Which of the following proposals can be used to diagnose diabetes?

2 fasting blood glucose levels > 1.26 g/L

Fasting blood glucose > 2 g/L at any time of the day

False, association with symptoms of hyperglycemia is necessary

Blood glucose > 2 g/L at 2 hours from OGGH 75g

HbA1c is not used in France for the diagnosis of TD

Fasting blood glucose > 2 g/L at any time of day associated with polyuria

True, associated with one or more symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, ...)


Which of the following are true about type 1 diabetes?

Alpha-pancreatic cells are destroyed by autoantibodies

These are the Beta-pancreatic cells that secrete insulin!

True, although it is more common to diagnose it in young people


Which of the following proposals designate drugs that can cause hypoglycemia?

This is thanks to the discovery of a PU of Réa de Montpellier who realized that his patients had unexplained manifestations under Sulfonamides (then used as ATB).
By measuring their blood sugar he realized this unsuspected therapeutic action.


Regarding the basics of nephrological (or renal) hematuria:

Urological hematuria corresponds to an anatomical lesion

Communication of a urinary tract (between the calyx and the prostatic urethra) and one or more blood vessels

Nephrological hematuria is most often due to tubular disease

It is most often a disease of the glomerulus

Alport syndrome is a congenital anomaly in the composition of the basement membrane

Red blood cells have a diameter of 70 mm

We are several orders of magnitude lower; the diameter of red blood cells is 7 μM

Macroscopic hematuria of glomerular origin does not find clots or voiding burns


Hematuria can be the consequence of a urological condition

The main etiology of urological hematuria is taking anticoagulant therapy

The main etiologies of these hematuria are urinary tract infections and neoplasias. We also find renal lithiasis.

Nephrological hematuria is most often glomerular

Microscopic hematuries can be objectivized by confocal or two-photon microscope only

Diagnosis of hematuria is based on quantitative cytological examination of urine


Hematuria is defined as the presence of more than 50 red blood cells per mL

That's more than 10,000 red blood cells per mL. It is quite physiological to have some red blood cells that cross the barrier of the glomerulus.

Quantitative cytological examination of urine eliminates false hematuria

See item in the last (8th) edition of the college p.111

A red coloration of urine is the pathognomonic sign of hematuria

There are many other causes of red urine: hemoglobinuria, myoglobinuria, porphyria, metronidazole, rifampicin, beets, ...

Initial macroscopic hematuria is often cervico-prostatic

Nephrological hematuria finds associated lower back pain most often

No lower back pain, no clots, no fever, no burning urination


One of the main causes of mascroscopic hematuria of glomerular origin is IgA deposition nephropathy

Associated with significant alteration of GFR, glomerular mascrocopic hematuria indicates an imperative and urgent renal biopsy

And this because of the need to quickly treat the causes of extracapillary proliferative glomerulonephritis

The most common etiologies of microscopic hematuria due to glomerular nephropathics are trauma and cysts.

These are diseases of the basement membranes (Sd d'Alport for example) and Berger's disease

Renal ultrasound with bladder time is indicated in case of microscopic hematuria after 50 years

The presence of haematic cylinders and/or deformed red blood cells points to a glomerular cause


Which of the following propositions point to a nephrological origin of hematuria?


The nodal tissue that constitutes NS and NAV is contrasted with the "Purkinje" tissue that makes up the bundle of His, the branches and the Purkinje network.

Sinus dysfunction and BAV can be symptomatic unlike branch blocks which are never symptomatic if isolated

NS is under close dependence on the autonomic nervous system

NS is vascularized by a branch of the left coronary artery or circumflex artery

NS is vascularized by a branch of the right coronary artery or circumflex artery

Sinuslae dysfunction or DS may follow a bradycardial medication


In case of DS, an escape rhythm may hatch in the atrium or NAV (emergency rhythm)

The bundle of His is the only communication between atrium and ventricles and travels through the membranous septum

The AV Node is also under close dependence on the autonomic nervous system

NAV is most often vascularized by a branch of the left coronary artery that arises from the cross of the furrows (artery of the NAV)

NAV is most often vascularized by a branch of the right coronary artery that arises from the cross of the furrows (artery of the NAV)


In the case of a full nodal BAV, an escape rhythm may hatch in the His beam at a frequency between 35 and 50 bpm

In case of BAV in the beam of His or infrahissian, the escape rate is unstable and slower (15 to 30 bpm), which makes the gravity of this localization

The bundle of His is divided into right and left branches which are subdivided into thin and thick anterior hemi-branches or hemi-branches.

The branches are very highly sensitive to the effects of the autonomic nervous system

The branches are not very sensitive to the effects of the autonomic nervous system

In the branch block, there is a slowdown or interruption of conduction in a branch


A BAV can be totally asymptomatic, this is of course the case of the BAV of the first degree and most blocks of the second degree)

Nodal blocks are often responsible for first-degree BAVs or Möbitz I type second-degree BAVs

Blocks in the bundle of His or infra-hissians occur beforehand on branch blocks or BAVs of the second degree of type Möbitz I

Blocks in the His or infra-hissian bundle occur beforehand on branch blocks or second-degree BAVs of the Möbitz II type.

At BAV III, the exhaust is wide (40%) or thin (60%)

Block is sometimes promoted by beta-blockers or reperfusion;  in the latter case, the BAV contraindicates beta-blockers


In BAVs, the width of the QRS often gives the seat of the block

The 24-hour ECG (Holter) is very helpful and non-traumatic

A branch block is always asymptomatic if isolated

A branch block is often of fortuitous discovery

The isolated left branch block can be benign and considered a variant of normal, whether complete or incomplete.

The isolated right branch block can be benign and considered a variant of normal, whether complete or incomplete


Right branch block is almost always seen in most congenital heart defects affecting the right ventricle

The left branch block is never considered benign.

A left branch block is observed in 10% of cases of anterior infacrtus, with uni-, biou trifascicular block type, either pre-existing or acquired during infarction

A prolonged sinus arrest or complete BSA are the cause of asystole or simple bradycardia thanks to an escape for example atrial

A progressive elongation of the PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval signs a second degree BAV mobitz 2

BAV of the second degree type Möbitz I or Luciani-Wenckebach: – progressive prolongation of PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval; – often associated with a 2:1 BAV; – as a rule, nodal seat and most often QRS duration < 120 ms (fine QRS)


Vascular nephropathies include heterogeneous diseases characterized by damage to the renal vessels.

Nephroangiosclerosis involves the small vessels of the kidney

High blood pressure is very rarely associated with these diseases

It is often very present. It can be either the cause or the consequence

Vascular nephropathies can be classified according to their rate of evolution

These diseases can be classified according to the arterial territory affected.


Which of these nephropathies are rapidly progressive or acute?


Thrombotic microangiopathy syndrome belongs to the group of chronic or slow-growing NVs

It belongs to the group of acute or rapidly progressive NV

Moschowitz syndrome preferentially affects children

Mostly affects adults. Cerebral damage is at the forefront.

Hemolytic uremic syndrome preferentially affects children

Hemolytic uremic syndrome is, most often, due to toxins produced by enterobacteriaceae that destroy the endothelium

HUS is the leading cause of acute renal failure in children aged 1 to 3 years


Regarding hemolytic uremic syndrome (HUS) in children:

Post-diarrheal HUS is a reportable disease in all cases

Only when the patient is under 15 years of age

The infectious agent most often involved is Shillega

HUS starts slowly and gradually with low back pain

The onset is brutal with diarrhea, fever, acute renal failure and anuria

Renal biopsy is indicated in emergency in front of a supiscion of HUS

Treatment is purely symptomatic most often


Malignant nephroangiosclerosis is the renal consequence of malignant hypertension by ischemic lesions

HTA generates a significant natriuresis called "pressure"

Paradoxical hypovolemia puts the renin angiotensin (RAS) system to rest

Blood renin and asdosterone are very low

They are increased because of hypovolemia


Regarding nephoangiosclerosis due to malignant hypertension:

Malignant hypertension is clinically defined

Proteinuria and renal failure are observed

Secondary hyperaldosteronism causes hyperkalemia

PBR is indicated in diagnostic emergency

It is contraindicated as long as hypertension is not controlled

Treatment of malignant hypertension is a medical emergency


The positive diagnosis of an occlusive syndrome is based on a combination of the following functional and clinical signs:


Bowel obstruction is one of the most common reasons for emergency hospitalization in surgical settings

The most specific sign is the cessation of transit and in particular gases

Stool transit can be temporarily preserved

Vomiting may be late in case of high and progressive obstacle

Vomiting may be late in case of low and progressive obstruction

Meteorism may be minimal in case of low occlusion

Meteorism may be minimal in case of high occlusion


Flanged occlusion is the most common cause of colon occlusion

It is the most common cause of small bowel occlusion

Volvulus of the pelvic colon occurs most often in postpartum women

Volvulus of the sigmoid most often in the elderly ( > 70 years)

It is possible to perform a diagnostic endoscopy.

Contraindicated: risk of perforation. Endoscopy only indicated for placement of colonic or duodenal prosthesis or treatment of a sigmoid volvulus.

The CT scan is the reference morphological examination

In case of high occlusion the hydroaeric levels are multiple, central and wider than high

Signs present qd standing. Lying down: presence of conniving valves (spring aspects). Look for abdominal scars, palpate hernial orifices and perform a digital rectal examination.


The occlusive syndrome, defined by an interruption of normal intestinal transit with a cessation of materials and gases, is a diagnostic and therapeutic emergency

Small bowel occlusions are observed at any age, colonic occlusions are more frequent beyond 50 years

The volvulus corresponds to a twisting of a digestive loop on a vascular axis

Most often, the patient is seen in the emergency room for abdominal pain syndrome

Shutting down of materials and gases can be replaced by false diarrhea (downstream segment emptying)


imaging is systematically indicated when occlusion is suspected

The abdominal CT scan is the reference exam

Moderate renal impairment secondary to dehydration is not a contraindication to injection

The sensitivity and specificity of the CT scan is greater than 95% to make a positive diagnosis of an occlusion

In case of occlusion of the small intestine, the CT scan shows a dilation of more than 5 cm of the small loop and more than 9 cm in case of colonic occlusion

In case of occlusion of the small intestine, the CT scan shows a dilation of more than 2.5 cm of the small loop and more than 6 cm in case of colonic occlusion


A caecal distention of more than 9 cm should raise fears of a perforation

The place of ultrasound is very limited. In occlusive syndrome, it can nevertheless be useful in children (intussusception)

Absence of peristalsis and hypoechoic parietal thickening are signs of intestinal distress

In case of occlusion of the small intestine the clinical signs are in the foreground with: – a sharp pain of sudden onset, – abundant vomiting, – and a rapid alteration of the general condition

The shutdown of materials and gases is not very clear in case of hail obstruction


Which of the following is a first-line recommended examination(s) for the diagnosis of an occlusive syndrome?

