The fluid of pseudocysts is most often inflammatory in nature rich in pancreatic enzymes and tissue and necrotic debris can superinfect

The formation of pseudocysts requires several hours

The formation of pseudocysts requires several weeks

Severe acute forms of pancreatitis represent, depending on the series, 10 to 30% of pancreatitis

• Cholelithiasis and alcohol poisoning are the most common causes of pancreatitis, observed in 35-45% of cases for each of them


The reason for APs in the emergency department is most often acute abdominal pain syndrome

Diagnosis in the emergency department is based on a combination of intense epigastric abdominal pain with posterior irradiation and elevated amylasemia (> 3N)

Diagnosis in the emergency department is based on a combination of intense epigastric abdominal pain with posterior irradiation and elevated lipasemia (> 3N)

• Normal amylasemia does not exclude diagnosis

Chest X-ray is systematic at admission and looks for pleural effusions

• Pancreatic imaging is requested urgently systematically


Weighing should be a systematic part of any clinical examination

Changing clothing sizes, belt circumference and previous photographs can help the practitioner in the absence of prior weight available.

The SEFI score is used to assess food intake

A SEFI < 7 signs a risk of undernutrition

Skin examination makes it possible to objectify possible melanoderma

Or on the contrary a depigmentation, a conjunctival jaundice, a pallor


Weight in kg / the square of the height in meters


What are the possible etiologies of weight loss with involuntary food restriction?


What are the possible etiologies of weight loss without dietary restriction?

Some inflammatory pathologies induce weight loss with involuntary food restriction

Weight loss with voluntary dietary restriction


This is a very rare reason for consultation.

The consultation is always conducted by a uro-pediatrician

Often the general practitioner in first consultation

About 12% of children aged 6 to 8 have urinary leakage

Urinary leakage is exclusively nocturnal from 6 years old


Physiological urination should result in complete emptying of the bladder

During urination, bladder sphictera contract

They relax in harmony with the contraction of the detrusor

The acquisition of voiding control is contemporary with birth

The diagnosis of a voiding disorder is clinical


It makes it possible to objectify certain urinary disorders

It quantifies the severity of the emergency

It differentiates between the organic or functional nature of leaks

Above all, it allows to objectify the urinary disorder and to quantify the urgency

It requires increased patient compliance


Which of these proposals is/are malformative uropathy(s)?

It occurs as a result of a defective migration of the primordial genital tubercles to the cloacal membrane, and therefore a malformation of the genital tubercle, around the 5th week of gestation.


A urine strip is performed to rule out diabetes

The search for a bladder globe is systematic

The appearance of the urinary stream is important to assess

The search for a fecal impaction is done at the digital rectal exam

The search for stercoral congestion is done on abdominal palpation


Regarding acute urine retention in children:

It is defined by a complete and painful inability to urinate for more than 6 hours

First-line treatment is ureteral catheterization

These are the measures to stimulate urination

Second-line treatment is suprapubic catheterization

One of the possible etiologies is the adverse drug effect


Permanent leaks with preserved urination point to ureteral ectopic abouchement

Dysuria may point to a urinary disorder of the lower apparatus

Isolated nocture enuresis is often of very little concern

Oxyurosis is an infectious cause of voiding disorders

Detrusorian hyperactivity causes pollakiuria


Pathology of the valves of the posterior urethra causes permanent leakage

Functional detrusor hyperactivity causes emergency

Pollakiurias are often accompanied by urgency

A neuro-orthopedic disorder can cause emergency

Dysuria may be due to hyperactivity of the functional detrusor


It is associated with ADHD in 45% of cases

The positive diagnosis is made by flow-volume curve

It is said to be isolated when there are no daytime symptoms

It mainly concerns children under 5 years of age


The natural course of peritonitis is marked by a septic state that can be accompanied by septic shock that is often fatal.

In patients with underlying diseases, the occurrence of peritonitis often results in abrupt decompensation of the picture with an inaugural state of shock or multiple organ failure.

The maximum frequency of postoperative peritonitis occurs between 5 and 7 days after the procedure

Biological examinations are mainly used to assess the impact of the infection and to make a pre-operative assessment

In case of suspicion of peritonitis, as in the face of any suspicion of sepsis, blood cultures should be taken


The terrain plays an essential prognostic role: age, comorbidity, immunosuppression, undernutrition, obesity

The more proximal a perforation, the higher the septic risk

The more distal a perforation, the higher the septic risk (colonic stercoral peritonitis)

Postoperative peritonitis is a good prognosis

Postoperative peritonitis has a poor prognosis and the time to reintervention plays a major role

Regardless of the origin of peritonitis, the main prognostic factor is the precocity of surgical treatment

Other main diagnoses are mesenteric ischemia, chronic pancreatic (check for amylasemia), occlusions

Other main diagnoses are mesenteric ischemia, acute pancreatitis (lipasemia), occlusions


In case of spontaneous infection of ascites fluid, it is recommended to use macrolides combined with vascular albumin filling

In case of spontaneous infection of ascites fluid, it is recommended to use a 3rd generation cephalosporin, combined with vascular albumin filling

In case of infection on peritoneal dialysis, intraperitoneal antibiotic therapy is oriented on staphylococci, gram-negative and Candida (Vancomycin + aminoglycosides)

Removal of the dialysis catheter should be discussed according to the course

Treatment of secondary and tertiary peritonitis combines resuscitation and emergency surgical treatment

