Perinatal psychiatric disorders are mainly characterized depressive episodes

Seeking and preventing a risk of suicide and/or infanticide is an imperative

In cases of severe postpartum depressive episode, the use of a joint mother-child hospitalization unit is currently recommended.

* In cases of depressive episodes with psychotic symptoms, management may be close outpatient

* In case of serious maternal failure or in case of immediate danger to the baby (risk of infanticide), hospitalization of both must be carried out urgently


Regarding mental disorders of pregnancy and postpartum:

Postpartum blues is a condition that we do not know how to treat at present

Psychotropic treatments should be prescribed with caution

Pregnancy and the arrival of a child are essential stages in a woman's life and involve profound physiological and psycho-social changes, which are to be considered as major stressors.

The perinatal period is a period of particular vulnerability for psychiatric disorders

They exist and must be evaluated and detected as early as possible by the various partners in care in the perinatal period (attending physician, gynaecologist-obstetrician, midwife, maternal and child protection services, psychiatrist)


Regarding the management of per-pregnancy disorders:

An "early prenatal interview" is systematically offered in the 4th month of pregnancy

Every pregnant woman should be informed about the risks of taking addictive substances during pregnancy

Blame for risky behaviour allows for more effective cessation and should be preferred in emergency cases such as pregnancy.

We must avoid any guilt and stigmatization that only have opposite effects to those sought

Treatment of a maternal addictive disorder involves evaluating the benefits of withdrawal versus psychotropic treatment

The evaluation of associated psychiatric comorbidities must lead to a proposal for specialized follow-up


Regarding the management of anxious trooubles:

Pregnancy anxiety disorders are often the expression of pre-existing anxiety disorders

The postpartum period is a period conducive to the physiological compensation of anxiety disorders thanks to the major release of endorphins

The postpartum period is a period conducive to their aggravation, especially regarding obsessive-compulsive disorder (OCD)

Consultation with the Reference Centre for Teratogens will allow a safer prescription in case of need for psychotropic treatment

Abrupt cessation of treatment upon discovery of pregnancy is not recommended

The possible occurrence of transient neonatal disorders will be systematically taken into account when examining the newborn of each patient who has received psychotropic treatment during pregnancy.


Regarding the treatment of psychiatric disorders in pregnant women:

The prescription of benzodiazepines is totally contraindicated in pregnant women

Anxiolytics The prescription of benzodiazepines is to be avoided if possible, but if the clinical situation requires it then benzodiazepines with short half-life are to be preferred in particular Oxazepam (Seresta®)

Benzodiazepines also contraindicate breastfeeding

Breastfeeding is possible with these molecules prescribed in low doses

Serotonin reuptake inhibitors (SRIs) in pregnant women should be preferred over other anti-depressants

Both first and second generation antipsychotics can be used

No thymoregulators can be prescribed in pregnant women

The most documented thymoregulators, recommended and can be prescribed in pregnant women are: olanzapine (Zyprexa®) and lamotrigine (Lamictal®)


Which of these proposals are behavioral addictions?

Behavioral addiction is not defined by a lack of behavior

Simple gambling is not an addiction. It is the repetition of behavior despite negative consequences and the inability to control it that make it an addiction.

Uncontrolled and negative sexual activities


General information on behavioral addictions:

The only behavioral addiction found in the DSM-5 is sex addiction.

Only one is officially defined in international classifications: gambling disorder also called "pathological gambling" (ICD-10, DSM-IV) or "pathological gambling" (DSM-5)

The mechanisms of behavioural addiction share the pathophysiological basis described in illicit substance use disorders

One of the main systems involved in these disorders is the serotonin reward system.

In addictive disorders, the homeostasis of neurotransmission networks is disrupted

Behavioral addictions are of multifactorial origin


Regarding risk factors and the impact of behavioral addictions:

Behavioral addictions have a zero genetic component in view of the almost total impact of the environment

There are genetic predisposing factors (estimated heritability of 40-60% for addictive disorders), but also other individual risk factors (gender, age, sensation-seeking personality traits or impulsivity)

Psychiatric comorbidities are an important risk factor

Anxiety disorders are a risk factor for behavioral addictions

Attention deficit disorder predisposes to behavioral addictions only when there is hyperactivity

Definition Games of chance and gambling are games for which the subject irreversibly bets a good based on chance


By definition, it is impossible to predict or control the outcome of a JHA.

There are phenomenological similarities, neurocognitive, neurobiological and therapeutic similarities between pathological gambling and other addictive behaviors

Gambling behavior is motivated solely by the hope of making money

Gambling behavior is motivated by different reasons: hope to earn money, search for thrills (especially feeling the "thrill", or thrill), desire to relieve negative emotions, search for social connections

A pathological gambler is invaded by urge to play, called "craving"

JHA is very unpopular and not very present in France because it is associated with alcoholism

In France, in 2014, three-quarters of French people between the ages of 15 and 75 said they had already played a JHA in their life, with just over half saying they had played it in the year.


Expenditures related to the practice of JHA represented 0.8% of annual household expenditures in 2012, in France

More than half of players spend less than 100 euros per year

The most represented games are blackjack and poker

Online games are mainly about horse betting

Online games (7.3% of players, a third of whom are mobile) are more concerned with poker and sports betting.

The prevalence of pathological gambling in France is estimated to be 0.5% in the general population


The practice of anesthesia is governed by the decree of 5 December 1335

December 5, 1994: it is a relatively recent specialty

Anesthesia consultation, pre-anesthetic visit and immediate post-operative monitoring are mandatory

General anesthesia is defined by irreversible loss of consciousness

The loss is reversible, otherwise it would be problematic x)

GA is broken down into 4 phases: falling asleep, unconscious, waking up, opening the eyes

3 phases: induction, maintenance and awakening

The purpose of locoregional anesthesia (ALR) is to transiently interrupt the transmission of nerve conduction while preserving the state of consciousness.


They are subject to the same regulatory obligations

A distinction is made between perimedullary ALR (around the peripheral nerve) or peripheral ALR (around the spinal cord)

IN ALR, the local anesthetic is injected by MI, SC or IV

Local anesthesia is defined as the administration of a local anesthetic by infiltration or topically (by contact) in relation to the area to be operated or analgesive. IV injection is at risk of cardiology or neurological disorders.

Transdural analgesia is the gold standard technique for ensuring quality analgesia during obstetric labour

In 2010, more than 11 million procedures of anaesthesia were recorded in France


About 2% of anhestesic procedures are treated on an outpatient basis

In case of unscheduled intervention (emergency), the pre-anesthetic visit replaces the consultation

The purpose of the consultation is to carry out a medical evaluation of the patient

Anaesthetic risk is assessed according to the ASA (American Society of Anesthesiologists) classification

Patient information is an issue in consultation so that the patient can formulate informed consent


The pre-anesthetic visit takes place a few days (maximum 7) before the scheduled procedure under anesthesia

A few hours before. The objective is to confirm the information

General anesthesia (GA) is defined as a reversible loss of consciousness induced by the administration of a hypnotic often combined with an analgesic agent

A benzodiazepine is frequently used to cause muscle paralysis facilitating tracheal intubation and surgery.

ALR techniques are indicated in the surgical setting only

ALR techniques are indicated in the anesthetic context (allowing surgical intervention) but also for analgesic purposes (intraoperative, post-operative, obstetrical, etc.)

Local anesthesia is defined by the administration of a local anesthetic either by infiltration (intradermal, subcutaneous or diusion plane) or topically (by contact) in relation to the area to be operated or analgesia


A delay of a few hours is recommended between the anesthesia consultation and scheduled surgery

There are 3 phases in general anesthesia: Maintenance -> Induction -> Awakening

Well 3 phases, but the order is: Induction -> Maintenance -> Awakening

Curare allows relaxation of all the muscles of the human body.

Trap;) not of the heart (which is a skeletal muscle but not governed by the motor plate)

A passage to the SSPI is mandatory for any general anesthesia or regional loco, even if the patient was conscious

According to decree, any surgical procedure with the use of an anesthetic product requires postoperative monitoring (AG and ALR included)

In general, morphine is THE drug used to put the patient to sleep during general anesthesia.

It is the hypnotic that puts the patient to sleep in general (propofol IV / inhaled halogenated ...)


A patient must undergo a scheduled endoscopy in 48 hours, but he goes on a trip in 24 hours, what are the true answers.

Not within the deadline for the anesth consultation, postponement of the mandatory endoscopy

He can have his pre-anesthetic consultation now and have the endoscopy right after.

Scheduled surgery. It would have been true in a hurry.

He may have a pre-anesthetic visit before having his endoscopy right after

If he had had his anesthesia consultation 24 hours ago, he can do the endoscopy in 24 hours (48 hours after consultation) and directly jump on his plane just after the endoscopy

Use of anesthetic products, so mandatory passage to SSPI

If he had been able to have his endoscopy, the patient would have had a pre-anesthetic visit a few hours before the endoscopy.

Visit pre anesth qq hours before the act, to check that there have been no new events.


What is the minimum conditioning in a patient who will undergo general anesthesia?

False. It is a pulsed oxygen saturation (SpO2)

A measurement of the concentration of O2, CO2, NO and anesthetic gas of the inhaled and exhaled gases

False. The fraction in NO is not measured

Conditioning in anesthesia is called multiparametric monitoring


Which of these trips are considered to be very risky?

Young adults on an unorganized trip to India for 4 weeks

Hitchhiking travellers in Eastern Europe

3 types of travellers most at risk: young adults travelling unorganized to India or Sub-Saharan Africa for a stay of several weeks, immunocompromised people and people who have emigrated to France and stayed in their country of origin when it is a source of endemic


Among these proposals, which are the first and second causes of medical repatriation or death during a stay in a tropical zone?