A snapshot of the abdomen without preparation of face and profile

True, this is the only indicated examination recommended in first line


Regarding the veins of the lower limbs and varicose veins

The veins of both superficial and deep networks of the lower limbs are provided with valves

The superficial femoral vein is a deep proximal vein

Venous insufficiency is defined by obstruction of the venous system, with or without valve dysfunction

It's the opposite: Valvular dysfunction, with or without obstruction of the venous system

A varicose vein is defined by a permanent venous dilation of more than 3mm in orthostatism


Varicose veins affect 30 to 60% of the population of industrialized countries

Chronic venous insufficiency affects both men and women

Primary venous insufficiency is promoted by post-thrombotic syndrome

By definition, post-thrombotic syndrome is the cause of secondary venous insufficiency

Cockett syndrome refers to the compression of the left common iliac vein by a pelvic tumor, which can result in iliofemoral thrombosis.

Compression of the left common iliac vein by the right common iliac artery

Obesity and constipation promote chronic venous insufficiency


Telangiectasia is defined by a diameter <1 mm

And a reticular vein by a diameter between 1 and 3 mm

Symptoms are aggravated by contact with the cold, when walking, or when elevating the legs

These symptoms are calmed by contact with the cold, when walking, or when raising the legs.

The clinical examination of varicose veins is performed in the supine position

The clinical examination of varicose veins is performed in a standing position, at best on a platform with altered unipodal support, in order to highlight ambulatory venous hyperpressure

Venous ulcer is the most common cause of leg ulcer

Typically, the venous ulcer is perimalleolar, round or oval in shape, little algic


Corona phlebectatica is a therapeutic emergency

This is a very early cutaneous clinical sign of venous insufficiency. Not to be confused with phlegmatia cerulea (ischemic DVT, therapeutic emergency)

Hemorrhagic ruptures of varicose veins are common

Stasis dermohypodermatitis has an initial course by inflammatory flare-ups

Eczema secondary to venous stasis predominates in the upper 1/3 of the leg

Atrophic dermatitis concerns advanced old venous insufficiency, and fears the occurrence of a venous ulcer


In case of septic venous thrombosis, class 2 venous compression is indicated

In this case, venous compression is contraindicated

Compressive bands should be preferred in case of venous ulcer

Compression should be worn within two months of an episode of deep vein leg thrombosis

Compression must be worn within two years, usually by Class II compression socks

In case of chronic venous insufficiency, and especially in the ulcer stage, venous restraint must be worn daily and for life

In cases of peripheral arterial disease (PAD), compression is contraindicated if the systolic pressure index (SPI) is less than 0.09

Compression is contraindicated if the systolic pressure index (SPI) is less than 0.5. It should be reduced to a maximum of 30 mmHg for patients with an SNI between 0.5 and 0.9


Among these proposals, which are situations of lack of inputs?

This is an increase in losses by malabsorption, according to the College of Nutrition (2019 edition, page 134)

Post-stroke sequella swallowing disorders

Increased protein losses via skin tissue


Which of these proposals are situations of increased losses?

May cause an obstacle of the upper digestive tract, and therefore a limitation of the intake

May have as an adverse effect anorexia and therefore a decrease in intake


Lean mass is mainly represented by skeletal muscle

Lean body mass is the body's main protein store

The lean butse is the compartment most affected by nutrition

Fat mass disappears in case of malnutrition

The metabolism is protein in case of prolonged youth

Higher prevalence at the extreme ages of life (infants and the elderly) but also exists between the two


A BMI below 18.5 indicates undernutrition

Unintentional weight loss of more than 5% in 6 months is a sign of undernutrition

An involuntary weight loss greater than or equal to 15% in 6 months is a sign of severe undernutrition

Without inflammatory syndrome, a serum albumin less than 50 g / L suggests severe malnutrition

The thresholds are 30 g/L for undernutrition and 20 g/L for severe undernutrition


Which of these proposals are social risks?

Includes social and medical benefits related to maternity

It is a crime. It is its consequences on employment or health that are social risks.


Social protection refers to all collective pension schemes that enable individuals or households to cope financially with the consequences of social risks.

Social risks are situations that can lead to a decrease in resources or an increase in expenses within a household

In France, there is only one social protection body (unlike Germany or the USA)

There is not just one social protection body but several: mutual societies, private insurance, social security, etc.

Social Security was founded in 1981 on the occasion of the election of Francois Mitterand

On 4 and 19 October 1945, two ordinances instituted "an organization of Social Security intended to guarantee workers and their families against risks of any kind likely to reduce or eliminate their earning capacity".

Social security is the main source of social protection.


Social security consists of two main schemes: general and SNCF.

It consists of four main schemes: the general scheme the agricultural scheme the social scheme the special schemes for self-employed persons and civil servants (non-agricultural self-employed persons) 2.2. HISTORY-MAIN REFORMS

Creation in 1945 (ordinances of 4 and 19 October) according to 3 principles: Equal access to care Quality of care Solidarity

The 1967 ordinance saw the creation of the 3 autonomous branches: sickness, old age, family

80% of French people are covered by the general scheme

The CNAMTS manages the risk of maternity only

Manages sickness, maternity, disability, death and, as part of a separate management, occupational accidents


Regarding the organization of social security:

The sickness branch is managed by the CNAMTS only

There are 166 CRAMs (1 for about 2 departments)

The old-age branch is managed by the CNAV and CARSAT

The family branch is managed by CAF and CNAF

The recovery branch is managed by the URSSAF

The URSSAF is responsible for collecting contributions and social contributions but it is the ACOSS that manages and coordinates the URSSAF"


The agricultural scheme is managed by the MSA

The agricultural scheme is a special scheme

3 types of special regimes: the civil service, public establishments and enterprises and 'others'

The RSI is the regime of computer scientists

This is the regime for the self-employed

The current trend is towards an increase in special diets

The public service plan is managed by the IHR

The RSI is the regime for the self-employed"


Concerning the different social protection schemes

The agricultural scheme covers material risks linked to the weather

It covers farmers and agricultural employees

The agricultural scheme is administered by the Ministry of Agriculture

It is managed by the Mutualité Sociale Agricole (MSA)

The MSA collects the contributions itself

The MSA operates as a "one-stop shop": all benefits (sickness, family, old age) are covered by the MSA

The IHR covers graphic designers and computer scientists

It covers craftsmen, traders, industrialists and liberal professions"


Regarding the sources of financing of the social security system:

There are 3: social contributions, taxes and public contributions

VAT contributes directly to the financing of social security

The taxes and taxes allocated to the financing of social security are: compulsory levies, general taxes, the CSG, the CRDS and taxes on alcohol, tobacco and medicines.

Social contributions are paid directly to the Ministry of Health

Social contributions (employer and employee) are paid to the URSSAF

Its scope of levies is wider than that of the CSG

The CSG only concerns employees on permanent contracts

It concerns all the incomes of people living in France (including pensioners for example)"


Concerning the different schemes and the financing of social protection

The IHR operates as a one-stop shop for collecting contributions and paying benefits.

The Social Security Financing Act has been in place since 1945

The LFSS aims to control social and health spending

The National Health Insurance Expenditure Target (ONDAM) is approved by Parliament each year

In 2015, the expenditure of the various basic social security schemes was more than €500 billion.


Which of these costs are covered by the sickness branch of social security?


Concerning the reimbursement of social protection

The social security deficit is of the order of 10 million euros per year

The deficit of the general scheme, for all risks, was 6.8 billion euros in 2015: This is the famous "hole" of the social security

The amount of the reimbursement is made on the basis of conventional or regulatory tariffs

The assumption of certain expenses is subject to the agreement of the medical officer of the CPAM

The co-payment is the amount covered by the mutual insurance company

Rest at the expense of the insured after reimbursement by !' Health insurance on the "compulsory" part

Co-payment applies to all reimbursable medical expenses


Which of the following is a type 2 reaction (according to Gell and Coombs)?

Hypersensitivity due to IgM and IgG mediated cytotoxicity

Hypersensitivity mediated by immune complexes


Which of the following is a type 3 reaction (according to Gell and Coombs)?

These lymphocytes do not mediate any hypersensitivity reaction


Which of the following is a type 4 reaction (according to Gell and Coombs)?


Atopy is a genetically determined ability to produce IgE against certain allergens

Sensitization is a positive reaction to a known allergen

The definition of allergy is clinical. This is a manifestation of exposure to a sensitized allergen

The preferred treatment is the eviction of the allergen

Binet's classification makes it possible to differentiate the different mechanisms of immunological hypersensitivity

This is the classification of Gell and Coombs. Binet's classification is a prognostic score for CLL (Chronic Lymphocytic Leukemia)


Which of the following is a type 1 reaction (according to Gell and Coombs)?

Hypersensitivity due to IgE-mediated cytotoxicity


Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.

Support and closeness to family, a loved one, a spouse and social relationships are risk factors

Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.

The search for protective factors allows the identification of members of the patient's entourage who can be caregivers


The most common mode of suicide is hanging

The incidence of suicide increases with age, and men over 85 are the most affected

The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants

Women most often resort to drug autointoxication

Suicide is the act of deliberately killing oneself


Support and closeness of family, relative, spouse and social relationships are risk factors

Clinical experience shows that asking the question usually has the effect of relieving the suicidal person, by offering to talk openly about suicide and to clearly express his suicidal ideations.


