despite an unstable limb


One of your patients is being treated with VKA for her PE. VKAs prevent hepatic synthesis of several coagulation factors. Which?


Which of the following propositions are found in junctional tachycardia?

Purposes unless pre-existing branch blog

True, until you reach maximum heart rate (220 - age)


A 57-year-old patient comes to see you for a left epistaxis of low abundance

ATCD: Repeated MTEV
TTT: Fluindione

What is the 1st measure to be carried out?

True. In front of an epistaxis:
1. We decoiled by blowing the patient's nose

2. Bidigital compression is done to try to stop the bleeding

Prescription of Group O+ phenotyped RGCs


What does the FIGO 0 classification of a uterine fibroid mean?

Fully intracavitary pedunculated submucosal fibroid

Interstitial fibroid in contact with the endometrium


Which of the following propositions are true regarding extemporaneous examination?

It is always complemented by an analysis

The result must be fast (in less than 30 minutes)


Regarding the epidemiology of Crohn's disease:

The threshold for rare diseases is 1/2000


Which of the following are etiologies of jaundice with normal urine?

Rotor syndrome is a benign inherited liver disease characterized by predominantly conjugated chronic hyperbilirubinemia without hemolysis or histological hepatic abnormalities.


Which of the following are the causes of hematocrit elevation?

True. Cause of false polycythemia (ht/hb increased but normal total mass). It often corresponds to young, sedentary, overweight men and other associated vascular risk factors. The measurement of the globular mass is normal.


You are an intern in cardiology and your outpatient, asks you during the visit what are the main differences between mechanical prostheses and biological prostheses?

True, unlike bioprostheses that often have a lifespan of 20 years.

Mechanical prostheses have a theoretically unlimited lifespan

False, because of their limited lifespan, we will rather implement these prostheses in elderly subjects.

Biological prostheses are preferred in young subjects because they avoid taking an anticoagulant

False, there is the same risk regardless of the type of prosthesis

The risk of infective endocarditis is greater in front of a mechanical prosthesis than in front of a bioprosthesis

True, finesse of the college of cardiology that I did not know but that an expert cardiologist could drop in IQ

The risk of thromboembolic complications is higher for mitral prostheses than for aortic prostheses

True, so make sure your patients take their blood thinning treatment!

The main risk factor for thromboembolic event on prosthetic valve is insufficient anticoagulant therapy


Which of the following are true about corneal transplantation?

There is a risk of immune rejection of the graft

There is a risk of cell rejection of the graft


Regarding the classification of Salter and Harris

The trait respects the germinative layer of the growth cartilage: the risk of epiphysiodesis is therefore low

A Salter 1 fracture is characterized by a trait passing exclusively through the growth zone, which induces a high risk of epiphysiodesis

A Salter 2 fracture is characterized by a trait passing through the growth zone and the epiphysis

The trait passes through the growth zone and the epiphysis (the germinative zone of cartilage is located towards the epiphysis)

In a Salter 3 fracture, the germinative layer is always crossed by the fracture line

The line goes from the metaphysis to the epiphysis: it crosses transversely the growth cartilage

In a Salter 4 fracture, the fracture line is transverse to the growth cartilage

It is generally associated with other fractures, in case of compression mechanism (axial trauma)

A Salter 5 fracture does not exist in isolation


Which of the following are risk factors for lithiasis?


Which of the following is the optimal management of asymptomatic cholelithiasis?

True, therapeutic abstention in front of asympatomatic cholelithiasis (80% are asympto)

It is the management of hepatic colic calmed by analgesic / NSAIDs / antispasmodics

Cold cholecystectomy (less than one month)

This is the management of acute cholecystitis

This is the management of cholitis (with cholecystectomy)


Screening is done the anti-tranglutamase IgA assay

Screening is done the anti-endomysium IgA assay


Which of the following proposals are part of the initial assessment recommended urgently in the face of confusion?


Concerning Headaches in children. Which of the following are situations for a Brain Scan indication?

Statural inflection in a 2-year-old child

An abnormality on neurological examination in a 3-month-old child

Positional headaches of decubitus, morning with vomiting in jets in a 7-year-old child

A progressive appearance of horizontal diplopia of the right eye that converges to the left associated with a headache in a 4-year-old child

Statural delay in a 5-year-old child associated with progressive onset headaches


You are a nuclear medicine intern and you receive, Mr. Banner, Bruce, 76 years old, to have him perform a PET-CT, as part of a pulmonary cancer extension assessment. During this examination, you do everything to minimize the body's exposure to ionizing radiation. What factors influence this exposure?

True, notion of highly fallable course at the ECN

False, it's a stupid distractor because it needed one

The dose previously received during a previous exposure

Thickness and composition of any screens


Which of the following are true about abiraterone acetate?

It is a selective inhibitor of androgen synthesis

Daily oral form in combination with prednisone (10 mg/day)

It is in the form of subcutaneous injection


Which of the following designates an essential isotopic examination in the assessment of neuroblastoma?

Possible in the prostate cancer extension assessment


One of your patients is being treated with VKA for her PE. VKAs prevent hepatic synthesis of several coagulation factors. Which?


It is transmitted in an autosomal dominant manner

Phenylalanine (Phe) is an essential amino acid

Clinical signs are due to accumulation of neurotoxic products


True. It includes the eardrum, the posterior wall of the external auditory canal, part of the pinna of the ear (the conch) (according to Wikipedia, mentioned on page 84 of the 4th edition of the college of CMF)


Which of the following are the false causes of increased sedimentation rate?

True, I know it sucks, but there are many PH who do this kind of MCQ because they are simple MCQs... Refer to the table on page 110 of the College of Internal Medicine. To remember this I told myself that it was decreased when there were too many "normal" cells (polycythemia, leukocytosis, thrombocytosis) or not enough proteins (hypofibrinogemia, hypogammaglobulinemia).


Which of the following are causes of idiopathic ICT?

No hypervitaminosis in water-soluble vitamins (the too full we piss!) --> Here cause of idiopathic HTIC = Hypervitaminosis A

Not idiopathic because anomaly visible on imaging


Which of the following propositions are true about diverticular hemorrhages?

They are the cause of a third of lower bleeding

The positive diagnosis can only be made by colonoscopy


Which of the following are possible pathophysiological explanations for confusional state?


Regarding the monitoring of prosthetic heart valves, what are the exact proposal(s)?

False, AOD are never indicated in case of prosthetic valves, only VKAs are used

Treatment with VKA requires regular INR monitoring, but not treatment with DOAC, which promotes the use of the latter

False, even if it can indeed be benign, it must know how to look for a prosthesis dysfunction

The appearance of a new breath after valve surgery is common and benign

False, the ECG is totally normal because the prosthesis has no connection with the electrical current of the heart unlike a pacemaker

The ECG is classically slightly altered by the functioning of the valve prosthesis

False, bioprostheses are organic tissue, unlike mechanical prostheses

Bioprostheses are highly radiopaque on chest X-ray

True, the ETT is the monitoring examination but does not allow the fine analysis of the valve or prosthesis

ETO is performed in case of suspected thrombosis or prosthesis dysfunction


Trastuzumab is always combined with chemotherapy

False. If the HER is 2+ in immunohistochemistry, the FISH analysis should be completed. If it is not amplified in FISH, anti-HER2 treatment is not indicated.

Trastuzumab is still indicated if immunohistochemistry regains HER2 2+

The two most commonly used classes of chemotherapy for breast cancer are anthracylins and taxanes

Adjuvant radiotherapy is always indicated in a woman who has received conservative breast surgery (lumpectomy) for carcinoma in situ.

Anti-aromatases may aggravate pre-existing osteoporosis requiring bone densitometry monitoring


Which of the following are risk factors for post-febrile seizure epilepsy?

True because Complex Febrile Crisis is a fdr


Which of the following can cause lesional esophageal dysphagia?

True. All these proposals are causes of non-lesional esophageal dysphagia


Which of the following are risk factors for recurrence of febrile seizures?

And no: it's <38.5 ° C, which is logical since the child had a feverish attack on a fever that was not that hot. So it can recur on low fever.

1st degree family history of febrile seizure


Which of the following are nerves involved in the corneal reflex?

True. Also called ophthalmic nerve. It is a mixed nerve involved in the afferent pathway of the corneal reflex.

Motor nerve innervating the lateral right (abduction of the eye)

Motor nerve innervating medial right, inferior oblique, lower right, and superior right

True. Mixed nerve involved in the efferent pathway of the corneal reflex

Mixed nerve involved in many reflexes such as the reflex of the palé veil


Which of the following are pro-inflammatory cytokines or proteins increased during inflammation?

True, I know it may seem like detail to you, but remember that these are targets of certain biotherapies in chronic inflammatory diseases, so the MCQ can fall...

True, see A. even more frequent MCQ on TNF alpha

True, remember in general that ALL proteins of inflammation are positive except 3: albumin, transthyretin, transferrin.


Which of the following are factors in the severity of pre-eclampsia?

False. According to the new 2020 recommendations, it is > 90 μmol/L.

Severe headache that does not respond to treatment


Which of the following propositions are true about House Brackmann's classification?

Grade 2 = discrete deficit, visible during movement

Grade 3 = complete palpebral occlusion possible with effort

complete palpebral occlusion impossible, very asymmetrical movements, severe syncinesis and hypertonia


Which of the following are parasites that can occur as liver nodules?


What are the risk factors for recurrence of a complex febrile seizure in children?

True. To retain these criteria more simply, it is enough to remember that children at risk are those with "a small brain sensitive to heat".

Short time between onset of fever and seizure

True. A low fever at the time of the febrile attack testifies to this sensitivity to heat

Low fever at the time of the febrile attack (< 38.5°C)

False. It's a trap. It is a low fever at the time of the seizure that is a recurrence FDR.