For localized forms with abscess formation, radiological or surgical drainage is useful and should be associated with the control of the causal focus by antibiotic therapy


Peritonitis is an acute inflammation of the peritoneum, localized or generalized, the cause of which is most often infectious

The diagnosis must therefore be rapid and treatment is an emergency in the vast majority of surgical cases

The Hamburg classification separates peritonitis into 5 classes according to the origin of the infection

The Hamburg classification separates peritonitis into 3 classes according to the origin of the infection

Secondary peritonitis accounts for 5% of acute peritonitis

Secondary peritonitis accounts for 90% of acute peritonitis

Primary peritonitis is due to a monobacterial spontaneous infection of the peritoneum of hematogenous origin or by translocation


Treatment of primary peritonitis is surgical

It is primarily medical, based on antibiotic therapy

The most common causes of primary peritonitis are ascites infection in cirrhosis; staphylococcus infection via the peritoneal catheter in patients with peritoneal dialysis; pneumococcal spontaneous peritonitis

Secondary peritonitis is related to the spread of a localized abdominal infection or perforation of a digestive viscera

Tertiary peritonitis corresponds to persistent abdominal infections despite treatment (adapted antibiotic therapy and eradication of the primary abdominal focus by one or more interventions)

The diagnosis of peritonitis is radiological

BDiagnostic positive The diagnosis of peritonitis is clinical and usually easy


Paraclinical examinations are useful to clarify the origin of peritonitis and / or plan management; under no circumstances should they delay treatment

The diagnosis of peritonitis is quickly made on physical examination in front of the presence of peritoneal signs

Contracture is the essential sign of acute peritonitis

Peritoneal signs may be moderate or absent, especially in the elderly, or malnourished

All peritonitis is accompanied by pneumoperitoneum

Be careful, not all peritonitis is accompanied by a pneumoperitoneum


The abdominal CT scan is the best examination when the clinical examination is doubtful (immunocompromised, asthenic peritonitis of the old man, obesity, post-operative peritonitis, traumatized abdomen)

The interrogation looks for a history of ulcer, recent use of gastrotoxic drugs

In an ulcer perforation generalized or localized contracture to the hypogastric region with defense in the rest of the abdomen

Upper GI endoscopy is formally contraindicated in peritonitis caused by ulcer perforation

There is no pneumoperitoneum in appendicular peritonitis


Which of the following are acute urine retention etiologies?


Which of the following are contraindications to suprapubic catheterization?

True
On
The elimination of the presence of an intestinal loop by ultrasound is necessary beforehand


Which of the following proposals designates a contraindication(s) to bladder probing?


Which of the following are absolute contraindications to bladder probing?

True, these are the three absolute contraindications to bladder probing


A full bladder differentiates acute urine retention from anuria

Anuria (= no urine secreted by the kidney) is a differential diagnosis and something else

Anuria is not accompanied by bladder globe

Ultrasound makes the difference between anuria and RAU


Which of the following are absolute contraindications to suprapubic catheterization?

Vascular bypass surgery in the suprapubic region

True, these are the two absolute ICs of suprapubic catheterization.


Peripheral venous tracts are used to infuse drugs with low venotoxicity

The most common immediate complication is puncture failure

The complications of these venous approaches although relatively rare constitute because of the number of catheters used a frequent problem

The monitoring of these venous surroundings in search of complications is therefore the domain of the doctor's daily life.

In addition, in order to limit this iatrogenic risk as much as possible, the first peripheral installation must be systematic

In addition, in order to limit this iatrogenic risk as much as possible, the doctor must constantly ask himself the question of the indication to maintain these venous approaches in place.


The term peripheral venous catheter is used when the end is placed in the superior or inferior vena cava

The term central venous catheter is used when the tip is placed in a "central" vein, i.e. the superior or inferior vena cava.

The central venous tracts are reserved for toxic products for the veins (chemotherapy, some antibiotics) only

Central venous lines are reserved for vein toxicants but can also be used for long-term infusions or in patients with "poor" peripheral venous capital.

in the first superficial ways The most common complication is the wound of the vein that will cause a hematoma

If this wound is not diagnosed promptly, an extravenous infusion may occur

The most common complication is puncture failure


Learned societies recommend the use of ultrasound and the performance of ultrasound-guided puncture for the approach of the internal jugular vein

The catheter (and/or the guide used for its placement) can perforate the vein and have an aberrant path in the soft parts

A Pneumothorax may result from puncture of the pleural dome during an attempt to puncture the subclavian vein

Air embolism can occur during catheter placement when the lumen of the vein is in communication with atmospheric air

This risk is all the more important as the mediastinal pressure is lower than atmospheric pressure


Concerning the complications of venous surroundings

The contributing factors of an infection include the duration of maintenance of the venous line, manipulations, loss of tightness of the occlusive dressing

Monitoring and complications of venous approaches ²²Ä Deep catheters: infection starting with a central venous line is rare

Surveillance and complications of venous approaches ²²Ä Deep catheters: infection starting with a central venous line is relatively common since the coordination center for the control of nosocomial infections estimates that the prevalence is of the order of 2% of carriers of a central venous line

In addition to the general factors favoring infection, the occurrence of this complication directly depends on the duration of use of the catheter and

The catheter can be colonized by skin germs during placement or subsequent manipulations: this is contamination by the extraluminal route

The endoluminal pathway will be likely to be colonized during microbial contamination from taps and tubing that will be connected to the catheter.