Suicide is the leading cause of death for young adults (25-35 years)

Suicide is the leading cause of death among adolescents (15-24 years)

There are about 10,000 suicides a year in France

There is about 1 suicide every 4 minutes

1 suicide every 40 minutes, 1 TS every 4 minutes

There is about 1 suicide attempt every 4 minutes


Hospitalization is systematic in case of suicidal ideation

Hospitalization 🏥 occurs when UDR is elevated, if TS is proven, or when there is no viable alternative.

It happens and they mostly concern adult men

Symptomatic treatments (hypnotics, sedatives, anxiolytics) are contraindicated in adolescents


3.9% of the population had suicidal ideation (SDI) in the year.

There are 10,000 suicide attempts (HCPs) per year in France

10,000 suicides per year in France, 100,000 TS

Rigel's pre-suicidal syndrome corresponds to a state of deep calm before suicide

Suicidal ideation is impossible before 10 years 👦

Quite infrequent, but can appear as early as 5 years. The preferred means are hanging or defenestration.

In adolescents, there are mainly IMVs (80% of cases)


The risk of hepatitis B transmission is zero with effective vaccination

The declaration of accident at work must be made within 72 hours


What are the first steps to take in case of EAS?

Report the occupational disease within 48 hours

Antiseptic rinsing should last 30 seconds

First, clean with soap and water. Then rinse with an antiseptic for several minutes. It is important that all patient cells that can be removed are removed.

We go to the occupational medicine that will take care of us

Occupational medicine has a preventive and not curative role

Washing should be done with water and mild soap


There are only 3 important risks: the needle is deep, the needle is hollow, and the needle is intramuscular (arterial or venous)

The needle is intravascular (arterial or venous)

Mucocutaneous exposure with a contact time > 15 minutes


Regarding the ESA. Which of the following are true?

The declaration of accident at work is mandatory within 24 hours

The declaration of work accident is mandatory within 48 hours

An initial medical certificate describing the injury and expressly stating that it is an accident with risk of HIV seroconversion is mandatory


The declaration of a compulsory work accident must be made in:


Regarding the cleaning of the wound following an accident of exposure to blood, which proposal(s) are true?

Absolutely not! This can create a capillary breach and promote infection by passing into the systemic circulation.

We are looking for an effect of cleansing and elimination of organic matter brought by the accident

Antisepsis: Bleach with 2.5% active chlorine diluted 1/5 or 1/10, Dakin solution, or failing that alcohol at 70 ° or polyvidone iodine, with a maximum contact of 5 minutes

It takes a contac of more than 5 minutes! The rest of the statement is true.


After an accident of exposure to blood with a high risk of HIV infection, the duration of TPE is:


The seroconversion rate is estimated to be 1% after insertive anal intercourse

The seroconversion rate is estimated to be 1% after susceptible anal intercourse

The seroconversion rate is estimated to be 1% after insertive vaginal intercourse

The seroconversion rate is estimated to be 0.1% after insertive vaginal intercourse

The seroconversion rate is estimated at 0.3% after an AES

The risk of HIV transmission through non-traumatic vaginal sex is zero when the infected partner is on antiretroviral therapy, an HIV load that has not been detectable for more than 6 months


LAD (age-related androgen deficiency) is an age-associated biochemical syndrome,

LAD is inconsistent although it is common (10–20% of men after age 50, and up to 50% after age 70)

The depth of LAD varies from one subject to another, and its onset is very gradual.

Decreasing nocturnal or morning erections is an essential call sign

During LAD, erectile dysfunction is functional in origin


The erection is generally longer to obtain despite ever greater stimuli

Detumescence is faster and the refractory phase lengthens

A decrease in libido should be sought during questioning, as well as a reduction in the frequency of sexual intercourse

The quality of orgasm remains the same but its occurrence is slower

An alteration in the quality of orgasm is sometimes associated with these disorders

Semen volume is increased most of the time

Rather, there is a reduction in volume and low sperm expulsion


The decrease in muscle mass corresponds to sarcopenia and can be severe (up to 40%) accompanied by muscle weakness

Skin atrophy eliminates the diagnosis of LAD

It is recommended to try to perform a bioavailable testosterone assay

TRUE: Sex Hormone Binding Globulin (SHBG) and albumin must also be measured with total testosteronemia to estimate the bioavailable concentration

Total testosterone dosage cannot be used as a rough value for bioavailable testosterone

When this assay is not possible, the determination of total testosterone should be used as an approximate value of bioavailable testosterone.

Testosterone dosage should be carried out in the evening at midnight

The dosage should be carried out between 8 a.m. and 10 a.m.


A new dosage of bioavailable testosterone 2 to 4 weeks after the first is recommended

Advanced age (over 75 years) contraindicates treatments for LAAD

The patient should be treated if there are one or more deficiencies in the androgen-dependent systems and a lower than normal testosterone level. Age is not a contraindication at all.

There is no pre-therapeutic assessment specific to the treatment

If. It includes prostate evaluation (IPSS score, digital rectal examination and total PSA assay), endocrine laboratory work (hematocrit, lipid profile, liver test, blood glucose) and bone densitometry in case of deep LAD or clinical call points

Treatment is based on the administration of natural testosterone to the patient until a plasma concentration is obtained as close as possible to physiological secretion.

The only possible route of administration of testosterone is IM

Transdermal or intramuscular according to the College of Urology (5th edition, page 239)


General information on the characterized depressive episode:

Depressive disorder is associated with a major suicidal risk

A depressive episode characterized is defined in particular by a break with the previous state

Symptoms must be present every day for 6 consecutive days

present almost every day for at least 2 consecutive weeks

The significant increase or decrease in weight or appetite is a symptom of a characterized depressive episode


What symptoms are associated with the rupture of the previous state to define the characterized depressive episode?

Indecision or alteration of concentration


Regarding the management of the characterized depressive state:

The only complication is the risk of suicide

Complications are mainly represented by the risk of suicide, socio-professional disintegration, depressive recurrences and psychiatric and non-psychiatric comorbidities

Drug treatments have no place in the management

For moderate to severe forms, drug treatment is always necessary: antidepressant (1st line SSRI) for at least 6 months

ECT is indicated in the most severe forms of depressive episode

Management is often combined with supportive psychotherapy

Characterized depressive disorder is a common psychiatric disorder associated with a high risk of suicide


Regarding the epidemiology of the characterized depressive episode:

The characterized depressive episode is an isolated psychiatric disorder most often

The characterized depressive episode fits into different nosographic entities (characterized depressive disorder, bipolar disorder) or can be comorbid of another psychiatric disorder (anxiety disorders, addictive disorders) or a non-psychiatric disorder

The term "depression" corresponds in the current DSM-5 classification to the characterized depressive episode (formerly "major depressive episode")

WHO records more than 100 million cases of characterized depressive episodes worldwide each year.

30-50% of suicide attempts in France are secondary to a characterized depressive episode

The first characterized depressive episode occurs in adolescence most often

The first characterized depressive episode can occur at any age


Regarding the presentation of the characterized depressive episode:

The first EDC occurs more frequently in young adults

It is more common in women from adolescence with a sex ratio of 1/2 (1 man to 2 women)

A depressive syndrome can be evoked in case of pathological sadness of mood and a drop in energy

It is one of the rare psychiatric pathologies whose interindividual variability of symptoms is almost zero.

It is characterized by a constellation of symptoms and signs, which varies from one subject to another.

Psychomotor slowdown or agitation may alternate or be associated


What symptoms are not compatible with a first EDC?

Possible neuro-vegetative sign. Congruent of anxiety

Must evoke a neurological differential diagnosis

Must have extrapyramidal syndrome sought


Negativism translates into active resistance exclusively

Anhedonia is an intense feeling of sadness

Anhedonia is the inability to feel emotions

Bradypsychia is the inability to express one's thoughts with fluidity

Bradypsychia is the slowness of reflection

Amoemia is the absence of the usual facial expression

Mutism is the voluntary loss of language


SSRIs are to be reserved for chronic, resistant and disabling forms.

The 'obsessive' part corresponds to the act of avoidance

Obsessive = thought. Compulsive = act in reaction to thought.

The most recurring themes are the 'washer', the 'magician' and the 'recuperator'

It is a rare disorder, found in 3% of adolescents

OCD is considered common and is found in both adolescents and adults.

SSRIs should be prescribed at a minimum dose

Doses are high or maximum for at least 12 weeks, and up to 2 years


It is a possible characteristic of EDC (such as psychotic, mixed, anxious, catatonic, etc.) that defines a maximum EDC, with major suicidal risk, deep sadness, etc.

Cotard's syndrome is a delusional syndrome during a melancholic EDC

A catatonic EDC may regain echolalia or echopraxia

An EDC may be associated with a schizophrenic disorder


In which pathologies is CBT psychotherapy indicated?

Treatment of EDC = SSRIs + Supportive Psychotherapy

Not in first line given the short duration


Regarding treatments for anxiety, which proposals are true?

Hypnotics are contraindicated in adolescents

Oxazepam is the shortest-lived benzodiazepine

OSA is a relative contraindication to benzodiazepine

Absolute contraindication: severe respiratory failure, OSA, myasthenia gravis, hepatic impairment


What symptoms lead to post-traumatic stress disorder?

Rather to classify in the symptoms of anxiety. The 3 symptoms of repetition syndrome are flashbacks, revivals and nightmares.


Which of these proposals are found in post-traumatic stress disorder?

This is neuro-vegetative hyperactivation syndrome

Heteroaggressiveness is a consequence of PTSD


Which of these proposals are predictive factors for EDC's recurrence?

A very low intensity of the first episode

A very high intensity of the first episode increases the risk of relapse

The sicker you are, the more likely you are to redo an EDC


Which of the following proposals fall within the scope of diagnosing the characterized depressive episode?

Clinically significant suffering or impaired functioning

The absence of non-psychiatric medical causes and the absence of toxic causes


Which of the following are true about amoebose?

The intestinal form is accompanied by fever

No, this is the case with the hepatic form

Treatment of the intestinal form is based on Metronidazole and Tiliquinol

True. Tiliquinol is a contact antiamibian


Which of the following are true about oxyurosis?

False, unlike cysticercosis (by tapeworm)

The interrogation mainly finds a pruritus of the back


Which of the following propositions are true concerning Giardiosis?