High fever at the time of the febrile attack (> 40°C)


About high blood pressure in children
Which of the following are true?

True
In pediatrics we think a lot in percentile and standard deviation.

In children, normal BP is below the 90th percentile.

True
Hyper important in practice. It gives you a first idea. In practice, still think about taking the size into account because if the child is tall for age, we can find a HTA with this formula which is not necessarily present if we are based on the size.

To calculate the systolic blood pressure corresponding to the 95th percentile, one can use the formula: 100 + 2x Age (in years)

High blood pressure in children is defined as a BP measurement above the 95th percentile for the child's sex, age and height

False.
The prevention of hypertension in children is estimated at 3.5%

The prevalence of hypertension in children is estimated at 0.7%

FAAUUUX
Unlike the adult population, in pediatrics hypertension is always a priori secondary and must lead to the realization of an etiological assessment, which must be all the more exhaustive as the hypertension is of high level and the child is young.

For the record, we must not let a hypertension in children linger: last week at the CHU, HTA in a 5-year-old child, we did a Doppler ultrasound in search of stenosis of the renal arteries: highlighting a mass suggestive of neuroblastoma that compressed the renal artery ..

As in adults, hypertension is a priori primary and it is necessary to leave a few months before making an etiological assessment.


Which of the following proposals concerning the hospital management of a polytrauma patient is (are) true?

False, the first 15 minutes are devoted to the continuation of the acts of resuscitation initiated in pre-hospital, the conditioning of the patient and the realization of the clinical examination. The bodyCT will only be performed in a 3rd step if the patient has been stabilized.

The first 15 minutes are dedicated to the realization of a bodyCT

False, everything must be done to fight against hypothermia, which is a contributing factor to bleeding disorders, among other things.

The patient must be put in hypothermia to protect him from brain damage

False, the nasal route is contraindicated in a patient who has suffered facial or head trauma because of the risk of false route, especially intracerebral in case of ethmoid fracture.

The possible placement of a gastric tube must be done nasally in the context of facial trauma

Diphtheria vaccination status should be checked

The 2nd phase of care is dedicated to the realization of the biological and radiological assessment


A 57-year-old patient comes to see you for a left epistaxis of low abundance

ATCD: Repeated MTEV
TTT: Fluindione The patient also explains that he has lost weight and feels tired for 4 months. He also says he has the feeling of an obstruction of his left nasal cavity.

What is the exact answer(s)?

FALSE: In front of an epistaxis on bleeding disorder or angiomatosis: we use ABSORBABLE wicks

It is necessary to carry out a previous stamping with greasy strands

Previous buffering with absorbable wicks must be performed

FALSE. The INR is within its target (between 2-3 in this VTE situation). We are not dealing with serious bleeding. So no need to stop the VKA

If the patient's INR is 2.6, VKAs should be stopped for 24 hours in this patient

True. In front of unilateral epistaxis + progressive nasal obstruction + AEG => Suspicion cancer ETHMOID and CAVUM

CAVUM cancer is also to be evoked in front of reflex otalgia or seromucosal otitis


Which of these health security agencies/health vigilance missions pairs is accurate?

True, the ANSM's mission is pharmacovigilance, drug dependence, hemovigilance, materiovigilance, reactovigilance, cosmetovigilance, vigilance of tattoo products

National Agency for the Safety of Medicines (ANSM) and Drug Dependence

True, the missions of ANSES are nutrivigilance (including NOCs), toxicovigilance (toxic effects of substances on the body) and veterinary pharmacovigilance

National Agency for Food, Environmental and Occupational Health and Safety (ANSES) and Nutrivigilance

False, the missions of the biomedicine agency focus on biovigilance (organs, tissues, cells), ART

Agency for Biomedicine and Haemovigilance

Agency for Biomedicine and Vigilance with regard to medically assisted procreation

National Agency for Food, Environmental and Occupational Health and Safety (ANSES) and Réactovigilance


False, we distinguish precisely degenerative dementias from dementias with a vascular, inflammatory mechanism etc.

Degenerative dementia may be due to vascular or inflammatory disease

True, impaired autonomy is essential to talk about dementia

Dementia is defined by impaired cognitive and/or behavioural function associated with impaired autonomy

Alzheimer's disease is the leading cause of dementia


Which of the following are possible pathological signs in UC?


Which of the following are true about neuroblastoma?

It is a cancer affecting embryonic stem cells of the neural crest

It may be associated with Hirschsprung's disease

Less than 2 years old. It is mainly found between 1 and 2 years

It mainly concerns children under 6 months

It is the most common extracranial solid tumor in young children

There are genetic forms (ALK or PHOX2B gene)


Which of the following are d'Amico's treatment options for intermediate-risk prostate cancers?

Low risk or if probability of survival < 10 years

Active surveillance if probability of survival > 10 years

True. + Cleaning if probability of survival > 10 years

True. Or in combination with hormone therapy for 6 months

True. In gormes of best prognosis (PSA 10-15, GG2 or Gleason 3+4)


Which of the following propositions/are true for biamniotic bichorial pregnancies?

There is an antenatal risk of transfusion-transfusion syndrome (TTS)

False, a twin pregnancy is a multiple pregnancy

The term multiple pregnancy only applies when the uterus contains 3 or more fetuses.


Constipation is chronic if greater than:


Which of the following are signs or symptoms of Korsakoff syndrome?


Which of the following are risk factors for hernia?


Regarding major neurocognitive disorders, what are the exact proposal(s)?

A. Wrong, three times wrong! The MMS is a screening examination, the repetition of the latter allows to have an intuition on the evolution of the pathology, certainly, but it is much more advanced neuropsychological tests that allow the diagnosis in addition to the interrogation and the elimination of differential diagnoses

Has. The repetition of MMS (Mini Mental State) makes it possible to make the diagnosis of a major neurocognitive disorder

B. True, it makes it possible to rule out an expansive pathology (hematoma, infection, tumor) and to characterize brain damage (hippocampal damage for Alzheimer's and its relatives etc ...)

B. MRI (or failing that, cCT) has an essential place in the evaluation of major neurocognitive disorders

C. Alzheimer's disease and vascular encephalopathies account for the majority of causes of major neurocognitive disorders

D. False, it is quite brief (NFS, CRP, TSH, Ionogram, Glycemia, Albuminemia) and the rest is performed on call point

D. First-line laboratory work-up is comprehensive to eliminate all possible differential diagnoses

E. True, HDJ memories are becoming more and more present, and allow active management of major neurocognitive disorders

E. For the management of major neurocognitive disorders, there are day hospital treatments to perform cognitive remediation


4 grades: no procidence / procidence in the lumen of the anuscope / reducible / irreducible external procidence


The nodule is non-painful according to the College of Urology (4th edition)


Which of the following propositions are true about biological examinations?

Normal apart from flare-ups or complications

High γGT and MCV support an alcoholic cause

Signs of inflammation are found during flare-ups

Lipasemia is elevated in acute pancreatitis


Which of the following propositions are true about MMR?

A morbidity and mortality review (MMR) is a collective, retrospective and systemic analysis of cases marked by the occurrence of a death, a complication, or an event that could have caused harm to the patient.

Its objective is to implement and monitor actions to improve patient care and care safety.

The systemic analysis, conducted during the MMR, is a global analysis of the situation

The medical-nursing team that brings together professionals, who usually work together, and who contribute to the management of a patient.


Which of the following propositions are true about the urinary ionogram?

A plasma urea/plasma creatinine ratio of less than 50 supports organic AKI

A urinary Na/K ratio greater than 1 is in favor of an organic ARI

A urinary Na/K ratio greater than 1 supports a functional ARI

This is the EF threshold for urea. The threshold for sodium is 1%

A sodium excretion fraction of less than 35% would be in favor of a functional origin

Natriuresis can only be interpreted if diuretics have not been put in place


About 1 third of adults are affected by hemorrhoids


In prostate cancer, the fraction of free PSA is lower than in benign prostatic hyperplasia

The actual contribution in clinical practice of urine tests has not been demonstrated

A high PSA must be almost systematically reassessed

The USP questionnaire focuses on sexuality

The IIEF questionnaire focuses on urinary symptoms


Which of these proposals designate a serious access to RCH?

True, severe acute colitis (Truelove-Witts criteria) can be complicated by: colectasia (dilation) and perforation

The Truelove-Witts criteria (💞) define the severe RCH crisis


Which of the following proposals are necessary to diagnose confusion?

True. Indeed, confusion is a clinical diagnosis.


Which of the following are true about shaken baby syndrome?

The CT scan is the exam of choice for the diagnosis of lesions

The absence of bleeding disorders should always be checked

They can also be cephalic, thoracic, ...


The flat-rate remuneration of physicians is paid by:


Regarding resistant hypertension, which of the following propositions are true?

Resistant hypertension = persistent on oral antihypertensive therapy (including at least one diuretic) + HRD well followed

It is defined by the persistence of hypertension despite well-followed hygiene-dietary rules.

It may be due to unknown secondary hypertension.

The patient's adherence to treatment can be assessed by the Girerd questionnaire.

It may be due to excessive consumption of dietary salt.

A cardiological opinion should be systematically requested in front of a resistant hypertension.


Which of the following are possible etiologies of cirrhosis?


Which of the following are symptoms or signs of Gayet-Wernicke encephalopathy?


An X neuroma could mimic lymphadenopathy:

Two differential diagnoses (DD): brachial plexus schwanoma or lung apex cancer

DD of lymphadenopathy concerning this chain: ectopic thyroid, cyst of the thyroglossal tract or laryngocele

2 schwannomas: that of the XI and that of the superficial cervical plexus


Which of the following are RHD treatments for hemorrhoidal disease?


