Regarding the central and peripheral origins:

In pyramidal syndrome, the lesion may be in the cerebral hemisphere, brain stem or spinal cord

Lumbar spinal cord involvement is peripheral involvement

Central involvement is characterized by the presence of an extrapyramidal syndrome

The central involvement is characterized by the presence of a pyramidal syndrome: the motor deficit predominates on the extensor muscles of the upper limbs (radial, interosseous) and the shortening muscles of the lower limbs (psoas, anterior hamstring)

A spastic deficit is always of peripheral origin

Remember A spastic deficit is always of central origin

A flaccid deficit is always of peripheral origin


Regarding the neurological semiology of motor deficits:

The RCP is in flexion in pyramidal syndrome

It is the only syndrome where it is in extension = Babinski's sign

Hemiplegia reflects damage to the central nervous system above the cervical cord (included)

Alternate motor syndrome is the combination of hemiparesis or hemiplegia and contralateral involvement of a motor cranial nerve (III, VII, XII)

Tetraplegia reflects damage to the thoracic or lumbar spinal cord

It reflects damage to the upper cervical spinal cord or brain stem

Paraplegia reflects damage to the motor cortex

It reflects low, thoracic or terminal cone cervical involvement, the spinal cord ending at the L1-L2 level


When the lesion is small and/or spares sensory structures, the motor deficit can be isolated

Peripheral neurogenic syndrome is characterized by impairment of voluntary and reflex motor skills

Spontaneous fasciculations may be observed upon inspection in peripheral neurogenic syndrome

There is no amyotrophy in perpipheric neurogenic syndrome

Abolition of osteotendinous reflexes and Amyotrophy of affected muscles when motor deficit is prolonged

There are three main types of diffuse neuropathies depending on the mode of installation


Acute polyradiculoneuritis has unilateral involvement

Acute polyradiculoneuritis has symmetrical involvement

Acute polyradiculoneuritis is exclusively proximal

Multiple mononeuropathies are multiple truncal disorders

Focal neuropathies are related to the involvement of a root, plexus or trunk responding to a precise systematization


Concerning motor and sensory impairments:

Myogenic syndrome is characterized by a motor deficit of varied topography

Myogenic syndrome affects the distal muscles

In case of complete transverse involvement of the spinal cord, in addition to motor deficit (tetra or paraplegia), there is a sensory level with a lesional and sublesional syndrome

Hemi-marrow syndrome (Brown-Séquard syndrome) has a very high localizing value

Plexic involvement corresponds to the involvement of a single dermatome

The sensory territory corresponds to the involvement of several dermatomes


Sialitis is an inflammation of the salivary glands

Sialitis can have an infectious component


Difficult to formally diagnose a tumor, except by histological examination

An isolated non-inflammatory swelling evokes a tumor in first line

Tumours of the main salivary glands sometimes appear for several years

Differential diagnoses are numerous and must be eliminated

They are relatively rare (mastoiditis, transverse apopysis of the atlas, etc.)

The most common parotid tumors are pleomorphic adenomas


Treatment of pleomorphic adenoma is surgical

Post-surgery monitoring of pleomorphic adenoma is unnecessary

Prolonged because it exsites a small risk of cancerization

Malignant tumors account for 50% of tumors

In children, almost 50% of parotid tumors are malignant


Treatment is started as soon as the hromonal assays have validated the diagnosis.

Treatment is urgent even without diagnostic certainty. Hormonal assays can be carried out secondarily.

Hemoconcentration is found in primary adrenal insufficiency

Hyponatremia is specific for primary adrenal insufficiency

No, but hyperkalemia yes, due to aldosterone deficiency

Metabolic acidode is found in blood gases


Regarding the symptoms of acute adrenal insufficiency:

Extracellular dehydration is often marked

These include a skin fold and hypotension up to collapse

Hypernatremia can lead to confusion and seizures

It is hyponatremia and hypoglycemia that have these effects.

The presence of fever eliminates the diagnosis of adrenal insufficiency

Fever may be present, it may be part of an infection that has precipitated decompensation

Associated urinary disorders confirm the picture


Regarding the diagnosis of acute adrenal insufficiency:

It is biological (determination of cortisol and ATCH). In children, renin is additionally dosed.

Known chronic adrenal insufficiency renders hormone testing unnecessary

Hormonal dosages are of no interest if adrenal insufficiency is known

Cortisolemia collapsed in acute adrenal insufficiency

ACTH collapsed in primary adrenal insufficiency

It is greatly increased in primary adrenal insufficiency

Complete adrenal enzyme block (21-hydroxylase) is an etiology of acute adrenal insufficiency


Regarding the management of acute adrenal insufficiency:

The patient is transferred to emergency or intensive care

At the patient's home, 100mg of hydrocortisone is injected

In IV or IM. failing that, in SC. A patient with known adrenal insufficiency should have at least two packs of Hydrocortisone 100 mg with him and know how to make an SC injection of hydrocortisone in case of Emergency.

In hospitals, dehydration is compensated by filling with 0.9% NaCl

Hydroelectrolyte disorders are compensated by the administration of potassium and bicarbonates

No potassium supplementation, because hyperkalemia (+++)

Maintenance therapy is 100 mg per 24 hours as an IV infusion


Regarding adrenal insufficiency, which propositions are true?

Melanoderma is specific for secondary adrenal insufficiency.

Melanoderma (due to excess ACTH) is specific for primary adrenal insufficiency, it is a clinical element that can help guide the diagnosis

In children, the treatment of adrenal insufficiency can not correct the signs of hyperandrogenism in the long term, in case of deficiency of 21 hydroxylase

The absence of signs of long-term hyperandrogenism is one of the objectives of treatment in case of 21 hydroxylase deficiency

In the biological follow-up of the treatment of chronic adrenal insufficiency in children, it is recommended to measure cortisol and plasma ACTH

In the case of acute adrenal insufficiency in a newborn or infant, persistent cholestatic jaundice may be found.

Hypoglycemia, hypotonia, convulsions, low blood pressure and persistent cholestatic jaundice

Acute adrenal insufficiency can be triggered in older children by abruptly discontinuation of long-term, high-dose inhaled corticosteroid therapy.

Abrupt cessation of corticosteroid treatment p.o., inhaled (high-dose and prolonged Fluticosone) or topically applied (large area)


Which of the following are etiologies of false syphilitic serology?


Which of the following are true about Chlamydia trachomatis?

It is the leading cause of bacterial STIs in Europe

The incidence is more common between 15 and 34 years of age in women

The gram is negative, like many bacillus (except Clostidioides, Listeria and Tropheryma)

Carriage is never asymptomatic in humans


Which of the following is the first-line treatment for N. gonorrhoeae?

True, indeed, it is Ceftriaxone in IM monodose of 500 mg


CAPG is defined as progressive optic neuropathy

It is the widely predominant clinical form of all glaucoma in Western countries.

CAPG mainly affects the population over 40 years of age

It is the second leading cause of blindness in Western countries (after AMD) and the leading cause of irreversible blindness worldwide.

CAPG has several risk factors such as age or ethnicity


Ocular hypertonia is not a known risk factor

ocular hypertonia: increased intraocular pressure (IOP) beyond two standard deviations is a risk factor

Ocular hypertonia is a known cause of CAPG

Direct family history confers a 3-fold higher risk of developing CAPM for offspring

No genes predisposing to CAPG were found

Genes have been identified but their research has no clinical application at the moment


Melanoderma patients have a 3-fold higher risk of developing CAPM

Myopia regardless of its intensity multiplies by three the risk of developing a CAPM

Cardiovascular and metabolic diseases are not proven risk factors

Other risk factors such as diabetes, cardiovascular diseases are described but much less well supported than those retained above

The pathophysiology of CAPM is part of neurodegenerative diseases

There are about 1 million ganglion cells in each eye


After 40 years, the simple fact of aging leads to the loss of about 8000 ganglion cells per year

CAPG is the sudden and fleeting loss of retinal cells whose impact is spread over time

CAPM is actually the accelerated loss of these optical fibers compared to age-related physiological loss.

An open angle is observed in gonioscopy (visibility of the pigmented trabeculum of more than 180 °)

Visual acuity drops steadily and aggravates myopia already often present

Visual acuity is not affected, except in the late stages of the disease or in case of other associated eye pathology (cataract, age-related macular degeneration)

It accounts for about 70% of CAPM cases in Western populations.


It is characterized by progressive optic neuropathy with structural and/or functional abnormalities

Increased papillary excavation accompanies loss of the neuroretinal ring

An asymmetry of this ratio greater than 0.2 between the two eyes is suspicious of glaucoma

OCT can calculate areas and volumes at a resolution of about 5 microns

It is useful for the positive diagnosis and differential diagnosis of CAPM as well as for the evaluation of the follow-up and effectiveness of the treatments put in place.


Central visual acuity is affected very late

The key examination is the visual field performed today with automated static perimetry (PSA)

The PSA takes about 30 minutes per eye and is performed by an orthoptist

This exam, which today takes about 5 minutes per eye, requires good cooperation and understanding of the test.

The alteration of the visual field is mainly marked by the appearance of scotomas

The usual form of CAPM occurs untreated with IOP greater than 21 mmHg


Normal pressure CAPM accounts for approximately 70% of CAPM cases in Asian populations

Alterations in structure and function are substantially the same as high-pressure CAPM

Unlike the classic form of CAPG, normal IOP CAPM occurs untreated with IOP less than or equal to 21 mmHg

CAPG is a risk factor for retinal vein occlusions

Ocular hypertonia is defined as IOP greater than 15 mmHg

Ocular hypertonia It is defined as IOP greater than 21 mmHg, an open angle in gonioscopy and the absence of optic neuropathy


Diffuse interstitial lung disease (PID) brings together many entities whose common point is to give diffuse infiltrative opacities on the chest X-ray

Acute IRS is dominated by infectious and hemodynamic causes

Bronchoalveolar lavage is the key examination during acute febrile PID

Cardiology is essential during acute febrile IRS

Cardiology is essential during acute non-febrile IRS

Sub-acute or chronic PID are dominated by sarcoidosis, idiopathic pulmonary fibrosis and pulmonary fibrosis associated with connective tissue


Clinical presentation and EFRs of IRS are indiscriminate

Chest CT is the cornerstone of the etiological orientation of sub-acute or chronic IRS

PIDs have in common to chest imaging DIFFUSE, non-systematized, bilateral and symmetrical parenchymal opacities

The diagnostic approach and management are fundamentally different, depending on whether you are dealing with acute PID or sub-acute or chronic PID (PID-SC)

The LBA is very effective for the diagnosis of infections and allows diagnostic guidance in other cases


The analysis of the predominant lesions, their topography and associated lesions makes it possible to define radiological profiles (patterns) which each have an etiological orientation value.