The protozoan involved is Giardia duodenalis

It is based on parasitological stool examination (PSE) and PCR

True. There are loose stools without fever


Which of the following propositions are true about ascariases?

Worms are visible only under a confocal 🔬 microscope

A bioclinical Löffler syndrome can be observed

True. Löffler syndrome or Loeffler syndrome, is characterized by the presence of parahilar or subclavicular pulmonary infiltrates, labile, most often related to mechanical and allergic phenomena secondary to the presence of parasite larvae in the pulmonary alveoli. These radiological images are associated with blood eosinophilia.

Treatment is based on Albendazole PO (or Flubendazole PO)


Concerning the monitoring of vascular prosthesis wearers

Mechanical heart valves require definitive anticoagulant treatment with vitamin K (risk of thrombosis of the prosthetic valve) and therefore expose to the risks of this treatment

Mechanical valves have excellent durability

Biological valves are most often animal valves (especially pigs)

The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month

The durability of biological prostheses is poor


There is a major risk of infective endocarditis (IE) regardless of the type of prosthesis, mechanical or biological,

Thromboembolic complications are the most common complications of prosthetic valves

Thromeboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond

The risk is lower for mitral prostheses than for aortic prostheses


Concerning the monitoring of vascular porthesis carrier

Hospitalization for emergency reoperation is required for valve change in case of acute denture thrombosis

In case of prosthesis dysfunction of lesser gravity, the patient will have to be reoperated in a deliasis of one month

In case of less serious prosthesis dysfunction, anticoagulant treatment should be rebalanced with transient transition to heparin if necessary

The differential diagnosis of prosthetic thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis

The diagnosis of disinsertion of a porthesis is made by the ETT and especially by the ETO:

Postoperative mediastinitis is one of the leading causes of early mortality from valve surgery


Concerning the survival of vascular prosthesis wearers

Mechanical heart valves require definitive anticoagulant treatment, by vitamin K or LMWH and therefore exposing to the risks of this treatment

No MA for LMWH in this indication. However, they remain an "acceptable alternative" in practice.

Mechanical valves have excellent durability and should, in principle, last the patient's entire life.

This is the principle of mechanical valves versus biological valves.

Biological valves are, most often, animal valves (pigs in particular)

For biological valves, bovine pericardium or porcine aortic valve can also be used.

The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month.

The durability of biological prostheses of the order of 55 years

10-20 years of lifespan (varies according to sources)


Thromboembolic complications are among the most common complications of prosthetic valves

Thromboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond

The risk is higher: for mitral prostheses (which operate at low pressures) than for aortic prostheses; for antique prostheses than for double-finned prostheses; in case of atrial fibrillation (AF), or left ventricular dysfunction


In case of less serious prosthesis dysfunction, the patient should be reoperated within one month

The differential diagnosis of prosthesis thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis

The diagnosis of disinsertion of a prosthesis is made by the ETT and especially by the ETO


All anticoagulants are authorized in bioprostheses from 3 months post-op as part of a non-valvular indication (e.g. AF)

For mechanical valves and bioprostheses, cardiac Doppler ultrasound monitoring is done every 1 to 2 years

For mechanical valves: every 1 to 2 years / For bioprostheses: at M3, 1 year, 5 years and then every year if there is no sign of degradation or infection.

It is unnecessary to prescribe an antiplatelet agent in the case of a post-op thromboembolic complication under effective INR.

Antiplatelet indications: if TAVI (lifetime), if stent placement or thromboembolic complications under effective INR.

There is no self-measurement of the INR to date.

CoaguCheck (same principle as the blood glucose monitoring device): 50% of patients use it

The fibrous Pannis is an atrial connective tissue covering the aortic prosthesis and performing extravalvular stenosis.

Atrial connective tissue if mitral valve, ventricular connective tissue if aortic valve.


Among these proposals, which are symptoms that can be found in case of Horton's disease?

It can be found in osteoarthritis or shrinking lumbar canal syndrome

CBH = ptosis, myosis, enophthalmos. It is found in case of involvement of the sympathetic pupillary territory homolateral to the symptoms and has nothing to do with GCAs.


Acute anterior ischemic optic neuropathy

Non-ischemic NORB = nerve damage = sign of MS

It is transient blindness. Patients describe a falling veil. It's painless

Occlusion of the branches of the retinal artery

There are no migraines, but temporo-occipital headaches


What organs can be affected by Horton's disease when isolated?

This is not described in the College of Internal Medicine


It is carried out in strict condition of asepty in the operating room

Is done, conventionally, in the service (with satisfactory conditions of asepsis of course)

A simple local anesthesia is sufficient, as during sutures in the emergency room.

It is done before any corticosteroid therapy

Biopsy should not delay starting treatment, especially if eye signs occur

In some cases, ultrasound may be preferred.

Ultrasound gives interesting results, but there is greater inter-operator variability


Peripheral lesions are generally not accessible in bronchial endoscopy

Bronchial endoscopy = paramedian lesions

Diagnosis of peripheral lesions is based on CT

Diagnosis of peripheral lesions is based on transparietal needle puncture

The diagnostic discussion is based on the location of the lesion in one of the 2 mediastinal compartments

CT scan is the key examination for anterior and middle mediastinum masses

Ultrasound is the reference examination for the diagnosis of masses of the posterior mediastinum

This is MRI for masses of the posterior mediastinum


Which of the following proposals favor the benignity of a micronodule?

Only biology makes it possible to have a diagnosis of certainty.

Malignancy criteria: high size, irregular contours, spiculate, attractants


Sleep Apnea Syndrome (SAS) is a real public health problem

OSA mainly results in the presence of nocturnal hypersomnia and nocturnal snoring in a patient who is frequently overweight but

OSA mainly results in the presence of daytime hypersomnia and nocturnal snoring in a patient who is frequently but not systematically overweight.

The diagnosis of certainty is based on polygraphy during sleep

Continuous positive airway pressure (CPAP) treatment with the nasal mask is the most effective treatment for OSA


The effectiveness of CPAP treatment is conditioned by initial therapeutic education as well as by the quality of its adherence and patient follow-up _ _

Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of the ventilatory control during sleep and which is observed in particular in advanced respiratory insufficiency

Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of ventilatory control during sleep and which is observed in particular in advanced heart failure

OSA and SACS have a very different nocturnal oximetry profile

OSA and SACS have a similar nocturnal oximetry profile

Pure alveolar hypoventilation manifests itself in oximetry by deep and sustained desaturations, most often contemporary with REM sleep periods

A central appnea is the cessation of the naso-oral airflow for at least 10 seconds with no ventilatory efforts during apnea


Mixed apnea begins as a central apnea and ends with breathing efforts

The severity of OSA is based on AHI or apnnea index is hypopnea

We talk about severe OSA for an AHI ≥ 60

Severe OSA is called for AHI ≥ 30 The importance of daytime sleepiness should also be considered in assessing severity.

Obesity, especially abdominal obesity, is a major risk factor for OSA

There is no parallelism between the prevalence of obsity and the severity of OSA

The prevalence of OSA increases with the severity of obesity (60-80% of morbidly obese patients have OSA)


The prescription of hypnotic is recommended as a first-line treatment in the treatment of chronic insomnia in adults

Hypnotic prescription is not recommended as a first-line treatment for chronic insomnia in adults

The prescription of hypnotic should only be done for a short time in the context of transient acute insomnia

The presence of restless legs syndrome should systematically be sought in front of a complaint of chronic insomnia with difficulty falling asleep in adults

Obstructive sleep apnea syndrome should always be evoked in the face of a complaint of excessive daytime sleepiness and snoring

Severe drowsiness in young subjects should suggest central hypersomnia


Normal sleep occurs at night, it lasts on average 7 to 8 hours, with large interindividual variations

It is suspected that these inter-individual variations are largely genetic.

The reference test for the study of sleep is the EEG during sleep

The reference examination for the study of sleep is polysomnography

The alternation of sleep cycles can be visualized by means of the hypnogram

The complaint of insomnia is extremely common in the general population: 30% of adults have experienced transient insomnia during their lifetime, and 10% chronic insomnia

Prevalence is higher in males and increases with age

Prevalence is higher in women and increases with age


Insomnia is a subjective complaint that is not defined by the objective duration of sleep

Insomnia must be responsible for a negative daytime impact on the subject's activities

It is associated with functional symptoms

Actimetry is a tool that makes it possible to assess sleep-wake rhythms under standardized conditions

This tool makes it possible to appreciate sleep-wake rhythms in ecological conditions

The drug approach is the first-line treatment for chronic insomnia

The non-drug approach is the first-line treatment for chronic insomnia


Insomnia disorder must be distinguished from the insomnia 'symptom', which is then one of the clinical manifestations of another etiology.

Symptoms such as dyspnea, pollakiuria, gastroesophageal reflux, or pain can cause sleep disorders

Restless Legs Syndrome (RLS) is most often associated with a complaint of sudden awakenings in the early morning

Restless Legs Syndrome (RLS) is most often associated with a complaint of insomnia falling asleep and maintaining

The diagnosis of restless legs syndrome is clinical and defined by the presence of unpleasant sensations in the legs responsible for an irrepressible need to mobilize them.

Electromyogram of the lower limbs reveals numerous abnormalities in restless legs syndrome

An electromyogram of the lower limbs is not indicated to explore an RLS, if performed it reveals no abnormality


Treatment of insomniac disorder relies on CBT

The prescription of hypnotic is not recommended as a first-line treatment in the treatment of chronic insomnia in adults.

The prescription of hypnotic is contraindicated in case of insomnia in adults

It should only be done for a short time in the context of transient acute insomnia.

OSA only affects adolescents over the age of 16


The homeostatic, accumulative process increases throughout wakefulness and decreases during sleep.

The biological clock is located in the basal ganglia

It is located in the suprachiasmatic nuclei

The biological clock modulates states of alertness but also other parameters including hormonal secretions, internal temperature, cell division cycles and mood.

The ultradian rhythm of alertness is faster than the circadian rhythm


Which of these proposals are included in sleep polysomnography?

There is a monitor of cardiorespiratory parameters but not as advanced as an ECG


There are two main types of sleep: slow wave sleep and deep sleep.