Which of the following are etiologies of non-traumatic coma?


Which of the following are signs and symptoms of distal (intraparotid) facial nerve involvement?

No hearing impairment because we are downstream


From what time frame do we speak of prolonged diarrhea?


Which of the following are the side effects of amiodarone?


Which of the following are extra-digestive signs of celiac disease?


Which of the following proposals are part of the immediate management of postpartum haemorrhage?


Which of the following proposals can increase the PSA?


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


Which of the following proposals are part of probabilistic antibiotic therapy for ulcerative-necrotizing enterocolitis?


Concerning the fractures of the child, which of the following propositions, which are true?

Ultrasound is rare in emergencies. It can be useful for soft tissue lesions

Orthopedic treatment++ in young children <6A, for any diaphyseal / metaphyseal FR (PAS for joint fractures: risk of stiffness)

For a metaphyseal fracture in a 5-year-old child, first-line treatment is orthopedic, with or without reduction

No risk of stiffness for non-articular fractures (see College of Pediatrics)

For a diaphyseal fracture, prolonged orthopedic treatment induces a risk of stiffness

In the opposite position of that which caused the fracture (for example, if wrist fracture in hyperextension: immobilization in flexion)

Concerning orthopedic treatment: the limb must be immobilized in a neutral position

Thromboembolic complications are exceptional in children. Anticoagulant therapy will be discussed only in adolescents

Anticoagulant therapy is indicated in children in case of cast for more than 21 days


Which of the following are causes of idiopathic ICT?

No, abnormal imaging therefore not idiopathic


Which of the following are true about Boerhaave syndrome?

True. They all concern Mallory Weiss syndrome


Which of the following are the risk factors for prolonged febrile seizures >15 minutes?

Personal history of Febrile Crisis > 10min


Which of the following proposals are included in the para-clinical assessment in case of suspected shaken baby syndrome?

True, differential diagnosis of bone lesions

True, looking for papillary edema and hemorrhages


Which of the following are true about migraines?

The opposite: more without aura than with aura

There are more migraines with aura than migraines without aura

Migraine is three times more common in women than in men


What are the mandatory clinical signs to be able to talk about the severe discomfort of the infant?

A change in tone (hypertonia or hypotonia)

Is not a mandatory clinical sign. It may nevertheless be present during severe discomfort.

True. The 2 obligatory clinical signs are a change in tone and a change in the coloration of the integuments. In the absence of one of these 2 clinical signs, we can not speak of the severe discomfort of the infant.

A change in the coloration of the integuments (pallor, cyanosis, sometimes erythrosis)

Not part of the criteria for severe infant discomfort.


Which of the following proposals are part of the supraglottic stage?


In cholitis, ERCP (endoscopic retrograde cholangiography) should be done:


What is Amico's classification of prostate cancer with a PSA of 15 ng/mL, a Gleason of 3+3 and a normal TR?

True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8


When was the Order of Physicians created in France?

Code of Ethics Revision Date (112 articles)

Date of creation of the Medical Association in Great Britain


Mrs. Clauss, panicked, brings you her 14-year-old son, Santa, who "can't stay awake during the day." She worries because his academic performance is declining and she is afraid he may suffer from sleeping sickness. By argument of frequency and in front of this case what are the 2 pathologies that you will suspect first?

False, even if it can stick in this patient, we find more this pathology in older women.

True, you should always think about eliminating cannabis poisoning.

True, caricature in the teenager who goes to bed late and gets up early. Highlighted by a sleep diary and treated by hygienic measures and melatonin.

False, night owlism does not cause daytime sleepiness


43-year-old patient, with a history of chronic alcoholism, presents to the emergency room for sudden onset epigastric pain

What will be the exams to be carried out in a first 1 time?

True. Lower myocardial infarction is a differential diagnosis to evoke in this situation

False. Not right away. It can be done in a 2nd time if we find a cardiac ischemic cause to evaluate hemodynamics

True. The positive diagnosis of acute pancreatitis is based on the combination of PAIN + LIPASE > 3N. In addition, an associated significant cytolysis is in favor of a biliary origin of this pancreatitis

False. It has not been recommended for more than 5 years

False. Not right away. In case of confirmed acute pancreatitis, the AP CT scan should be performed at 48h-72h. On the other hand, abdominal ultrasound will be done as soon as the diagnosis is confirmed in order to eliminate a lithiatic cause


Which of the following are signs of hepatocellular insufficiency?


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


Malaise and loss of consciousness account for about 60% of emergency room admissions

10 to 20% of syncopes are the expression of a life-threatening pathology in the short or medium term

The etiological diagnosis of malaise is primarily clinical

Capillary blood glucose and electrocardiogram are systematic

The search for orthostatic hypotension is systematic in patients over 35 years of age


What is the Amico classification of prostate cancer with a PSA of 8 ng/mL, a Gleason of 3+3 and a normal TR?


During treatment during pregnancy, the newborn may show signs of overdose at birth

During treatment during pregnancy, the newborn may show signs of withdrawal at birth

The pharmacist may substitute an originator by a generic of himself, unless otherwise stated

Its MA does not require new studies if the molecule is exactly the same.

A generic drug is subject to phase III studies before its marketing authorization

Adherence is one of the important parameters that determines the effectiveness of the treatments put in place


Orthopedic insoles are on medical prescription

Orthopedic insoles do not have an analgesic effect

Standard prostheses are << small appliances>>

Rheumatoid arthritis in flare-up is an indication for spa ♨ treatment

Upper limb prostheses often have a mainly aesthetic role


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


Regarding the assessment to be carried out in front of an essential hypertension of grade 1, among the following additional examinations, which are to be carried out in first intention?

fundus if grade 2 or 3 hypertension or diabetic hypertensive patient

If cognitive impairment and/or neurological symptoms.


Regarding the classification of Salter and Harris. Which of the following are true?

True. Growth cartilage is radiolucent. A non-displaced Salter 1 detachment will only be identifiable on the location of the pain and on the thickening of the soft parts.

A non-displaced Salter 1 detachment is invisible on radiography

A Salter V corresponds to a lesion on the germinative layer of cartilage by axial trauma

A Salter II corresponds to a trait that passes through the growth cartilage and epiphysis

A Salter IV corresponds to a trait that passes through the growth cartilage, epiphysis and metaphysis

A Salter III corresponds to a trait that passes through the growth cartilage and metaphysis


Which of the following are scannographic signs of advanced chronic pancreatitis?


What is the definition of an infection of ascites fluid that is controlled?


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

This syndrome includes 20% of childhood epilepsies

The EEG is classically in ample and diphasic waves, Centro temporal, calmed by sleep


Regarding the reduction criteria to be checked in a fracture of the lower end of the radius, which of the following propositions, which are true?

Front: a negative radio-ulnar index -2mm non-zero

Front: an anteversion of the radial glenoid

Front: Restoration of the bi-styloid line inclined 15° outwards

In profile: realignment of the cortical of the 2 radial fragments

Front: a negative radio-ulnar index -2mm or zero


What diseases are included in newborn screening?

True, first disease to look for by the blotting paper test (guthria test)

True, not included in the blotting paper test but is part of the screening at birth

True, is part of the blotting paper test, but is not systematic. Targeted according to parents' origins

True, hence the acoustic otoemission test to be done before discharge from maternity


How often is endobrachyoesophagus less than 3 centimetres monitored?

Control every year (2 times in the first year) if low-grade dysplasia


Which of the following are biomarkers that can be found disrupted in neuroblastoma?


An orthosis is a device that compensates for an absent or deficient function

A prosthesis is a device that compensates for an absent or deficient function


Which of the following propositions are true regarding decortication?


With regard to anaemia in children, what are the right proposals?

False, we judge his tolerance to effort classically during feedings.

It is impossible to talk about dyspnea of effort in an infant because he does not have physical activity

True, at birth the child has a high level of hemoglobin that drops sharply between 3 and 6 months to 9.5 g / dL as a low limit. From 6 months his Hb level increases little by little to reach the adult norm from 12 years

From 12 years old anemia is considered with adult norms

True, martial deficiencies of intake may be due to exclusive feeding of breast milk which is low in iron.

It is necessary to diversify food intake from 6 months


Which of the following are criteria for poor prognosis of localized forms? (Cancer Medline, Table 2, page 393, 2018 edition)


What are the indications for surgical management of a fracture of the child

Orthopedic treatment in 1° intention for any diaphyseal / metaphyseal fracture of children under 6 years of age

Femoral diaphyseal fracture in a 3-year-old child

At school age, surgical management is preferred for certain diaphyseal or epiphyseal fractures for a faster resumption of walking (lower limb) or writing (upper limb)

A fracture of the 2 bones of the forearm in an 8-year-old child

Yes, to avoid joint stiffness in case of immobilization

But surgical indication in the case of a pathological fracture (delayed healing in case of orthopedic treatment)

Orthopedic treatment would complicate nursing care, which is already cumbersome in these cases.


How many physicians must be present, at a minimum, for CPR:


Which of these diseases can be revealed by peripheral anemia?

True, it gives a central anemia by default of erythroblast production but also gives toxicity to red blood cells that can hemolyze with a reticulocyte response.

True, also Minkowski Chauffard disease, autosomal dominant disease. By a membrane defect, RBCs are sequestered in the spleen and hemolyze. Classically manifests itself as jaundice of the newborn.

True, it is a thrombotic microangiopathy that by definition gives consumption thrombocytopenia and mechanical hemolytic anemia.

True, it is an enzyme deficiency that gives hemolysis when exposed to an oxidative stressor: infection, bean ingestion, drugs such as quinine.


Which of the following proposals are acts/consultations for which it is not mandatory to go through the general practitioner to be reimbursed?