The diagnostic approach uses histology very frequently

Histology is used in less than 10% of IRS

The complexity of the reasoning in the face of IRS justifies that the vast majority of cases are the subject of a multidisciplinary discussion

1 Idiopathic pulmonary fibrosis (IPF) The most common IRS of unknown cause after sarcoidosis

Hypersensitivity pneumonitis rare in smokers


Regarding the main generalities on osteoarthritis:

It mainly affects the spine, knees, hips and hands

It is a disease of all joint tissues affecting primarily articular cartilage, but also the synovial membrane and subchondral bone

When it becomes symptomatic, it causes mechanical pain and functional disability

It affects about 1% of the French population

Excess cardiovascular mortality is observed in gonarthrosic patients


Chondrocytes are in charge of the production and degradation of the extracellular matrix of cartilage

The extracellular matrix is composed of more than 10% water

This matrix is composed of more than 80% water and a network of collagen and proteoglycans, strongly hydrophilic

The interactions between bone and cartilage are very important and allow the passage of nutrients and different mediators

The inner surface of the joint capsule is lined with the synovial membrane responsible for the production of synovial fluid

Cancellous bone provides nutrients for articular cartilage

It is the synovial membrane that takes care of it


The pain is due to inflammation of the cartilage

Pain is a poorly understood phenomenon in osteoarthritis and complex since cartilage is not innervated. It is rather a suffering of the subchondral bone that is responsible for the pain

Coxarthrosis refers to gonalgia due to osteoarthritis

Functional limitation is the most common reason for consultation

The most specific localization of coxarthrosis pain is in the groin crease

Mechanical knee pain is very specific to gonarthrosis

Careful! The pain of coxarthrosis can be said to be "projected" in front of the knee, which can be misleading


Which of the following proposals could correspond to an installed coxarthrosis?

Is rather seen in the after-effects of stroke (stiffness of the knee, hypertonia of the quadriceps / triceps sural which gives an attitude of the foot in varus)

Rather seen in Charcot-Marie-Tooth or in peripheral neurological disorders, where there is a defect in dorsiflexion of the foot


Concerning cognitive disorders in the elderly

The most common cause of dementia is Alzheimer's disease

Demeance includes deterioration in cognition

In the predemential phase of Alzheimer's disease the most common clinical sign is forgetfulness


The histological stigmas of Alzheimer's disease are


The minimum balance sheet of a demence shall include


Carriage of homozygosity for apolipoprotein E ε4 allele is a risk factor for Alzheimer's disease

abnormal accumulation of β-amyloid proteins (Aβ-42) in extracellular clusters characterizes Alzheimer's disease

Low level of education protects against Alzheimer's disease

Analysis of cerebrospinal fluid found during Alzheimer's disease finds a massive decrease in AB42 and an increase in TAU-p

The diagnosis of certainty of Alzheimer's disease is based on neuropathology (post mortem)


Which of the following proposals are mandatory and systematic in the first instance?

Biology: NFS, CRP, TSH, ionogram, Blood glucose, Calcemia

Not recommended. The recommended serologies according to the context are: HIV, Syphilis, B9 and B12

Brain MRI with sections passing through the axis of the hippocampuses

False, on the other hand this is the case of typical Parkinson's disease


Which of the following proposals can be found in Alzheimer's disease?

Visuopraxic disorder with errors when copying the MMSE figure

Delayed recall disruption during the 5-word test, normalized by indication

There is no problem of restitution or access to information in Alzheimer's disease

Delayed recall disruption during the 5-word test, little improved by cueing

Difficulty with motor sequences during the BREF (Fast Battery of Frontal Efficiency)

As its name suggests, it would be found in frontal syndromes


A neurological deficit is the loss of function related to a temporary dysfunction (transient deficit) or lesional (permanent deficit) of a region of the nervous system

A recent neurological deficit (less than 1 month) is a common reason for emergency room and neurology visits

A recent neurological deficit most often indicates an attack of the central nervous system but can also be caused by an attack of the peripheral nervous system, the neuromuscular or muscular junction

A recent neurological deficit is a sign of entry into a chronic disease and is therefore never urgent.

A recent neurological deficit may be a sign of a serious neurological problem requiring specific and urgent treatment, but may also be a mode of entry into a chronic neurological disease.

Any recent neurological deficit of sudden onset should lead to suspicion of a stroke


In the case of central nervous system involvement, the lesion is located on the roots, plexuses, nerve trunks, neuromuscular junction or muscles

Damage to the peripheral nervous system is evoked in front of the involvement of a hemibody (motor or sensory)

Damage to the central nervous system is evoked in the face of such an attack

The homonymous lateral hemianopsia is a sign of involvement of the frontal cortex

Homonymous lateral hemianopsia is a sign of retrochiasmatic involvement

The sign of Babinski is an interesting sign the spinal cord

Babinski's sign = pyramid sign = central involvement

Damage to the peripheral nervous system is evoked in front of fasciculations


Concerning etiologies and differential diagnoses:

Involvement of the neuromuscular or muscular junction is evoked in front of pure motor impairment

The clinical analysis must make it possible to define the syndrome

There is no non-neurological differential diagnosis of recent neurological deficit

Metabolic, psychiatry, orthopedics, etc.

A cuff rupture can mimic a recent neurological deficit

Speech disorders always have a neurological origin

For speech, balance and vision disorders, the cause may be non-neurological, of local origin: ENT


A deficit can have a psychogenic origin, it is then a conversion disorder

It is then a somatomorphic disorder: motor or sensory territory a little "aberrant", non-anatomical, with discordance of the clinical examination, changing complaints, "beautiful indifference"... Somatoform disorders can be part of different contexts: hysterical (conversion), simulation, depressive syndrome...

The mode of installation of the deficit is a major element of diagnostic orientation

The study of the anamnesis must be particularly careful

Age The older the patient, the more frequent the vascular causes

Complementary neurological examinations are guided by topographic diagnosis


What is the corrected QT threshold to suspect long QT syndrome?


EBV is an important risk factor for cavum cancer

Unilateral earache can sometimes be the only symptom of VADS cancer

HPV is a very important risk factor for oropharyngeal tumors

HPV-induced oropharyngeal tumors are favored by sex

The most common histological type of sinus tumours is undifferentiated carcinoma

This is the case of the cavum. For the nasal cavity and sinuses, we mainly find adenocarcinomas


Cervical radiation therapy can induce hypothyroidism

MRI is mainly indicated in the assessment of extension of tumors under the hyoid bone

Above the hyoid bone (oral cavity, cavum, sinuses, nasal cavity, oropharynx): MRI. Below: Scan

The CT scan is mainly indicated in the assessment of extension of tumors above the hyoid bone

Above the hyoid bone: MRI. Below (larynx, hypopharynx): CT scan

The localization of VADS tumors is often bilateral

Often almost exclusively unilateral. The accompanying symptoms are therefore also unilateral.


Which of these specialties are absolutely necessary for the holding of a CPR?

Three specialties: surgery, oncology, and radiology


The cavum is the new name for the oropharynx

The cavum is the new name for the nasopharynx (or nasopharynx)

It is specifically promoted by HPV infection

Examination of the ear can find unilateral seromucosal otitis


Which of the following is the most common histological type of ethmoid tumor?

Common in tumors of the oral cavity, oropharynx, larynx and hypopharynx

True, common in nasal cavity and sinus tumors

It is not a histological type but a stage T

Adenocarcinoma is the most common hystrophological type of ethmoid tumors.


Regarding the epidemiology of VADS tumors, which proposals are true?

The peak frequency is between 60 and 70 years.

The peak frequency is between 60 and 70 years (except HPV-related oropharyngeal cancers)

They are often associated with a low socio-economic level.

They are most often located at the level of the cavum.

False, cavum in < 1% of cases. Most often in the larynx (35%).

There is currently a decrease in the incidence of these tumours in humans.

There is currently a decrease in the incidence in humans of these tumors due to the decrease in alcohol and tobacco intoxication.


Regarding the cancer risk factors of VADS, which proposals are accurate?

Not CMV but EBV for cavum cancer and HPV for oropharynx.

Exposure to wood dust (possible recognition as an occupational disease)


Ethmoid cancers are frequently associated with EBV.

False, these are nasopharyngeal cancers.

Cavum cancers are usually squamous cell carcinoma.

False, they are most often UCNT type (undifferenciated carcinoma of nasopharyngeal type)

Alcohol and tobacco are the most common risk factors for head and neck cancers.

Adenocarcinoma of the ethmoid is considered an occupational disease.

Ethmoid adenocarcinoma is considered an occupational disease (occupational exposure to wood dust)

VADS cancers are the 5th most common cancer in France.


What is the annual incidence of childhood cancer in France?


What is the approximate cure rate for childhood and adolescent tumors?


Have very slow and pauci-symptomatic growth

They are indeed pauci-symptomatic, but their growth is very fast (in general, much more than adult tumors)

Except in some leukemias, there is a general condition fairly well preserved

Result in disparate and non-specific clinical signs


Which of the following are elements of Claude Bernard Horner syndrome?

False, this does not fit into the definition of CBH

It is a myosis of the affected eye that falls within the definition of CBH

The CBH includes: ptosis, myosis and enophtalmos, all on the same side


Which of the following are true about Lactate Dehydrogenase?

It is often used as a marker of tissue damage

It catalyzes the conversion of pyruvate to lactate

LDH are enzymes found in a wide variety of organisms, both plant and animal.

It is abundant in red blood cells and can therefore be used to guide hemolysis


Lameness corresponds to an asymmetrical approach

Additional examinations will be requested based on the data collected by the clinic

The age of the child is the determining factor that points towards one pathology rather than another.