Travel to Australia requires yellow fever vaccine

The endemic areas of yellow fever are intertropical Africa, South America and the Amazon region. In this case, the vaccine is recommended

Vector protection measures are advised in malaria prevention

Food hygiene helps limit the risk of turista and faecal diseases

Traveller education during consultation is essential


Abstention/monitoring is indicated in case of:

Moderate SBAU with return on quality of life

Moderate SBAUs with no clear impact on quality of life

Minimal SBAUs without impaired quality of life


α-blockers are effective after 6 months of treatment

This is the case for 5-alpha reductase inhibitors. A-blockers are effective in 48 hours

After TURP or AVH, the prostate adenoma should be sent to anatomical pathology in search of prostate cancer

The main side effect of surgical management is the spread of cancer

The main side effect is retrograde ejaculation

Prostate cancer screening by TR and annual PSA is recommended in patients aged 30 to 50 years in the general population

Screening for prostate cancer by TR and an annual PSA is recommended in patients aged 50 to 75 years or from 45 years in case of risk factors (Afro-Caribbean origin, family history)

Benign prostatic hyperplasia (BPH) is a subvesical obstacle to urine flow


BPH is hyperplasia of the glands in the marginal zone of the prostate

It corresponds to hyperplasia of the glands of the periurethral prostate (transition zone of the prostate)

The symptomatology may be stable or worsen more or less rapidly

There is a clear parallelism between the volume of BPH and the severity of SBAUs

There is no parallelism between the volume of BPH and the severity of SBAUs

BPH is hyperplasia of the transition zone of the prostate surrounding the subbladder urethra


The evolution of a prostate adenoma does not systematically lead to the appearance of complications

BPH cannot be latent, it is always symptomatic, especially from the age of 70

BPH may be latent and responsible only for functional discomfort

BPH never escalates into prostate cancer

Prostate cancer is developed from the transition zone of the prostate

Prostate cancer, developed from the peripheral area of the prostate, is therefore often sought when diagnosed with BPH.


For the following definitions, check the correct answer(s):

Autonomy and dependence are two opposite terms

Autonomy is the person's ability to move

Autonomy refers to the person's ability to make a free choice.

Addiction is defined by the need for human help

The assessment of dependence in the elderly must be systematic during its management

The assessment of dependence in the elderly is part of the personalized health project


A person is said to be "old" after the age of 50 or 55

A person is said to be "old" after the age of 70 or 75

Sarcopenic obesity is defined by BMI ≥ 30 and sarcopenia

An undernourished obese is defined by a BMI ≥ 30 and a criterion of undernutrition

Obese undernourished BMI ≥ 30 and a criterion of undernutrition

Decreased muscle performance signs probable sarcopenia

Severe sarcopenia (see Table 11.1, page 155, College of Nutrition, 3rd edition)

Entry into an institution is one of the criteria of fragility


Which of these proposals make it possible to define undernutrition?

Weight loss greater than or equal to 15% in 3 months

Weight loss greater than or equal to 5% in 1 month or 10% in 6 months

Weight loss greater than or equal to 15% in 6 months


Which of these proposals make it possible to define severe undernutrition?

Weight loss greater than or equal to 10% in 1 month or 15% in 6 months


BMI increases with age, reaching about 26–27 on average between the ages of 70 and 80

There are changes in body composition during aging: fat mass increases, muscle mass decreases.

Muscle mass decreases by about 40% between the ages of 20 and 80

The prevalence of obesity increases with age with a peak of 20–23% at age 55–65 years, then gradually decreases.


Among these proposals, which are pathologies of which obesity could be a protective factor?

Decreased risk of fracture (mechanical protective role of adipose tissue in case of trauma, stimulating pressure of weight on bone structure and hormonal effect related to the transformation of adrenal androgens into estrogens by adipose tissue)


vascular tumors are most often capillary

The term 'angioma' is a generic term for vascular tumours such as hemangiomas and vascular malformations such as CAVs.

The main vascular tumor is angiocarcinoma of the elderly

The prevalence of infant hemangiomas is 0.01%

Most common childhood tumours, with a prevalence of 10%

Hemangioma is a malignant tumor and a diagnostic emergency

Benign skin proliferations of vascular endothelial cells, non-congenital, more common in girls, premature infants and low birth weight infants


The origin of infant hemangiomas is unknown

The endothelium is proliferating in malformations

Biopsy is usually unnecessary in typical uncomplicated hemangioma

The hemangioma is non-blowing on auscultation


Hemangiomas are the most common tumours in children, with a prevalence of 10%

Deep hemangiomas are arterial and present with bright red swelling

Deep hemangiomas are more elastic in consistency than superficial forms

Subcutaneous hemangiomas are always clinically diagnosed only

The clinic is sometimes non-specific: imaging may be necessary

Doppler ultrasound shows a richly vascularized tumor


Hemangiomas regress completely and the majority require no treatment

The variation in the evolution of hemangiomas is important depending on the individual

Their natural history is stereotyped and is an important part of the diagnosis

The growth phase begins between the 3rd and 6th month of life

A beginning in the first days/weeks of life

The increase in size is quite rapid during the first 5 to 6 months


The life-threatening prognosis of severe trauma is still at stake

By definition, a severely traumatized person is a trauma patient whose violence or mechanism of trauma may result in life-threatening injuries.

The first 15 minutes in the hospital are spent performing standard X-rays and a biological work-up

The first fifteen minutes of hospital care are devoted to clinical assessment and conditioning

The first 30 minutes in the hospital are devoted to the radiographic assessment including the CT scan

TDM does not enter the process of the first 30 minutes

Whole body computed tomography with contrast injection should be performed in all severe trauma patients whose haemodynamic status has been stabilized

Pre-hospital management includes an assessment of the haemodynamic, infectious, urinary and orthopaedic impact of lesions

What interests us urgently is the hemodynamic, ventilatory and neurological repercussions


Regarding the management of polytrauma patients:

Hemodynamic failure is managed by the treatment of hemorrhagic shock

Surgical management prioritizes bleeding lesions

Treatment of ventilatory failure involves orotracheal intubation

Treatment of neurological failure involves orotracheal intubation


What are the roles of the witness of an accident?

avoid the "super-accident", protect yourself, remove the injured person(s) from the traumatic agent

call 15 (Samu-SMUR), 18 (Firefighters), look for help around you.

compression of active bleeding, lateral safety position (PLS), basic cardiopulmonary resuscitation (CPR)

The 3 essential roles of the first link in the chain of survival are: Protect, Alert, Rescue


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

Pre-eclampsia is defined by the combination of blood pressure ≥140/90 mmHg and proteinuria ≥ 300 mg/24h occurring at any time during pregnancy

Pre-eclampsia is said to be early when it occurs before 34 SA

In the majority of cases, pre-eclampsia disappears before the end of the 6th postpartum week

Pre-eclampsia affects less than 1% of pregnancies

A woman who has already had pre-eclampsia will have a decreased risk of pre-eclampsia for a later pregnancy.


Which of the following proposals for the treatment of pre-eclampsia are true?

The only effective treatment is delivery of the placenta.

It is recommended to use calcium sulfate during the appearance of severe neurosensory signs and during eclampsia.

IV nicardipine is the attack treatment for pre-eclampsia with a SBP of 190 mmHg.

True, for a SBP > 180 mmHg or a > 140mmHg MPA, the attack treatment is Nicardipine IV bolus of 0.5 to 1 mg, then infusion of 4-7 mg over 30 min. Evaluation of the efficacy and safety of the treatment after 30 min.

Blood pressure objectives are a PAD between 80 and 105 mmHg.

Perindopril is part of the antihypertensive therapeutic arsenal in pre-eclampsia

False. All ACE inhibitors and angiotensin II receptor antagonists (sartans or ARA II) are contraindicated in the 2nd and 3rd trimesters of pregnancy!! Perindopril is an ACE inhibitor, and therefore contraindicated! They are contraindicated because they can induce acute renal failure in the fetus, resulting in oligo-amnios.


Any accident at the workplace is considered a TA, it also concerns the home-to-work journey or accidents in common areas (toilets, cafeteria)

The TA only concerns the company's employees

It also concerns stagaire pupils, people under contract, temporary workers, etc.

This is particularly relevant for differentiation with PD

The maternality of the accidental event refers to the material that caused the accident

These are the precise conditions, localizable in time and space, in which TA occurs.

Accidents occurring during strikes are TAs

There is suspension of the employment contract, so it is not a TA


The insured must provide proof of this in the TAs

There is a presumption of accountability

The insured must provide proof in the PM

Via the classification tables for example which will determine the minimum exposure times

In the TA, imputability is established by the occupational physician

The CPAM medical officer is responsible for determining accountability

Relapses and late complications of TAs are covered by the presumption of initial imputability

The presumption of imputability applies only to initial injuries and direct complications

No one can dispute a TA and its accountability

Within the time limits, the employer and the CPAM may contest the imputability of a TA


Progressive and insidious unlike TAs which are sudden

The only way to recognize PM is the array system

There is an ancillary system with the Regional Committee for the Recognition of Occupational Diseases which will in particular recognize as PM pathologies in workers who do not meet the criteria set out in the tables

It is the victim who must notify the employer

Unlike the AT, it is not the employer but the employee who must send the declaration of PM to the CPAM within 15 days of the finding of the disease.


Esophageal cancers are the most common digestive cancers

This is the 4th digestive cancer after colorectal, pancreatic and stomach cancer

Esophageal cancers are most often excellent prognosis

Esophageal cancers more common in the northwest


What is the risk of malignant transformation of an endobrachyoesophagus (EBO) during life?


Which of the following are true about Plummer-Vinson syndrome?

It is also called "Kelly-Paterson syndrome"

True. It is a risk factor for squamous cell cancer of the esophagus


Which of the following are true about endobrachyoesophagus?

Monitoring is done, in the absence of dysplasia, every year

Every 2, 3 or 5 years depending on the length of metaplasia

Monitoring involves only a clinical examination

Suspected low-grade dysplasia involves fibroscopic control after 6 months of PPI

Low-grade dysplasia involves fibroscopic control after 2-3 months of double-dose PPI

It is an important risk factor for adenocarcinoma of the esophagus


Which of the following are risk factors for squamous cell cancer of the esophagus?

Caustic esophagitis after several decades of evolution


What is the 5-year survival of esophageal tumors?


About 10% of ovarian cancers occur in a context of genetic predisposition

About 5-10% of women will have an ovarian tumor in their lifetime, and it is most often a benign ovarian cyst.

The ovary is a complex organ that is home to many different cell types

Mature dermoid cysts or teratomas derive from a highly differentiated cell

Mature dermoid or teratoma cysts derive from a multipotent cell that can be the source of different tissues present within the cyst


Which of the following are formal contraindications in case of suspicion of ovarian cancer?

True, except in very special cases (end of life), it is necessary to explore urgently because the prognosis is very poor


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

Lynch syndrome: mainly colon, endometrium, small intestine and excretory urinary tract


Which of the following proposals are part of the assessment of the extension of adenocarcinoma of the cecum?

Not in the first intention. Can be done in case of an increase in CEB

True. An elevation of the CEA suggests a metastasis that will be sought by PET-CT

However, a liver MRI injected with gadolinium can be performed with a chest CT scan without injection, if an injected TDP-TAP is contraindicated (renal failure for example)


Which of the following are true for preoperative measures in a patient with adenocarcinoma of the cecum?