Psychiatric consultation, up to 25 years

Mammography as part of organized screening


Which of the following are functions performed by the facial VII nerve?

Motor innervation of the skin muscles of the face

Motor innervation of the stapedial muscle

Innervation of the lacrimal and submandibular glands

Sensory innervation of the Ramsey-Hunt area

Sensory innervation of the anterior 2/3 of the tongue


Which of the following proposals regarding the care of a burn victim are true?

A 1st degree burn is only painful erythema

A 2nd degree burn is only a dolourous erythema

Phlyctenes and epidermal detachment are present in 2nd and 3rd degree burns

Discoloration with vitropressure disappears in the 3rd degree

True, in addition the appendages no longer adhere

A 3rd degree burn is sluggish, dry, cardboard, insensitive and painless


In which diseases can Rheumatoid Factor (RF) be found?


Which of the following are true for the treatment of mild esophagitis?


Which of the following propositions concerning polytrauma are true?

A severely traumatized person is a trauma patient whose violence or mechanism of trauma can result in life-threatening injuries.

Injuries are the second leading cause of death among young people under 40

A defect in orientation of a polytrauma patient requiring secondary transfer to a specialized center is associated with excess mortality

Vittel's algorithm can be used to define a severe trauma patient and direct it to a structure adapted to its condition

False, the Glasgow score assesses the severity of head injury. It can be used from the pre-hospital phase

The Glasgow score is not usable in the context of polytrauma


Which of the following proposals are more oriented towards Crohn's disease rather than ulcerative colitis?

True, typical (but not constant) in crohn's

Gigantocellullar granulomas without caseous necrosis


Which of the following proposals are part of the initial additional assessment in case of suspected acute postpartum endometritis?

Vaginal sampling for bacteriological purposes


Which of the following propositions are true regarding UC?

MRI is the exam of choice for a positive diagnosis

Sclerosing cholangitis is a common association


Which of the following are etiologies of gigantoepithelioid granuloma without caseous necrosis?

True, it is very common not to find caseous necrosis in tuberculosis. But it must also be remembered that this pathology gives caseous necrosis


Which of the following propositions are true regarding prophylaxis in a splecnectomized?

Vaccination is combined with antibiotic prophylaxis with oral penicillin. It is generally recommended until adolescence in children and for one or two years in children.
the adult.

It is based on oral penicillins and vaccination

Oral penicillin is to be taken for 3 months in adults

Oral penicillin is usually to be taken until adolescence in children


Which of the following are causes of malabsorption diarrhea?


Which of the following proposals favor peripheral nystagmus?

No change of meaning depending on the look


Which of the following are true about tularemia?

Tularemia is caused by Francisella tularensis

Cervical lymphadenopathy most often (especially in hunters)

Fluoroquinolones as a first-line treatment

It is treated with C3G IM monodose in first line


Sudden infant death syndrome (SIDS) is an unexpected infant death (MIN) with no etiology found despite extensive investigations.

Unexpected infant death (MIN) is sudden infant death syndrome (SIDS) with no etiology found despite exhaustive investigations.

Sudden infant death syndrome accounts for 6% of infant mortality.

Unexpected infant death is defined as a sudden death in a child under 2 years of age, when nothing in its known history could have predicted it.

Unexpected infant death is defined as a sudden death in a child under 3 years of age, when nothing in his known history could have predicted it.

Abuse, acute dehydration and bedding accidents are among the most common etiologies of MIN.

The male sex of the infant, a young mother and the winter period are risk factors for sudden infant death syndrome (SIDS).

The male sex of the infant, the old age of the mother and the summer period are risk factors for sudden infant death syndrome (SIDS).


Which of the following are complications of centromedullary nail osteosynthesis?

displacement (scanning) of the cervical screw

Aseptic osteonecrosis of the femoral head


Which of the following are complications of repeated vomiting?


What elements are part of the C.A.M. classification useful in detecting and reassessing confusion?

True, confusion can settle in a few minutes, hours or days and we are talking about a break with the previous state

Wrong, having a major neurocognitive disorder is different from being confused, certainly, but you can have both!

Absence of major neurocognitive disorder

False, they are not part of the C.A.M. classification.

True, this very item is used very often in emergencies to detect confusion

Temporo-spatial disorganization and thought and language

True, remember that a confusion is equal to a Glasgow at 14!


The only clearly established exogenous risk factor for pancreatic adenocarcinoma is tobacco

The only clearly established exogenous risk factor for pancreatic adenocarcinoma is alcohol

Obesity is a risk factor as it is for many other cancers

The existence of an affected first-degree relative and tobacco use increase the risk of developing pancreatic adenocarcinoma by 5

Pancreatic conditions predisposing to an endogenous risk of pancreatic cancer are diabetes and chronic alcoholic pancreatitis in particular


Which of the following are factors in poor prognosis for idiopathic (or frigore) paralysis?

Poor prognosis factor = quick installation


Which practitioners can set up in sector 2?

Part-time hospital practitioners after 3 years


Which of the following are relevant tips for the management of irritable bowel syndrome?

Anti-diarrheals may have their place depending on the type of IBS


Which of the following are modifiable cardiovascular risk factors?

Age, sex and heredity are non-modifiable risk factors


What is the most common infectious entry point in case of septic shock?


False. This is invasive carcinoma of nonspecific type (or invasive ductal carcinoma or invasive ductal adenocarcinoma)

The most common type of cancer is invasive lobular carcinoma

Screening is routine for all women who are asymptomatic or without risk factors for BRCA1/2 between 45 and 75 years of age

The most common metastatic sites are the bone, lungs and liver.

False. It is a humanized antibody (-zumab). The suffix -mumab means that the monoclonal antibody is human.

Trastuzumab is a human monoclonal antibody targeting HER2


Which of the following are signs of peripheral facial paralysis?


Regarding level II analgesics, what are the exact proposal(s)?

False, nefopam (or ACUPAN) is not a level II analgesic, but a co-analgesic.

Level II analgesics include codeine, tramadol and nefopam among others

True, the very definition of level II analgesics being "weak opioids".

False, three times false. This is a mistake that is unfortunately very common, because even if the combinations of level 1 and level 2, specialties such as Lamaline or Izalgi are ALREADY a combination of opium powder and Paracetamol (+/- caffeine). Prescribing these specialties with Paracetamol leads to an overload of Paracetamol harmful to the liver.

It is not forbidden to prescribe combinations of level I and II together, such as Paracetamol + Lamaline or Paracetamol + Izalgi

True, this is THE drug contraindication of tramadol

False, it is with level III analgesics (strong opioids). For level analgesics it is according to the symptoms

The prescription of a laxative is systematic with opioid analgesics of level II


Which of the following proposals should be sought primarily in case of Turner syndrome?


Which of the following propositions regarding compartment syndrome is true?

False. It is an immediate/early complication that occurs within 24 hours. The development of unbearable pain at the site of the fracture is the diagnostic key to this complication.

A. It is a late complication that can occur after fracture of a limb

False false false !! The pulse is preserved. If they disappear, we should rather suspect acute ischemia of the limb ... or the very late stage of the compartment syndrome... that is, when the patient has lost his leg and is no longer in pain at all. So remember that "PALOR" and "PULSELESSNESS" are signs too late in the syndrome of the compartments

False. The figure is correct: it is pathological if > 20 mmHg BUT the diagnosis is CLINICAL +++. So no need to make a pressure measurement to everyone

The measurement of a pressure in the compartments > 20 mmHg is essential for diagnosis

A discharge aponeurotomy is indicated within 6 hours

True! It is related to a syndrome of the compartments of the forearm responsible for muscle retraction! Syndrome well to know that can be found in pediatrics when one performs poorly plasters (among others).

All this information can be found on page 343 of the last college of anesthesia resuscitation (not essential to read but it is free and online so it is the only one I have on hand

Volkmann syndrome is responsible for a claw deformity of the hand


Which of the following are compatible with cirrhosis?


Regarding endometrioma. Which of the following are true?

True. Endometrioma is ovarian endometriosis. See HAS 2017 recommendations.

Pelvic ultrasound and pelvic MRI have similar performance for the diagnosis of endometriosis

If endometriosis is diagnosed, it is necessary to look for associated deep endometriosis

The diagnosis of endometrioma should be made with caution after menopause so as not to ignore a malignant tumor

False. Not at all. Endometrioma = ovarian endometriosis. Adenomyosis is the presence of endometrial cells in the myometrium.

Endometrioma is synonymous with adenomyosis


Which of the following propositions are true about the MIN, when the doctor arrives at home?

Resuscitation maneuvers will be interrupted within a reasonable time in the absence of resumption of cardiac activity

The doctor may propose to the parents, if they wish, to be present during the resuscitation

If resuscitation maneuvers are undertaken, parents must leave the room

In the presence of the parents if they wish, it is recommended that the deceased child be completely stripped naked to be examined

Intervention sheet + Examination of the child (as early as possible)

No post-mortem gesture should be performed at home

The child's body must be transported to an MIN reference centre


Which of the following are enzymes that sign cholestasis?


What is Amico's classification of prostate cancer with a PSA of 18 ng/mL, a Gleason of 3+5 and a normal TR?

True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8


Which of the following proposals are additional examinations to be carried out systematically upon discovery of hepatomegaly?


With regard to sexual violence, which of these proposals are true?