Slow wave sleep, on the other hand, ranges from light to deep.

Slow wave sleep is characterized by increased EEG activity

On the contrary, in slow-wave sleep, EEG activity gradually decreases

REM sleep is characterized by an EEG state close to wakefulness

Slow-wave sleep accounts for more than 50% of total sleep

REM sleep is accompanied by rapid eye movements


The alternation of sleep cycles can be visualized by means of the hypnogram.

3 stages of slow wave sleep: light, moderate, deep.

30% of the general population complains of chronic insomnia.

The sleep agenda is conventionally done over 3 nights

Polysomnography is not recommended when exploring primary insomnia.


Slow-wave sleep is subdivided into three stages, of increasing depth, defined on ECG criteria.

Slow wave sleep is subdivided into three stages, of increasing depth, defined on EEG criteria

The amount of slow delta waves during sleep reflects the depth of sleep and is regulated in a homeostatic way

Circadian sleep pressure is highest between 1 a.m. and 5 a.m.

Serotonin is the main hormone regulating chronobiological rhythms

Melatonin is the main hormone regulating chronobiological rhythms

Insomnia is dissatisfaction with the quantity or quality of sleep with daytime repercussions


Insomnia can be secondary to a psychiatric pathology

Psychophysiological insomnia is the most common primary chronic insomnia

Treatment of insomnia in children and adolescents should be etiological

In children and infants, the therapeutic approach is often behavioral and educational in first line

Drug treatments are often overprescribed and should be avoided


The main differential diagnosis is circadian rhythm phase delay which can be confused with insomnia of sleep initiation or falling asleep.

Regardless of the nosological framework used, the diagnosis and evaluation of insomnia is essentially based on the questioning of the patient

Sleep aggenda is an essential tool for the assessment of insomnia and its management

The sleep diary often highlights discrepancies between the patient's overall appreciation of his sleep disorders and their reality.

Actimetric recording makes it possible to establish the activity-rest rhythm over several weeks


Polysomnography in the laboratory is still necessary for diagnosis

Laboratory polysomnography Not necessary for diagnosis but indicated punctually to eliminate a specific etiology including

It also exerts a hypnogenic effect but should not be considered a hypnotic substance

Immediate-release melatonin can be used to improve sleep-onset insomnia at night

Extended-release melatonin (Circadin®) may be used to improve sleep-maintaining insomnia (intrasleep wakefulness)

Hypnotics are indicated in the treatment of transient or occasional insomnia for a limited time


Persistent complex bereavement is the persistence, for more than 12 months (or 6 months for children), of severe and disabling psychiatric symptoms.

Psychiatric disorders occurring during bereavement have a specific management

When a psychiatric disorder is identified as a result of bereavement, in particular a characterized depressive episode, it should be managed in the same way as if it had occurred in another context.

Grief corresponds to the reactions that the body develops as a result of the announcement of the death of a person we have already met

Definition Grief refers to the reactions: * emotional, * cognitive, * behavioral, * and sociocultural, to the loss by death of a loved one to whom one was significantly attached (such as a parent, a spouse, a friend)

It is classic to distinguish 3 phases in the grieving process


Grief is a stressor that exposes to biological, psychological and social changes

Bereavement is a risk factor for the occurrence of decompensations of existing pathologies

Psychological reactions usually disappear within a few hours

Grief in children and adolescents may manifest as a moderate initial reaction, and then they experience the full effects later

The impact of grief is purely psychiatric in children

The child may also manifest polymorphic symptoms of cognitive appearance (regression in acquisitions for example) or non-psychiatric (enuresis for example)


The elderly are no longer at risk of pathological bereavement from the age of 60

The elderly are particularly at risk of a marked depressive episode and the risk of suicide is all the higher as one ages, especially in men

Despite the pain of grief, most people adapt to the loss and cravings of the deceased and continue to live satisfactorily.

Normal grief lasts on average 1 to 2 week(s)

Normal grief lasts on average 2 to 3 months, but will depend on the bond of attachment that united the bereaved to the deceased, the age of the deceased, and the circumstances of the death

Persistent complex grief occurs when a subject has experienced the death of a loved one and has clinically significant symptoms after more than one year.

The characteristic symptoms of persistent complex grief are those of nostalgia related to the state of withdrawal of the deceased and invasive ruminations


Subcutaneous vaccination is done in the deltoid region

Flu vaccination can be done without a doctor's prescription

Attenuated vaccines are most often effective at a single dose, whereas inactivated vaccines must be administered multiple times.

Measles, mumps and rubella vaccine is an inactivated vaccine

Contraindications of vaccination should be systematically sought


Live vaccines are generally contraindicated in cases of congenital or acquired immunosuppression.

Serious complications of vaccination are exceptional

The hepatitis B vaccine is a mandatory vaccine

Mandatory since the law of 1 January 2018

The measles, mumps and rubella vaccine is a mandatory attenuated vaccine before 2 years of age

Since January 2018, vaccination against tuberculosis is mandatory and helps prevent severe forms of the disease


Pneumocooccal vaccination is recommended for all children before 2 years of age

Flu vaccination is recommended from November to March (to be done as soon as possible)

Vacciantion against pneumococcus is strongly recommended in spelonectomized subjects

The flu vaccine is an attenuated live vaccine


The vaccines provide protection against a large number of serious diseases for non-existent or benign side effects

Vaccination not only prevents the vaccinated person from the disease, but also prevents the circulation of the disease in the population, provided that vaccination coverage is sufficient.

Live vaccines usually do not need a booster; they are contraindicated in immunocompromised patients

Tenuated vaccines require several administrations close together during primary vaccination

Polysaccharide vaccines (pneumococcus, meningococcus, Haemophilus influenzae, Salmonella typhi) are more effective in their so-called "conjugate" form, which should be preferred


Serotherapy is an active humoral immunoprophylaxis

Serotherapy is passive humoral immunoprophylaxis

Vaccine provides immediate but transient protection

Pneumococcal vaccines and most meningococcal vaccines have several antigenic valences of the pathogen, allowing vaccination against several serogroups

Attenuated vaccines produce rapid protection is durable


Concerning vaccination and catching up on vaccinations

Only conjugate vaccines can eliminate carriage (pharyngeal for example for pneumococcus)

The subcutaneous route is generally more effective than the intramuscular route

The intramuscular route is generally more effective than the subcutaneous route

In an adult or child of unknown vaccination status, a complete age-sensitive regimen is delayed at the outset.

For diphtheria and tetanus, we can use the anti-tetanus antibody assay after a 1st injection: if the titer is high, the subject has already been vaccinated and we can schedule a booster at the ages provided for in the schedule

All vaccines are given SC or IM (in the deltoid), except BCG (intradermal)


Which of the following are recommended vaccines for splenectomized patients?


At 3 months, which vaccines have been injected?


Which of the following proposals are contraindicated in immunocompromised patients (CD4 < 200)?

True, live attenuated IC vaccine if CD4 < 200

True, always CI in HIV patients with CD4 < 200


At what ages is it recommended to inject the pertussis vaccine?


Which of the following are mandatory vaccines in the second month of life?

True. 2 months, 4 months, 11 months (booster) and 6 years (booster)


Regarding abortion and the morning-after pill:

The Veil law is definitively renewed from 1979

The doctor must obtain the authorization of one of the two parents which is mandatory

The doctor must endeavour to obtain the authorization of one of the parents or the legal representative, or verify that this has been done during the social consultation. But this authorization is not mandatory. However, the minor must be accompanied by an adult.

In the absence of parental consent, an abortion may be performed solely by an adult accompanied by an adult.

If the person is a foreigner, the abortion can only be performed if he or she has been living in France for more than 3 months.

For foreign women: abortion is no longer subject to any condition of duration and regularity of stay in France

The law requires pharmacists to dispense the morning-after pill free of charge to minors


The reception centre must ensure a correct reception with respect for confidentiality

Abortion care facilities operate seasonally

Structures must ensure fast deadlines with weekly operation all year round

An abortion can only be performed in an establishment with a surgical technical platform

Up to 12 weeks, they can be carried out in a simple sound establishment with a gynecology-obstetrics department

Abortions must be taken care of in a structure with a surgical technical platform when they are between 12 and 14 SA

Reception centers are required, by the HAS, to have at least one ultrasound machine with a vaginal probe


Anyone requesting an abortion must get a consultation appointment within 30 days of their call

The earlier abortion occurs during pregnancy, the lower the risk of complications

Access to abortion must therefore be simple and fast in all circumstances

Abortions require 24-hour hospitalization for monitoring and psychological support

Except in exceptional cases, abortions must be performed on an outpatient basis or in a day hospital (stay of less than 12 hours). This in a concern for confidentiality in particular

A psychosocial interview is systematically offered for adults


The psychosocial interview is mandatory for adults

Psychosocial retention is compulsory for minors

We must try to understand the reasons for the failure of current contraception or its absence

Gestational age is deduced from the interrogation or ultrasound

The subsequent contraceptive method must be prescribed from the visit preceding the abortion

It is discussed and discussed, but it is by no means mandatory (neither to prescribe it, nor that the patient accepts it)


The cooling-off period is 7 days and must be respected in all circumstances

There is no longer a mandatory reflection period of 7 days (or 48 hours) between the two consultations.

All patients should have Rhesus groupage and RAI

If Rhesus is positive, a prophylactive injection of anti-D gamma globulins should be performed

If the Rhesus is negative, a prevention of Rhesus immunization by an injection of gamma globulins anti-D, should be carried out at the time of the act

The initial certificate of request for abortion must be given to the patient if the doctor agrees to perform the abortion


Regarding the second abortion consultation:

The second consultation is carried out 21 days after the initial consultation

7 days after the initial consultation, which corresponds to the cooling-off period

The patient must confirm the abortion request in writing during the second consultation

If the patient is a minor, she must present the certificate of social maintenance

The second consultation is when the abortion is performed

This is a confirmatory consultation. Abortion is performed at the third consultation

A surgical abortion can do without a pre-anhesthesic consultation since anhesthesia is local

Pre-anesthetic consultation necessary in case of surgical abortion. They are also not reserved for general anesthesia.