Acute otitis media is a very common infection

Streptococcus pneumoniae and Staphyloccocus Aureus represent the two main bacterial etiologies

Haemophilius influenzae and Streptococcus pneumoniae

The diagnosis of purulent AOM should be evoked in front of fever and earache

The diagnosis is confirmed by performing an otoscopy showing inflammatory signs of the eardrum

After the age of 2, the majority of purulent AOMs heal spontaneously


Otitis externa is an inflammation of the skin of the external auditory canal

Seromucosal otitis corresponds to chronic retrotympanic effusion

In nasopharyngitis, the viral infection also affects the lining of the inner, middle and outer ear.

Viral infection also affects the lining of the middle ear

It is much less common after the age of 6

Externalized mastoiditis with purulent retro-auricular collection is exceptional


In case of purulent AOM in a child > 2 years, antibiotic therapy is recommended from the outset

If the evolution is favorable, systematic control of eardrums at the end of treatment is not necessary

In case of otitis externa, the fever is usually very high

Seromucosal otitis (OSM) is defined by the existence of chronic inflammation, evolving for more than 3 months, of the middle ear with closed eardrum

Seromucosal otitis is unlateral in the vast majority of cases

It is bilateral in the vast majority of cases


Which of the following are indications for antibiotic therapy for acute otitis media?

Children under two years of age, systematically

True, systematic in children under two years of age

Children under two years of age, with mild symptoms

True, regardless of the severity of symptoms for children < 2 years (in 1st line Amoxicillin PO 2-3 taken / D, 80 to 90 mg / kg / Day)

Child over two years of age, in case of severe symptoms

Children over two years of age, with mild symptoms

In children > 2 years of age, antibiotic therapy is introduced if AOM is poorly tolerated or in case of treatment failure or complication


What antibiotic therapy should be prescribed for otitis-conjunctivitis syndrome in a patient with no particular allergy?

The SOC strongly suggests Hameophilus influenzae infection


Which of the following is the recommended duration of antibiotic therapy for acute otitis media in children under two years of age?


Which germ is most often incriminated in front of otitis-conjunctivitis syndrome?


Which of the following proposals lead to serous otitis?

Otitis externa, tympanic perforation or cholesteatoma

Disappearance of the luminous 🔅 triangle


The range of motion required for walking is as follows:

Hip: 100 degrees flexion and 30 degrees extension

It's the opposite: 30° bending and 100° extension


Joint movements necessary to go up and down the stairs by chaining the stairs: hip flexion 110 ° and extension 10 °

Joint debate required to sit: 90° for hip and knee flexion

The quadricpes is a braking muscle when taking support in the support phase

The anterior tibial is a propellant muscle at the beginning of the support phase and a muscle

The gluteus medius and the tensor of the facia lata are lateral stabilizing muscles of the flexed knee


Regarding walking and balancing disorders:

The essential muscles of standing are the antigravity muscles, namely the extensors of the lower limb and the paravertebrals.

During a dodge lameness, there is a decrease in the time of monopdal support and the downforce on the side of pain

Steppage is related to a deficit of the muscles of the posterior compartment of the leg

A loss of quadriceps strength is at the origin of a lameness with greeting

Damage to the posterior tibial nerve causes stepping


Regarding walking and balance disorders:

Walking, a highly automated motor production, largely escapes conscious control

Romberg's sign is the aggravation of instability at the closing of the eyes and signs the sensory origin of ataxia

It can be vestibular or proprioceptive ataxia

Postural reflexes are impaired in case of damage to the basal ganglia or frontal regions

Almost all drugs prescribed in the field of neuropsychiatry can induce low blood pressure and attentional disorders that can increase the risk of falls.

The walk is classically drunk, the lifting polygon is widened, the tightrope walk is altered early during proprioceptive impairment


Peripheral vestibular syndrome is noisy, manifested as rotational vertigo accompanied by vomiting and vegetative signs

In vestibular syndrome the abnormalities of walking and balance are lateralized from the side of the slow saccade of nystagmus, to the healthy side

Abnormalities in walking and balance are well lateralized on the side of the slow saccade of nystagmus, but this is the diseased side

Romberg's test is very disturbed, aggravated markedly when the eyes close during proprioceptive ataxia

During proprioceptive ataxia, posture reflexes are disturbed, the polygon is enlarged.

The polygon is well enlarged but posture reflexes are normal.

During proprioceptive impairment, walking is heelating, ground support is poorly controlled and contact is sometimes violent.


The sequelae of stroke are essentially in the form of hemiparesis or hemiplegia causing mowing, the homolateral upper limb being fixed in abduction.

In the sequelae of stroke, the homolateral upper limb is fixed in adduction

Paraparesis with spasticity is secondary to spinal cord disorders: multiple sclerosis, myelitis, tumor or mechanical compression, and hereditary spastic paraparesis.

Lower limb dystonias are always bilateral

A dopa-sensitivity test should be performed in front of dystonia, most often

In Huntington's chorea, gait and balance disorders are complex: severe impairment of the postural reflexes, akinetic syndrome, axial and limb choreodystonic movement


In Parkinson's disease, levodopa-induced dyskinesias induce imbalances when walking

Chronic hydrocephalus in adults is clinically characterized by the Hakim and Adams triad: walking and balance disorders, sphincter disorders and dementia.