16% of women say they have been raped or attempted rape in their lifetime

True, DNA being fragile, it is necessary to take samples urgently to detect the presence of DNA to identify the aggressor

A rape of less than 72 hours is a therapeutic emergency

False, the lubricant may destroy the DNA or semen elements present in the vagina and thus "contaminate" the samples

The clinical examination is done with caution, with a lubricated speculum

False, the presence of toxic is made only if an element of the anamnesis or clinical examination indicates that there has been a possible consumption of toxics

Among the samples systematically taken, we will look for STIs, the presence of pregnancy and the presence of toxic

True, as well as the medical certificate that will be given to the patient or to the authorities in case of requisition

Conventionally, among the documents given to the patient in case of rape there will be a prescription for emergency contraception, a prescription for preventive antibiotic therapy and a work stoppage


From what time frame do we talk about chronic diarrhea?


Which of the following are signs of hepatic encephalopathy?

Insomnia at night, hypersomnia during the day


Which of the following propositions are true with regard to febrile seizures?

A generalized febrile attack of 16 minutes with a fever at 41 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires a lumbar puncture.

A generalized febrile attack of 2 minutes with a fever at 38.5 ° C, in a child of 3 months without post-critical deficit, without any particular history, with a normal neurological examination requires a lumbar puncture.

A generalized febrile attack of 2 minutes with a fever at 38.5 ° C, in a child of 3 months without post-critical deficit, without particular history, with a normal neurological examination requires monitoring of 4 hours in hospital.

A febrile seizure with a focal onset of 22 minutes with a fever at 38.5 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires the introduction of a background epileptic treatment.


Which of the following are true for the treatment of severe esophagitis?


Which of the following proposals are among the risk situations where screening for HCV infection is recommended?


A generic must have a qualitative composition in active substance equivalent to that of the originator medicinal product

A generic must have a quantitative active substance composition equivalent to that of the originator medicinal product

Same scientific name but trade name (trademark) protected by intellectual property

A generic can have the same trade name as the originator drug

A generic may be offered by the pharmacist instead of an originator drug

A generic has excipients exactly identical to the originator drug


Which of the following proposals regarding breast cancer is true?

True. Extension assessment to be carried out if invasive cancer T3/T4 or N+

Extension assessment is indicated in case of invasive ductal carcinoma stage T3

True. The extension assessment is based on: TAP CT + bone scintigraphy OR PET-CT. Chest X-ray + abdo echo + bone scintigraphy is no longer done today (reason why it has disappeared from some referentials)

The extension assessment can be based on the couple CT-TAP + bone scintigraphy

True since the tumor is at the T2N0Mx stage. So no need a priori for an extension assessment if we stick to the recommendations of the reference system

A patient with invasive ductal carcinoma of 3 cm on mammogram without lymph node involvement will not need an extension workup (a priori)

FALSE, archi false!! The risk of lymphedema of the upper limb is major if we do this! This is a contraindication. For information, upper limb lymphedema and its management fell at the 2021 national white competition

In case of axillary dissection, radiotherapy of the axillary hollow will be performed in addition

TRUE:
- Before menopause: anti-estrogens
- After menopause: anti-aromatase

Discriminating notion: It is said in the course that anti-estrogens are responsible for endometrial cancers while they have a beneficial action on breast cancer...

This is because they act:
- on receptors in the breast as inhibitors to the action of estrogen = rotector role against cancer

- on endometrial receptors as ACTIVATORS to the action of estrogen = pro-oncogenic

The hormone therapy of choice after menopause are anti-aromatase


At what stage of the Hinchey classification is surgery mandatory?

Radiological drainage possible (if >3-5 cm depending on the source)


Outside the care pathway, what percentage of the tariff is covered by social security (excluding exceptions such as emergencies)?

This is the case when it is in the care pathway


Regarding vaccination in pregnant women. Which vaccine(s) are not recommended during pregnancy?

True. It is not a live vaccine so it is not contraindicated during pregnancy, but it is not recommended to vaccinate pregnant women in France. On the other hand, it is desirable to vaccinate women before or after childbirth.

True. It is a live vaccine and therefore contraindicated in pregnant women. On the other hand, it is recommended to vaccinate all women with rubella-negative serology pre-conceptional. Women who have received 2 prior vaccinations should not be vaccinated, regardless of the result of serology if it is performed. Due to the teratogenic risk, it is necessary to ensure the absence of an early pregnancy and to avoid any pregnancy within 2 months of vaccination.

True. It is a live vaccine with a teratogenic risk. Women of childbearing age who have no history of chickenpox should be vaccinated. Vaccination is possible if the pregnancy test is negative. Effective contraception for 3 months is recommended after each dose of vaccine.

The flu vaccine is recommended for pregnant women because pregnant women are a population at risk of severe influenza (fetal death and maternal death, refractory hypoxemia, etc.).

True. It is a live vaccine, therefore teratogenic.


Which of the following are differential diagnoses (DD) of right supraclavicular lymphadenopathy?

It would give lymphadenopathy of the submandibular chain

Not a DD but a sign + lymphadenopathy would be on the left

It would give pre-laryngeal lymphadenopathy


How many years should a medical record be kept after a person's death?


Which of the following signs indicate the severity of aortic insufficiency?

FALSE: The breath of aortic insufficiency is HOLODIASTOLIC decrescendo. The ejective systolic murmur is not a sign of severity but an added noise that can be heard in the IAo

FALSE: Abolition of B2 is a criterion of severity of aortic stricture

True. In total, the signs of severity of aortic insufficiency are: - apexian flint rolling (= functional mitral narrowing) - protodiastolic gallop (B3) - enlargement of the peak shock - the regurgitated volume > 60 mL at ETT


True, MisMatch Repair -> we can no longer repair errors😥

The gene is caused is part of the MMR system

The risk of developing colorectal cancer is 70 to 80% over the course of a lifetime.


Which of the following are true about Meld's score?


How many years should a medical record of a minor patient be kept?

10 years after reaching the age of majority


Which of the following is an additional examination(s) to be performed to confirm diverticulitis?

True, cornerstone of diagnosis. We see diverticula, a colonic wall > 4mm, and fatty infiltration

Transaminases are useless. A NFS-P CRP (for PNN hyperleuco and biological inflammatory syndrome) Creatinine (before angioscan) is done. In women of childbearing age who do not have well-followed contraception, it is thought to ask for DDR +/- b-HCG 🙃

Don't go too far ahead on confirming diverticulitis 😬


Which of the following are true about peripheral facial paralysis?

There is no automatic-voluntary dissociation

It concerns damage to the facial nerve VII

There is a frank automatic-voluntary dissociation

The motor deficit concerns only the lower part of the face


Which of the following are treatments for acute cholecystitis?


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

It is the main precursor of mucosal squamous cell carcinomas

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

Benign epithelial tumor without malignant potential


Which of the following are tumours with a risk factor for sun exposure?

True, short sun exposure, no precancerous lesion, clear phenotype

True, chronic and prolonged sun exposure


Which of the following propositions are true about brachytherapy?

It is a permanent implantation of iodine-125 grains perineally under ultrasound control

As well as two subgroups of intermediate risks: PSA between 10 and 15 and/or presence of minority grade 4 (GG2)

It concerns the low-risk group of Amico exclusively

It is contraindicated if the prostate is more than 60 mL

This is the standard treatment option with the lowest risk of leading to erectile dysfunction.

The risk of erectile dysfunction is maximum


Which of the following are PSRs for treating physicians?


Which of the following proposals are shocks with decreased cardiac output?

True, DC = LVEF x FC. Decrease in LVEF in hypovolemic shock

True, DC = LVEF x FC. Decreased HR in cardiogenic shock


False, renin is the enzyme that cleaves angiotensinogen into angiotensin I. Angiotensinogen is of hepatic origin. Renin is of renal origin

Renin is responsible for the secretion of angiotensinogens that will be metabolized to give angiotensin I

True, renin is secreted in response to sympathetic nervous system stimulation, hypovolemia or increased natriuresis

Autonomic neuropathy may decrease renin secretion

False, angiotensin vasoconstrict large vessels as well as efferent arterioles of the glomeruli

Angiotensin II is a powerful vasodilator

True, angiotensin II stimulates vasoconstriction as well as adrenal aldosterone secretion

Angiotensin stimulates the secretion of aldosterone


Which of the following are causes of dilated cardiomyopathies?


How many health professionals are there in France approximately?

This is the approximate number of doctors


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


Regarding infant epilepsy. Which of the following are true?

A fall of the head with elevation of the arms must evoke West Syndrome.

False: infantile spasms of West syndrome are to be distinguished from myoclonus

Myoclonus in flexion should evoke West Syndrome.

Psychomotor regression or stagnation of acquisitions associated with MRI hypsarrhythmia should suggest West Syndrome.

Dravet syndrome is rare, and usually gives an intellectual disability

Dravet syndrome is resistant to treatment


Traumatology is the leading cause of death between the ages of 1 and 19 years

Cancers are the leading cause of death between the ages of 1 and 19

Before two years any trauma with invoice must always evoke abuse

Solitary bone cyst is a cause of pathological fracture

The ligament structures of the child are more resistant than the metaphyses

True sprains and isolated dislocations are more common than fractures


Which of the following proposals reduces the risk of hyaline membrane disease in premature infants?


Regarding the abnormalities of the menstrual cycle which of these propositions are true?

Wrong, it's the other way around. In addition, the terms oligomenorrhea and spaniomenorrhea are synonymous.

Hypomenorrhea are too infrequent, while oligomenorrhea are too low periods

True, this is what corresponds to the rating of the Higham score which must be >100 to talk about menorrhagia

To assess the abundance of gynaecological bleeding at the interrogation it is necessary to ask the number of protections used as well as the amount of blood on them.

True, hence the adage "every woman of childbearing age is pregnant until proven otherwise"

Pregnancy should be systematically considered and ruled out by a BHCG assay

False, in front of bleeding and a positive pregnancy test, the first cause to eliminate is ectopic pregnancy.

Bleeding associated with a positive BHCG assay should eliminate a spontaneous miscarriage as a first line

True, but also adenomyosis, bleeding disorders etc...