In view of the emergency that is not vital, we start by questioning the patient

Episodes of fever strongly point to an infectious phenomenon


Regarding interrogation and clinical examination:

The precise origin of the lameness is difficult to trace in small children

The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the physiological hip

The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the pathological hip

A skin lesion points to endocrine pathology

The tibial diaphysis is palpated with particular attention to detect a possible fracture of the acetabulum


In hip diseases, adduction and external rotation are impossible

In hip disease, abduction and internal rotation are limited

The neurological examination looks for an equine walk, tests muscle tone, muscle strength, osteotendinous reflections

Refusal to sit is sometimes the only objective sign

The disease area is more easily identifiable in small children than in adolescents

Hip pathologies are often responsible for projected heel pain


Biological examination is systematic in search of an inflammatory syndrome

The best test to identify a joint effusion is the x-ray at the hip

It is the ultrasound that best visualizes a joint effusion at the hip or ankle

Ultrasound can objectify an effusion of soft parts

Comparative images are only justified in case of doubt about an image of osteolysis, or edema of the soft parts

MRI is indicated as a first-line test when the suspicion of ligament rupture is moderate to strong


An infectious assessment is essential in case of suspicion of osteoarticular infection

The puncture for bacteriological research is urgent in case of doubt about osteoarticular infection

Lameness in a febrile context is suspected of tendon rupture in the first place

Ë Lameness in a febrile context is due to an osteoarticular infection until proven otherwise

Bacteriological samples must be taken under general anesthesia, as a matter of urgency


An osteochondritis of the hip is febrile and concerns the child between 8 and 10 years

Non-febrile and between 3 and 8 years old

Infantile cerebral hemiplegia can occur at any age in childhood

Congenital hip dislocation is very common before 3 years of age

Transient acute synovitis is very febrile at peak


Lameness in a febrile context is due to an osteoarticular infection until proven otherwise

Initial antibiotic therapy is urgent, intravenous and adapted to the susceptibility test


Zoonoses are infectious diseases transmitted to humans, either directly by an animal or indirectly via vectors.

In metropolitan France, the most frequent zoonoses are Lyme borreliosis, pasteurellosis, toxoplasmosis and cat's scratch disease.

Brucellosis has been controlled and is currently almost non-existent in France

See item in the latest edition of the college

Slow incubation is characteristic of pasteurellosis

It is the speed of incubation is characteristic of pasteurellosis

In 10% of cases of pasteurellosis, an ophthalmic form combining conjunctivitis and pretrageal lymphadenopathy is described, mainly in children


The cat flea is the vector of cat scratch disease

In humans, from the inoculation lesion, the bacterium will multiply in a relay ganglion

Lymphadenopathy is a sign of an inflammatory reaction with caseous granuloma

This lymphadenopathy is the site of an inflammatory reaction with epithelioid granuloma without caseous necrosis

This disease is more common in children and young adults, with an incubation of 2-3 days on average.

In half of the cases, there is a primary papular erythematous lesion located in the lymphatic drainage territory of the skin lesion


Man is mainly stung during walks in fortê

From the inoculation point, the bacterium migrates and multiplies in the dermis (erythema migrans)

In a second step, it can spread through the blood and reach the central and peripheral nervous system, meninges and large joints.

A large proportion of infections are inapparent, leaving the only trace of their occurrence being the detection of specific antibodies

The vast majority of diagnoses are made in the tertiary phase of the disease

The vast majority of diagnoses are made in the primary phase of the disease


Humans are contaminated either by the digestive tract (consumption of raw milk) or by inhalation (inhalation of aerosols from elements contaminated by the bacteria: straw, manure, etc.)

Ticks can eventually transmit the bacteria

It is an exclusive disease of the Mediterranean basin and the Caribbean, more common in rural areas

It is a cosmopolitan disease, more common in rural areas

About 95% of infections will remain asymptomatic

About 60% of infections will remain asymptomatic

It is the fever Q eagle that is by far the most common clinical form of the disease


Which of the following are directly transmitted 🐩➡👩 pathologies?


Which of the following are vector-borne pathologies?


Which of the following are possible heart effects of Lyme disease?


Which of the following propositions are true regarding rabies 🐕 🦺?

True. Lyssaviruses are a genus of viruses in the family Rhabdoviridae, order Mononegavirales, which includes rabies virus and related viruses. In 2017, this genus has at least 14 members, the first known serotype of which is the rabies virus or RABV for RABies Virus, responsible for human rabies.

Wound management involves washing with soap, antiseptic and trimming

Vaccination should be carried out urgently if the patient is no longer immunized 🚨


Which of the following are signs or symptoms of congenital toxoplasmosis in a newborn?

Rather prematurity so a low birth weight


Which of the following are true about the Zika virus?


A zoonosis is a disease that can be transmitted from animals to humans

Brucellosis is transmitted by only one vector

Erythema migrans is found in Lyme disease


Which of the following are encapsulated bacteria?

The 3 to remember are: Haemophilus, Neisseria, Streptococcus


Constipation is a symptom that corresponds to a dissatisfaction of the patient during defecation

The chronic nature of constipation is defined by a duration of symptom evolution greater than 6 weeks

According to international criteria (Rome criteria), the chronic nature of constipation is defined as a duration of symptom evolution greater than 6 months

In drug addicts and especially morphine addicts, constipation is almost constant

Hyperactivity corresponds to an increase in segmental contractions in the sigmoid region, which slow down the progression of materials


The elements that point to distal constipation are:

This is the case for transit constipation

Sensation of a gene at the passage of stool or incomplete evacuation


Daily fibre intake should be greater than 5 g/d

Recent constipation or worsening of chronic constipation should investigate an organic cause

Osmotic laxatives are the first-line treatment for any constipation

In case of transit conservation, rectal laxatives are often necessary

This is the case for distal constipation

Certain medications can cause constipation such as anti-depressants and opiates


What is the antidote to paracetamol poisoning?


What is the antidote to benzodiazepine poisoning?


Which of the following are systematic additional examinations in case of suspicion of acute intoxication?


Which of the following proposals are providers of serotonin syndrome?

Antidepressants that inhibit serotonin reuptake


Which of the following proposals are providers of sympathomimetic syndrome?


Which of the following are the providers of anticholinergic syndrome?


Poisoning is the leading cause of hospital admission for adults under 30 years of age

True, this is exactly what is written in the college of anesthesia-resuscitation (2018 edition, page 365)

CO2 poisoning accounts for 4,000 to 8,000 victims each year in France

False, it is at the CO (note that it is written 4000 in the college of resuscitation, and 8000 in the college of emergencies)

The incidence of poisoning is drastically decreasing

The most frequent etiology is represented by voluntary intoxication with psychotropic drugs.

True, exactly the sentence of the Emergency Medline


Hypereosinophilia is defined as an absolute number of eosinophilic polynuclear > 5 G/L, confirmed on a second sample

Hypereosinophilia is defined by an absolute number of eosinophilic polynuclear > 0.5 G / L, confirmed on a second sample

The main causes of eosinophilia are, in order of frequency: allergic, infectious (parasitic), more rarely neoplastic (hematological malignancy, cancer) or related to a systemic disease

Major eosinophilia, whatever the cause, can have harmful consequences on the functioning of different organs and in particular the heart

TRUE. Activated NEPs release mediators (ationic proteins, toxic oxygen metabolites), toxic to certain organs, including the heart

A careful interrogation must seek in particular the possibility of giardosis

Among parasitosis, only helminthoses cause eosinophilia

It is most often a helminthosis, but other parasites may be involved


Hypereosinophil is found in some hemopathies

Mainly Hodgkin's disease, T-cell lymphomas, especially cutaneous, or myeloproliferative syndromes

The interrogation will have to look in particular for elements towards a parasitic attack such as the consumption of undercooked meat or a stay in a tropical zone

In case of eosinophilia with signs of severity, the patient must be put under emergency outpatient treatment

The patient must be hospitalized urgently with a specialized opinion

The introduction of new medicinal products and the taking of medicinal products must be sought at the interrogation

The imputability of a drug in the development of EO is difficult to prove, proof is sometimes provided only with the slow and gradual disappearance of HE after eviction of the drug

Hypereosinophilia> 1 G/L for >3 months are signs of severity

Hypereosinophilia> 1.5 G/L for >6 months


The first-line assessment of an asymptomatic patient who has stayed in the tropics will be completed by

The IgE assay is not in 1st intention but after the antiparasitic treatment of test of a chronic HE according to the college of hematology

Parasitological examination of stool to be repeated three times

Serology schistosomiasis, fillariosis, stronglyoidosis


The 5 spondyloarthritis are: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory enterocolopathies and undifferentiated SpA

The overall prevalence of all spondyloarthritis is 0.35% in France

The majority of cases begin in young adults (before thirty-five or forty years of age)

Entheses are the bone insertions of organs on bones

Rather tendons, ligaments, capsules and fascia on the bones


Sacroiliitis is a pain of the buttock of mechanical schedule

If. It can radiate below the gluteal fold and be confused with truncated sciatica

Neurological signs associated with this pyalgia can be found

No neurogenic or root character in pure sacroillitis

We manage to trigger these pains by shearing maneuvers of the sacroiliacs


Psoriatic arthritis may be accompanied by arthritis of the distal interphalengals

The characteristic involvement of spondyloarthritis is the distal fracture of the femur

Only the entheses of the lower limbs and back are affected

The most frequent and characteristic condition is heel pain


Regarding the associated signs and symptoms:

Dactylitis is pathognomonic of spondyloarthritis

SpA has purely rheumatological manifestations

In psoriatic arthritis: dermal involvement. In SpA associated with enterocolopathy: digestive involvement. etc

Acute anterior uveitis is, most often, non-granulomatous

Acute anterior uveitis can be either unilateral or bilateral

Acute anterior uveitis is never inaugural

Its prevalence is 20% and it can quite be inaugural


Psoriasis precedes the onset of psoriatic arthritis by 10 years in most cases

Ankylosing spondylitis is the most typical and severe form of SpA

Peripheral syndrome is clinically predominant

Pelvirachidal involvement is at the forefront

The ossification of entheses is not always painful

The extrarheumatic sign in the foreground is acute anterior uveitis


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

Undifferentiated SpA are SpA that meet the criteria of the ESSG for example

Peripheral enthesitis is the most common clinical sign

Undifferentiated SpA is most often benign


At the clinical examination of a 75-year-old patient at the UAA you find a BP at 106/67 mm Hg in the supine position and 85/45 mm Hg in the standing position and a skin fold. NFS = Hb: 16 g/dL, pq: 250 G/L, leuko: 9.6 G/L. Natraemia: 115 mmol/L. Kaliemia: 3.5 mmol/L. Protidemia 90 g/L. What is the state of hydration?

Skin fold, hypototension, hyperprotidemia


Formula for calculating plasma osmolarity:


Analyze this GDS: pH = 7.20 pCO2 = 45 mmHg pO2 = 75 mmHg HCO3 = 17 mmol/L.

Ventilatory acidosis with metabolic compensation because bicarbonates are elevated

Metabolic acidosis with ventlatory compensation because capnia is elevated

Mixed, ventilatory and metabolic acidosis

We speak of acidosis when the pH is < 7.38

In case of simple metabolic acidosis, the expected PaO2 is = 1.5 x HCO3+ 8 ( +/2 )


Which of the following are etiologies of inappropriate hypothalamic secretion of DHA?