In chronic hydrocephalus of adults, there is an enlargement of the lifting polygon and freezing in 2-3% of cases

There is an enlargement of the lift polygon and freezing in 20 to 30% of cases

The diagnosis of chronic hydrocephalus in adults is based on brain MRI which shows tetraventricular dilation with little cortical atrophy and T2 hyposignal ranges around the ventricles

Treatment of chronic adult hydrocephalus consists of a ventriculoperitoneal bypass that results in inconsistent improvement in motor and cognitive disorders


The oscillating phase concerns 60% of the running time

Oscillating phase = 40%; Support phase = 60%

The beginning of the walking cycle begins with an attack through the heel

For normal walking, you need a hip extension at 10° and a hip flexion at 30°

For normal walking, you need a knee flexion at 70° and a knee extension at 10°

A knee extension of 0° is required. Beyond this angle, we speak of recurvatum of the knee which is abnormal when walking.

For normal walking, you need a plantar ankle flexion of 15° and a dorsal flexion of 10°


Postural reflexes are modified by lesions in which part(s) of the brain?


Ataxia can be of vestibular, proprioceptive or cerebellar origin

A worsening of balance disorders when closing the eyes (Romberg's sign) is a sign of cerebellar syndrome

Closing the eyes eliminates sensory afferents from the eyes that help keep balance. There will be a worsening of balance if there is a vestibular syndrome or proprioception disorder.

Kinetic cerebellar ataxia is secondary to vermis injury

Cerebellar ataxia is multidirectional in the Romberg test

The walk is classically drunk, the lifting polygon is widened, the tightrope walk is altered early during cerebellar syndrome


Vertebrobasilar territory stroke with AIPD


Biermer's disease can cause proprioceptive ataxia

Biermer's disease is an autoimmune disease with antibodies to intrinsic factor, which inhibits the absorption of vitamin B12. This vitamin B12 deficiency induces combined sclerosis of the spinal cord: posterior cordonal syndrome (proprioceptive ataxia, Romberg's sign, deep sensitivity disorders) and pyramidal syndrome by lateral cord damage (bilateral Babinski's sign, exaggerated ROT).

During vestibular ataxia, walking is in a star pattern

During proprioceptive ataxia, walking is tillering, ground support is poorly controlled, ground contact is sometimes violent and the lift polygon is increased

MS can cause cerebellar ataxia and proprioceptive ataxia

Cerebellar ataxia by cerebellum damage and proprioceptive ataxia by posterior cord involvement of the spinal cord

Damage to the cerebellum worm can cause static cerebellar ataxia


Dystonias are only caused by prolonged use of L-Dopa in Parkinson's disease

They can be caused by inherited generalized dystonias and neonatal anoxia

If there is the presence of dystonia, a dopa-sensitivity test should be done


Regarding the Hakim and Adams triad in chronic hydrocephalus in adults:

There is a dementia syndrome of the subcorticofrontal type

There is a loss of arm swing when walking

There is an enlargement of the lift polygon when walking

Just like late-onset Parkinson's disease


The quadriceps is a braking muscle during the support phase

The anterior tibial muscle shortens the limb during the oscillating phase

A dorsal flexion of 10° is necessary for normal walking

The triceps sural allows a propulsion of the limb at the end of the support phase

A toe extension is not necessary for normal walking


Which anomaly(s) is/are likely to cause a start of walking by an attack by the tip of the foot?


Walking is controlled by subcortical circuits, including basal ganglia, brainstem and spinal cord regions.

The stride is defined as a succession of 2 steps

The gluteal medius muscle is a stabilizer of the hip

There is always at least 1 ground support when walking


Which propositions are true? (one or more correct answers)

Management in intensive care involves continuous monitoring of vital functions and, where appropriate, the use of methods of replacement of failing organs

Resuscitation is based on active therapies only

Supportive care should always be continued

Unreasonable obstinacy is defined by the initiation or continuation of a curative therapy not desired by the family.

Unreasonable obstinacy is defined as the initiation or continuation of a curative therapy or diagnostic strategy (and this is why unreasonable obstinacy is more inclusive than therapeutic relentlessness) that is unnecessary and unjustified in terms of prognosis in terms of survival or quality of life.

Palliative care is acute care delivered in a comprehensive approach to the person with a terminal illness

It must concern all chronically ill patients (especially cancers, whatever their phase of the disease)

An LATA involves the cessation of all care and replacement of organs, regardless of the LATA made.

A LATA defines ethically authorized care (light monitoring at least, replacement of organs if decided)


Vertigo is an illusion of movement of the environment exclusively, without subjective movement

Vertigo is an illusion of movement, either of the patient or of the environment, which most often results in an impression of rotation or sometimes linear displacement

The impression of displacement is always rotating

The peripheral vestibular system consists of the semicircular canals, utricle and saccule

The ampullary ridges of the semicircular canals detect the rotational movements of the head

The otolithic macules of the utricle and saccule detect linear head movements and gravity direction


Information from the posterior labyrinth is conveyed in the twelfth cranial nerve

Cochleovestibular nerve = VIIIth cranial nerve

The vestibular nuclei are closely connected with the vestibular cerebellum

An acute or subacute lesional process of one of the vestibular structures leads to asymmetric functioning, resulting in the appearance of acute vestibular syndrome

Chronic involvement of vestibular structures is mainly manifested by nystagmus

The duration and frequency of seizures make it possible to classify dizziness into four categories useful for diagnosis.

This is the determining element of the interrogation that makes it possible to classify vertigo into four categories very useful in terms of etiological diagnosis.