Post-abortion consultation is done between the 14th and 21st day after the act

It is impossible to perform an abortion under general anesthesia

In all cases where possible, women must be able to choose the technique, medical or surgical, as well as the mode of anesthesia, local or general.

Surgery involves dilation of the cervix and evacuation of uterine contents by aspiration

A medicated cervical preparation can help with cervical dilation in surgical technique

The medical technique is based on the combination of antiprogesterone and prostaglandins


Which of the following are complications of low molecular weight heparins?

True, at the injection site. Patients are therefore asked to vary the injection sites as much as possible.


Which of the following are drug causes of MAT?

Functional IR, glomerular involvement and allergic nephritis


Which of the following are drug causes of functional renal failure?

True, by inhibition of vasoconstriction of efferent arteriole

Renal organ failure due to direct tubular toxicity


Regarding general information on epidemiological investigations:

Epidemiology is a discipline that deals with health problems within a population

TRUE. This is the description given in the Public Health KB

An experiment is any investigation where the attribution of exposure is controlled by the proponent alone.

An experiment is any investigation where the attribution of exposure is controlled by the investigator.

In epidemiology, studies are most often experimental

They are rare in epidemiology because the exposure of subjects to a particular factor often cannot be controlled.

Experimental studies may or may not be randomized

Observational surveys are very rare in epidemiology

Observational surveys are often the only possible ones. Their interpretation is often more difficult, but they have the advantage of reflecting more faithfully the real situation of the subjects of a population."


Prevalence is a parameter from analytical epidemiology

Descriptive epidemiology, incidence and evolution

Incidence is a parameter from evaluative epidemiology

Descriptive epidemiology, prevalence and evolution

The cohort study is part of analytical epidemiology

There are 2 types of observational epidemiology: descriptive and analytical

3: descriptive, analytical and evaluative

There are 3 types of analytical studies: cohorts, case-controls and cross-sectional studies


Among these proposals, which ones designate markers of fragility of the elderly?

A marker of fragility only when it is involuntary

It's pathological when it's so pathological. But decreased grip strength (with normal testing) is a marker


The 1 concerns the decompensating factor

The 2 corresponds to the chronic disease

The 3 corresponds to physiological aging

The 2 corresponds to the decompensating factor


It is the Certified Advancement Program in Technical and Experience

This is the Continuous Improvement Program of Teamwork

It is proposed by the Ministry of Health

The primary challenge is to reduce EIAS to an acceptable level.


Debriefing is the short sharing of information before team action

Debriefing: Short information sharing after the team action.

Team accreditation has been launched by the ANSM

Physician accreditation involves an evaluative component and a cognitive component

Team accreditation is complemented by a collective work dimension

Team accreditation has been launched by the HAS


Regarding the formulation of the scientific question:

This is PICOT, for P = study population, I = the type of intervention, C = the comparison group, O = outcome (= outcome) and T = type of study

There must be an element of comparison/control

The population studied may be vague (for example: seniors)

The type of population must be extremely well detailed.

The design of the study is chosen according to the question


Regarding literature search and Clinical Research Methodology hypotheses

HO: alternative hypothesis (which we wish to reject)

H1: alternative hypothesis that we wish to demonstrate

Documentary research is a process of identifying relevant information

Literature search should aim for completeness

The formulation of the research question is an essential step


Which of these proposals are secondary sources of information?

Produces professional recommendations on the use of the drug

NICE is in England. It is indeed a secondary source (equivalent to HAS)

The AHRQ is in the USA. It is indeed a secondary source (equivalent to HAS)"


Which of these proposals are part of 'grey literature'?


Concerning the bibliographic search of Methodology in clinical research

The primary sources are the recommendations of the HAS (in France)

Primary sources are accessible reports Either in the form of a summary in electronic banks: study, data Or in full by the search of the periodical (paid access most often)

Accessibility to primary sources is extremely simple (internet search)

Accessibility to primary sources is problematic: cost of subscriptions, time needed for research, need for training, etc. 2.3.2. Secondary sources

Secondary sources convey information directly from research laboratories

Secondary sources convey information previously digested by an intermediary Syntheses, literature reviews, meta-analyses, professional recommendations The intermediaries are mainly:

The journal Prescrire is independent of the pharmaceutical industry

"Grey literature" refers to publications funded by the pharmaceutical industry

The search for "grey literature": literature not indexed in conventional channels of information dissemination (congresses, government documents, unpublished studies, other unconventional documents)"


OPHANET is a research server on diseases concerning orphans

Open access rare disease and orphan drug information server for professionals and the general public

ORPHANET is a non-scientifically validated portal set up by patients

Global Reference Portal on Rare Diseases

Comprehensive and effective keyword research is important to find relevant results

Reading the summaries of the publications allows you to make a first sort

The abundance of references requires a critical mind at all times


Regarding the different types of research

Routine care research is a type of non-interventional research

Intervention research because there are specific monitoring modalities

Biomedical research is a type of intervention research

Biomedical research focuses on health products only

May also include things other than health products

Biomedical research involves action on the person

Randomized controlled tests (RCTs) are interventional


Sample research is generally non-interventional

Data research is generally non-interventional

Biomedical research is carried out on human beings with a view to developing biological or medical knowledge

Biomedical research involves sick people only

Involves an action on the person (healthy or sick) who habitually takes care of modifies the RESEARCH

Routine care research is an assessment of current medical practices


The preclinical phase takes place in vitro (cells or cell cultures) and/or in vivo (animal)

Clinical trials are organized in 3 phases

Clinical trials are organized in 4 phases (see table) In total, 10 to 15 years are needed for the research and development of a new drug. PHASES OF THE CLINICAL TRIAL POPULATION OBJECTIVES l F#iB PHASE I PHASE IL Healthy volunteers ■ Safety (maximum tolerated dose) Small number in some (Patients ■ Toxicity cases, in ■ Pharmacokinetics oncology for example) Patients (effective dose) Small number ■ Pharmacodynamics ■ Efficacy PHASE Ill Patients Large comparative number ■ Efficacy ■ Toxicity Ratio ■ benefit/risk PHASE IV General population ■ Pharmacovigilance of new ■ Research After MA indications = study of the fate of the drug in the body: absorption, metabolism, pharmacokinetics distribution and elimination Pharmacodynamics Toxicity MA = Authorization = side effects of Marketing = effect of the drug on the body 0 (.9 LJ. J a: (.9 LJ. J a: CO 0 z a: LJ. J > in z 0 fC = 0 LJ. J @ 228 ITEM 18 1 THE METHODOLOGY OF EXPERIMENTAL AND CLINICAL RESEARCH 4.2. REGULATORY FRAMEWORK FOR THERAPEUTIC TRIALS The founding texts 4.2.1. The founding texts:

In total, it takes between 10 and 15 years to develop a new drug

Phase 2 involving patients with small numbers of patients

The objective of Phase 3 is to assess the benefit/risk balance


Cephalic duodenopancreatectomy (CPD) is the gold standard of care for tail pancreatic tumours

pancreatic head tumour = cephalic duodenopancreatectomy

Cephalic duodenopancreatectomy (CPD) is the standard of care for tumours of the body of the pancreas

Cephalic duodenopancreatectomy (CPD) is the standard of care for pancreatic head tumours

Left splenopancreatectomy is the standard of care for left pancreatic tumours

Left splenopancreatectomy is the standard of care for pancreatic head tumours

left pancreatic tumour = left splenopancreatectomy


Serous cystadenoma degenerates only exceptionally

Cystic tumors of the pancreas are most often of incidental discovery

Ultrasound is the exam of choice to study cystic tumors of the pancreas

Mucosal cystadenoma does not communicate with the main pancreatic duct


Which of the following are useful markers for the diagnosis and/or monitoring of neuroendocrine tumours?

This dosage should no longer be done (College of HGE, 4th edition)

True. It is a general marker of all neuroendocrine tumors. The college of HGE (4th edition) does not report other markers to be measured


Which of the following are true for endocrine pancreatic tumors?

Pancreatic neuroendocrine tumors are malignant in more than 60% of cases

Symptoms are related to hormonal secretion

Gastrinoma causes maladaptive organic hypoglycemia

This is the case with insulinoma. Gastrinoma causes recurrent OGD ulcers and diarrhea

Necrolytic erythema migrans may be a sign of glucagonoma

Spiral TAP CT +/- Abdo MRI (liver metastases) +/- endoscopic ultrasound (if little or not visible)


Which of the following are tumors that preferentially metastasize to the bones?


The appearance or increase of a heart murmur in a febrile context is very suggestive of the diagnosis

The diagnosis should also be evoked in front of a stroke, purpura or febrile low back pain.

The absence of breath makes it possible to exclude the diagnosis

However, the absence of breath does not exclude the diagnosis

Any febrile heart failure should suggest the diagnosis of endocarditis


The two pillars of AE diagnosis are blood cultures and echocardiography

Blood cultures isolate the responsible microorganism in 100% of cases

They make it possible to isolate the responsible microorganism in 90% of cases

They should be repeated for 2 or 3 days if the initial blood cultures are negative, especially in subjects who have received antibiotics.

The suspicion of AE is to be reported to the microbiology laboratory, because it sometimes takes a long culture time for microorganisms with difficult growth (HACEK group, Brucella, deficient streptococci, yeasts)

Echocardiography affirms the diagnosis in front of one of the characteristic lesions: vegetation, abscess, valve perforation or disinsertion of prosthesis


Vegetation is identified by transthoracic echocardiography (ETT) or transesophageal ultrasound (TEO) especially in case of valve prosthesis

The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETT

The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETO and on the aortic ring rather than mitral

Gastric fibroscopy or colonoscopy in case of germ of digestive origin are performed in search of the front door

The clinical manifestations of endocarditis are very varied, not very specific and can affect several organs

Diagnostic classification of infectious endocarditis based on Jones criteria


Infective endocarditis (IE) is a rare but serious infection

Staphylococci (mainly Staphylococcus aureus) and streptococci are responsible for 50% of cases of infectious endocarditis

The rapid initiation of antibiotic therapy is crucial even before blood culture is performed

The identification of the causative infectious agent is crucial for diagnosis and treatment: 3 aero-anaerobic blood cultures should be collected before any antibiotic therapy in case of suspicion of AE

When AE is suspected, an echocardiogram should be performed as soon as possible and repeated if the first is negative.