Cause of paraneoplastic syndrome (ectopic tumor secretion of ADH, or ADH-like substance)


Posm = [Na+ x 2] + Blood glucose (mmol/L) + Kaliemia

The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea

Posm = [Na+ x 2] + Blood glucose (mmol/L) + Chloremia

Posm = [Na+ x 2] + Blood glucose (mmol/L) + Uric acid


It is indeed a cause of DHA secretion, but the secretion is ectopic (paraneoplastic syndrome) and not pituitary

It potentiates the effect of DHA (such as chlorpropamide or clofibrate) but does not cause more secretion


Which of the following are causes of isotonic hyponatremia?

Isotonic hyponatremia called "pseudohyponatremia", are those that are associated with severe hyperlipidemia or hyperprotidemia and do not darken with any intracellular hydration disorder.


Which of the following proposals can aggravate severe hypokalemia?

This is the right care. It must not exceed 20 mmol / h and under rhythmic supervision

Not recommended in case of severity, but does not aggravate it


Which of the following are clinical signs of intracellular dehydration?


Which of the following may be ECG abnormalities secondary to hypokalemia?


Bicuspidism is the most common etiology between 35 and 65 years of age

Bicuspidism is a "progressive" malformation that eventually leads to aortic narrowing in adulthood.

The bicuspid valve is often associated with an aneurysm of the ascending aorta

Post-rheumatic acquired aortic stricture is a very common etiology in France

Post-rheumatic RA has become rare in developed countries

The prevalence of degenerative aortic valve narrowing decreases with age

Prevalence increases with age and, in fact, is by far the most common cause of aortic valve narrowing


The main etiology of RA is degenerative in the majority of cases after 65-70 years

In the presence of an obstacle to ventricular ejection, there is the appearance of left intraventricular hyperpressure with ventriculo-aortic systolic pressure gradient: PVG > PAorta

The pressure gradient VG-aorta is lower the tighter the aortic narrowing

The tighter the AR, the greater the pressure gradient

When the VG-aorta pressure gradient reaches 4 mmHg, the AR is considered tight

it is when the VG-aorta pressure gradient reaches 40 mmHg that the RA is considered tight

Patients with AR maintain normal systolic performance for a long time


Initially, overall LV systolic performance is most often normal in a patient with AR.

Systolic performance of the ventricle can normalize as soon as the aortic obstacle is removed

The onset of symptoms in the presence of tight AR is preceded by a long asymptomatic period that can last several years

Cough, anginal pain and edema are the three main symptoms of aortic narrowing

The three main symptoms are: stress angina, stress syncope and exertional dyspnea.

When symptoms appear, the prognosis may be life-threatening


We find at auscultation a mesosystolic murmur, intense, soft, grating, maximum in the 2nd left intercostal space, radiating into the left armpit

The murmur is mesosystolic, ejectional, intense, rough, raspy at the maximum at the right intercostal 2nd space, radiating into the vessels of the neck

In advanced cases, there is a widening of the peak shock that is deflected at the top and left

The deviation of the tip shock is at the bottom and left signifying the dilation of the left ventricle

There is potential atrial fibrillation, usually poorly tolerated

Symptomatic tight AR is never complicated by sudden death

This is why the vital prognosis can be engaged according to hemodynamic tolerance

Sometimes it shows cardiomegaly is pulmonary overload


The size of the aorta is important to evaluate, especially in case of biscupidia in the preoperative assessment to know if an associated gesture on the aorta may be necessary

Catheterization is performed systematically

Catheterization is not usually performed

Angina can be seen in AR in the absence of any direct coronary involvement

The place of the coroCT scan as a replacement for preoperative coronary angiography is established

The scanner reliably assesses the size of the aorta


Replacement with mechanical prosthesis requires lifelong anticoagulant treatment

A biological prosthesis, indicated in the patient is young, avoids anticoagulant treatment

The biological prosthesis avoids anticoagulant treatment well but is indicated in patients over 65 years of age because there is a risk of degeneration within 10–15 years

The indication of percutaneous aortic valve cannot be carried without the approval of an experienced medical-surgical team and only after a multidisciplinary discussion in dedicated staff in trained teams

Any symptomatic tight aortic stricture should be operated on in view of the existing life-threatening risk and virtually without age limit, subject to a general condition preserved

In case of asymptomatic tight RA according to the interrogation, a surgical valve replacement is systematically proposed

In case of asymptomatic tight AR according to the interrogation, a stress test is proposed to check that the patient is really asymptomatic and thus detect false asymtomatics that are related to surgery: if blood pressure does not rise during the stress test or decreases with effort, the operative indication can be discussed


Mitral insufficiency is a leak in the mitral valve resulting in blood backflow from the left ventricle to the left atrium during diastole

The backflow of blood from the left ventricle to the left atrium is during systole

In type III MI according to the Carpentier classification: at least one valve protrudes beyond the plane of the ring during ventricular systole

type II: at least one valve protrudes beyond the ring plane during ventricular systole

Rheumatic etiology has become rare in developed countries

The combination of stenosis and mitral insufficiency is referred to as mitral disease.

Dystrophic mitral insufficiency is a very common etiology


The onset of dyspnea is slow and progressive

On examination, there is a deflection and lowering of the peak shock if there is a dilation of the LV

Auscultation contains a systolic murmur of maximum regurgitation at the tip

ECG remains normal for a long time in moderate MI


On radiography, cardiomegaly by dilation of the VD is found even in moderate MI

RT is often normal in MIs. In severe and advanced MI, cardiomegaly may be observed by LV hypertrophy

ETT is the key test for positive diagnosis and etiological diagnosis

The mitral leakage is confirmed by a holosystolic Doppler signal behind the mitral floor recorded in pulsed, continuous and color Doppler

The mechanism must be specified by echocardiography (according to the Carpentier classification)

ETT is a fundamental examination for the diagnosis of MI on endocarditis, highlighting sometimes very fine vegetations

ETO is a fundamental examination for the diagnosis of MI on endocarditis, highlighting vegetations sometimes very fine and impossible to see in ETT


Coronary angiography is systematic as part of the preoperative assessment when a surgical indication is retained in case of cardiovascular FDR

The gradation of MI is based on the calculation of the regurgitating fraction

Right catheterization allows the measurement of cardiac output by thermodilution and the measurement of straight pressures (capillary and pulmonary pressures)

The main interest of the test is to unmask symptoms and understand them in patients who say they are asymptomatic.

The stress test with VO2 measurement makes it possible to better assess the patient's exercise capacity


A low maximum O2 consumption < 15 mL/kg/min indicates poor tolerance of MI

Stress echocardiography makes it possible to assess the leakage during exercise, its possible increase, its impact (increase in PAPs> 60 mmHg)

In general, gradually formed MIs are well tolerated for a long time, and signs of heart failure appear late.

On the contrary, MI of sudden onset (rupture of ropes, endocarditis, MI on infarction) are generally poorly tolerated and quickly evolve towards the appearance of a picture of edema of the lung

Complications of MI include infective endocarditis


The appearance of atrial fibrillation or atrial flutter can lead to cardiac decompensation

Heart failure is late onset in chronic MI but can occur rapidly in acute MI. It can be favored by a rhythm disorder

Always look for signs of other associated pathologies (e.g. stigmata of Marfan's disease)

If mitral leakage is significant and responsible for functional symptomatology, it is urgent to consider surgery

In case of acute MI, treatment for OAP or shock should be initiated, and emergency surgery should be discussed.


Regarding Aortic Narrowing, which propositions are true?

Monckeberg's disease is synonymous with calcified aortic narrowing (CAR)

Aortic narrowing leads to an increase in afterload and thus induces a decrease in the ventriculo-aortic gradient.

Aortic narrowing leads to an increase in afterload and thus induces an increase* in the ventriculo-aortic gradient.

Aortic narrowing is well tolerated for a long time, until an advanced stage with the appearance of stress symptoms such as exertional angina, exertional dyspnea and intermittent claudication of the lower limbs.

The clinical triad of tight aortic stricture is: stress angina, stress syncope, exertional dyspnoea

Criteria for tight aortic narrowing on cardiac Doppler ultrasound include: a mean gradient > 40 mmHg and an aortic surface area > 1 cm2 (0.6 cm2/m2 body surface area)

Aortic surface <* 1 cm2 (0.6 cm2/m2 body surface area)

It is possible to find on the ECG: left ventricular hypertrophy, left atrial hypertrophy, conduction disorder (BAV 1 and left branch block), as well as a rhythm disorder (atrial fibrillation).


About cholelithiasis and its complications

The frequency of vesicular lithiasis in Western countries is about 20%

The frequency increases with age to reach 60% after 80 years

•Almost 90% of subjects with a gallbladder never have any symptoms

A gallstone complicates this in 20% of cases, this complication is the migration of the stone into the cystic duct or the main bile duct

• It can therefore be estimated that 2 to 4% of French people are likely to develop at least one complication requiring an exploration of the bile duct


Concerning vesicular lithiasis and its complications

Despite its frequency, screening for vesicular lithiasis is not indicated

The incidental discovery of an asymptomatic gallstone does not lead, in most cases, to any treatment

The most typical symptom is hepatic colic

Hepatic colic is due to the sudden tension of the bile ducts, by permanent blockage of a stone, either in the cystic duct or in the main bile duct

It is due to the sudden tension of the bile ducts, by transient blockage of a stone, either in the cystic duct or in the bile duct

Typically, hepatic colic is a sudden pain often intense, permanent, sitting in the epigastrium (2/3 of cases) or the right hypochondrium


Treatment of cholecystitis is cholecystectomy without delay

Clinical manifestations can be of varying severity, and are: colic, cholitis, cholecystitis

Cholangio-MRI and endoscopic ultrasound are the most sensitive tests to detect a stone of the main bile duct

Acute cholitis lithiasis results in the successive appearance of 3 signs


Video game addiction is a neurodevelopmental disorder

Video game addiction does not fall within this framework

These disorders have a prevalence of about 10% in the general population in France

These disorders are more common in girls than boys

It's the opposite: they are more common in boys


The management of these patients is done by the psychiatrist only

Multidisciplinary care is very important

The origin of these disorders is essentially genetic

It is multifactorial and unknown. The genetic part is surely non-zero.

Neurodevelopmental disorders are often associated with other psychiatric disorders

These disorders are common in the general population (~10%) and more common in boys than girls.

Neurodevelopmental disorders are defined in particular by their functional impact


Regarding the impact of parents and child development:

There is very little inter-individual variability in child development

Inter-individual variability is important

Developmental age is measured directly by automatic standardized tools

Tests measure skills. Developmental age is based on statistics: 95% of children have acquired these skills at this age

Early parent-child interactions have little impact on child development, which is essentially controlled by genetics.