True because all surgical procedures are at risk of malnutrition. In case of oncological digestive surgery, a supply of micronutrients to begin 7 days before the intervention, is recommended to limit infectious complications and postoperative mortality.

Unnecessary in the case of laparotomy or laparoscopy.


Which of the following propositions are true regarding the monitoring of Lynch syndrome-prone patients who have previously had resected colonic adenocarcinoma?

True, for Lynch syndrome (endometrial cancer)


Which of the following are true about Lynch syndrome?

There are more polyps in the lining of the colon than in Familial Adenomatous Polyposis (FAP)

The risk of developing CRC during life is about 70% in humans

The risk of developing CRC during life is about 70% in women

In the majority of cases, cancer develops in the sigmoid

The positive relative risk is only for colon tumours

Also cancer of the urinary tract, small intestine, endometrium. Also from the ovary, stomach, bile ducts, pancreas and brain


In case of stage T3 N+ stage T3 N+ lieberkühnian adenocarcinoma surgically resected, what postoperative treatment(s) do you prescribe?

True, this is the only adjuvant therapy in stage 3 colonic adenocarcinoma (i.e., which are N+). 5-FU and oxaliplatin are preferred


Which of the following are true in cases of adenocarcinoma of the cecum with negative extension assessment?


True, for Hereditary Non Polyposis Colorectal Cancer

It is responsible for 25% of colorectal cancers

4% of CRC, it is the most common form of hereditary cancers

The abnormality is expressed on the genes of the mismatch repair proteins

True, MMR (MisMatch Repair) genes. Mainly MLH1 and MSH2

Replication errors are mostly found on chromosome 6 and 18

They are found at the level of micro-satellite sequences (DNA sequences formed by a repetition of patterns), which themselves are found in all chromosomes


Among these proposals, which favor the occurrence of renal colic?

Heat, on the other hand, is a contributing factor

It can, however, cause kidney failure, in very rare cases


Urolithiasis affects 50% of the population in France

Between 5 and 10%. It is a common disease

It recurs in 50% of cases if preventive treatment is not put in place

Calcium lithiasis is the most common. It represents 80% of urolithiasis

Infectious stones account for 5% of urolithiasis


What are the elements of gravity to look for?

It is then a question of acute obstructive renal failure

It is one of the three risk areas: pregnancy, kidney transplantation and kidney failure.

Doesn't matter. It is a normal sign associated with


Which of the following are true about melanoma?

True, the incidence of melanoma doubles almost every 10 years 😱

True, mortality increases less than incidence, which can be attributed to earlier 😊 diagnosis.

The clear phenotype ⚪ is not a risk factor

The main prognostic index is the Breslow index

The main prognostic index is the Clark index


Which of the following propositions are true about the halo nevus?

The Ota nevus is a birth nevus 👼 with a distribution in unilateral rule, superimposed on the territories of the two upper branches of the trigeminal. The other name for the halo nevus is the Sutton nevus

There is a development of an achromic halo (white)

The halo observed is due to cytotoxic inflammatory infiltrate

It occurs mostly around the second decade and on the trunk. A later onset or irregular appearance of the halo should lead to fear of melanoma. (cf College of Dermatology, 7th edition, page 305). It is the Ota nevus or Mongolian blue spot that occurs from birth 👼


Which skin carcinoma should suggest a budding, ulcerated and crusty lesion in an elderly person who has worked outdoors all his life?

True. These are the 3 characteristics that make you think of a squamous cell tumor

Raised skin nodule. We think about it especially in front of a short and intense sun ☀ exposure

It is not cutaneous carcinoma. Melanoma is developed from melanocytes


Bowen's disease is invasive squamous cell carcinoma

Squamous cell carcinoma is squamous cell carcinoma in situ

Epidermoid and squamous cell are synonymous 😊

Basal cell carcinoma does not have a precancerous lesion

The evolution of invasive squamous cell carcinoma is first done in the lymph nodes

True. Stereotyped evolution: lung blood ➡ ➡ nodes ➡ then other organs

Hematogenous metastatic course is more common for cutaneous squamous cell carcinomas than for mucosal squamous cell carcinomas

It is more common for mucosal squamous cell carcinomas


The discovery of a heart murmur is a very common possibility in children

A third noise or B3 is common at the apex in children (50% of cases), it is physiological

There is a correlation between the intensity of a breath and the severity of the underlying disease

It should be noted that there is often no correlation between the intensity of a breath and the severity of the underlying disease.

Exertional dyspnea is the most common symptom


Chest pain is exceptionally of cardiac origin in children, unlike in adults

Abnormalities of physical examination, such as hypertension and absence of femoral pulse, immediately point to aortic coarctation

The heart rate is all the faster the older the child is

The heart rate is all the faster the younger the child is

The QRS axis is straighter than in adults, the PR delay is shorter

The echocardiogram-Doppler is the key diagnostic test


In newborns (from birth to the end of the 2nd month), a very early breath is less pathological than when it is heard after a few days

In newborns (from birth to the end of the 2nd month) 1 Isolated breath in a newborn A very early murmur is more pathological than when it is heard after a few days

It is necessary to perform a cardiac ultrasound before leaving the maternity in case of breath heard on Day 1 or Day 2

Transposition of the great vessels is the most common cause of neonatal cyanosis

Transposition of the large vessels represents the very type of neonatal cardiology emergency

Regarding the transposition of the large vessels, anatomical correction surgery must be performed in the first 15 days of life


Early surgery is imperative for infants with large shunts, especially IVC

Anorganic or innocent breaths are very common in children

In case of innocent breathing, no therapy, or supervision, or restriction of activity, is justified, and these children can lead a strictly normal life.

In case of innocent breath it is useful to see the child periodically in consultation

It is useless and even harmful to see the child periodically in consultation

Asymptomatic systolic murmurs discovered in infancy most often correspond to anorganic murmurs, or "innocent" or "functional" murmurs.


What are the two physiological shunts in the fetal circulation?

False. The round foramen is a round foramen is a foramen of the middle stage of the base of the skull.


Which of the following are cyanogenic heart diseases?

True, the leading cause of cyanogenic heart disease in children according to the College of Pediatrics


What heart defects form a left-right shunt?

False. It causes an obstacle of the right heart.

False. It causes poor connections in the heart.


Which of the following are non-cyanogenic heart diseases?


What is the prevalence of congenital heart disease in live births?


The Pearl Index (PI) is the number of pregnancies that occurred in 100 women exposed to the method studied for 1 year

The higher the Pearl Index (PI), the more effective the contraceptive method concerned

It's the other way around. The lower it is, the more effective the contraceptive method.

The patch is a progestin-only contraception

The ring is an estrogen-progestin contraception

Macro-progestogens have no MA for contraception

Their prescription is off-label. No study has calculated a Pearl index.


Which of the following proposals are part of the follow-up assessment in a woman on an estrogen-progestogen contraceptive?


After unprotected sex, how soon should levonorgestrel be taken?

This is true for EllaOne®, Ulipristal Acetate

Norlevo® is an emergency contraception consisting of a 2nd generation progestin (levonorgestrel 1.5 mg)


What is the concentration of ethinyl estradiol (EE) of a so-called "normodosed" contraception (in micrograms)?

True: the pill is called "normo-dosed" if it contains 50 μg of EE


What emergency contraception is administered 4 days after sexual intercourse?


Which of the following are absolute contraindications (ICs) of estrogen-progestogen contraceptives (OCCs)?

Not an absolute CI if it is family, personal only. Family = relative (we will not CI a COP to a patient because her older sister had phlebitis at 65 years after 8 hours of plane returning from Reunion ^^)

The absolute ICs of COP are: ischemic heart disease, complicated valvular heart disease, ischemic stroke ATCD, migraine with aura, porphyrias / connective tissue (lupus are hormone-dependent),
Personal ATCD or venous (DVT or PE) or arterial TED accident
major surgery with prolonged immobilization, hereditary or acquired predisposition to thrombosis (AV), tobacco > 15 cigarettes / day if > 35 years, severe unbalanced hypertension or FdR CV, confirmed or suspected pregnancy, breastfeeding < 6S postpartum, severe dyslipidemia, active viral hepatitis, severe or recent liver disease (including cirrhosis), benign hepatic tumor, malignant or suspected breast tumor, uterus, meningioma, pituitary tumor (on a case-by-case basis) and non-genital hemorrhages Diagnosed.


Which of the following have a Pearl Index (PI) of less than 1?

True, one of the contraceptives with the lowest Pearl index

True. IP = 0.6 for classics. IP = 0.2 for impregnated IUDs


How soon should ulipristal be taken after unprotected sex?

It is a progesterone receptor antagonist


Among the following proposals, which are part of the biological assessment to be prescribed essential before starting estrogen-progestin contraception in a woman without personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal?

True. In a person with no personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal, the laboratory assessment can be performed 3 to 6 months after prescription.


Which of the following are true about emergency contraception? (one or more exact propositions)

Free only for minors. Reimbursed at 65% for adults, if medical prescription.

It can be issued to minors free of charge, anonymously and without a doctor's prescription, regardless of the medication used.

Contrairement à ce que l'on peut trouver dans certaines sources, l'ulipristal est bien disponible sans ordonnance d'après cette fiche de la HAS (mise à jour en 2019) : https://webzine.has-sante.fr/upload/docs/application/pdf/2015-07/contraception_urgence_officine_maj_juillet2015.pdf Si elle n'est plus valide, n'hésitez pas à nous prévenir en signalant la QI :)

Or in a CeGIDD, in a family planning or education center, with the school nurse or academic medicine

Two ICs: Allergy to one of the components and pregnancy. In addition, it is not recommended in cases of severe hepatic impairment and severe asthma insufficiently controlled by oral glucocorticoid. After taking UPA, breastfeeding not recommended for one week (during this period, express and discard breast milk in order to maintain lactation stimulation). (according to HAS)


Which of the following are true for intrauterine devices (IUDs)?

True, L-5134 of the CSP: "The insertion of intrauterine contraceptives can only be performed by a doctor or midwife."

Wilson's disease is a contraindication to the copper IUD

It is refunded. It is proposed as a first-line treatment for multiparous women with stable sex lives


The Pearl Index of the progesterone IUD is less than 0.5

The Pearl number of the copper IUD is less than 0.5

A history of ectopic pregnancy is a contraindication (CI)

Taking chronic NSAIDs is a contraindication (CI)


Which of the following are true about progestin-only contraception?