Renal (glomerulonephritis) and digestive complications are the most frequent and serious complications

Cerabral and cardiac complications are the most frequent and serious complications


Management of patients with AE without signs of severity can now be ambulatory

The management is hospitable and must involve an experienced multidisciplinary team

Indications for antibiotic prophylaxis of infective endocarditis are restricted to invasive dental procedures

Infective endocarditis (IE) is an infection of one or more heart valves, native or prosthetic, most often by bacteria, more rarely by a fungus

Right heart valves are affected more often (90% of cases) than left heart valves

The valves of the infectious left heart are more often affected (90% of cases) than the valves of the right heart (mainly tricuspid valve in case of drug addiction)

Bacterial grafting at the endocardium level results in the development of infectious lesions associating vegetations and progressive lesions consisting of fibrin clusters.


It affects men more than women and is more common before age 70.

Predisposing factors are intravenous drug addiction, prosthetic heart valves, degenerative valve sclerosis.

Oral streptococci have supplanted staphylococci and are in first place in the distribution of infectious agents responsible for AEs

The most frequent streptococci are oral streptococci, of oral origin, and Streptococcus gallolyticus

In 40-50% of cases, blood cultures remain negative and the causative agent may not be identified


Regarding the basics of urinary incontinence:

The diagnosis of urinary incontinence is clinical

Urinary incontinence is defined as a subjective feeling of urinary loss

Urinary incontinence is defined as an involuntary loss of urine, objectively demonstrable, constituting a social and/or hygiene problem.

For women, it is a major public health problem

Urinary incontinence in men is due to prostate pathology in 95% of cases


It is defined as "involuntary loss of urine through the urethra"

Overactive bladder urinary incontinence is due to sphincter insufficiency

Sphincter insufficiency = UI of cerco-cystoptosis/hypermobility origin. It is a type of UI in itself

It is more common in women, especially postmenopausal women, with a history of obstetric trauma

There are two types of mechanisms explaining SUI: cervicocystoptosis/urethral hypermobility (HMU) and sphincter insufficiency (SI)

There is no etiology specific to the SUI

Many possible etiologies: trauma, trophic disorders, urological disorders, neurological disorders, etc.


SUI is an involuntary loss preceded by an urgent and uninhibited need from the outset

This is the case with overactive bladder UI

Bladder hyperactivity UI is an involuntary loss of urine without feeling of craving

Intense sports activity protects against UI

Drug treatments must be identified because some aggravate the voiding status and in particular anticholinergics and opioids (decrease in bladder contraction)


Addiction is often the result of inappropriate prescriptions

Among psychotropic drugs, benzodiazepines and related have a very marked addictive potential

About 2% of women in France have been prescribed benzodiazepines or related benzodiazepines

Harmful use results in medical complications or prolonged social repercussions

Dependence is defined by an inability to stop use because the desire to stop is not present

Dependence is defined by an inability to stop benzodiazepine use, either because of signs of withdrawal or because of excessive cravings.


Regarding the effect of benzodiazepines:

In case of dependence, there is a risk of withdrawal syndrome at the sudden cessation of consumption

In therapy, benzodiazepines are used exclusively for sedative purposes

In therapeutics, benzodiazepines are used for anxiolytic, sedative and hypnotic purposes, but also muscle relaxant and anticonvulsant

Benzodiazepines and related drugs are among the most prescribed psychotropic treatments in France and Europe

3 benzodiazepines or related benzodiazepines are currently marketed in France


Regarding the consequence of benzodiazepine addiction:

They are orogenic and require a check-up (EAL and blood glucose)

60% of benzodiazepine or related users are women

Half of the subjects treated with this type of molecule are treated for a period of more than two years

In case of significant disturbances of alertness, benzodiazepine poisoning is a vital emergency

It is very clearly established an increase in the risk of dementia type Alzheimer's disease in case of prolonged use of benzodiazepines

French authors have recently found an increased risk of Alzheimer's dementia in case of prolonged use of benzodiazepines, but these results are still debated internationally.


Article analysis is a standardised method of analysing a study in order to assess its quality and to be able to define the level of evidence.

Assessing the conflicts of interest of the CPP is done by the AGREE grid (second version)

The AGREE grid is used to develop a method for creating CPRs

Advances in medical knowledge require an effort of synthesis

The only method to develop recommendations is the PRC

There are several methods, 2 will be presented: Consensus Conference (CC) Recommendations for Clinical Practice"


Consensus conference begins with the presentation of expert reports synthesizing knowledge at a public conference

The second step in a consensus conference is the drafting of recommendations by a multidisciplinary jury in a public manner.

Then the drafting of recommendations by a multidisciplinary jury behind closed doors 3.2.2. The 1. The promoter actors

The promoter of consensus conferences are either university hospitals or pharmaceutical companies

It is in practice either a scholar, an organization of health professionals, insurance organization of a health health organization, a public association, a patient society, an industrialist. .. Its role: the initiative

The promoter does not have the opportunity to choose the theme of the reflection

The promoter provides the financial means


The organizing committee is composed of members from the promoter

Persons nominated by the sponsor (usually 5 to 10 members), but independent of the sponsor

A leader (the President of the organizing committee) is designated to organize and coordinate the meetings

The jury of a consensus conference is composed of 5 researchers and doctors

8 to 16 members, multiprofessional methodologists, researchers, other ethical, economic: physicians, and multidisciplinary representatives or legislative professionals, health, representatives of the general public

The jury is coordinated by a president, appointed by the organizing committee (sometimes in consultation with the promoter)

Jury members must have no financial or professional interest (no conflict of interest)


The bibliographic group provides an objective analysis of the literature, literature analysis without interpretation of the results

The experts are chosen by the organizing committee

Experts must have particular expertise on the theme of the conference (recent works and publications)

The composition of the expert panel must be representative of the diversity of opinions on the subject

The expert group must present its results orally to the jury

Provide a text gathering the information (from their experience and literature) to answer"


Regarding recommendations for clinical practice

The CPM is an analysis of the extensive literature by a working group that drafts the recommendations

The subject to be dealt with must be sufficiently broad

Literature data must be diverse and dispersed

We make a PRC when there is a lot of controversy on the subject

Proponent takes the lead in developing recommendations


Concerning links and conflicts of interest

The concept of a link of interests covers the interests or activities, past or present, patrimonial, professional or family, of the expert in relation to the object of the expert opinion entrusted to him.

A conflict of interest arises from a situation in which the links of interest of an expert are by their nature or to call into question his impartiality or independence.

The declaration of links of interest is optional if one has nothing to reproach oneself with.

The declaration of links of interests concerns direct and indirect links

The declaration of links of interest concerns only physicians

It must be carried out by any expert called upon to draw up expertise in the field of health and health safety"


Concerning links of interest and their impacts

The declaration of links of interest engages the responsibility of the order of physicians which must ensure that it is updated

It engages the responsibility of the declarant, who must ensure that it is sincere, up-to-date (continuous updating) and exhaustive

The anteriority of the links to be declared is 15 years

The anteriority of the links to be declared is 5 years

The longer a collaboration lasts, the stronger the impact of the link of interest will be.

Too strong links of interest can lead to erroneous expert conclusions

The stronger a healthcare professional's interests, the more patients trust him/her.


LDL-cholesterol is the most powerful cardiovascular lipid risk factor

Pure hypercholesterolemia affects 10% of 35-64 year olds.

30% ! All dyslipidemias combined, 51% of this population is concerned

The LDLc level is calculated with the Friedewald formula only if the triglyceride level is greater than 4g/L

An EAL is routinely requested for an overweight individual (BMI >25)

If a screening EAL is abnormal, it should be repeated

It is then associated with a measurement of fasting blood glucose


Tuberous xanthomas are a clinical sign of hypertriglyceridemia

During an EAL, in the creaming test, a cloudy subnatant indicates an abnormality in the chylomicronemia level

An anomaly in the VLDL level. A creamy supernatant indicates an abnormality in the rate of chylomicronemia.

In the Frederickson classification, dyslipidemia of phenotype IIA is pure hypercholesterolemia

<b>Chronic</b> renal failure is a cause of secondary hypercholesterolemia

Loop diuretics are an iatrogenic cause of mixed dyslipidemia


Primary monogeneic hypercholesterolemia by mutation of the LDL-cholesterol receptor is inherited autosomal dominant

The involvement can be heterozygous (50% functional receptors) or homozygous (0% functional, severe++)

Familial combined hyperlipidemia affects 1 to 2% of the general population in France

And 10-11% of patients who had a myocardial infarction before 60 years

According to the HAS 2017, the LDL-cholesterol objective to be achieved in case of moderate cardiovascular risk is a level below 1.3

Attention, the thresholds recommended by the ESC are different

In a patient with a SCORE calculated at 7% who has not reached his LDL-cholesterol goal, lipid-lowering drug therapy is indicated from the outset

Here, the cardiovascular risk is high (5-10%): drug treatment from the outset

The combination statin + fibrate is recommended from the outset in case of mixed dyslipidemia

The combination statin + fibrate is classically at risk and strongly discouraged


Initiation of lipid-lowering drug therapy is not recommended for primary prevention in patients over 80 years of age

Statins induce a decrease in triglyceride levels

Statins are contraindicated in pregnancy

This concerns statins, ezetimibe and fibrates. Cholestyramine induces digestive disorders.

Treatment with fibrates is indicated in 1°intention in a patient with a triglyceride level of 3 g / L

Fibrates are indicated only after failure of hygienic measures, or in case of isolated severe hypertriglyceridemia


Gemfibrozil + Simvastatin is not recommended

It is absolutely contraindicated!! And the combination of a statin with any other fibrate is not recommended

A monitoring EAL is indicated 4 weeks after initiation of lipid-lowering therapy to assess effects

12-24 weeks in case of low/moderate cardiovascular risk, 8-12 weeks if high/very high

When the LDL-c objective is reached, a control EAL is scheduled every 3 years (except comorbidities)

CPK testing is recommended before statin initiation, 8 weeks after any dose change, and then 1 time per year

This concerns the control of liver function. CPK testing is only recommended in case of muscle pain or risk factor for muscle damage

In case of increase in CPK < 5 times normal on statins with moderate myalgia, treatment can be continued

CPKs are rechecked at one week. In case of severe myalgia, statins are discontinued


Their prevalence varies greatly from one pathology to another, but taken together, they would affect about 1% of the population of industrialized countries.