Regarding posture disorders in the context of peripheral vestibular syndrome:

A vestibular syndrome usually gives postural disorders aggravated by closing the eyes

A normal subject holds more than 6 seconds with his eyes closed standing in static without moving his feet

In case of proprioceptive disorders, the oscillations of the body are in all directions

In case of vestibular involvement, there is a slow deviation of the axis of the body towards the back

In case of vestibular involvement, there is a slow deviation of the axis of the body always on the same side (lateral)

In case of vestibular involvement, the lateral deviation of the axis of the body contributes to the fact that the subject does not remain on the same line but moves in a star


Which of these structures make up the vestibular system?

The peripheral vestibular system consists of the semicircular canals, utricle and saccule


The decubitus is without consequences during a night's sleep in the healthy subject

Decubitus and hypomobility are the cause of complications in bedridden patients

Decubitus has no impact on sensory functions

We have an impoverishment of sensory afferents

Reduced effort induces cardiorespiratory maladaptation


There is a neuropsychological impact that is sometimes significant

The complications of hypomobility and decubitus can be distinguished according to their precocity and their local, regional or general character.

Muscle retractions are early complications

Constipation is an early complication of decubitus


Among these proposals, which are early complications:


Which of these proposals are late complications of decubitus?


What medical circumstances really require bed rest?


Complications are predictable and often prevented by appropriate therapeutic care, undertaken from the beginning of the decubitus position

Neurological deficit with disorders of trunk tone is a pathology inducing a decubitus for life

Only at the initial stage. It must then be put an end to it by appropriate means

Immobility promotes venous stasis and the occurrence of thromboembolic disease with a risk of pulmonary embolism

Preventive treatment of VTE relies on low molecular weight heparins (LMWH)


The definition of cirrhosis is biological

The definition of cirrhosis is pathological

The definition of cirrhosis is histological 🔬

The definition of cirrhosis is radiographic


Which of the following are included in the calculation of Maddrey's score?

True, unless it is < 30% (because the score is then always greater than 32)

The Maddrey score is a prognostic score assessing the severity of alcoholic hepatitis. Score = TP * 4.6 + (Total bilirubin / 17)


Which of the following are ultrasound (or Doppler echo) signs of cirrhosis?

True. More specifically, a repermeabilization of this vein (collateral circulation set up because circulation within the liver is too difficult)

Presence of peritoneal effusion (ascites)


Which of the following are biological signs of cirrhosis? 💉


Which of the following are included in the Child Pugh calculation?

True. TP > 50%: 1 point. TP 40-50%: 2 points. TP <40%: 3 points

Encephalopathy. Absence: 1 point. Mild to moderate: 2 points. Severe: 3 points.

Does not fit into the calculation. The 5 things to consider are: ascites, bilirubin, encephalopathy, prothrombin and albumin levels.

True. In g/L. Albumin> 35 : 1 point. Albumin 28-35: 2 points. Albumin< 28: 3 points.

It is the total bilirubin that is taken into account. < 35: 1 point. 35-50: 2 points. >50: 3 points.


Which of the following are signs of portal hypertension?

Sign of hepatocellular insufficiency (increased bilirubin)

True, by increasing hydrostatic pressure (increased resistance of hepatic capillaries)


Which of the following are true for chronic lymphocytic leukemia?

Most often it is a hematological disease of the child

The diagnosis can be made incidentally on the blood count

Richter transformation (5-10% of CLL results in aggressive Non-Hodgkin lymphoma)

Binet's classification has 5 possibilities, from A to E

3: Binet A, Binet B and Binet C (most pejorative)


What is the Binet stage of a patient in whom there are only 2 axillary lymphadenopathies without hepatomegaly or splenomegaly, without biological abnormalities (except hyperlymphocytosis)?

True. <3 lymph node areas affected, no anemia, no thrombocytopenia.


What is the Binet stage of a patient with 2 left axillary lymphadenopathy, 2 left inguinal lymphadenopathy, 4 right cervical lymphadenopathy, hepatomegaly and splenomegaly, without biological abnormalities (except hyperlymphocytosis)?

True. >= 3 lymph node areas affected, without anemia or thrombocytopenia


At the time of diagnosis, 1/3 of patients are BINET A

70 to 80% of patients are in Binet A at the time of diagnosis

Binet's classification is exclusively clinical

Clinico-biological (anemia or Binet C thrombocytopenia ➡)

Binet A stage does not require treatment most often

True. Clinicobiological surveillance every 6 months

CLL is the most common childhood leukemia

It is not found in children. The median age at diagnosis is 72 years.

The discovery of CLL is most often fortuitous


Which of the following proposals are poor prognosis?

Doubling time of blood lymphocytosis less than 36 months

Somatic mutation of the immunoglobulin heavy chain gene (LHIVG)


What is the Binet stage of a patient in whom there is no axillary lymphadenopathy but hepatomegaly and splenomegaly, and anemia <10g/dL?

True. Anemia directly classifies CLL as stage C


What is the Binet stage of a patient in whom there is no axillary lymphadenopathy but hepatomegaly and splenomegaly, without biological abnormalities (except hyperlymphocytosis)?


Which of the following is one or more visible complications in polycythemia vera?

Rather, there is a martial deficiency due to bloodletting

Phosphorus-32 is no longer used in France because of its highly leukeogenic potential. It is hydroxycarbamide (prescribed in +60 years or in case of history of thrombosis) that has skin side effects


Which of the following is the minor criterion for polycythemia vera according to WHO (2016)?

Spontaneous growth of medullary erythroblastic progenitors


Which of the following proposals makes it possible to define a polycythemia with certainty?