They have an important role in the development of the child

It is very pathological for a child aged 6 months to show anxious manifestations in moments of separation from his parents

Quite physiological in most cases. The College of Psychiatry indicates that it is physiological until the age of 1 year

Separation anxiety is an anxiety disorder that appears in situations of separation from parents at a young age


Psychologists have no role to play in these pathologies

Psychologists can intervene in the raliization of assessment, for psychotherapy and learning

The functional impact corresponds to the difficulties in carrying out actions in one or more given areas

A deficit in the development of a domain is said to be "specific" when it is not explained by another disorder

Children with hearing loss frequently have oral language delay

There are several levels of severity of intellectual disability


It is also called staphylococcal scarlet fever

This is the case of streptococci. Staphylococci secrete enterotoxins, also called TSST1

Also: infants, young children or immunocompromised adults

Exanthemas begin at the level of the large folds


Infectious mononucleosis is caused by HCV

Epidemic megalerythema has a fracture-type rheumatological component

Kawasaki syndrome cannot give morbiliform exanthema

The incubation of measles is about a month


Its indications are very numerous and go far beyond the framework of hematological pathologies

This is the most prescribed exam in France

It is made from a blood sample taken by venipuncture and collected in a tube containing a dry anticoagulant type EDTA

It aims to provide quantitative information on blood cells but also qualitative information

Accurate identification of cells and their possible abnormalities requires a good quality blood smear


Normal values vary by age, gender and ethnicity

Thrombocytopenia <200 G/L should always be checked on the blood smear examination

We speak of thrombocytopenia if < 150 G / L (serious if <50 G / L)

The lower limit of hemoglobin (anemia) is as follows: Newborn: 14 g/L ● Adult male: 13 g/L ● Adult female: 12 g/L

The limits are: Newborn: 140 g/L Adult male: 130 g/L Adult female: 120 g/L Pregnant woman (from the second trimester of pregnancy): 105 g/L

MCV can be calculated as the ratio of hematocrit to red blood cell count.

The normal value is 80 to 100 fl in adults


MCV < 80 fl signs microcytosis in adults

CCMH is the Average Corpuscular Hemoglobin Concentration

CCMH normal values range from 32 to 46 g/dL

The leukocyte formula, expressed in %, has no interest taken in isolation

Preference should be given to absolute values concerning the leukocyte formula


Normal TGMH values are 27 to 32 pg per cell

Any thrombocytopenia without bleeding signs should be investigated for false thrombocytopenia with EDTA by platelet agglutination

A hemoglobin level < 60 g / L or poorly tolerated requires urgent management by a specialist

Anemia is defined as a decrease in CCMH concomitant with clinical signs

Anemia is defined as a decrease in hemoglobin at the hemogram, after eliminating false anemia by hemodilution

Microcytic anemias (MCV < 80 fl) reflect a disorder of hemoglobin synthesis

The most common cause is iron deficiency


The most common microcytic anemias are hyposideremic anemias due to iron deficiency.

Macrocytic anemias (MCV > 100 fl) first evoke 3 major etiologies: Ethylism, vitamin B12 deficiency, myelodysplastic syndrome

Regenerative anemia with reticulocytes < 150 G/L reflects periperic involvement

Viral infections do not usually result in neutrophil polynucleosis apart from superinfection

Myelemia is the passage into the blood of immature forms of the granular line of the spinal cord


Blood erythroblastosis (erythroblastemia) corresponds to the passage into the blood of erythroblasts

Erythromyelemia is the combination of myelemia and blood erythroblastosis

The two main etiologies of eosinophilia are parasitic and allergic etiologies

True hyperlymphocytosis is defined as an increase in the absolute number of blood lymphocytes


Which of the following are causes of false anemia?


Which of the following are healthcare professionals?


Which of the following are enzyme inhibitors?


Which of the following are enzyme inducers?


How long does it take to affirm a couple's infertility?

A couple is considered infertile in the absence of pregnancy after 1 year of unprotected sex


How many couples in France consult for pregnancy?

In France, one in seven couples (14%) consult for children


The term sterility can only be used if the situation of infertility is definitive

A bilaterally castrated person is sterile

A postmenopausal woman is said to be infertile

A postmenopausal woman is said to be sterile, the term infertility is reserved for couples

The fecundability of the woman per cycle is about 75% per exposure cycle.

At best, fecundability is 25% per cycle.

Fertility is a term defined in the context of a couple.


Regarding the epidemiology of the origin of infertility:

1/3 female, 1/3 male and 1/3 of shared origin

It is of male origin in about 33% of cases


The frequency of reporting needs to be addressed

In particular, whether they are regular or episodic

Gynecological history will need to be clarified

Pelvic pain in women may suggest endometriosis

It is not important to look for a possible history of abortion, especially in the presence of the husband

This is not at all useless since there can be consequences. On the other hand, it will obviously be necessary to discuss it alone with the patient, at first.

Libido disorders cannot impact fertility

Libido disorders can decrease the frequency of sexual intercourse


Regarding first-line hormonal exploration in women:

In case of irregularity of the cycle, the dose is mainly LH

The first attempt is to clarify the origin of the irregularity

In case of irregularity of the cycle, the FSG is mainly dosed

Estradiol (E4), LH, FSH and prolactin are dosed

Indeed we dose LH, FSH and Prolactin. It is not estradiol E4 but estradiol E2!

The objective in case of regular cycle and to determine their ovulatory character (or not)

If the cycles are regular, we try to clarify their character
ovulatory by plasma progesterone assay, on Day 22-Day 23 of the cycle

Not systematic but depending on the clinic


It is a very informative examination in humans

It should be done after 1 week of abstinence

Below we talk about hypospermia and above we talk about hyperspermia

Mobility of less than 30% defines asthenospermia

Necrospermia is defined by a rate <58% of living forms


COPD is a common disease, causing morbidity, mortality and high health costs

COPD is defined by the presence of chronic respiratory symptoms and permanent bronchial restriction

It is defined as the presence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging lower respiratory infections) and permanent bronchial obstruction: there is an obstructive ventilatory disorder (defined by a FEV1/FVC ratio<0.70) that persists after taking bronchodilators

Occupational exposures may also be involved

The main symptom is dyspnea but it is late often underestimated


The main differential diagnoses are asthma and bronchial dilatations

Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement in the absence of any medication

Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement after bronchodilator

pulmonary rehabilitation is an integral part of treatment

COPD is a chronic respiratory disease defined by the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging) and reversible obstruction

Frequent chronic respiratory disease, defined as the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnoea, repeated or dragging) and permanent and progressive airway obstruction = obstructive ventilatory disorder (OVD) not completely reversible

Obstructive ventilatory disorder (OSVD) is defined as a FEV1/FVC ratio < 0.7 (or < 70%)


Chronic bronchitis is a daily or near-daily productive cough lasting at least 3 months a year and for at least two consecutive years

− Asthma should be evoked when there is a very significant reversibility of bronchial obstruction (increase in FEV1 of more than 400 ml),

− The "frequent exacerbator" phenotype is an element in assessing the severity of COPD

The severity of exacerbations: 1 exacerbation / year requiring hospitalization is an element of poor prognosis


COPD is a major health problem affecting 5-10% of the population over 45 years old

Worldwide, COPD is on the rise and is expected to be the 3rd or 4th leading cause of death by 2030

Exposure to occupational air contaminants is implicated as a risk factor for COPD

Alpha-1 antitrypsin deficiency is the only identified genetic risk factor for COPD


The severity of TVO assessed by VEMS post BD makes this simple measure an important prognostic factor

Parameters such as dyspnoea intensity and undernutrition are also strongly predictive of COPD-related mortality.

Spirometry allows the diagnosis of certainty, helps in differential diagnosis with asthma, evaluates severity, participates in therapeutic choices

Obstructive TV rises after BD administration

This TVO persists after BD administration. He gets up in case of asthma:)

The severity of bronchial obstruction varies depending on the value of post-BD FEV1


reversibility is studied by performing a 1st spirometry before the administration of fast-acting BD and a 2nd spirometry 10 minutes after

The measurement of carbon monoxide transfer capacity (which reflects the available gas exchange surface) makes it possible to evaluate alveolar destruction

Any value of DLCO (or OBT) < 50% of the predicted value is considered pathological

Any value of DLCO (or OBT) < 70% of the predicted value is considered pathological

Chest X-ray has no interest in the positive diagnosis of COPD

Chest X-ray may suggest associated heart disease


Regarding the generalities of facial dermatoses:

Acne is a chronic inflammatory dermatosis of the pilosebaceous follicle

Sebum secretion is triggered and maintained mainly by dihydrotestosterone

Circulating androgens are often increased in acne

Circulating androgens are present at normal levels and acne results only from a particular sensitivity of androgen receptors present on sebocytes and keratinocytes (peripheral hyperandrogenism)

The formation of comedo is due to hyperproliferation of keratinocytes of the pilosebaceous follicle

The anaerobic flora of the sebaceous follicles is dominated by a gram-positive bacterium Propionibacterium acnes


Acne is not an infectious disease but an inflammatory disease of the pilosebaceous follicle

Seborrhea is an abnormally thin aspect of the skin

Acne mainly affects areas low in sebaceous glands such as the face and back

Affects areas rich in sebaceous glands: central part of the face (nose, forehead, chin, cheeks) and upper thoracic region (neck, back and anterior surface of the chest)

Ironed comedones are small papules of 2 to 3 mm of normal skin color


Closed comedones correspond to "blackheads"

Open comedones correspond to the accumulation of oxidized keratinocytes within the dilated orifice of the infudibular duct

Open comedones are on the order of a centimeter

These are infracentimetric lesions, between 1 and 3 mm

The natural course of open comedones is inflammation in any case

can spontaneously expel or become inflamed

Inflammatory papules progress to resorption or pustule formation


Pustules are usually derived from papules

The contents of pustules are inflammatory by accumulation of lymphocytes

Nodules larger than 10mm reaching the dermis

The nodules are of the order of a centimeter and reach the dermis


Regarding the different clinical forms of acne:

Juvenile combination acne is the most common form of acne

Juvenile mixed acne occurs in late adolescence

Exogenous acne has a predominance of open comedones

Acne in adult women appears after about 25 years

Adult female acne concerns women who did not have acne during adolescence only

Most of the time, juvenile acne extending into adulthood


Which of the following is true for acute inflammatory polyradiculoneuritis?