Given the extreme diversity of the repertoire of these antigen receptors, the appearance of lymphocytes recognizing antigens of the self is statistically inevitable.

Pathological autoimmunity is the result of a breakdown in immunological tolerance

The presence of isolated autoimmune biology (e.g. isolated positivity from anti-nuclear antibody testing) poses the inevitable diagnosis of autoimmune disease

The presence of isolated autoimmune biology (e.g. isolated positivity from an anti-nuclear antibody test) without clinical or other biological manifestations is not sufficient to define an autoimmune disease as such.

The term "overlap syndrome" refers to patients who meet the criteria for classification of several autoimmune diseases at once.


Autoimmune dysthyroidism is very common in the general population, while primary ANCA vasculitis is very rare.

According to the European definition, a pathology is said to be "rare" when its prevalence is less than 50/100,000 (i.e. affects less than 1 in 2,000 people)

Autoimmune diseases are multifactorial pathologies, which result from the complex interaction between a genetic terrain at risk and environmental factors favoring

The existence of a genetic predisposition to autoimmune diseases is attested

In the majority of cases, autoimmune diseases are monogenic

In the majority of cases, autoimmune diseases are called "polygenic", because the genetic terrain favoring these diseases is determined by the polymorphisms of many genes each conferring only a low to moderate excess risk of developing the disease


Anti-nuclear antibodies are encountered in about 10% of healthy subjects

aPLs are common during systemic lupus (30-80%) but can be present in many connective tissue diseases such as RA and systemic scleroderma

The Rheumatoid Factor was classically sought after by Elisa

By the Waaler-Rose reaction and the latex test

Anti-CCP are positive in 30% of RA that are negative for RF

The joint positivity of RF and anti-CCP confers a very good positive predictive value for the diagnosis of RA, but with a sensitivity not exceeding 40-50%


Which of the following are possible complications of Sjögren's syndrome?

No, however, we can sometimes observe a tubulointerstitial syndrome by lymphocyte infiltration (significant diapedesis)


Which of the following are causes of dry syndrome?

Not directly. But some psychotropic treatments can cause dry syndrome.


What types of ACAN are found in Sjögren's syndrome?

Rather in the case of lupus (useful in follow-up)

Rather in favor of native anti-DNA (lupus)


Which of the following are additional tests useful in the diagnosis of Sjögren's syndrome?

Schirmer's test to objectify xerophthalmia

Useless in this case (useful in rheumatoid arthritis)


Which of the following proposals can cause polyclonal hypergammaglobulinemia greater than 20 G/l?


Which of the following proposals are possibly associated with Sjögren's syndrome?


Children with Autism Spectrum Disorder (ASD) have deficits in communication only

Children with Autism Spectrum Disorder (ASD) have deficits in 3 clinical domains: (1) Verbal and nonverbal communication abnormalities (2) abnormal reciprocal social interactions and (3) Restricted and repetitive behaviours, interests and activities

The prevalence of ASD is 0.01% in the general population

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

Diagnosis of ASD is done clinically in a single consultation

The diagnostic evaluation is based on the patient's current symptomatology as well as his developmental trajectory over time. It is a dynamic diagnosis

Management of patients with ASD really begins at puberty

Management of patients with ASD should be early, intensive, multidisciplinary and adapted to the clinical profile of each child


ASD is the presence of persistent deficits in ideation and social behaviour

This syndrome corresponds to the presence of persistent deficits in 3 clinical domains: * abnormalities in verbal and non-verbal communication * abnormality of reciprocal social interactions * restricted and repetitive nature of behaviors, interests and activities

The prevalence of ASD in the general population is 1%

The sex ratio of ASD is 4 boys to one girl

Childhood affected by ASD seeks to attract the attention of others

It does not seek to draw the attention of others to an object or situation


One of the symptoms of the autistic child is that he does not respond when called even insistently.

The child only participates in games that do not require interaction with adults

No reciprocal social games, with adults or children

The child has an aversion to all objects and does not tolerate physical contact with them

Repetitive use of objects: the child tends to line up his toys or other objects, spin the wheel of a small car, etc.

Verbal stereotypies are a sign that can point to autism


Autism severity levels are assessed based on impact on parents, social interactions, and school adjustment

These levels of severity are determined from the intensity of autistic symptoms and their functional impact.

40% of patients with ASD have an intellectual disability

15% of children with ASD have attention deficit hyperactivity disorder (ADHD)

20% of patients with ASD have impaired acquisition of motor coordination

The presence of genetic disease (such as Rett syndrome) eliminates the diagnosis of ASD

Many genetic (such as Rett syndrome or fragile X syndrome) and metabolic diseases are associated with ASD.


Which of the following proposals are structures dedicated to the management of ASD at home?

Medical and psychological centres. It is not home care, but close to home.

Psycho-pedagogical medical centres. Not at home.

Centre for Early Medico-Social Action. Not at home.

Medical-educational institutes. Not at home. These are structures whose mission is to take care of patients with intellectual disabilities, and whose missions are education, care, and general education.


The main goitrogenic factor is iodine deficiency

Even relative iodine deficiency is a risk factor

The recommended iodine intake in a pregnant woman is higher than in the general population

Normal population: 100-150μg in adults, In pregnant women: 200-250μg

A family predisposition is often found. Several susceptibility genes have been identified but it is a multigenic condition that does not warrant screening.

This is the TSH test. If it is abnormal, free T4 is dosed to quantify the extent of hormonal dysfunction.

A goiter and increased TSH makes suspect a disease of Graves.

TSH is lowered in Graves' disease. This biological context makes us suspect rather an autoimmune thyoiriditis of Hashimoto, which leads us to perform an assay of anti-thyroperoxidase antibodies (anti-TPO), then, in case of negativity, anti-thyroglobulin antibodies (anti-Tg).


A thyroid nodule is a localized enlargement of the thyroid gland

The majority of nodules are malignant and require surgical management

About 10% of thyroid nodules are hyperfunctional

They are therefore at risk of hyperthyroidism

Transition to malignancy of a benign nodule is exceedingly rare

As for the goiter, the sex ratio is 3-4F/1H


It is not necessary to explore nodules less than 1 cm in diameter except in special circumstances.

The first-line biological assessment is the TSH assay

Ultrasound uses very low frequency probes

Low frequency probes allow deep penetration. The thyroid being superficial, very high frequency probes are used, which also have the advantage of making images of better definition.

An isolated low TSH strongly points to a functional adenoma

Hyperfunctional nodules that cause hyperthyroidism are treated with surgery


The overall prognosis is good, with a 10-year survival greater than 90%

Differentiated papillary carcinomas are the most common vesicular carcinomas

In 85% of cases. Differentiated vesicular carcinomas constitute 5% of cases while the rest is represented by poorly differentiated and oncocytic carcinomas, and anaplastic carcinomas

Surgery is the first-line treatment for virtually all thyroid cancers.

Papillary or vesicular differentiated thyroid cancers never recur

Papillary or vesicular differentiated thyroid cancers can recur in the long term, requiring prolonged monitoring

Cervical recurrences are treated with hormone therapy

Surgery remains the best treatment for local recurrences, supplemented by radioactive iodine when these recurrences fix.


Benign adenoma is accompanied by euthyroidism

Papillary carcinoma may be accompanied by euthyroidism

A benign goiter is accompanied by euthyroidism

An over-functional nodule is accompanied by hyperthyroidism


Iodine-139 is a very rare isotope not used at all in medicine. Iodine-131 is used.

The treatment is done over one week in day hospital (outpatient)

Hospitalization in radio-protected rooms

It is a complementary treatment to surgical management


Regarding malignant nodules and cancers:

A male sex directs to a malignant nodule

Papillary cancers have a pretty good prognosis

Papillary carcinomas constitute 85% of differentiated carcinomas, they have an excellent prognosis (95% survival at 10 years), it is the only form observed in young people and follow-up is carried out using thyroglobulin

Vesicular carcinomas can be encapsulated or invasive

Anti-Tg for follow-up, anti-TPO are indicated in particular for the etiological assessment of hypothyroidism


Up to age 40, the annual incidence of distal radius fractures is higher in women

Up to age 40, the annual incidence of distal radius fractures is higher in men

There is no link between the quality of anatomical reduction and functional outcome

There is a parallelism between the quality of the anatomical reduction and the functional result

Fractures of the distal end of the radius are fractures mainly involving the proximal epiphysis

Fractures of the distal end of the radius are fractures mainly involving the metaphysis but can also concern the distal epiphysis

The distal epiphysis is articular with the head of the ulna and the first row of the carpus

It is necessary to oppose extra-articular fractures which are the prerogative of the elderly subject and which most often follow a low-energy trauma, complex joint fractures affecting more readily the young subject and resulting from a high-energy trauma


Health safety is the protection of health against the risks induced by the metabolism of infectious agents

It is the protection against the risks induced by the functioning of the company

A health crisis is an unforeseen and complex situation

A health crisis is always of proven seriousness

Not always proven. It may only be potential

A health crisis requires immediate action

The means of managing health crises is exceptional


Cosmetovigilance only concerns consmetic products sold in pharmacies

Manufacturers report any adverse reaction to the ANSM directly

The Biomedicine Agency is the authority that deals with biovigilance

Reactovigilance concerns radiation risks

Materiovigilance is organized around 4 levels of procedure

Minor, major, critical incidents and the overall assessment


Disorders of motility or sensitivity of a limb are very rare

Limb motility or sensitivity disorders are common reasons for consultation, sometimes in emergency situations

This type of disorder must be referred directly to hospital neurologists in view of the potential seriousness

Every physician must know how to guide his diagnosis: by distinguishing between a deficit due to impairment of motor or sensitivity pathways and a disorder of non-neurological origin

There are four major neurological motor syndromes

Syndromic diagnosis makes it possible to establish the topographic diagnosis of the attack

Involvement of the first motor neuron is responsible for pyramidal syndrome