True, this is the reference examination (isotopic measurement). By definition, the measurement of blood mass is increased: we speak of true polycythemia when the total corpuscular volume is 25% higher than the normal value.


Which of the following are clinical signs in favor of polycythemia vera?

True, related to myeloproliferative syndrome (just like water pruritus)

No relationship described between these two pathologies in the college


Which of the following are true for the V617F mutation in JAK2?

This is a constitutional genetic anomaly

It may be present in circulating polynuclear drugs

It is mandatory at the diagnosis of polycythemia vera

There are other mutations that can induce a primitive polycythemia (mutation of exon 12 of JAK2, mutation of CARL, mutation of MPL ...). They are much rarer

It is present in about half of cases of essential thrombocythemia

It is not found in chronic myelogenous leukemia


Which of the following are the causes of false polycythemia?

There is red blood cell sequestration and hemodilution, so rather anemia (often moderate with a small hemolytic component of stasis). For information, a voluminous splenomegaly can sequester up to 25% of the total blood mass.

In acute cases, there is no impact on the CBC (equivalent loss of red blood cells and plasma). Prolonged, we find anemia


Which of the following are the major criteria for polycythemia vera according to WHO (2016)?

Does not fall within the scope of the WHO 2016 criteria because it is not very specific

Does not fall within the scope of the WHO 2016 criteria because it is not very sensitive (only 2/3 of patients) and not very specific (many differential diagnoses)

Myeloid hypertrophy on bone marrow biopsy


Which of the following are causes of moderate polynucleosis?

In this case, it is mostly lymphocytosis. Polynucleosis is found in bacterial infections.

NSAIDs do not cause polynucleosis, on the contrary


Which of the following propositions are true regarding the etiology of CML?

It may be secondary to exposure to ionizing radiation

It may be secondary to exposure to benzene

True, these are the only two occupational diseases in the PM tables.

It may be secondary to exposure to statins

It may be secondary to exposure to cocaine


Which of the following are true about myelofibrosis?

Secondary myelofibrosis can complicate all myeloproliferative neoplasias

In polycythemia vera, this course is more common in case of bloodletting treatment

The diagnosis is made on the appearance of poor marrow to the myelogram

We do not see the appearance of the bone marrow on the myelogram but on the osteospinal cord biopsy. Abnormalities of the medullary structure are observed.  Myelofibrosis is an abnormality highlighted by specific stains, which can evolve in several stages (reticulin stained by silver derivatives, collagen visible with trichrome, or sclerosing and then willingly mutilating) and often prevents aspiration of bone marrow juice.

In primary myelofibrosis, the JAK2 mutation is found in about 50% of cases

There is targeted therapy with JAK2 inhibitor


What is the most common cause of tumor hypoglycemia in adults?


Regarding the diagnosis of hypoglycemia:

Whipple's Triad: Sign of neuroglucopenia + Low venous blood glucose < 0.50 g/L (2.75mmol/L) + Symptoms disappear during re-sugaringnot to be confused with Whipple's disease, infection caused by the intracellular bacterium Tropheryma whipplei

Normalization of blood glucose should lead to correction of symptoms

Indeed, as indicated in the reference system, the diagnosis of hypoglycemia is based on Whipple's triad which involves a correction of symptoms after normalization of blood glucose

Signs of insulinopenia are in the foreground

Signs of neuroglucopenia (i.e. NS dysfunction) are in the foreground

Low capillary glucose measurement is the basis of diagnosis

It is the measurement of venous blood glucose that must be performed in order to be able to make a diagnosis of hypoglycemia

A blood glucose level of 0.4 g/L is used to diagnose hypoglycemia

An isolated low blood sugar is not enough to carry the diagnosis, it is necessary to find the elements of the triad of Whipple


Which of these proposals are signs of adrenergic reaction to hypoglycemia?


Which of these proposals are signs of neuroglucopenia?

This is a sign of the adrenergic reaction


Regarding hypoglycemia, which of the following propositions are true?

Whipple's triad, essential to the DG, includes: neurovegetative syndrome, blood glucose < 0.5 g / L and correction of symptoms after normalization of blood glucose.

Whipple's triad, essential for the DG, includes: NEUROGLUCOPENIC syndrome*, a blood glucose < 0.5 g / L and a correction of symptoms after normalization of blood glucose.

Functional hypoglycemia, synonymous with idiopathic hyperketotic hypoglycemia, is characterized in particular by its appearance during a short fast.

Hypoglycemia in a child with soft and bulky hepatomegaly suggests glycogen storage disease.

Hypoglycemia associated with multiple organ failure suggests a deficit in the β oxidation of fatty acids.

Hypoglycemia associated with multiple organ failure suggests primary adrenal insufficiency.


Which of the following are true for progressive multifocal leukoencephalopathy (PML)?

It is common between 200 and 400 circulating CD4 lynphocytes

It can be sensitive and/or motor, depending on the fibers that are demyelinated

True, no fever, headache, or intracranial hypertension


What is the prevalence of HIV in France?

True and an incidence of about 6400 cases per year


Triple therapy is to be continued for about 15 years

Classically no fever, no HTIC, no headache

True, just as in EBV, CMV, toxoplasmosis and DRESS syndrome

The risk of mother-to-child transmission is almost zero when management is adapted

All live attenuated vaccines are contraindicated in HIV patients

Not if CD4 LTs are greater than 200, except for BCG (always contraindicated in HIV patients)


Which of the following are true about HIV?