The lesions affect the motor neurons of the precentral cortex

Root of nerves and their nerve trunks downstream


Cytomegalovirus infection may precede Guillain-Barré syndrome

Epstein-Barr virus infection often causes an axonal form of GBS

Campylobacter jejuni often causes an AMAN-like demyelinating form of GBS

The lesions affect in particular the roots of the nerves


Regarding Guillain-Barré syndromes (GBS):

They evolve in 8 phases more or less long (about 1 year in total)

3 phases: extension, plateau, recovery. The duration of each of these phases varies

The diagnosis is confirmed by MRI and biopsy

Acute axonal motor neuropathies are pure motor

Acute motor axonal neuropathies (AMAN) are at risk of intubation


Regarding the extension phase of Guillain-Barré syndrome:

True for the sensory form, but false for the motor form

The motor impairment is unilateral and not very severe most often

Relatively symmetrical, extensive and severe, it predominates proximal and then affects the extremities

Motor involvement begins in the extremities and then goes up

First proximal and then affects the extremities

1-5% of patients should be on assisted ventilation


Regarding the plateau phase of Guillain-Barré Syndrome:

One hundredth of patients require respiratory support

Tendon reflexia in deficit territories fades rapidly

It persists throughout the plateau phase

It can last up to several months in some cases. It's very variable


Which of the following propositions about Miller-Fischer syndrome are true?

There is a progressive fatigability throughout the day


Nausea is a painless disagrable subjective sensation originating from the upper digestive tract.

Differential BDiagnostics • Regurgitation: passive rise of gastric contents Regurgy

• Merycism or rumination: are involuntary rises in the mouth of recently ingested food that is then swallowed again after chewing

Upper GI endoscopy is necessary to confirm the diagnosis and, if necessary, to perform hemostasis; Rupture of the oesin case of Mallory-Weiss syndrome


Chronic vomiting is vomiting that lasts more than 7 days

Drug use may be accompanied by vomiting (cannabis), as well as withdrawal syndrome (heroin)

The evaluation of the metabolic impact of vomiting is systematic

Vomiting should be sought for pregnancy, adrenal insufficiency and intracranial hypertension

Vomiting related to chemotherapy can be treated with antihistamines

Chemotherapy-related vomiting can be treated on a case-by-case basis by:


Which of the following proposals is expected in case of pyloric stenosis?


Which of the following are ultrasound signs in favor of pyloric stenosis?

True. The signs are: "roundel" appearance, thickening of the muscle ≥ 4 mm, lengthening of the pyloric canal and gastric stasis (College of Pediatrics, 2021)


All sexual disorders are of the order of psychiatric pathology

They may be related to non-psychiatric pathologies or psychological disorders

Hypersexuality is considered addictive behavior

Sexual health is a state of physical, mental and social well-being in the field of sexuality

'Normal' sexuality requires a positive and respectful approach to sexuality and sexual relationships


The excitation phase is characterized in men by the establishment of erection

The sexual relationship is preceded by a phase of sexual desire consisting of sexual and erotic thoughts or imaginative fantasies.

The orgasm phase consists of several successive phases in men

In men, orgasm and ejaculation usually coincide

Vaginal or clitoral stimulation is the same

The vaginal or clitoral difference corresponds to different stimulation modalities, but is underpinned by the same anatomophysiological entity (glans or pillars of the clitoris)


Notions of deviance, normality of sexual performance, and behavioral role identity can vary across cultures and times.

The interview is a fundamental moment in the assessment of a sexual complaint

The interview must look for all history of psychiatric disorders

Nocturnal penile plethysmography and cavernography (venous leakage, Peyronie) are almost no longer used in common practice.

Sexual conduct disorders are classically distinguished into six pathophysiological categories

3: sexual dysfunction, paraphilic disorders, and hypersexuality


Sexual dysfunctions often correspond to one of the phases of sexual intercourse (desire, arousal, or orgasm)

Sexual pain is not a real sexual dysfunction

Sexual pain is part of sexual dysfunction

A fairly high proportion of men and women in the general population suffer from sexual dysfunction (5-35% depending on type and sex)

Comorbid psychiatric disorders have little impact on sexual dysfunction and should not be considered in etiological research

A comorbid psychiatric disorder is found in 30% of cases – depressive or anxiety disorder, addictive disorder, anorexia nervosa, etc.

Non-psychiatric differential diagnoses are to be systematically sought by a systematic clinical examination


Exhibitionism is the act of being excited to show one's body to one's partner(s)

It is sexual arousal caused by exposing one's body to strangers in public places.

Exhibitionism is the act of being sexually aroused by objects

Exhibitionism is being sexually aroused by showing one's body to strangers in public places.

Fetishism is being sexually aroused by humiliating others

Fetishism is sexual arousal caused by visual and/or physical contact with a specific object, body part or situation.

Pathological if it meets the 4 criteria of the DSM


Which of these proposals can promote sexual conduct disorder?

Any history of psychiatric disorder can promote sexual conduct disorder


In any case, it is not mentioned in the colleges

Rather, it is hyperprolactinemia, which may be responsible for secondary amenorrhea or erectile dysfunction.


What propositions are part of classic sexual behavior in both sexes?

Desire -> Arousal -> Plateau -> Orgasm -> Resolution -> Refractory period (in men only)

The orgasm phase, which always corresponds to ejaculation in men


What is the neurotransmitter most involved in the refractory period?

These are endorphins. Researchers believe that serotonin curbs arousal and desire

College does not report GABA role in sexuality


What is the neurotransmitter that curbs arousal and desire?

Researchers believe that serotonin curbs arousal and desire

Endorphins are involved in the refractory phase mainly


Which of these proposals can cause hypersexuality?

However, some dopamingergic agonists used in the treatment of Parkinson's disease can cause hypersexuality.

Frontal and temporal syndromes can cause hypersexuality. But not occipital syndrome.


In symptomatic radiculalgia, the pain is:

Awakening in the second part of the night


Which of these proposals refer to mechanical pain?

Or positional awakening in the first part of the night


Which muscles are affected by a C5 deficiency?

The biceps is innervated by C5 and C6, like the deltoide


The anterior surface of the arm is innervated by C6

Outer side of the forearm is innervated by C7

By C6, which innervates the front of the arm, the outer surface of the forearm and the thumb

The brachial plexus is notably composed of C7 and C8

The roots of the brachial plexus are mostly sensitive


C7 = the 3 medial fingers, especially the middle finger


The posterior side of the arm and forearm is innervated by C7

The three middle fingers (especially the middle finger) are innervated by C8

By C7, which also innervates the posterior surface of the arm and forearm (the root arrives from the back)

C8 innervates the lateral side of the arm and forearm

Medial side of the arm and forearm, as well as the 4th and 5th fingers

The Deltoid allows the abduction of the arm


The Brachial allows the flexion of the elbow

The Triceps brachial allows the extension of the hand

Elbow extension since it is a muscle of the arm (and not the forearm)

Interosseous muscles are innervated by C8

The Bicipital reflex is only dependent on C6


Regarding sensory territories and reflexes:

The Cubito-pronator reflex is dependent on C7

The front of the thigh is innervated by S1

Anterior surface of the thigh = L3. Posterior side of the thigh = S1

The medial side of the knee is innervated by L3


Regarding the sensory territories of the leg:

The anterior side of the knee is innervated by L4

The anteromedial side of the leg is innervated by L3

L3 stops at the medial surface of the knee after passing through the anterior surface of the thigh. It is L4 that innervates the anteromedial surface of the knee

The posterior side of the thigh is innervated by L2

The lateral side of the leg is innervated by S1

It's L5. S1 innervates the posterior side of the leg


Regarding the sensory territories of the leg and the patellar reflex:

The back of the foot and the big toe are innervated by L5

The posterior side of the thigh is innervated by L4

The posterior side of the leg is innervated by S1

The sole of the foot and the 5th toe are innervated by L4

The Patellar reflex is dependent on the root L3


Regarding the bases of risks related to the consumption of water or food:

Encapsulated commercial water bottles do not normally contain bacteria, viruses or parasites

Transmission of intestinal infections through food is impossible

Swimming is not a vector of transmission until you drink the water

During swimming (in swimming pools, fresh water or at sea), contact with dirty water is a vector of transmission

Human-to-human transmission can be reduced by simple hygiene measures

Food can be vectors of toxins responsible for digestive tables generally brief and benign


Certain foods are responsible for poisoning

Any TIAC must be declared to the departmental health authority

Only the physician must make the mandatory declaration of TIAC

This declaration is also mandatory for the person in charge of the premises where the patients are located.

Mandatory reporting is unnecessary from a health point of view, its only function being administrative

It is this that makes it possible to decide, if necessary, on an epidemiological inquiry

The main causes of TIAC reported in France are Escherichia Coli

These are, in order of frequency, salmonella (70% of TIAC), Clostridium perfringens and Staphylococcus aureus


Gout is intermittent inflammatory rheumatism, in countries with high GDP, the most prevalent

Chronic arthropathies are due to dysregulation of renal purification

This is due to intra-articular and bony tophus

The diagnosis of gout is made by the detection of strongly birefringent tapered microcrystals in the joint fluid

It is a polygenic disease with several predisposing genes

The usual terrain is the young vegan woman

The middle-aged man with too much calorie diet and too much animal protein


The symptomatological peak is reached in about 31 days

There is swelling and local redness, a sign of inflammation

The most frequent localization is the first metatarsophalangeal

The resolution of the crisis necessarily requires drug treatment associated with good hydration

Resolution is spontaneous but can be shortened by NSAIDs

Any patient who has uricemia greater than 60 mg/L is at risk of gout


Joint ultrasound is unnecessary in this context

This is very useful in the absence of specific radiographic signs. We can see a "double contour" aspect

The female predominance of chondrocalcinosis decreases with age

Diagnosis is based on cubic deposits in articular cartilage that are not refrigent

In apatitic rheumatism, the diagnosis can be made by anamnesis


The only diet of the baby under 5 months is milk

Breastfeeding strengthens the mother-child bond

For 100 kcal, a 1st age milk contains about 3kg of cow's milk protein

Low sodium is less than 1 mg of salt per 100 kcal


Never force a healthy baby to finish rations if he seems full.

Growth charts for weight and height confirm the baby's good nutrition

During the first three years of life, the child multiplies his weight by 4

The brain grows 30 to 200 grams between 0 and 3 years

During the first three years of life, the child multiplies his height by four


Daily energy requirements vary little in the first 36 months

Diversification is a stage arriving at the third week of life

There are three types of external breastfeeding: 1st age milk, 2nd age milk and growth formulas

Nitrogen absorbed = nitrogen ingested urinary nitrogen

Nitrogen absorbed = nitrogen ingested faecal nitrogen

Nitrogen retained = nitrogen absorbed urinary nitrogen


AaE can be provided by sources with complementary chemical indices

For premature or very low birth weight children, we have milks covering their specific needs such as milk with non-hydrolyzed proteins

Food diversification involves stages of gradual substitution

Like slow-digesting sugars, fiber, different proteins, etc.

The second category of foods to introduce, after slow-digesting sugars, is those rich in fast sugars.