Causes of menometrorrhagia include fibroids, myomas or endometrial cancers.


Which of the following proposals regarding the hospital management of a polytraumatized patient are true?

The biological assessment of a polytrauma patient necessarily contains the grouping and search for RAI

Transcranial Doppler looks for cerebral hypoperfusion in the anterior communicating artery.

False, FAST is a rapid abdominal, pleural and cardiac ultrasound.

FAST ultrasound verifies the integrity of the vascular axes of the 4 limbs

False, the whole body scanner is performed in 2nd step, without, then with injection of iodinated contrast medium.

The BodyCT, performed during the 3rd phase of management as part of the lesion assessment, is a whole body scanner without injection.

The thoracic part of the bodyCT allows among other things to find the 10-20% of pneumothorax that are not visible on the standard X-ray


Which of the following proposals designate oncogenic viruses?


Which of the following are the following proposals for a normal umbilical cord?


From a certain volume (2L or 5L depending on the source)

It is done regardless of the volume of ascites punctured

1 L of ascites corresponds to 20 g of albumin

It is only below a certain blood pressure threshold


Which of the following are causes of osmotic diarrhea (by attraction of water into the intestinal lumen)?


NIMs would occur more frequently when the socio-economic conditions of the family are unfavourable.

NIMs would occur more frequently when the socio-economic conditions of the family are favourable.

Co-sleeping (the fact that the infant sleeps in the same bed as the parents) is a risk factor for MIN.

To avoid unexpected infant death, co-sleeping should be encouraged.

Unexpected infant death most often occurs in infants between 2 and 4 months of age

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

To prevent unexpected infant death, the temperature of the chamber should be maintained at 24ºC.


What is the main etiology of chronic calcifying pancreatitis in developed countries?


Which of the following are signs of facial paralysis?

No ptosis but, on the contrary, a difficulty in closing the eye


Which of the following are true about abiraterone acetate?

It is contraindicated in case of treatment-refractory hypertension

The appearance of oedema should be monitored

The toxicity of prednisone 10mg/day should be monitored

Concomitant corticosteroid therapy is too low to require monitoring


What is the proportion of asymptomatic cholelithiasis?


Bilirubin is a breakdown product of platelets

True, upstream of the liver so unconjugated

Hemolysis is a possible etiology of unconjugated bilirubin jaundice

Gilbert's disease is inherited autosomal recessive

A normal billirubine is below about 20 millimoles


What is the prevalence of pregnant women not immune to toxoplasmosis?


Which of the following are true about corneal transplantation?

Existing and mandatory national waiting list

Unlike other types of transplants, there is no national waiting list for corneal transplantation.

The eye stays in place, we just scalp the cornea

It consists, in the donor, in removing the eyeball

No impact of age or abnormalities of refraction

The transplant success rate is high (>80%)

Hepatitis infection is a contraindication to corneal sampling


Which of the following propositions are true regarding uterine rupture?

True. Text the explanatory sentence of the msd manual: https://www.msdmanuals.com/fr/professional/gyn%C3%A9cologie-et-obst%C3%A9trique/anomalies-et-complications-du-travail-et-de-accouchement/rupture-ut%C3%A9rine

Uterine rupture is a spontaneous tear of the uterus that can cause the fetus to expel into the peritoneal cavity.

We think about it especially in case of history of caesarean section

It is an absolute emergency, putting the child's ⚡ prognosis at stake

The vital prognosis of the fetus is not at risk in the short term

sudden acute pain, uterine deformity, red blood metrorrhagia (arterial) 🔴

We find the triad: chronic pain gradually ascending, uterine deformity, metrorrhagia of blackish ⚫ blood

Fetal heart rhythm abnormalities are almost always found


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

X-ray of the spine from the front and profile


How often is endobrachyoesophageal monitoring longer than 6 centimeters?


Which of the following proposals is (are) a marker(s) of organ-specific autoimmune diseases?

True, autoimmune diseases of the intestine

Anti-cytoplasmic antibodies of neutrophils

Anti-mitochondrial antibodies of type M2


What is the examination to request in first line in case of suspicion of non-traumatic subarachnoid hemorrhage?

False, IC if signs of commitment or ICH (common in case of subarachnoid hemorrhage)


Which of the following propositions are true about transfusion-transfusion syndrome (TTS)?

It is also known as feto-fetal transfusion syndrome

True, 60-100% in severe cases (wikipedia)

It concerns monochorionic twin pregnancies

It appears in the first half of pregnancy


True. The onset of puberty is defined in girls by the appearance of breasts that occurs physiologically between 8 and 13 years of age.

The onset of puberty is defined by the appearance of breasts (thelarche).

The onset of puberty in boys is defined by the increase in testicular volume (volume > 4ml) observed between 9 and 14 years.

The onset of puberty in boys is defined by an increase in the size of the penis.

Voice molting in boys usually occurs between the ages of 14 and 15.

True On side in SX/GX-PX Sometimes you can see AX that corresponds to the development of axillary pillosity that we also side in practice?

The Tanner classification is used to assess an individual's pubertal development.

FALSE. There is no stage 0 in the Tanner classification. The absence of breast development corresponds to S1.

In the Tanner classification, S0 corresponds to the absence of breast development.


What is the amount of the medical deductible in the general case for a consultation with a doctor?


Asthma is often associated with allergic rhinitis

Asthma is responsible for about 1000 deaths per month

Asthma results from an interaction between genes and the environment


Adherence is often better in chronic pathologies than in acute pathologies

Adherence is often better in acute pathologies than in chronic pathologies

Lack of adherence can cause treatment failure

Adherence can be improved by simplifying medication intake

Generics can help reduce healthcare costs


True, flat-rate contribution = deductible (it's the same thing)

It corresponds to the co-payment + flat-rate participation

It corresponds to the flat-rate contribution + medical deductible


Regarding infant epilepsy. Which of the following are true?

Perinatal asphyxia is an etiology of West Syndrome, and gives it a poor prognosis

Bourneville's tuberous sclerosis, which gives brown spots, is a poor prognosis in West Syndrome

In 15% of cases, there is no underlying cause of West syndrome: it is therefore idiopathic

West syndrome is a therapeutic emergency: the appropriate treatment is often vingabatine

The EEG characteristic of a West Syndrome gives continuous slow waves, diffuse multifocal peaks, synchronous amplitude, without background activity


Which of the following are the causes of secondary constipation?


Which of the following proposals make it possible to assess the general condition of the patient?


Which of the following are clinical signs of hemorrhoidal thrombosis?


You are a pediatric intern and the baby in front of you is in pain. What are the analgesic means you can use in this baby?

FALSE. The MEOPA has the MA from 1 month

FALSE. The WMA says that EMLA patches are only possible in a full-term child. Even if in practice it can be prescribed off-label, for the ECNi we must stay on the rules of the CNG which say that we MUST stay on the MA

EMLA patch in premature infants possible according to the MA

FALSE. Sugar solutions up to 6 months MAXIMUM!

Sugar solutions if it is a 9-month-old infant

True. Not exceeding 60 mg/kg/24h [or even 30 mg/kg/24h in the < 1 year or < 10 kg] when taken PO


Which of the following are known carcinogens?


Which of the following proposals should be sought primarily in case of Di-Georges Syndrome?


Training to use equipment is part of what is called <<rehabilitation>>

The integration of the equipment into daily life is part of what is called << rehabilitation>>

Not all of course (reading glasses for example)

All devices require a medical prescription

Most equipment requires monitoring and follow-up


Uncomplicated diverticulitis is, according to Hinchey's classification, stage:

Purulent generalized peritonitis ( ➡ surgery)


You receive in office, little Heathcliff, 1 1/2 years who presents an acute flare-up of atopic dermatitis. You decide to give some advice to parents...

True, this is THE thing to remember, no herpetic contagion with atopic dermatitis, it gives a Kaposi Juliusberg a very serious form!

Avoid herpes contagion at all costs, even in case of simple cold sores

False, entirely false, there are no contraindications on vaccines

Favor vaccines in periods of lull in the dermatological disease

True, and avoid wool or synthetic clothing

False, there is no allergenic eviction to do

Avoid nuts and exotic fruits, with high allergenic potential


Which of the following proposals are medical or paramedical professions with an order?


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

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

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

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

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

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

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

True! These manifestations are fickle, however.

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

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

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


In the absence of effective breathing movements, what is the very first resuscitation maneuver to be undertaken in a newborn who is not screaming?

True, right after drying and stimulation

Nasopharyngeal aspiration and stimulation

Adrenaline administration is a last resort

If bradycardia persists despite effective ventilation

As a second line, after nasopharyngeal aspiration


The diagnosis of certainty of hepatomegaly requires:

True, ultrasound is necessary and sufficient


In 20% of cases, PD-NETs are revealed by symptoms related to hormonal secretion

Pancreatic adenocarcinoma is by far the most common pancreatic tumor (90%)

Endocrine tumours are the most common pancreatic tumour tumour

The average age of onset is between 60 and 70 years

In France, the incidence of adenocarcinoma of the pancreas has increased significantly over the past 20 years

Its prognosis is poor with a median survival between 6 and 9 months if the cancer is metastatic and 18 to 24 months if it could be resected

The prognosis for adenocarcinoma is very good, unlike neuroendocrine tumors


Which of the following proposals for acute renal failure and acute tubular necrosis is true?

Natriuresis in an NTA is increased

There is one exception though... NTAs secondary to rhabdomyolysis or iodinated contrast media: natriuresis has collapsed
For rhabdomyolysis, this is because there is volume depletion activating RAAS --> Na+ reabsorption
For iodinated contrast media I don't know...