Tenofovir is a reverse transcriptase inhibitor

Kaposi's disease requires the patient to offer an HIV diagnostic test

HIV, untreated, induces a significant decrease in LT CD8 helpers, up to the AIDS stage

These are the LT CD4 (helpers). CD8 LTs are cytotoxic lymphocytes

Primary infection is most often accompanied by thrombocytosis

Rather, cytopenia is observed: thrombocytopenia and leukopenia predominant on lymphocytes


Which of the following are verified types of HIV transmission?


What is the CD4 LT threshold below which the AIDS stage is defined?

True, it is from this threshold that most opportunistic infections can occur.


What is the annual incidence of HIV in France?


Which of the following proposals are NRTIs (Nucleoside Reverse Transcriptase Inhibitors)?

NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor). IC during pregnancy 🤰


Which of the following proposals are NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors)?

Nucleoside reverse transcriptase inhibitor (NRTI)


Which of the following are protease inhibitors?

NRTI (Nucleoside Reverse Transcriptase Inhibitor)

NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor)


Which of the following are true about HIV and TB?

Mother-to-child transmission of the virus is impossible

Very low risk (0.3%) if properly managed, but not impossible

Announcing the diagnosis to a teenager is useless as long as he is a minor

Diagnosis, treatment and prevention of essential complications at any age

Curative treatment for tuberculosis does not differ in HIV+ subjects from that recommended in non-HIV patients

Rifampicin interacts with many protease inhibitors

True. Pilly 2020: "Drug interactions between antiretrovirals and rifampicin"


Non-traumatic spinal cord compressions are extremely rare

Non-traumatic compressions of the spinal cord and cauda equina represent a frequent clinical situation whose diagnosis must be made very early at the onset of signs in order to limit the pathophysiological and functional consequences

Extradural compressions are the most common, with in particular vertebral metastases

Intramedullary compressions are the most common

Intramedullary: rarer (example: ependymoma)

The only reference test is the non-injected CT scan

The analysis of the level of the lesion is decisive to guide the level explored by the only reference examination that is magnetic resonance imaging (MRI)

The spinal cord extends in adults from the foramen magnum to the intervertebral disc L4

The medulla arises from the emergence of C1 and ends at the level of the intervertebral discs L1-L2


Below the T12 vertebra, there can be no spinal cord compression

Below the L2 vertebra, there can therefore be no spinal cord compression, it is a cauda equina syndrome

The lesional syndrome corresponds to the involvement at the site of the compression and the extent in height of the involvement of the gray matter and or several contiguous roots

The sublesional syndrome corresponds to the expression of the involvement of the long descending and ascending pathways at the level of the lesion

Tetraplegia is a deficit or loss of motor and sensory functions in the lumbar segments of the spinal cord

Tetraplegia (preferred term to quadriplegia): this term corresponds to a deficit or loss of motor and sensory functions in the cervical segments of the spinal cord due to damage to the neurax inside the spinal canal

Paraplegia is a deficit or loss of motor and/or sensory functions in the thoracic, lumbar and sacral segments of the ME


Regarding the initial management of patients:

ASIA Grade E corresponds to normal sensory and motor functions

The systematization of the examination of the spinal cord injury, including the examination of the sacral sphere, makes it possible to identify initial prognostic factors for recovery

Additional motor testing of non-key muscles is optional

A proprioception assessment should be performed

The assessment of spasticity is made by the modified Allen scale

an assessment of spasticity (modified Ashworth scale, Penn spasm scale) and its impact on motor control and functionality


Spinal cord compressions most often produce incomplete pictures when the diagnosis is not too late

Cauda equina syndrome should be suspected and investigated during any sciatica

Cauda equina syndrome is never lateralized

Cauda equina syndrome may be lateralized and incomplete

The great specificity of spinal cord injuries is to be at the origin of a table of multi-organ and multi-system deficiencies

Management of spinal cord injuries is the responsibility of physical medicine and rehabilitation services


The rehabilitation scheme for non-traumatic spinal cord injuries follows the same principles as that for traumatic injuries

The spinal cord injury is a major risk of esores from 3 months post-accident

From the initial phase and throughout the patient's life

The pathophysiology of pressure ulcers in the medulla injured is related to sensory disorders alone

The pathophysiology of pressure ulcers in the medulla-injured is related to the sensory and motor disorders induced by the spinal injury but also to the associated vegetative paralysis (lack of microcirculatory adaptation to pressure)

The incidence and prevalence of pressure ulcers is in the order of 0.3%

The incidence and prevalence of pressure ulcers, whether acute or chronic, are in the order of 30%, and pressure ulcers are one of the leading causes of re-hospitalization in spinal cord injuries.

Chest involvement (Th6 and above) is characterized by sympathetic and parasympathetic involvement

Sympathetic impairment and parasympathetic preservation


The interruption of the efferent pathways of the baro-reflex is the cause of major orthostatic hypotension when the attack is above T6

Prevention of OH requires progressive verticalization on inclined plane

Thromboembolic risk requires prevention by LMWH for at least 8 weeks post-accident

Vesicosphincter disorders are rare in this type of lesion

These disorders are still today one of the leading causes of morbidity and rehospitalizations justifying specialized care and long-term follow-up.

In the initial phase, especially during the subacute installation of a spinal cord injury or cauda equina, bladder symptoms are non-existent

In the initial phase, especially during the subacute installation of a spinal cord injury or cauda equina, acute retention is the rule


Which of the following proposals are in favor of spinal cord compression?