They have the same contraindications (CI) as estrogen-progestogens

The cycle disorders they can cause are sometimes poorly tolerated

Their tolerance to forgetfulness is 12 hours

3 hours for progestin-based contraceptives

Personal history of ectopic pregnancy (GEU) is part of the contraindications (CI)


Which of the following proposals concerning estrogen-progestogen is (are) correct?

They are also called combined oral contraceptives or combination pills and are composed of a synthetic or natural estrogen and a progestin

Ethinyl-estradiol is a synthetic estrogen

The dosage of synthetic estrogen ranges from 15 to 50 μg

Estrogens and progestins may contain a natural estrogen, estradiol

The dose of estradiol in estrogen-progestogens is conventionally 1.5 mg


Which of the following is (are) correct?

The first generation progestinfs are levonorgestrel and norgstrel

1st generation = norethisterone and lynestrenol

The third generation progestogens are gestodene and norgestimate

Chlormadinone acetate is a toxic element contraindicated in humans

Chlormadinone acetate is not toxic at all and is used in combination pills

Nomegestrol acetate is in combination with levonorgestrel most often

It is a progestin in combination with estradiol most often in estrogen-progestin pills

Cyproterone acetate is a progestin used in combination pills


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

The first generation progestins were obtained from the testosterone molecule

Second-generation progestogens are gonans

Third-generation progestogens have a very high affinity for the progesterone receptor and a lower affinity for the androgen receptor

3rd generation progestogens have very minor antigonadotropic activity

Their antigonadotropic activity is very high and has reduced the dose of ethinylloestradiol used

The androgenic effect of 3rd generation progestins is major

They have a lesser androgenic effect, on the contrary


Among these proposals, which fall into the triad of symptoms of retroplacental hematoma:

Abdominal pain in stabbing, uterine contracture, metrorrhagia


Regarding acute abdominal pain in pregnant women:

Abdominopelvic pain without metrorrhagia in the 1st trimester may be a telltale sign of an ectopic pregnancy

The severity argument suggests a retroplacental hematoma in the 2nd and 3rd trimesters

Retroplacental hematoma is to be evoked systematically in the 2nd half of pregnancy

Retroplacental hematoma is life-threatening for the fetus

The HELLP Syndrome is to be evoked in case of epigatric pain or right hypochondrium


HELLP syndrome is life-threatening for mother and fetus

Salpingitis is a common and relatively benign algic etiology in pregnant women

Salpingitis and endometritis DO NOT exist in pregnant women!

Diagnostic criteria for UTI are extremely different in pregnant women compared to non-pregnant women

Urinary pathologies have no impact on pregnancy

Careful! Urinary pathologies can trigger a threat of premature delivery


Pregnancy drastically reduces the frequency of urinary tract infections

Caution: Pregnancy increases the frequency of urinary tract infections

Uro-scanner is contraindicated in pregnant women

Renal colic: The uro-scanner is possible if the ultrasound is not contributory

A pyelocalicial dilation of 100 mm is physiological and frequent in pregnant women, especially on the left

Be careful, a physiological moderate pyelocalicial dilation (< 20 mm) is common in pregnant women, especially on the right because of the physiological dextrorotation of the uterus

Injected abdominal CT scan is strictly contraindicated during pregnancy

Ultrasound is not always very effective because of pregnancy and injected abdominal CT is possible at any age of pregnancy (benefit/risk ratio)"


Digestive pathologies can trigger a threat of premature delivery

Uterine palpation is looking for uterine contracture or deformity of the uterus

Cardiotocographic recording is done from 25 SA

Retroplacental hematoma is ultrasound diagnosis

Retroplacental hematoma is exceptionally seen in ultrasound, the diagnosis is clinical

The BU always shows the presence of blood in case of metrorrhagia


Regarding acute abdominopelvic pain in pregnant women:

Ultrasound of the cervix is indicated only in case of imminent threat of delivery

Renal and abdominal ultrasounds are made difficult by pregnancy

In the absence of an identified etiology, the patient is redirected to her general practitioner with a close consultation.

The 4 major etiological families are obstetrical, urinary, gynecological and digestive

Urinary causes are only very rarely due to pain of this type


Which of the following are signs or symptoms of uterine rupture?

It is especially to be evoked in a nulliparous woman

Especially in case of uterine scars (history of caesarean section in particular)

Exceptional outside of work, it is especially during work that we evoke a uterine rupture


Which of the following proposals is(are) possible cause(s) of acute abdominal pain in pregnant women?

True, especially in the first trimester, to evoke systematically

True especially in the context of hypertension or preeclampsia

True, especially in cases of sudden pain, red blood metrorrhagia and uterine deformity


Primary headaches are far more common than secondary headaches

They often evolve by paroxysmal crises and less often in a continuous and daily mode

The diagnosis of a primary headache is clinical, based on questioning in particular

Additional examinations show an inflammatory syndrome in 60% of cases

Complementary examinations are by definition normal

Primary headaches are mild and do not require management

Although benign, primary headaches and essential facial neuralgia have a significant impact on quality of life


There is no specific treatment for migraine

The management of migraine is based on non-specific treatments (paracetamol, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]) and specific treatments (triptans)

Subarachnoid hemorrhage is a secondary headache etiology

Facial and cranial neuralgia are responsible for electrical discharges in the territory of a sensory nerve

The main causes of headaches occurring less than 15 days a month are intracranial hypertension and meningitis

Headaches < 15 days a month: the main causes are migraine and episodic tension headache

Chronic daily headache (CCQ) is the leading cause of headache occurring more than 15 days per month for at least 3 months


"Short-term" chronic daily headaches (QCDs) are seizures lasting less than 30 minutes a day

"Short-term" CCQ: seizures lasting less than 4 hours a day

The main causes of QCC are cluster headache and trigeminal neuralgia

Chronic migraine or, more rarely, chronic tension headache, both with or without medication abuse

With a prevalence of 75%, migraine is one of the most common neurological conditions

With a prevalence of 15%, migraine is one of the most common neurological conditions

Migraine without aura is a more common cause of CCQ than migraine with aura

Some patients have only one variety of migraine attacks and others have both (with and without aura)


Which of the following propositions are true about reversible cerebral vasoconstriction syndrome?

It can be triggered by the Valsalva maneuver

It can be complicated by cerebral ischemia

It can be complicated by cerebral hemorrhage


Sexual violence is any sexual assault committed with violence, coercion, threat or surprise

Rape is any act of sexual penetration of any kind, committed by violence, coercion, threat or surprise.

The competent court to try marital rape is the administrative court

Penalty: jurisdiction: crime: Assize Court 15 years imprisonment 20 years if aggravating circumstances (rape by spouse or common-law partner ...)

Limitation period: 10 years if adult victim 20 years if rape committed when the victim was a minor In France:

In France, there were 980 rapes in 2014 (about 3 per day)


16% of women and 5% of men report having been raped or attempted rape in their lifetime

Sexual assault is a non-penetrative act committed by violence, coercion, threat or susception.

The jurisdiction that judges sexual assaults is the criminal court

The penalty for sexual assault is a fine of up to 100,000 euros (but no prison sentence)

Penalty: offenses: (minimum) 5 years in prison € 75,000 fine these penalties vary the prison sentence depending on 7 to 1 0 years, and the fine to € 100,000 of "aggravating situations": increase of possible"


Concerning sexual violence and harassment

There were 26,700 sexual assaults in 2014

Sexual harassment is the infliction of non-consensual touching (without penetration) of a person.

Definition: Imposing connotations or intimidating on a person who repeatedly engage in sexual comments or behaviours that violate their dignity or create a hostile situation

Sexual harassment is a crime punishable by law

The competent court to deal with sexual harassment cases is the Assize Court only

Jurisdiction: Jurisdiction of High Court If sexual harassment at work: (private sector) Administrative Court (public sector)

Penalties can be up to 2 years in prison and a fine of €30,000 (without aggravating circumstances)


During the somatic examination of a rape victim, we look for:

It will have to be carefully described in the medical record

Never breast palpation spontaneously, unless clearly urgent and informed agreement of the patient"


Dealing with sexual assault/rape is an emergency

If the rape victim is a minor, contact the legal guardians and the public prosecutor.

If the person is of age, the information of the Public Prosecutor is done only with the agreement of the patient

Psychological examination of rape victim looks for suicidal risk and acute stress

Samples are taken with sterile gloves in duplicate for DNA (spermatozoa)


What are the biological elements to be systematically sought, within a reasonable time, in the event of rape?

Local sampling for chlamydia and gonococci but never blood serology"


Rape is defined as any act of sexual penetration carried out against the will of the person by surprise, threat, violence or coercion.

Lack of consent results exclusively from physical violence

Lack of consent may result from physical or moral violence

Victims of sexual abuse have experienced criminal violence that must be handled in the most professional manner

Epidemiology: 16% of women report having experienced forced or attempted forced sex in their lifetime

Oral penetration is sexual violence but not rape

Oral penetration is called rape because it involves a sexual organ and an orifice.


Concerning the care of victims of sexual violence

Taking samples to identify the perpetrator is crucial

The doctor must write an initial medical certificate

Rapes dating back more than 5 days require emergency care with samples and declaration to the prosecutor

It is the recent aggression of less than 72 hours that requires urgent care, in particular because it allows samples to be taken.

Medical consultation with genito-anal examination should be carried out with maximum competence

After explaining the objectives of the medical examination, it must be carried out in a welcoming, well-lit room


The interrogation of rape victims makes it possible to specify:

Difficult question to ask, like many others, but necessary

The relationship is a question that does not arise

The victim's behaviour after the assault is unnecessary

If she has lost consciousness, changed her clothes or made a toilet, the medical management changes


The Maddreay score calculates the probability of contracting viral hepatitis

Maddrey's score defines the severity of alcoholic hepatitis

There is never a severe form of HEV infection

The hepatitis B virus has a diameter of 2 microns

Viruses are smaller than cells (so about ten ometers). HBV is 47 ometers in diameter

Mutated pre-C HCV viruses cause more severe chronic hepatitis than non-mutated viruses

Hepatitis is said to be chronic when it lasts more than 3 months


There may be, but very rarely, fulminant hepatitis


A positive HBs antigen can be found in case of:

Immunoprotective vaccination against HEV


Regarding the transmission of hepatitis viruses:

HAV is not transmitted from mother to child during pregnancy

This is the case for all viruses are HEV

HCV is not affected by fecal-oral transmission

Blood transmission is possible for all hepatitis viruses

HEV cannot be transmitted during sexual intercourse


Which of the following designates active hepatitis B?