No hypertension, no edema in the NTA! The clinical picture of the different ARIs is to know by heart!

Clinically we find hypertension and edema

In NTA, glomerular flow is decreased due to pre- and post-glomerular vasoconstriction and increased intra-tubular pressure.


Approximately how many doctors are there in France?

This is the approximate number of health professionals


Which of the following are the causes of motor diarrhea?


Which of the following are signs or symptoms of confusion?


What is the frequency of monitoring of endobrachyoesophagus between 3 and 6 centimeters?

Control every year (2 times in the first year) if low-grade dysplasia


Regarding immune deficiencies, among the pairs type of deficiency - opportunistic pathogens, which one or which are accurate?

True, humoral deficiency does not lead to opportunistic infections but to severe pneumococcus, meningococcal and haemophilus infections.

True, cellular immunodeficiency leads to parasitic, fungal, or viral opportunistic infections

Cell deficiency - opportunistic infections

True, we most often know meningococcal infections but it can also give serious sepsis

Complement deficiency - invasive bacterial infections

True, we know less about this subtlety but it's true

True, a specificity related to PNN deficiency

Phagocytic Deficiency - Pyogenic Infections


Folate deficiency is responsible for macrocytic anemia

A central cause causes normo- or macrocytic anemia

Spinal cord invasion gives microcytic anemia


Which of the following propositions concerning Vittel's algorithm in the context of polytrauma are true?

Extreme gravity is defined as a Glasgow at 3, a SBP < 65 mmHg and/or an SpO2 < 80% or impregnable

A fall from a height greater than 4 meters is an element indicating violent kinetics and the need for treatment in a specialized center

Another passenger who died in the same vehicle is an element indicating violent kinetics and the need for care in a specialized center

A pelvic fracture is an anatomical lesion requiring management in a specialized center

A patient with normal vital signs, no evidence of violent kinetics and no anatomical lesions requiring specialized management, but where the shockproof pants are inflated requires transfer to a specialized center.


Who are the actors involved in the system for reporting serious adverse events associated with care?

Healthcare professionals and healthcare facilities


Which of the following are segments crossed by facial nerve VII?

True. It emerges at the level of the stylomastoid foramen


When should vaccinations be performed in case of emergency splenectomy?

This is an emergency splenectomy (no time to wait 2 weeks)


Where does the facial nerve emerge from?

Emergence of the hypoglossal nerve XII (motor for the muscles of the tongue, passing through the hypoglossal canal)

Emergence of oculomotor nerve III (motor, innervates the upper right, lower right, inferior oblique, medial right, passing through the superior orbital fissure)


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

It only concerns patients with serious illness

The designation can be done on plain paper, signed and dated

Quite possible (especially if the doctor is not treating)

The designated person cannot be a doctor


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

False, it is 100mg per day, it is one of the only dosages that is required from you, because it is medico-legal

Allopurinol is to be initiated at a dosage of 200mg per day

False, as we will see below it is the DRESS syndrome. It is Febuxostat that has this type of side effects

One of the most serious side effects of allopurinol is the occurrence of digestive disorders

FALSE, +++ DRESS syndrome is a serious toxiderma and must always be suspected, especially with purveyor treatments such as Bactrim or Allopurinol!

A rash after taking allopurinol is common and mild

True, it is to start during symptomatic hyperuricemia

Allopurinol is to be started after the first attack of gout or first uricemic renal colic

True, they are both hyperuricemic treatments

When re-evaluating treatment, it is necessary to look for thiazide diuretics or loop in the patient's prescription


Mr MELARK, Peeta, 25 years old, comes to see you in general medicine consultation, because for a few months he has regular palpitations. He explains that he has already consulted a cardiologist who has ruled out all transient and extracardiac causes of palpitations and who would have vaguely told him about Bouveret's disease. He is very anxious because he is afraid of having "a cardiac arrest" like his uncle. What can you tell him about Bouveret's disease?

True, it is one of the two causes of junctional tachycardia with Wolff Parkinson White syndrome.

This is a not uncommon cause of junctional tachycardia in young people

False, these are the ECG features of Brugada syndrome, here in Bouveret's disease we find a fine QRS tachycardia with retrograde P waves

The ECG conventionally finds negative T waves in V1 and V2

False, another feature of Brugada syndrome. Bouveret's disease is benign and does not require defibrillation under any circumstances

There is a risk of cardiac syncope and the need for defibrillation

True, this is the typical symptomatology with pollakuria

The symptomatology is characterized by bouts of palpitations at the beginning and abrupt end

True, these are two lesser-known methods of vagal maneuvers but which are much easier than carotid massage or eyeballs.

A vagal maneuver by inverted Vasalva or ingestion of ice water can make the diagnosis


You receive in consultation Mr Deux, Ramsès, 75 years old, who is followed in pneumology for idiopathic pulmonary fibrosis. However, he also caught CoVID 3 weeks ago, and he can no longer distinguish between the symptoms of his long CoVID and idiopathic pulmonary fibrosis. What symptoms can you relate to his idiopathic pulmonary fibrosis?

True, quite simple this one, fibrotic patients present a dyspnea of effort becoming easier and easier with time, for an effort less and less important

False, it is a sign of influenza-like illness, so CoVID!

True, visible in both cases. Dry cough is clearly distinguished from fibrotic, unlike expectorant wet cough from COPD

False, grumbling is rather COPD! We find under crackling bases in fibrotic. To give you ideas, the ronchis is literally a "fouling" of the bronchi


What is the most common progressive complication of acute community-acquired pneumonia in children?

Post-pneumococcal hemolytic uremic syndrome

Hyponatremia by SIADH (syndrome of inappropriate secretion of anti-diuretic hormone)

False: This is the 2nd most common just after pleurisy ++


Regarding additional examinations in diffuse interstitial lung disease, what are the exact proposal(s)?

True, it is characteristic of diffuse interstitial lung diseases, the infiltration being "around" the structures where the air passes, it will compress the air and be restrictive

EFRs regain a restrictive ventilatory disorder

True, because of a lower respiratory volume, when there is an effort, the lung can not mobilize additional respiratory volumes

There is a classic desaturation on exertion

True, DLCO explores diffusion abnormalities between the alveolus and capillary transmitted by the interstitium. An abnormality of the alveolus (e.g. OAP), interstitium (PID) or capillary (HTP) can cause a decrease in DLCO

False, the so-called "honeycomb" cysts have a subpleural disposition

Honeycombs are cysts located in contact with the mediastinum corresponding to bullous structures within the interstitium

True, it is a highlighting of these anatomical structures, the septas

Lines or cross-links are accentuations of anatomical structures that are usually not visible


Regarding thrombocytopenia in pregnant women, what are the exact proposal(s)?

True, it's not noted in the college, but given the prevalence of obesity in the general population I think it's not bad for your patients to retain this as a potential cause.

Pregnancy NASH (Nonalcoholic Steatose Hepatic) is a cause of thrombocytopenia

Thrombocytopenia in pregnant women should be tested for HIV infection

True, it's in its name (Hemolysis, Elevated Liver enzymes, Low Platelets)

HELLP syndrome is a cause of thrombocytopenia in pre-eclamptic pregnant women

True, as in the general population, but here there is more often heparin treatment because of the prothrombotic risk

Prophylactic treatment with heparin may lead to thrombocytopenia

True, in >75% of cases it is physiological

The most common cause of thrombocytopenia during pregnancy is benign


You receive in hematology consultation, Mrs. EVANS Lucy, a 65-year-old patient who consults after he was found at the blood test a thrombocytopenia at 12G / L. Your colleague had performed a myelogram on this patient who found a marrow poor in megakaryocytes. What are the possible diagnoses in this patient?

Evans syndrome corresponds to peripheral autoimmune involvement of platelets and red blood cells. The patient has central thrombocytopenia with us

True, as with anemia, deficiency thrombocytopenia is central because it leads to a slowdown in central production.

False, chronic lymphocytic leukemia causes anemia and not thrombocytopenia ...

False, this is a "burst" of platelets in the blood, and not spinal cord damage

True, here cancer cells take the place of megakaryocytes in the marrow


Regarding purpuras, what are the elements suggestive of vascular purpura rather than thrombocytopenic purpura?

True, thrombocytopenic purpura is flat a contrario

True, it is also said that purpura is declivated, unlike thrombocytopenic purpura which are diffuse

False, the presence of hemorrhages rather indicates thrombocytopenia

Purpura associated with clinical bleeding

False, vascular purpura testifies to an attack of the small vessels with inflammation that leads to localized purpura, unlike thrombocytopenic purpuras which will be in sheets, because of an active hemorrhage.

True, purpura will be raised and palpable, unlike thrombocytopenic purpura


Regarding Hodgkin's lymphoma, which propositions are true?

True, in the young subject (about 25 years) and the elderly (about 80 years)

True, very good effectiveness of treatments

After treatment, about 90% of patients are cured

True, allows the Ann Arbor classification (which is not the case with Binet's classification in CLL, because the latter is a clinicobiological classification, which does not take into account imaging)

PET-FDG is systematic in the extension balance

False, the most common histological subtype in classical Hodgkin lymphoma is the scleronodular form (67% vs. 25%)

Mixed cellularity histological subtype is the most common form of classical Hodgkin lymphoma

The localized stage (I/II in the Ann Arbor classification) is most common at diagnosis


Regarding non-Hodgkin lymphomas, what are the real proposals?

False, T/NK lymphomas account for only 15% of non-Hodgkin lymphomas

The majority of non-Hodgkin lymphomas are T-cell lymphomas

True, it is a diffuse large B-cell lymphoma (CD20+, CD 10+, bcl-). It evolves very quickly (aggressive). There are endemic (African), sporadic (non-African) forms and linked to immune deficiency.