First the fibers. They also provide water, minerals and vitamins


The interest of fiber is also to provide water, minerals, vitamins provided that we respect certain ways of cooking them

Fiber also has the interest of regulating the glycemic response, therefore hunger, and limiting the absorption of cholesterol

At 6 months a baby will be able to receive, instead of a bottle of milk at noon, a vegetable puree and dairy

Cooked cheeses can be introduced around 6 months of age

Around 9 months for cooked pasta, around 12 months for fermented pasta

There is no danger in leaving the bottle for several months or even years as breakfast


With diversification, fat intake increases from 50% to 30-35% of the daily energy intake

Also by fortified cereals or so-called 3rd age or growth milks that are fortified with iron

Eggs are a source of protein but do not contain vitamins

Eggs provide a lot of vitamins, proteins and cholesterol

During diversification, you have to be very careful not to introduce too much protein

What you really need to pay attention to is sugar+sodium+calories

Carbohydrate food excesses have no impact in view of age


Adolescence is a period of nutritional risk

Too often obesity is discovered in adolescents that began long before

Obesity usually begins between 3 and 5 years of age when the child should start to be lean

While the child is normal/coated, and this explains most of the obesity seen in adolescence

It is useful or even imperative to develop the habit of regular physical activity

One in two teenagers admits they don't like looking at themselves in a mirror or having their picture taken

and 63% of girls say they want to lose weight


It is recommended to administer vitamin D supplementation every 3 months during the peripubertal period

It is recommended to provide at least 100g of calcium per day

The recommended intake of iron is in the range of 15 to 22 mg/day

It is recommended to take a dairy product at each meal including snack


Which of the following are risk factors for gestational diabetes?

A first-degree family history of type 2 diabetes


Often, it is a diabetes present before but asymptomatic

It is conventionally revealed in the third trimester

It is conventionally revealed in the second trimester

It is now done on risk factor: age over 35, overweight or obesity, personal or family history of diabetes or macrosomia

There is an increased risk of macrosomia


At what time of pregnancy is OGGH for gestational diabetes indicated?

True, only indicated if fasting blood glucose < 0.92g/L (threshold of gestational diabetes in the first trimester


Breast cancer is the leading cause of cancer death in women

It is a major public health problem for all industrialized countries.

5-year survival rate (all cancers) = 73%

Cancer is the 1st leading cause of death in humans

Lung cancer is the 1st leading cause of cancer death in men


Concerning the epidemiology and prevention of cancer

Prematured mortality from cancer is twice as high in men as in women

Between 1980 and 2015, the overall incidence of cancer has increased since 1980 (+109% in both men and women)

Prevention must contribute to reducing inequalities in the face of cancer

At least 1/3 of cancers are preventable, the main risk factor being alcohol


Alcohol is responsible for 15,000 cancer deaths

The consumption of fruits and vegetables is associated with a reduced risk of several cancers: oral cavity, pharynx, larynx, esophagus, stomach

Eating salt and salty foods increases the risk of stomach cancer

Eating red meat and deli meats is associated with an increased risk of colorectal cancer

Infectious agents are responsible for 76% of cancers worldwide


A 57-year-old patient comes to your office.
Which of the following are screenings that she could have benefited from?


There are two eating disorders: anorexia and bulimia

There are also binge eating, atypical disorders such as nocturnal eating syndrome and food intake disorders such as pica.

It is important to eliminate non-psychiatric medical causes before any TCA

Psychiatric comorbidities are extremely rare and minor in intensity

Suicidal risk should be systematically assessed

TCA are among the psychiatric disorders with the highest mortality (about 10% of patients, half of whom by suicide)

It is never necessary to hospitalize these patients whose care is done on a long-term outpatient basis

Hospitalization criteria, especially for anorexia must be known


Diet belongs to the instinctual functions of mammals

The etiopathogenesis of TCA is still poorly understood

The lifetime prevalence of anorexia nervosa is estimated to be more than 6% in Caucasian women

Its lifetime prevalence is estimated at 0.6% in the Caucasian adult population

The sex ratio of anorexia is 1 man to 8 women


After coronary and cerebral involvement, PAD is by its frequency the third localization of atherosclerosis

It is, in its symptomatic form, 3 to 4 times more common in women than in men

The peak of presentation is between 60 and 75 years in humans

Diabetes is responsible for severe involvement from the outset, with more proximal involvement

Hypertension and diabetes are the two predominant cardiovascular risk factors in PAD


Symptomatic involvement affects 10 to 15% of people over 60 years of age

1-5% of people over 60. Asymptomatic forms affect 10-15% of this population

In the intermittent claudication stage, mortality at 5 years is 15%

It is estimated that for every symptomatic PAD case, there are two to four patients with a subclinical form of the disease.

The Leriche-Fontaine classification is the classification currently recommended to understand the severity of clinical involvement

It is supplanted today by the Rutherford classification.

PAD should be tested for in any patient over 50 years of age with cardiovascular risk factors


Long asymptomatic, due to a moderate hemodynamic impact and the progressive and compensatory development of collateral arteries

During intermittent claudication, symptoms disappear spontaneously within 10 minutes

Claudication is said to be severe if the walking distance is less than 300 meters

The walking distances of claudication can be variable from one day to another, in the same patient

Critical ischemia is a clinical diagnosis exclusively

Clinico-hemodynamics: infusion pressure <50mmHg at the ankle or 30mmHg at the level of the big toe


Leriche syndrome indicates femoral involvement

Aortoiliac involvement. As a reminder, Leriche syndrome associates gluteal claudication or fatigability with walking + erectile dysfunction

Pain at the pressure of the calf muscle masses testifies to moderate ischemia

Pain at the pressure of the muscle masses of the calf testifies to severe ischemia

The ABI is calculated by the ratio of the highest systolic pressure of the two arms to the higher pressure of the two ankles.

It's the opposite (ankle pressure / arm pressure)

Ulcers are generally very algic, small and hollow, on the support areas of the foot


Two causes of medicalcosis arterial stiffness are diabetes and tobacco use.

Diabetes and the dialysis patient. This arterial stiffness results in an IPS >1,4

Trophic disorders are systematically sought especially in interdigital spaces

An abolished pedinous pulse testifies to obliterating arterial disease

Pediose pulse may not be present congenitally, in 5% of the population

SPI <0.9 characterizes critical ischemia

If the ankle infusion pressure is >50mmHg, no. An IPS <0.9 characterizes a PAD

In case of IPS >1.4, ankle infusion pressure should be used to make the diagnosis of PAD

In this case the ankle perfusion pressure is not interpretable: the perfusion pressure at the big toe is used.


To diagnose PAD, injected CT angiography is frequently used

CT angiography is only used if there is an indication for revascularization

Critical ischemia pain is improved in the declivated position

It forces you to get up at night or keep your leg out of bed

In case of discovery of PAD, a resting ECG and ultrasound of the abdominal aorta are systematic

A patient with asymptomatic PAD should receive treatment with a statin and an ACE inhibitor

Revascularization may be offered in case of intermittent claudication

In case of threatening lesions or disabling symptomatology despite optimal treatment for 3 months


Which of the following are true for popliteal artery aneurysms?

They are frequently associated with abdominal aortic aneurysms

The operative indication arises when they are greater than 15 mm

The most common complication is embolism

They can manifest as compression of adjacent tissues


Among the following proposals, which are treatments to be implemented in case of stage I PAD according to the Leriche and Fontaine classification?

Implementation of Statine, and IEC/ARA2 if necessary


Regarding the management of glioblastomas:

Hormone therapy is applicable as a second line

Focal radiation therapy is often offered as a first-line treatment

In all intracerebral tumors, first-line excision is preferred, often supplemented by chemotherapy and/or radiotherapy.

Radiation therapy is often concomitant with chemotherapy


A hypoT1 image without injection of contrast medium


Among these tumor proposals, which are among the 4 cancers that metastasize the most intracranial?


There are many more metastases than primary tumors, from an epidemiological point of view

85% of intracranial tumors are subtentorial

There are more than 15 large entities of intrancranial tumors

There are more than 240 subtypes of intrancranial tumors, almost all of which differ in their management.

There are about 80 subtypes of intracranial tumors. There is a lot of overlap between them.

Glioma types 1 and 2: low grade. Glioma types 3 and 4: high grade. Type 3 glioma is anaplastic. Type 4 glioma is a glioblastoma.


Supratentorial tumors (85% of intracranial tumors) have a temporal commitment. It is the subtentorial tumors that cause tonsillar engagement

It results in hemiparesis, diplopia, ptosis and/or unilateral areactive mydriasis

It can result in stiff neck and torticollis.

It is as serious and urgent as temporal engagement


Intratumoral hemorrhages are more common in primary tumors

They are more common in cases of metastases of kidney or skin tumors.

Lumbar punctures are formally contraindicated in case of hydrocephalus

It depends on the type of hydrocephalus. If it is the tumor that prevents CSF from flowing, then PL is indeed contraindicated because it can cause, by << aspiration>>, occipital engagement. If, on the other hand, it is leptomeningeal proliferation that prevents the CSF from resorbing, then PL is possible.

Choroidal plexus tumors can cause hypersecretion of CSF

Temporal engagement corresponds to the passage of the uncus and hippocampus in the Bichat cleft

Between the free edge of the cerebellum tent and the brainstem

Meningeal stiffness is rare in tumor meningitis


Which of these tumor biomarkers have a good prognosis in diffuse gliomas in adults?

The codeletion of chromosomes 1p and 19q

Result of an unbalanced chromosomal translocation

Encodes the enzyme isocitrate dehydrogenase involved in the energy metabolism of the cell


Which of the following are signs of intracranial hypertension (ICPH)?


Which of the following propositions concerning gliobastoma are true?

The cell line is astrocytic or oligodendrocytic, not microglial


Which of the following are tumors metastasizing to the brain frequently?

The 4 to know by heart are: lung, breast, kidney, melanoma.


Which of the following proposals manifest itself in an image of a roundel on MRI?

Roundel = MAGIC. Meningioma, abscess, glioblastoma, infarction, contusion


Which of the following are classic signs or symptoms of intracranial hypertension (ICPH)?

True, it is nerve VI, innervating the lateral right. Its involvement is responsible for horizontal binocular diplopia. It is the most 'fragile' cranial nerve

True, aggravated at the end of the night or in the morning


The 4 to know by heart are: lung, breast, kidney, melanoma


Primary cerebral lymphomas occur only in immunocompromised patients.

False, the risk is increased in the immunocompromised patient (untreated HIV, organ transplant) but primary cerebral lymphomas exist in the immunocompetent.

Meningiomas have estradiol receptors. Their discovery should stop all hormonal contraception, THM or cyproterone acetate treatment.