HBsAg negative / Anti-HBs Ac negative / HBeAg negative / Anti-HBc Ac negative

HBsAg negative / Ac anti-HBs positive / HBeAg negative / Ac anti-HBc negative

HBsAg negative / Ac anti-HBs positive / HBeAg negative / Ac anti-HBc cloudy

HBsAg positive / Anti-HBs ac negative / HBeAg negative / Positive anti-HBc Ac

HBsag positive / anti-HBs ac negative / HBeAg positive / positive anti-HBc ac


It signs an increase in androgen or a decrease in estrogen

The opposite: an increase in estrogen and/or a decrease in androgens

Parapubertal gynecomastia must evoke a gonadotropic tumor

It is physiological and regresses spontaneously

The different etiologies are all endogenous

There are also many exogenous etiologies: alcohol, drug addiction, iatrogeny, etc.

An increase in hCG should be investigated for testicular choriocarcinoma


Which of these proposals can cause gynecomastia?

Inhibition of aromatization of androgens into estrogens

The genetic absence or decrease of estrogen receptors

Iatrogenic decrease in androgen receptor availability


What element(s) are included in the biological assessment of gynecomastia:

The assessment contains (according to the College of Endocrinology): hCG, estradiol, testoserone, LH, FSH, Prolactin, TSH, Liver enzyme, Ionogram and Creatitine


Adipomastia is a subcutaneous fat deposit next to the nipple

An increase in estrogen is a sign of Leydig cell tumor

An increase in estrogen may be a sign of a malignant adrenocortical carcinoma

A karyotype 47,XXY signs Klinefelter syndrome


The diagnosis of mononucleosis syndrome is clinical

The diagnosis of mononucleosis syndrome is made on the leukocyte formula of the blood count

The diagnosis is made on a blood count showing a proportion > 5% of mononuclear cells in the leukocyte population

Diagnosis is made on the blood count and the leukocyte formula: proportion > 50% of mononuclear cells in the leukocyte population; and proportion > 10% of activated lymphocytes (increased size, polymorphs, basophilic staining).

Mononucleosis syndrome shows intense activation of cellular immunity

T cells are activated by a virus, most often

The presence on physical examination of lymphadenopathy and/or angina should be sought on clinical examination.

TRUE. In EBV infection, fever and influenza-like syndrome are found with, on clinical examination, erythematous, erythematopultaceous or pseudomembranous angina, lymphadenopathy predominant in the cervical and posterior, splenomegaly and / or hepatomegaly (more rarely)

Other biological abnormalities can lead to a misdiagnosis of mononucleosis syndrome by the laboratory, especially in acute leukemia.

TRUE. Confusion between circulating blasts and activated T cells. In acute lymphoblastic leukemia, lymphocytes are immature and monomorphic.


An HIV infection is to be evoked systematically

TRUE. It's rarer than toxoplasmosis, CMV or EBV, but it's also much more serious.

Some drug hypersensitivity reactions (to sulfonamides, ß-lactams, certain anticonvulsants...) can result in a mononucleosis syndrome

A mononucleosis syndrome may accompany a DRESS syndrome (Drug Rash with hyperEosinophilia and Systemic Symptoms)

TRUE. Some drugs induce a viral reaction against certain viruses (present but asymptomatic), including EBV and CMV, causing severe toxiderma and containing a mononucleosic syndrome: this is the DRESS syndrome

The most common cause is primary infection with Epstein Barr virus.

TRUE. The Epstein Barr Virus (EBV) is the cause of infectious mononucleosis, or MNI. It is a DNA virus. The other two main causes are CMV infection (DNA virus too) and toxoplasmosis (intracellular parasitic zoonosis)

In the face of a mononucleosic syndrome, to look for primary EBV infection, a first-line serological search is carried out

First, a MNI-test is performed. This agglutination test is fast for diagnostic orientation, but not very sensitive.


Transmission occurs through contact with infected shedding

It is the leading cause of mononucleosis syndrome

This is the second cause. The first cause is NIM (infectious mononucleosis), caused by the EBV virus.

There is systematic screening for pregnancy

In pregnancy, seroconversion can be serious/fatal to the fetus


The virus has a tropism for B lymphocytes causing lymph node hyperplasia

The MNI-test has low specificity and high sensitivity

Low sensitivity. The College of Hematology does not mention its specificity


Regarding the ancillary causes of mononucleosis syndrome:

Rickettsiosis are parasites that can cause this syndrome

Hepatitis B and C viruses can cause this syndrome

SCA ST+ can be accompanied by this syndrome because of muscle soreness


Which of these virus proposals are not herpes viruses?


Which of these proposals are factors promoting primary post-infection reactivation?

For cutaneous tropism viruses such as HSV and VZV


Incubation of chickenpox is about 21 days

Scattered vesicles and pruritus with possible scratching lesions are then observed.


Herpes viruses are the second most common entity in infectious encephalitis

Herpes virus = first cause of infectious encephalitis

EBV is the most common cause of viral encephalitis.

HSV is responsible for about 33% of viral encephalitis

Primary HSV-1 infection is preferentially sexual

HSV-2 is more frequently responsible for encephality than HSV-1


Which area(s) is/are respected by chickenpox?

Only the extremities of the limbs are respected by chickenpox


In case of genital lesions due to HSV-2 concomitant with late pregnancy, caesarean section is recommended

Aciclovir is an inhibitor of HSV DNA polymerase

Aciclovir will be phosphated 3 times before use

The active metabolite is therefore aciclovir-triphosphate


Which pathology(s) is/are favored by HHV8?

The repository does not mention it in any case

Viral meningitis is clear fluid most often


Which elements of the blood count are greatly increased in case of infectious mononucleosis (EBV)?

These are the hyperbasophilic lymphocytes


How many viruses are there belonging to the group of Herpes Viruses?

VZV (varicella-zoster), CMV, EBV (mononucleosis), HSV1, HSV2, HHV6 (Castleman and Kaposi), HHV7, HHV8


Which of the following propositions about chickenpox are true?


The causative agent is herpes virus type 3 or VZV (Shingles and Chickenpox virus)

It is contagious until D + 2 of the beginning of the eruption

Until the appearance of crusts in practice

Transmission is possible through direct contact


There are several types of risk factors: * social, * psychological, * biological

The age of the individual has little impact on his or her likelihood of developing a psychiatric disorder

Some risk factors are more specifically related to the age of the individual

Any situation of social and family isolation is a risk factor for psychiatric disorder

Any stressful social environment is a risk factor for psychiatric disorder

Primary prevention does not exist in psychiatry

There are three types of prevention: * primary prevention is the set of acts aimed at reducing the risk of new cases appearing (incidence)


Mental health is an integral part of health

Mental health is defined by the College of Physicians as "a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his community"

The MDG does not make a definition. The latter comes from the WHO and is accurate

Psychiatric disorders are most often genetic in origin

Analytical epidemiology assesses the frequency and impact of psychiatric disorders

This is the role of descriptive epidemiology, while analytical epidemiology is concerned with the correlation and causal relationships between several variables (e.g. alcohol consumption and incidence of schizophrenia).

In France, about 3 million people suffer from a psychiatric disorder

In France, almost one in five people suffer from at least one psychiatric disorder, or 12 million people


On the impact of psychiatric pathologies:

The prevalence of psychiatric disorders in general practice is about 25%

Psychiatry pathologies are the 3rd most common disease, after cancer and cardiovascular diseases

Psychiatric disorders are a major cause of disability

Psychiatric disorders have no impact on mortality

The resulting socio-economic repercussions make it a major public health issue


Analytical epidemiology identifies vulnerability, risk and prevention factors

A genetic factor is defined as a characteristic regarding DNA material and may be heritable

Genetic and environmental factors are distinct and mutually exclusive

Genetic and environmental factors can interact

A risk factor (genetic and/or environmental) increases the likelihood of developing a disease

There are also genetic and/or environmental protective factors that decrease the likelihood of disease occurring.


According to the WHO: "Prevention is the set of measures aimed at avoiding or reducing the number and severity of diseases, accidents and disabilities"

Primary prevention is directly aimed at reducing prevalence

Primary prevention is the set of acts aimed at reducing the risk of new cases (= incidence and not prevalence, which can only be reduced by cure or time)

Primary prevention aims globally to improve the quality of life and living conditions of individuals

Primary prevention of psychiatric disorders, says WHO, should also aim to strengthen social integration

The objective of secondary prevention is to reduce the prevalence of a disease in a population


This is a critical period for psychic development

Harassment at work explains almost all possible psychiatric pathologies of adolescents

False for two reasons: we talk about school bullying at this age (except in special cases), and bullying is not the main risk factor for neurodevelopmental disorders (even if it is a very strong risk factor)


Which pathologies are more common in women?


Which pathologies are more common in men?


What are the real proposals regarding primary prevention?

It decreases morbidity and mortality directly

It increases the general quality of life of individuals

It is secondary prevention that aims to reduce the prevalence

It is part of general public health actions


Mental health is the absence of mental disorders

A much more complex definition given by the WHO and which boils down to the sufficient degree of adaptation to the social group

Mental health is "a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his or her community."

Only biological and social factors impact mental health

3 factors: biological, psychological and social

Psychiatric disorders affect 1 in 2 French people

12% of the population. 25% of consultations in general practice

Psychiatric disorders are the 8th type of disease in terms of prevalence


The committee for the protection of persons makes it possible to involve citizens in ethical reflection.

It is the National Consultative Ethics Committee (CCNE) whose one of its objectives is to involve citizens in ethical reflection.

Medical ethics is the "set of rules and duties that govern medical practice and individual relationships vis-à-vis the practice concerning their patients and colleagues"

The ethical principles in the medical field are: Primum non nocere, beneficence, patient autonomy and justice/equity.

It serves as a reference for criminal courts

It serves as a reference for the judicial bodies of doctors, the Order but first and foremost as a guide to doctors in their daily practice, at the service of patients. 23 iKB PUBLIC HEALTH 2.CODE OF MEDICAL ETHICS 2.1. HISTORY The Hippocratic Oath: from the Code of Ethics

The Hippocratic Oath has nothing to do with the Code of Ethics

Always used to take an oath of the Code of Ethics: 1st version


He is completely free to refuse to take medication if he does not want to. He cannot, however, oblige a doctor to prescribe a specific medicinal product.