EBV infection is a risk factor for Burkitt's lymphoma

One of the most common non-Hodgkin lymphomas is diffuse large cell B-cell lymphoma

False, compressive syndrome is more common in non-Hodgkin lymphomas

Compressive syndrome is less common than in Hodgkin's lymphoma


Which of the following propositions about malignant lymphomas are true?

False, they are characteristic of Hodgkin lymphomas

The presence of Reed-Sternberg cells is characteristic of non-Hodgkin lymphomas

True, acquired or congenital immunosuppression

The immunosuppression field promotes malignant lymphomas

False, the diagnosis is based on lymph node biopsy because histological proof is absolutely necessary

Diagnosis of malignant lymphoma is based on lymph node aspiration

Superior cava syndrome is a therapeutic emergency

True, to be carried out after agreement of the patient!

Always think about performing an HIV serology


Regarding agranulocytosis, which propositions are true?

True, especially during a control blood count

False, this is extrinsic accountability. The intrinsic imputability of agranulocytosis to a drug is based on semiology and chronology

The method of intrinsic imputability of agranulocytosis to a drug is based on pharmacovigilance data

False, the elevation of PNN occurs 48 hours after the appearance of monocytosis

The appearance of monocytosis during follow-up is suggestive of the elevation of ANCs within 24 hours

Treatment is based on broad-spectrum antibiotic therapy even in the absence of fever


Which of the following are true about zoledronic acid?

It is a drug for the prevention of complications of bone metastases

It is a bisphosphonate inhibiting bone resorption related to osteoclastic activity

It is injected in slow IV every month or so.

There is a risk of osteonecrosis of the jaw and hypocalcemia


Which of the following proposals designate cystic tumors of the pancreas that do not develop within the pancreatic ducts?

They develop within these channels themselves.


In secondary amenorrhea, a low LH, FSH and estradiol assay points to an ovarian cause

False, these results point to gonadotropic insufficiency (central origin)

A beta hCG test is essential when looking for the etiology of secondary amenorrhea

True, to eliminate pregnancy, physiological cause of amenorrhea

FSH assay is found collapsed in amenorrhea with PCOS as an etiology

To explore gonadotropic insufficiency, a pituitary MRI is performed


Regarding thyroid goiters, which propositions are true?

If the TSH test comes back high, anti-TPO antibodies are dosed.

True, to look for Hashimoto's autoimmune hypothyroidism

If the TSH test comes back high, anti-TSH receptor antibodies are measured

False, anti-TSH receptor antibodies are dosed if the TSH dosage comes back low, to eliminate Graves' disease

De Quervain's subacute thyroiditis is a cause of goiter

A goiter can progress to thyroid cancer in 15% of cases


Regarding thyroid nodules, what are the true propositions? (one or more true propositions)

Nodule size is synonymous with malignancy

False, the size does not presume the malignancy of the nodule

The first-line examination in thyroid imaging is the scintigraphy

False, the 1st intention examination is ultrasound

The determination of calcitonin is always recommended in the first-line assessment when a nodule is discovered

False, it must be practiced systematically in certain situations only: known hereditary context of medullary thyroid cancer, if suspicion of malignancy of the nodule at cytopuncture and before any intervention for goiter or nodule

A nodule with a score of 2 on the Bethesda cytological classification is a malignant nodule

The course of action for a Bethesda 6 non-functional nodule is surgery


Regarding thyroid cancers, which proposals are true?

Recurrent paralysis may be a clinical sign allowing the revelation of a thyroid nodule

The most common vesicular carcinomas are differentiated vesicular cancers

False, they represent only 5% of thyroid cancers. The most common is differentiated papillary carcinoma (85% of cases)

Anaplastic carcinomas require urgent management

Medullary thyroid cancers develop at the expense of calcitonin-secreting C cells

Medullary thyroid cancers can integrate into multiple endocrine neoplasia type 2 (MEN2)


Insulin intermediate (NPH) is a suspended insulin (powder) that needs to be reconstituted

TRUE. NPH insulin is a powdered intermediate insulin that is injected subcutaneously

Rapid insulin works in 15-30 minutes and lasts about 4-6 hours

TRUE! - Rapid insulin: Acts in 15-30 min and lasts 4-6h
- Slow insulin: Acts in 1-2h and lasts 24h = "insulin to live"

TRUE! Page 280 of the new college (5th edition). Rapid insulin exists in IV/IM/SC/pump form

TRUE, unlike the fast one that acts in less than 30 minutes. Its action lasts 24 hours

A type 2 diabetic with HbA1c > 10% and cardinal syndrome will immediately require insulin treatment

TRUE! Overall here, the patient is unbalanced (HbA1c > 10%) with clinical decompensation (cardinal syndrome). This is an indication to introduce insulin from the outset


In France, the prevalence of obesity is around 15%

Obesity prevalence declines after age 65

The mutation of the melanocortin receptor would be responsible for less than 5% of severe obesity


What element(s) are complications of obesity?


What examinations are systematic in the face of obesity?


A new patient comes in for consultation and asks you for surgical care. You explain the conditions according to the HAS. Check the true answer(s):

Need for management and follow-up of at least 6 months before

Possible under certain very strict and exceptional conditions


What comorbidities are improved by surgical management of obesity?


What are the contraindications to bariatric surgery?

Prolonged medical follow-up not feasible


There are 2 consecutive phases in Guillain Barré syndrome

Up to 1 year and a half (18 months). Patients are then hospitalized for a long time (often in MRP wards). After 18 months, the lesions are considered fixed

This is the second phase. It can last up to 3 weeks


What percentage of patients have permanent sequelae (motor deficit, ataxia) of Guillain Barré syndrome?


Which of the following are PSRs for treating physicians?


You are a medical gynecology intern and you receive today Mrs. Z 28 years old to perform a cervical smear as part of cervical cancer screening.
She has the following background:
- type 2 diabetes,
- a Helicobacter pylori infection treated 2 years ago,
- a solid organ transplant under immunosuppressive therapy since the age of 24.
A few days after the consultation you receive the result of the smear: ASC-US.  What is the exact proposal(s)?

An HPV-HR test should have been performed as a first-line test before smear cytology.

Fake the patient at 29 years old and cytology on FCU must be performed in first line between 25 and 30 years!

Following the result of the smear, an immediate colposcopy should be performed.

False! If AUC-US = indeterminate = HPV test, if the latter is positive then a colposcopy will be done, otherwise a cytology at 1 year.

Annual cervical cancer screening is recommended for this patient as part of a specialized follow-up.

True she is on immunosuppressant +++ = increased risk of cervical cancer or rapid progression to cervical cancer after HPV infection!

Type 2 diabetes is a risk factor for cervical cancer.

False! Risk factor for endometrial cancer!

If the smear result had been: LSIL, colposcopy would have been indicated.


What are the risk factors for gastric adenocarcinoma?

False, it is a risk factor for esophageal cancer

True, because partial gastrectomy leads to stagnation of stomach contents in the stump, which will lead to an additional risk of cancer. This is why we do control fibroscopies in the follow-up of sleeve (at 2 and 5 years)

True, i.e. salt and nitrites, which partly explains why low socioeconomic status is also a risk factor

True, because like all gastritis there is inflammation and therefore a risk of cancerization

Presence of chronic GERD for more than 20 years


You receive in digestive oncology consultation Mr RAT, Paddy, 75 years old that you have brilliantly operated on a gastric adenocarcinoma, via a total gastrectomy. You will now explain the necessary elements for the rest of the support

Meal splitting (6 to 7 meals per day in small quantities)

True, simply the stomach can not hold more food, so to avoid dilating the stump, we split the meals

False, some surgeons can do it, but there is no clear indication.

Taking carbohydrates every 2 hours to avoid dumping syndrome

False, completely fanciful! Dumping syndrome corresponds to hypoglycemia related to the delay in the absorption of carbohydrates in the body (basically the pancreas detects carbohydrates in the stomach, and secretes insulin when we have not even sent carbohydrates into the blood, to schematize roughly that's it)

Antiplatelet therapy for a period of 6 months

False, no antiaggregant necessary except possibly in case of postoperative hyperplatektosis and still it is discussed.

Wrong, big trap! It's intramuscular!!! You no longer have a stomach so you can no longer absorb Vitamin B12... (even if you will see that the literature retains that we can supplement PO anyway, but not to ECN)


What are the signs on pelvic ultrasound of an ovarian tumor in favor of malignancy?

False, it is seen in particular in the hormonal stimulations of ART, to ovulate many oocytes to the patient

True, it often indicates contralateral and advanced involvement

True, vegetations are often signs of cancer

False it is a central hypervascularization


Mrs. DAPHNIS, Chloé, 75 years old, comes to consult you in oncology appointments, because she has just been diagnosed with ovarian cancer. Very familiar with item 303 of the ECN, she asks you questions about the BRCA1 and BRCA2 genes that are predisposing to ovarian cancer. What can you say to him?

False, these are tumor suppressor genes! Generally oncogenes are autosomal recessive and autosomal tumor suppressor genes dominant, I remembered like that!

BRCA 1 and BRCA 2 genes are inherited in an autosomal dominant manner

True, it is enough to have only one mutated to express the disease

There is a higher risk of developing ovarian cancer when you have mutated BRCA1 compared to mutated BRCA2

True, up to 50% for BRCA versus 25% for BRCA2 (versus about 12% in non-mutated women, and 6% in the general non-mutated population)

Any diagnosed ovarian cancer requires testing for mutated BRCA

True, cancer so rare that it requires genetic research (Lynch and / or BRCA often involved)

For mutated BRCA, treatment for ovarian cancer is based on targeted monotherapy

False, there are many targeted therapies with PARP inhibitors but they are in addition to chemotherapy.