Tobacco is a risk factor for primary brain tumours.

In front of a glial tumor, it is necessary to look for certain molecular abnormalities for diagnostic and prognostic purposes.

True:
-mutation IDH1 and IDH2
- codeletion 1P19Q
-MGMT methylation (better prognosis and sensitivity to temozolomide)

In front of a medulloblastoma, we look for a SHH mutation

True: Prognostic and theranostic value (introduction of SHH inhibitors)


In adults, the most common primary brain tumors are gliomas.

True: gliomas in 42% of cases then meningiomas in 32%

Primary CNS tumors account for 10% of cancers

In adults, the most common brain tumors are gliomas.

CNS metastases are thought to affect at least 20% of cancers.


Regarding the treatment of brain tumors, which proposals are accurate?

In medulloblastomas, prophylactic craniospinal irradiation is performed in addition to irradiation of the tumor area.

True: because frequent intra-neuraxic metastases.

Stereotactic radiation therapy can be performed on brain metastases

True: if small lesions circumscribed < 3 cm

Treatment of glioblastomas relies on chemotherapy alone

False: Surgical resection followed by radiotherapy and chemotherapy with TEMOZOLOMIDE

Treatment of meningioma is based on radiotherapy and chemotherapy.

False: no chemotherapy in meningioma, it is a benign tumor. Treatment is based on surgical resection or radiotherapy if not operable.

Radiation therapy of the brain in toto may be recommended in young patients with primary cerebral lymphoma.

True: primary cerebral lymphomas are chemo and radiosensitive > chemotherapy with methotrexate and consolidation by radiotherapy of the brain in toto or intensification of chemo with HSC transplantation.


Regarding intracranial hypertension syndrome, which proposals are true?

ICH headaches occur at the end of the day.

False: morning headache or second part night

There is classically an attack of the IV which has no localizing value.

In front of any ICH linked to a CNS tumor, it is essential to introduce high-dose corticosteroids.

False: corticosteroids are formally contraindicated in case of primary CNS lymphoma (risk of negativation of the histo diagnosis)

In front of an HTIC, it is necessary to perform a lumbar puncture in first line in order to search for the etiology.

False: Never in first intention! Always perform brain imaging before to rule out an expansive process or hydrocephalus (otherwise risk of commitment)


Regarding pilocytic astrocytoma, which proposals are accurate?

It is a low-grade glioma (grade I astrocytoma)

This tumor usually occurs around 50-60 years of age.

False: pilocytic astrocytoma occurs in young adults. These are grade III and IV gliomas that occur around 50-60 years of age.

True: associated with NF1 or Von Recklinghausen disease

These are well-circumscribed tumors, hypodense in CT, hyperintense in T2 MRI, taking the contrast and having a cystic component.

True, if not operable and progressive, it is possible to offer radiotherapy or chemotherapy.


Regarding carcinomatous meningitis, what are the exact proposals?

It results from the extension of a primary brain tumor to the subarachnoid spaces or the metastatic invasion of a systemic cancer

The diagnosis should be evoked in the face of any neurological symptoms in a patient with cancer

In imaging, there is abnormal meningeal or periventricular contrast taking

Meningeal stiffness is very rare in this type of meningitis.

Lumbar puncture can be used to make the diagnosis

True: the diagnosis can be made on imaging in case of typical image and/or on PL if cancer cells


Acute respiratory failure (AKI) is defined as the inability of a patient to maintain normal haematosis

• The haematosis disorder is accompanied by changes in blood gases with hypoxemia (defined as PaO2 < 90 mmHg), which may or may not be associated with hypercapnia (PaCO2 < 45 mmHg)

• Hypercapnia is not systematic, it may be absent or replaced by hypocapnia depending on the etiology of the AKI

• The appearance of signs of acute respiratory distress indicates the severity of a respiratory condition

An AKI is related to either the failure of the hematosis, or the failure of the acid-base balance function of the lung


Regarding acute respiratory insufficiency

Any situation causing fatigue of the respiratory muscles via an increase in ventilatory work can be a source of acute respiratory failure

Intrathoracic distension ("trapping" phenomenon in chronic respiratory failure) decreases the contraction of the diaphragm by flattening effect

Plasma pH varies between 7.36 and 7.42 at rest

Plasma pH varies between 7.38 and 7.42 at rest

Any pH value below 7.32 indicates the existence of associated metabolic acidosis

Any pH value below 7.30 indicates the existence of associated metabolic acidosis

Aggravaction of disorders of consciousness is an indcation to orotracheal intubation


Severe hypoxemia assessed by PaO2/FiO2 ratio in mmHg

Minimal ARDS: PaO2/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O

An average ARDS PaO2/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O

3/4SDRA severe: PaO2/FiO2 ≤ 100 with PEEP ≥ 5 cmH2O

Average ARDS: PaO2/FiO2 between 100 and 200 with PEEP ≥ 5 cmH2O


Which of the following proposals are additional examinations to be carried out urgently in the event of electrification?


Which of the following are systematic reviews of paraclinical assessment in acute respiratory failure?

False, only in case of obstruction of the VAS


Which of the following are mechanisms involved in hypoxemia where the alveolo-arterial gradient for oxygen is normal?

False, increases the alveolo-arterial gradient for oxygen


Which of these proposals is/are erysipelas risk factors?


First-line antibiotic therapy combines a penicilinase inhibitor

The erisypel is classically Streptococcus A. The first-line antibiotic is amoxicillin, without clavulanic acid


Indeed, its full name is "necrotizing fasciitis"

General signs are marked as well as infectious signs.

The notion of animal bite must point towards a pasteurellosis of inoculation.


Which of these propositions are true about eczema?

Its treatment is based on mid-dose antibiotic therapy

It is based on the eviction of the supposed allergen

The use of local corticosteroids leads to rapid improvement.

It is an immuno-allergic dermatosis due to hypersensitivity to a contact allergen.

The picture is clinically characterized by pruritus, the presence of vesicles on an inflammatory basis and crumbled border. It is usually located in the region of contact with the allergen.


Which of the following are characteristic of syncope?

It is due to global and transient cerebral hypoperfusion


Discomfort is a subjective feeling of malaise

Lipothymia is a decrease in postural tone without loss of consciousness

Syncope is a subjective feeling of malaise


Diagnosis of brutal BAV based on interrogation

The sensation of "flying flies" is myodesopsia

The speed of installation has little semiological value

Its speed of installation is fundamental in the diagnostic algorithm

Vision abnormalities never have associated pain

If. The interrogation specifies the presence or absence of associated pain and its type

Deep pain may radiate into the trigeminal territory


Regarding interrogation and examination:

Superficial pain suggests acute glaucoma

'True' headaches suggest a neuro-ophthalmological cause

Ocular trauma can have an impact on eyesight but only if it is major

Ophthalmological examination concerns only the pathological eye

Measurement of visual acuity from far and near is done without optical correction


Regarding the ophthalmological examination:

examination of the anterior segment includes vitreous and lens

examination of the anterior segment: cornea, anterior and crystalline chamber

Eye tone measurement is only done in rare cases

The measurement of eye tone is systematic

The examination of the fundus after pupillary dilation makes it possible to visualize the cornea

examination of the fundus after pupillary dilation: optic nerve, retinal vessels, retina

Complementary examinations such as OCT have become systematic

Additional examinations are not systematic and are guided by questioning and clinical examination:


In acute keratitis, decreased visual acuity is accompanied by significant superficial pain

Fluids are clear and transparent in acute keratitis

There is a decrease in transparency of the cornea, a perikeratic circle and one or more corneal ulcerations

Acute angle-closure glaucoma is painless in most cases

Acute angle closure glaucoma: The pain is deep, intense, ocular and periocular radiating into the trigeminal territory

Often nausea or vomiting occurs in acute angle-closure glaucoma

The anterior chamber is narrow in acute keratitis

The anterior chamber is narrow in acute glaucoma by closure of the angle


There is a major elevation of eye tone in acute glaucoma by angle closure

The decrease in visual acuity is most often minimal in acute glaucoma by closure of the angle

The decrease in visual acuity depends on corneal edema related to hypertonia and retinal perfusion, it is often significant

Decreased visual acuity and pain is common in iridocyclitis

A perikeratic circle eliminates the diagnosis of acute anterior uveitis


A pupil in miosis by iridocrystalline synechiae is a sign of iridocyclitis

Tyndall's phenomenon is pathognomonic of posterior uveitis

It is in acute anterior uveitis that slit lamp examination reveals the presence of inflammatory cells in the anterior chamber (Tyndall's phenomenon), possibly with retrocorneal precipitates and iridocrystalline synechiae

The most common cause of choroiditis is ocular toxoplasmosis.

Posterior uveitis is responsible for recurrent retinochoroiditis


Treatment of ocular toxoplasmosis based on antibacterials

Treatment is based on the antiparasitic drugs – pyrimethamine (Malocide®) and sulfadiazine (Adiazine®) – prescribed if there is a threat to visual acuity

Neovascular glaucoma is seen in unbalanced diabetes

The postoperative context is suggestive of endophthalmitis

The hypopion has anterior chamber fibrin visible to the slit lamp


Ultrasound B is contraindicated when the hemorrhage is massive because the retina is then not very visible

Ultrasound B is anyway always indicated when the retina is not visible to eliminate the presence of retinal detachment (+++)

Proliferative diabetic retinopathy is a cause of intravitreal hemorrhage

A retinal tear causes intravitreal hemorrhage only when there is retinal detachment

Terson syndrome is a genetic condition affecting chromosome 6 that increases the risk of intravitreous hemorrhage and subarachnoid hemorrhage.

Terson syndrome: unior bilateral intravitreal hemorrhage associated with subarachnoid hemorrhage due to intracranial aneurysm rupture (Terson syndrome may also be associated with traumatic subarachnoid hemorrhage)

Intermediate uveitis is a subgroup of uveitis where the vitreous is the main site of inflammation


Metamorphopsies concern patients with color blindness

Dyschromatopsias are a distortion of the image

Diploplolia has a purely central neurological origin

Can also be peripheral (oculomotor nerves)


Which of these pathologies can cause monocular involvement?

Rather binocular. On the other hand, TIAs by unilateral carotid stenosis can cause monocular involvement.


What are the recommendations in terms of daily calorie intake for adult men?


What are the recommendations in terms of daily calorie intake for adult women?


A diet that is too salty is a risk factor for high blood pressure

A diet that is too fat is a risk factor for type 2 diabetes

It is a risk factor for high cholesterol

A diet rich in protein promotes colon cancer

A diet that is too sweet is a risk factor for type 2 diabetes

An unbalanced diet is a risk factor for osteoporosis in the elderly