It is free to require the prescription of originators instead of generics

He can ask. The doctor can accept if necessary. But he is in no way entitled to oblige the doctor

His freedom is reinforced by the doctor's duty to inform


Medical ethics is the "set of duties imposed on professionals in the exercise of their profession"

Deontology brings together the elements of a discourse on duties

Medical ethics concerns the doctor who exercises a profession in the strict sense of the term, to which French laws have given for nearly two centuries a monopoly in the field of health

The patient has the fundamental freedom to choose his or her physician and to accept or refuse care

Medical acts cannot be tried by a court because it does not have the jurisdiction to do so.

May be tried at the criminal, civil, administrative or disciplinary level


Drugs used to treat nociceptive pain are classified into three tiers by WHO

Co-analgesic drugs are contraindicated when administering true analgesic

Specific drugs for neuropathic pain as well as so-called "coanalgesic" drugs can be combined with analgesics at WHO levels

Non-drug therapies are useless in times of crisis and should be reserved for cold periods

Non-drug therapies, alone or as part of multimodal analgesia in combination with drug therapies, can reduce the intensity of acute or chronic pain

The benefit/risk balance should be evaluated before the administration of analgesic therapies, except in case of 10/10 pain.

Pain relief is a fundamental right of every person


The source of the pain will need to be treated before the pain itself is treated

There is no ethical or scientific rationale for using placebos, even though 30-70% of patients seem sensitive to them to varying degrees.

Optimal treatment results from a proprietary medication approach that relieves pain

Optimal treatment results from the combination of several approaches, both drug and non-drug, ideally coordinated by a multidisciplinary team

Non-therapeutic approaches have several interests, so that of limiting iatrogeny

It would allow an improvement in analgesia as well as a reduction in side effects via a decrease in the doses of each drug

The source of the pain will need to be treated concomitantly with the pain itself


The WHO established a 3-tiered conceptual model in 1986 to guide pain management.

Therapeutic pain management always begins at level 1 and then increases in step until it reaches the desired effectiveness

Not at all. We go directly to the most suitable level

NSAIDs are contraindicated postoperatively if clearance < 50 ml/min

The choice of level is based on the assessment of the intensity of the pain

Moderate pain assessed between 3 and 7 requires a level 3 analgesic

Moderate pain is 4 to 6/10 and requires a level 2


Puberty in girls begins with the appearance of the breast bud

The absence of breast development at the age of 13 makes it possible to define a pubertal delay

Primary amenorrhea at the age of 15 can define delayed puberty

Puberty includes accelerated growth rate


The gonadotropic axis is functional for the first time during puberty

This gonadotropic axis is functional during intrauterine life and for a few weeks after birth

"Mini puberty" is seen during the few weeks postpartum in infants

During childhood, the gonadotropic axis is inhibited

Puberty is the consequence of the pulsatile secretion of GnRH by pituitary neurons

GnRH is secreted by hypothalamic neurons

The gonadal steroid is estradiol in girls


The age of onset of puberty depends on genetic factors only

Also environmental factors, especially nutrition and energy expenditure

Obese children have puberty later than children in the general population

Excessive physical exertion or lack of sleep induces delayed puberty

In girls, the first sign of puberty is enlarged breasts

In boys, the first sign of puberty is increased muscle volume


Regarding the clinical signs of puberty:

Pubarche is the appearance of pubic hair

The stage S2 or appearance of the breast bud corresponds to the telarche

Stage S2 occurs on average at the age of 16

The vulva changes from the horizontal to the vertical position

It changes from the vertical position to the horizontal position, the labia minora develop, the clitoral volume increases


The onset of menstruation is the first stage of puberty

First breast development and then changes in the vulva

In France, the average age of menarche is 16.9 years

An irregularity of the cycles during the first 2 years after menarche should lead to explore the pathology

In boys, Tanner's stadiums range from G1 to G3

The development of testicular size begins on average around the age of 11.5 years


Testicular volume greater than 4 mL or height greater than 2.5 cm is in favour of early puberty

Normal adult testicular volume is greater than 35 mL

The onset of puberty coincides with the appearance of capitatum

The onset of puberty coincides with the appearance of the sesamoid of the thumb, on the bone age X-ray performed on the left wrist in right-handed people and vice versa.

At puberty, there is an acceleration of the growth rate from 5 mm/year to 9 mm/year

The peak of growth occurs in the girl around the age of 12


Regarding pubertal growth and precocious puberty:

Total pubertal growth averages 25 cm in boys

Final height is reached on average at 21 years in boys

There is during puberty a major increase in lean mass compared to fat mass, in girls

When breast development occurs before the age of 8 in girls, it is called precocious puberty

Precocious puberty affects 15% of boys today

It is rather rare: 0.2% of girls and 0.05% of boys


Regarding precocious puberty and advanced puberty:

Precocious puberty is 10 times more common in boys than in girls

Converse: it is 10 times more common in girls than in boys

Puberty is said to be advanced when it occurs between 8 and 10 years of age in girls

Advanced puberty is as pathological as precocious puberty

Precocious puberty is of central or hypothalamic-pituitary origin

Precocious puberty can be a "true" puberty of central or hypothalamic-pituitary origin or a "pseudo puberty" of peripheral origin, either of gonadal or adrenal origin

Precocious puberty is idiopathic in 90% of cases in girls, it is pathological in 66% of cases in boys


Which of these proposals are possible etiologies of precocious puberty?

Associated with café au lait spots and fibrous bone dysplasia. Resulting from a mutation in the GNAS gene"


The main impact of precocious puberty in the long term is the permanent small size

Pubertal delay should be evoked in boys in the absence of an increase in testicular volume at the age of 14 years

Pubertal delay can be congenital or acquired

A family investigation is necessary in case of pubertal delay

Pubertal delay is always of central origin

Pubertal delay can be of central or peripheral origin


Among these proposals, which are times of the announcement device?

The 4 times of an announcement consultation are, in order: the medical time, the time of caregiver accompaniment, the time of support care and the time of articulation with the city medicine


Which of these proposals belongs to level 3 analgesics?


Which of these proposals is(are) supportive care?


Which of these proposals concerning medical information are true?

And we must ensure that the patient has understood and integrated it by asking him to reformulate

The information must be verified with relatives before being delivered to the patient

Medical confidentiality contravenes this proposal


It is contraindicated except in end-of-life care

It is usually established at a dose of 10 mg / day

There is no maximum dose common to all patients

The dose-efficacy-tolerability relationship varies greatly from one patient to another. It is therefore important to frequently evaluate efficacy and tolerability, and to adapt the dosage gradually according to the patient's needs. There is no maximum dose, as long as adverse effects can be controlled.

The only effect of morphine is analgesic


It facilitates the use of active euthanasia

Absolutely not. Active euthanasia is illegal in France

It makes it possible to stop all treatments

We do not stop medications that have a positive effect on patient comfort

They are set up exclusively at the patient's home

Possible also in the hospital, or with relatives for example

No more "than elsewhere", pain management is still essential

The main goal is to improve the patient's comfort of life through better control of symptoms.


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

Lefort III corresponds to an abnormal mobility of the upper dental arch compared to the base of the skull

Lefort III corresponds to an abnormal mobility of the dental arch superior compared to the eyebrow arch

Lefort II corresponds to an abnormal mobility of the upper dental arch compared to the cheekbones

The most common fracture is the Lefort I

The most serious fracture is the Lefort II


Which of the following are innervated by the mandibular V3 portion of the trigeminal nerve?


Pyogen skin infections are mainly due to Staphylococcus aureus and Streptococcus pyogenes (also called ß-hemolytic group C streptococcus)

Impetigo is a contagious infection of the epidermis due to S.aures or S. pyogènes

Local treatment is most often sufficient in impetigo

Folliculitis and boils are infections of the pilosebaceous follicle

General antibiotic therapy is indicated in boils of the face because of the risk of malignant staphylococcal disease


The skin abscess is most often linked to S. pyogènes

The skin abscess is most often linked to S. aureus

The treatment of abscesses is essentially based on antibiotic therapy

Erysipelas is a necrotizing dermohypodermatitis mainly due to S. Aureus

Erysipelas is a non-necrotizing dermo-hypodermatitis mainly due to Streptococcus pyogenes


Superficial mycoses are frequent and benign infections of the epidermis and appendages due to fungi

The diagnosis of mycoses is essentially microbiological

In France, community Staphylococcus aureus are sensitive to methicillin in > 95% of cases and the reference antibiotic is penicillin M (cloxacillin)

Streptococcus pyogenes is 100% sensitive to penicillin and the reference antibiotic is amoxicillin

In case of allergy to ß-lactam in staphylococcal or streptococcal infections, pristinamycin or clindamycin is used.


Which of the following propositions are true for osteitis of the foot in diabetic patients?


Which of the following propositions are true about impetigo?

S. aureus and S. pyogenes are the two most common germs found in impetigos

Diagnosis requires bacteriological sampling before starting antibiotic therapy

Treatment of simple impetigo is based on doxycycline

True, and water rinse them. Daily washing with soap and water of the lesions is a measure to advise in all cases


Ecthyma is a common pathology of precariousness

Complications of ecthyma include post-strep throat and rheumatic fever

Control of proteinuria 3 weeks after the infectious episode is necessary

Folliculitis is inflammatory papulopustulous in nature


The boil is a deep but non-necrotizing infection of the pilosebaceous follicle

Handling of boils by the patient should be avoided

For boils, oral systemic antibiotic therapy if necessary should be active on S. Aureus

Panari is an elementary lesion of the erythematous, edematous and painful nail fold

Incision and drainage in case of purulent collection of a panari are necessary


Agranulocytosis can be toxic or infectious

There are two possible causes of agranulocytosis: either it is immunoallergic or it is toxic. Infections do not cause agranulocytosis, on the contrary, there is an increase in PNN as part of the immune response

True agranulocytosis is defined by a PNN threshold of less than 1 G/L

The threshold for true agranulocytosis is set at 0.2G/L. Deep neutropenia is defined at 0.5G/L

Neutropenia corresponds to ANCs less than 1 G/L

The threshold for neutropenia is set at 1.5 G/L

Agranulocytosis corresponds to a sharp and dangerous drop in the number of monocytes in the blood

Monocytosis (i.e. dendritic cells and macrophages) do not fit into the definitional framework of agranulocytosis. Agranulocytosis is defined by the fall of neutrophils (PNNs) in the blood

Agranulocytosis accounts for less than 3% of iatrogenic accidents


Agranulocytosis is objectivable by a hemogram

True agranulocytosis is observed when the PNN is less than 0.2 G/L. However, we can speak of agranulocytosis in case of PNN less than 0.5 G / L (which is the threshold for severe neutropenia, grade IV);  The risk of infection is then very important.

5% of deaths are observed even with optimal care

Toxic agranulocytosis most often affects a single cell line

This is the case of immunoallergic (iatrogenic) agranulocytosis. Toxic agranulocytosis often leads to pancytopenia

Toxic agranulocytosis is now less common than drug-induced agranulocytosis

Drug agranulocytosis is acute, brutal and has given the phenomenon its formidable reputation; But it has actually become a minority today, since the eviction of pyramidon and phenylbutazone derivatives.


Which of these proposals are causes of agranulocytosis?

Bone metastases that do not affect flat bones (sternum, hip bones and vertebrae) cannot have any impact on the bone marrow since there are no more in these bones. Vertebral metastases very rarely have spinal cord invasion.


At what threshold, in G/L, can we speak of severe neutropenia (i.e. agranulocytosis)?

It is from here that the risk of infection becomes extremely high.

This is the threshold of "true agranulocytosis"


From what threshold, in G / L, can we speak of true agranulocytosis?

Threshold for severe neutropenia (stage IV)


Which of these molecules are most likely to cause drug agranulocytosis?

The drugs most prone to drug agranulocytosis are: antipsychotics (especially clozapine), synthetic antithyroid drugs, allopurinol and colchicine, sulfonamide antibiotics (e.g. cotrimoxazole, aka bactrim) and anti-epileptic drugs.


Collagenosis = connective tissue. It is very common. It is one of the classic biological signs in lupus

Most often, agranulocytosis is accompanied by a fall in other blood lines

Indeed, agranulocytosis is most often toxic (vs immunoallergic) and is accompanied by thrombocytopenia and anemia.

In toxic agranulocytosis, the megakaryocytic lineage is respected

This type of agranulocytosis results in pancytopenia if left untreated. Initially, it is often accompanied by anemia and thrombocytopenia.

Drug agranulocytosis is peripheral agranulocytosis

Toxic agranulocytosis is central agranulocytosis


It is often chemotherapy that is involved. Indeed, these molecules inhibit cell division and therefore have an impact on all cell types that divide a lot. The bone marrow, which produces several billion red blood cells, platelets and immune cells every day, is therefore a target (often collateral and non-voluntary from a therapeutic point of view) of chemotherapy.

It is predictable: we know the impact that molecules will have before administering them.


It concerns classical drug agranulocytosis

It can take place when a drug is first introduced

An external gave us this sentence in the college: College of Hematology (2020 edition; page 122): "toxicity may be due to treatment over a period of several days (even if first introduction of the drug)". Warning: this sentence means that toxicity occurs after the first intake (because the cells must be sensitized a first time) but can occur during the first PERIOD of introduction (for example after ten days of treatment with amoxicillin) :) Good luck!!


Regarding myelogram and osteomedullary biopsy:

It is necessary for the diagnosis of toxic agranulocytosis

The blood count, knowledge of the drug and temporality are enough most of the time

It shows, in both types of agranulocytosis, a decrease in the richness of the marrow

It is not so painful but it causes a very unpleasant feeling of "aspiration"


In clinical practice, diarrhea, according to the WHO, is when there are at least 3 very soft to watery stools per day.

Chronic acute diarrhea is said to occur for more than a month

Diarrhea is said to be acute when it evolves for less than 2 weeks, prolonged when it evolves for 2 to 4 weeks, chronic when it evolves for more than a month

A polyexemption related to a dyschesic syndrome and / or a pelvic static disorder: • fecal incontinence; • False diarrhea of constipated are the three differential diagnoses to rule out

Nocturnal stools reflect the organic nature of diarrhea

It is important to look at weight, height, body mass index and weight loss kinetics when weight loss is lost


In front of any motor diarrhea it will be necessary to look for hyperthyroidism

Celiac disease is one of the most common causes of chronic diarrhea

Celiac disease is diagnosed in particular thanks to anticorsantigliadin and anti-endomysium

An antitransglutaminase and anti-endomysium

Functional chronic motor diarrhea is generally easily improved by slowing down transit

The appearance of moderate diarrhea without significant biological abnormality in an adult with no personal history of functional intestinal disorders should suggest, among other hypotheses, pancreatic cancer and/or carcinomosis.


In case of diarrhea on return from travel it is necessary to look for chronic parasitosis

During motor diarrhea, watery stools typically occur upon waking and post-prandial

The transit time of carmine red is accelerated during motor diarrhea

Malabsorption diarrhea can be responsible for deficiencies and weight loss despite preserved food intakes

The stools are distributed over the day, voluminous, sometimes visibly greasy in osmotic diarrhea

This is the case for diarrhoea due to malabsorption


Which of the following proposals should be avoided in the case of a gluten-free diet?


Among these organs, which are preferentially the site of metastases of kidney cancers?

The 5 locations to remember are: CNS, Liver, Lungs, Bones, Lymph nodes. The most affected lymph nodes are those of the renal hilum and those of the retroperitoneum. Also to remember: kidney tumors have an accentuated tropism for the two glands that are the adrenal glands and the prostate.


Which of these proposals designates a criterion of severity of hemoptysis?

A hemoglobin less than 11 g/dL in a woman who had a real period 1 week ago

The severity of hemoptysis is not at all in the loss of hemoglobin. It is very rare, impossible way for hemoptysis to cause hemodynamic instability of any kind. The main severity is asphyxiation.

It is often said that it is important at more than 250 mL


A rectal bleeding is bleeding from the rectum

True, sorry for the ease but we had to find a fifth proposal 😅

A hemoptysis is bleeding from the respiratory mucous membranes


Which of the following is the possible cause of death for haemoptysis?

Digestive obstruction by posterior passage of blood

Blood is expectorated during reflex coughing efforts most often


The main causes of hemoptysis are COPD and right heart failure

Bronchiectasis, bronchopulmonary cancers, tuberculosis, aspergillomas are the main causes of hemoptysis

The management of severe hemoptysis is multidisciplinary involving pulmonologists, resuscitators, radiologists but never thoracic surgeons

Sometimes, when the EAB does not work, surgical management is required

Bronchial artery embolization is central to the management of severe hemoptysis

Hemoptysis corresponds to bleeding, externalized or not, of the nasal mucosa

Hemoptysis corresponds to bleeding, externalized or not, from the subglottic airways

Hemoptysis reflects the existence of an abnormality in the bronchi

Hemoptysis indicates the existence of an abnormality that can sit on all floors of the respiratory system


Which of the following are the severity elements of hemoptysis?

Severity is judged on asphyxiation and not hemodynamic involvement (there is classically none. When there is, it is caused by asphyxiation)

It can go as far as death by asphyxiation


Which of the following are common causes of hemoptysis?

True, this is one of the criteria of the Geneva Score


Haemoptysis is to be distinguished from haematemesis and epistaxis, based on the clinic

A hemoptysis should always be considered an emergency

The management of severe hemoptysis is multidisciplinary involving pulmonologists, resuscitators, radiologists and sometimes thoracic surgeons

It reflects the existence of an abnormality that can sit on all floors of the respiratory system


Which of the following immunotherapies is conditioned by HER2 overexpression?

EGF-R inhibitor (especially colorectal cancer or lung tumours)

Direct anti-EGF. Used, according to Wikipedia, in colorectal cancer, lung, breast, kidney and ovarian cancers, and glioblastoma

Anti-PDL1 (melanoma, Hodgkin's disease and non–small cell lung tumours)

Anti-CTLA4 (melanoma and high-grade kidney tumour)


Breast cancer is the most common cancer in women

It is much rarer than in women but there are

Breast cancer is the second leading cause of cancer death in women

It is the leading cause of cancer death in women

Breast cancer can affect women at any age


What is the TNM stage of a 3-centimetre invasive ductal carcinoma with mobile axillary lymphadenopathy without metastatic extension?

True. Tumor > 2 and ≤ 5cm. Mobile homolateral axillary lymphadenopathy. No distant metastasis.


Which of the following are possible options for breast cancer extension assessment?

Chest X-ray + abdominal ultrasound + bone scintigraphy


Which of the following are true about the BRCA1 mutation?

The risk of transmission to offspring is about 25%

The risk of transmission to offspring is about 50%


Inflammatory carcinoma directly classifies the tumour into:

The T5 does not exist. It is T4d which is the maximum


Which of the following are expected toxicities during anthracycline treatment?


Which of the following are poor prognosis criteria?

It is a criterion of good prognosis because accessible to hormonal treatment

True, also called Elston and Ellis. Grade III is the maximum grade


You biopsy a macroscopic lesion of the right breast. Which of the following propositions should appear in the histopathological report?

Not wanted for breast cancer (but lung or colorectal tumours)

True, as well as the Ki67 proliferation index

The degree of expression of hormone receptors

True, prognostic and therapeutic goal (if positive, adjuvant hormone therapy will be prescribed)


Which of the following are histological and immunohistochemical criteria useful for better characterizing the tumor?

Proliferation index (percentage of cells expressing Ki67)


Among the following proposals, what are the essential steps before therapeutic management?

Discussion in Multidisciplinary Consultation Meeting

False. A request must be made for ALD, but it is the attending physician who makes the request

False. Discuss with patient. It is not essential.


Which of the following proposals are included in conventional adjuvant chemotherapy for breast cancer?

False. Taxanes are inhibitors of depolymerization


Which of the following are diagnoses to evoke in front of a non-painful binocular diplopia?

True, with isolated involvement of the abducens nerve (which innervates the lateral right).

True, with common oculomotor nerve involvement. Pain is very inconsistent in diabetics

True, with the features of myasthenia gravis (ptosis, increased at the end of the day, etc.)


Which of the following are causes of painful diplopia?


The common oculomotor nerve innervates the superior rectus muscle

True, it also innervates the inferior rectus muscle, the inferior oblique muscle, and the medial rectus muscle. It is the nerve that innervates the most muscle of oculomotricity. It also innervates the eyelid levator and ensures the parasympathetic innervation of the pupil

The abducens nerve innervates the medial rectus muscle

As its name suggests, it deals with the abduction of the eye. It therefore innervates the lateral right

The trochlear nerve innervates the superior oblique muscle

True. This is the only muscle it innervates

The common ocular motor nerve ensures parasympathetic innervation of the pupil

The trochlear nerve innervates the levator muscle of the eyelid

It is the oculomotor nerve that innervates the levator muscle of the eyelid


Which of the following are diagnoses to evoke in front of painful binocular diplopia?

True, the aneurysm can reach the common oculomotor nerve. The latter ensuring the parasympathetic innervation of the pupil, its involvement can cause mydriasis (intrinsic involvement)

True, it is the most common even if the pain is inconstant, as always in diabetics

There is no diplopia in CBH. There is ptosis, myosis, and enophthalmos. Normally, there is no pain either (unless combined with carotid dissection)

True, any focal neurological deficit must evoke a stroke


The medial rectus muscle is innervated by the third pair of cranial nerves

The lateral rectus muscle is innervated by the third pair of cranial nerves

The lateral right is the only oculomotor muscle to be innervated by the VI pair (abducens nerve)

The inferior oblique muscle is innervated by the third pair of cranial nerves

The superior oblique muscle is innervated by the fourth pair of cranial nerves

The superior rectus muscle is innervated by the fourth pair of cranial nerves

It is innervated by the common oculomotor nerve (third pair of cranial nerves)


Which of the following are causes of binocular diplopies?


Which of the following are causes of monocular diplopies?


Glomerular nephropathies are chronic diseases

There are acute and chronic glomerular nephropathies

Glomerular nephropathy is always the consequence of genetic diseases

Not always. They can be related to a metabolic, autoimmune, infectious disease, etc.

Kidney damage may or may not be isolated

Diagnosis of glomerular nephropathies is based on Magnetic Resonance Imaging

Diagnosis of glomerular nephropathy is based on identification of glomerular syndrome


A glomerular pathology is evoked in front of proteinuria and / or hematuria

The presence of hypertension or edema eliminates the diagnosis of glomerular syndrome

Three signs may be associated with hematuria and/or proteinuria: hypertension; Edema; renal impairment

In IgA nephropathy, there is no hematuria

The main symptom is recurrent macroscopic hematuria to which may be added microscopic hematuria

Nephrotic syndrome combines proteinuria greater than 3g per 24h and albuminemia less than 30 g / L

HIVAN is a nephropathy associated with the HIV virus


Among these proposals, which correspond to a glomerular syndrome:

Recurrent macroscopic hematuria syndrome

It is an abnormality of proximal renal tubular reabsorption


Measuring ANCA tests the diagnostic hypothesis of lupus

For lupus, anti-nuclear antibodies and native anti-DNA are measured

Antiplatelet agents should be discontinued in case of renal biopsy

Stop several days before the gesture: 5 days for aspirin and 10 days for clopidogrel

In case of hemostasis disorder, it is possible to perform a transjugular PBR

Anti-glomerular basement membrane antibodies (MBG) test the diagnostic hypothesis of Alport syndrome

These antibodies are an argument for Goodpasture's disease

PBR is indicated in most glomerular nephropathy syndromes

Except for children between 1 and 10 years with pure nephrotic syndrome, hereditary glomerulopathies already documented, etc. (cf item 258, 8th edition of the college p. 151)


Infectious causes such as HBV, HCV, syphilis, leprosy, filariasis


Regarding the histology of glomerular syndromes:

Deposits are found in glomerulonephritis of ANCA vasculitis

Sirius red colorartion allows you to see amyloid deposits

Red Congo, Sirius for hepatic regeneration nodules

There is cell proliferation and deposits in the LGM

Linear IgA deposits along MBG are found in Goodpasture disease

Accumulation of glycosylated extracellular matrix is found in diabetic nephropathy


The primary form is called Berger's disease, it is the most common glomerulonephritis in the world

IgA deposits can be secondary to diseases such as cirrhosis, IBD, spondyloartritis or bullous dermatosis

After liver transplantation, there is recurrence on the graft, without loss of the latter

High blood pressure is a factor in poor prognosis


Which of the following are prognostic factors for mesangial IgA glomerulonephritis?

The importance of glomerular sclerosis and interstitial fibrosis


Which of the following propositions regarding rapidly progressive glomerulonephritis (GNRP) are true?

They are usually characterized by severe endocapillary lesions

Immunofluorescence makes it possible to differentiate the 3 types of GNRP

True. Type 1: Goodpasture syndrome (IgG on MBG with linear deposition). Type 2: associated with deposits of IgG immunoglobulin complexes (rheumatoid purpura, LES, mixed cryoglobulinemia). Type 3: associated with vasculitis (Wegener and Polyangiitis) where ANCA is found

Goodpasture disease is linked to anti-PLA2R antibodies

This is the case of primary extramembranous glomerulonephritis (GEM)

Depositions are linear in immunofluorescence in GEM

This is the case in Goodpasture syndrome


Which of the following propositions about Goodpasture's syndrome are true?

The antibody is directed against the alpha 3 chain of collagen IV

Treatment is based on corticosteroids, plasma exchange and cyclophosphamide

Unfortunately, renal replacement often happens quickly

There is frequently a biological inflammatory syndrome


Which of the following proposals should be sought in the face of suspected glomerulonephritis?

True, glomerulonephritis with mesangial deposits of IgA

Responsible for tubulointerstitial nephritis, but not glomerular syndrome

True, cryoglobulinemia (GNRP type 2) may be complicated.

No glomerular involvement, rather vascular nephropathy, unlike ANCA vasculitis (Wegener and Polyangiitis) which can make GNRP type 3


Diagnosis of latent TB infection is based on the tuberculin RDI or interferon gamma test

Primary tuberculosis infection most often asymptomatic

Tuberculosis disease represents the clinical expression of infection, pulmonary or extrapulmonary

Pulmonary tuberculosis is the most common form

Extrapulmonary tuberculosis is highly contagious

Extrapulmonary tuberculosis is non-contagious


The dissemination of a tuberculosis miliary is by lymphoid route

Miliarius tuberculosis = blood-borne dissemination

2nd line anti-tuberculosis drugs: are to be reserved for multidrug-resistant tuberculosis

Multidrug-resistant forms are those resistant to isoniazid and spiramycin.

Multi-resistance = isoniazid resistance +


It is the 3rd leading cause of death from infectious disease in the world

ƒƒ in active tuberculosis, BK will have 3 phenotypes in 3 compartments: intracellular in macrophages, extracellular within the caseum, extracellular in caves

ƒƒ The cave is the main support for human-to-human transmission of BK through the air

Only 10% of individuals exposed to BK inoculum develop primary TB infection

Only 1/3 of individuals exposed to BK inoculum develop primary TB infection

HAART makes it possible to detect the emrgence of naturally resistant mutants crossed


Which of the following proposals are part of the tuberculosis complex?


To which organism(s) should TB infection be reported?

True, urgently, nominative declaration that will investigate the case and the entourage

Regional Pharmacovigilance Centre (CRPV)


Which of the following propositions are true about quantiferon?

The RDI is another immunological test. The other name for Quantiferon is the interferon gamma release test.

It is very specific to infection with the tuberclosis complex

True. 98% specificity for tuberculosis complex bacteria: M. tuberculosis, M. bovis and M. africanum

It signs a tuberculosis infection (including latent infection).

Positivity to this test does not give an indication of the recent or old nature of the infection

Positivity to this test is not influenced by BCG vaccination


Which of the following propositions are true about tuberculosis?

Tuberculosis is the third leading cause of death from infectious disease worldwide

The annual incidence in children under 15 years of age in France is about 250

The proportion of direct tests positive is identical in children and adults

Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.
Despite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease. Their positivity will require screening around the child.

In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease

The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination


Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.
Despite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease.


Which of the following are true for preventing transmission of TB during hospitalization?

Permanent wearing of a surgical mask by the patient in his room

Wearing an FFP2 mask by anyone entering the patient's room

In case of leaving the room, wearing a surgical mask by the patient

Removal of mask worn by staff before leaving the patient's room

Single room with negative pressure for the patient


Which of the following proposals designate countries that allow euthanasia?

Euthanasia is authorized in Switzerland, Holland, Belgium, Luxembourg and 3 American states


Which of the following corresponds to a Rudkin score of 4?

The patient does not respond to mild tactile stimulation and has his eyes closed

The patient responds to mild tactile stimulation and has his eyes closed

The patient has his eyes closed but answers the call


An experience described as unbearable does not justify sedation in itself

Induction of sedation in adults is medically indicated only

The procedure for making a decision on sedation is the sole responsibility of the attending physician

The sedation decision-making procedure is collegial

The method of sedation is based on ketamine

The method of sedation is based on midazolam IV 1mg

Sedation decreases alertness and can lead to loss of consciousness


Which of the following proposals designate countries that allow physician-assisted suicide?

Countries that allow euthanasia are also those that allow physician-assisted suicide: Switzerland, Luxembourg, Belgium, Holland and 3 American states


There are 2 forms: acute benign pancreatitis, called edematous, and acute necrotizing pancreatitis, potentially serious

The migration of a gallstone into the common bile duct or chronic and prolonged alcohol consumption, account for 80% of the causes

The clinical examination also looks for signs of severity, including visceral failure: polypnea, sign of extracellular dehydration, blood pressure instability and tachycardia, disorientation

Determination of pancreatic enzymes in the blood The determination of amylase should be preferred

Determination of pancreatic enzymes in the blood The determination of lipase should be preferred (better sensitivity and specificity), with a threshold of 3 N; that of amylasemia must be abandoned

The elevation of lipasemia is early, sometimes fleeting, reaching a maximum in 4 to 8 hours

The elevation of lipasemia is early, sometimes fleeting, reaching a maximum in 24 to 48 hours


The incidence of acute pancreatitis is higher in men than in women

True, 30 per 100,000 in men vs. 20 per 100,000 in women

There are two forms to distinguish in acute pancreatitis (AP): edematous and necrotizing

To establish with certainty the diagnosis of acute pancreatitis, imaging is necessary

False, the diagnosis of certainty is made by the combination of typical abdominal pain and lipasemia > 3N

The Balthazar score is predictive of mortality and is based on a CT scan comprising a sequence with contrast injection

True, the CT scan is performed at best 48 to 72 hours after the onset of symptoms. Contrast medium injection assesses pancreatic necrosis


Organ failure is defined as cardiovascular shock, renal failure, Glasgow score < 13, thrombocytopenia < 80,000/mm3 or gastrointestinal bleeding

Necrosis is defined by the presence of gangrenous pancreatic tissue

Necrosis is defined by the presence of invasive pancreatic tissue

The diagnosis of necrosis is established by the presence of focal or diffuse areas that do not take the contrast at the arterial time of a CT scan with injection of contrast medium

Hemorrhagic lesions in the pancreas or surrounding tissues are possible

Pseudocysts • A pseudocyst is a collection of pancreatic fluid, circumscribed by a wall, without epithelium