Which of the following proposals can lead to a disco-radicular conflict in case of lumbo-cruralgia L4?

Foraminal or extraforaminal hernia X-Y = > X key

Median or paramedian hernia X-Y = > touch Y


Diarrhea is defined in adults by the emission of too frequent, too abundant stools, of abnormal consistency (liquid or very soft), and weight greater than 30 g / d

Definitions Diarrhoea is defined in adults by the emission of stools that are too frequent, too abundant, of abnormal consistency (liquid or very soft), and of weight greater than 300 g / day

Diarrhea is said to be acute when it has progressed for less than 2 weeks

In the majority of cases, acute diarrhea is sudden onset

It is then most often due to an infection, usually lasts less than a week and recurrences in the short term

It is then most often due to an infection, usually lasts less than a week and does not recur in the short term.

A dysenteric syndrome is defined by bloody and glairous evacuations that can be dissociated from the materials


When it involves afecal evacuations, dysenteric syndrome indicates a distal colonic organic lesion

Acute diarrhea most often regresses spontaneously or under symptomatic treatment within 3 days

Digestive losses due to diarrhea include water, sodium (about 50 mmol/L), potassium and bicarbonates

Physical examination of the abdomen is most often normal or shows only diffuse tenderness on abdominal palpation

In infants, dehydration can cause: apathy, difficulty waking up with moans, unusual behavior and bradypnea


Regarding generalities about rachialgia:

The infectious origin of spinal pain is the most common

Rachialgia, whether cervical, thoracic or lumbar, is a symptom whose etiology can be extremely varied, even if the degenerative origin (often called "common" vertebral pathology) is, by far, the most frequent

Neck pain is extremely common pain of the cervical spine

Torticollis is an acute cervical pain syndrome with associated muscle contracture

A distinction is made between torticollis, which is an acute cervical pain syndrome with associated muscle contracture, and subacute or chronic neck pain, most often of degenerative origin.

The so-called "common" neck pain is related to osteoarthritis or disc disease lesions

Discopathic lesions are always symptomatic

In the majority of cases, it is asymptomatic, and this notion must be present in mind so as not to attribute the symptomatology too easily to radiographic abnormalities.


"Common" neck pain is cervical pain related to degenerative discovertebral mechanical lesions

Common circles check for the absence of general signs or a particular general context

Common low back pain is an inflammatory lesion

Spinal muscles can be painful on palpation

A median and impulsive low back pain in a person between 20 and 60 years of age points to an inflammatory origin


Standard X-ray In front of a common neck pain is necessary to eliminate any inflammatory, infectious or neoplastic process

In front of a simple torticollis, acute neck pain, or a recurrence of chronic neck pain known and already explored, without any red flag, there is no need to perform imaging

Dynamic images (in flexion and profile extension) are useful if there is a traumatic history when X-rays are indicated

MRI is contraindicated in front of neck pain because useless

It is only useful in front of red flags,

In the disc origin, pain is little present, if at all

The picture is often very algic, with cervical stiffness and contracture, analgesic attitude, impulsivity

Degenerative/osteoarthritis origin is the most common


Senile kyphosis known as "Schmorl" is linked to Scheuermann's disease

Scoliosis promotes costovertebral osteoarthritis

Just as hip dysplasia promotes coxarthrosis; and varus/valgus gonarthrosis

"Common" low back pain is lumbar spine pain related to degenerative discovertebral mechanical injuries


Which of the following proposals are in favour of common low back pain?


Which of the following are mixed nerves?

Motor nerve (lateral straight, abduction of the eye)


Which of the following propositions are true regarding decebration?


Which of the following proposals are involved in the reflex of the veil of the palate 👄?

True. Mixed nerve involved in the afferent pathway of this reflex

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

This nerve does not exist, it is invented 🧙 ♂


Which of the following are attenuated forms of coma? (Emergency MedLine)


It presents an epidemic with a seasonal rhythm autumn-winter

It has a strict human-to-human transmission

The high attack rate in case of close and repeated contact

In epidemiology, the attack rate (ATR) is an indicator used to characterize the morbidity of an epidemic. It most often corresponds to a cummule incidence rate

Transmission mainly within the family and in communities

Influenza is a disease circulating in 2 modes: seasonal and pandemic


During an epidemic season, about 10% of the world's population is infected

Children play a major role in the spread of an epidemic

Being often asymptomptopopatic, they play the role of healthy carriers

Influenza easily decompensates an underlying medical condition

This is why people at risk (elderly or immunocompromised) should be monitored.

Secondary bacterial pneumonia (post influenza) is found particularly in the elderly

Chest X-ray will be systematically useful

Chest X-ray will be useful in for differential diagnosis or in case of complications


Staphylococcus aureus, Haemophilus influenzae and pneumococcus are the main bacteria implicated in bacterial superinfection

Microbiological tests have no indication for uncomplicated seasonal influenza

The reference method of virus detection is antigen detection by ELISA

An inflammatory syndrome (high CRP) can appear in case of bacterial superinfection and is very specific

An inflammatory syndrome (elevated CRP) may occur in case of bacterial superinfection. But beware, this is not at all a specific sign


Rest at home and, where appropriate, a work stoppage are to be prescribed

Analgesics and antipyretics are prescribed if poorly tolerated fever

NSAIDs and corticosteroids should be avoided

Cough suppressants and bronchial thinners are ineffective in treating influenza

If bacterial pulmonary superinfection characterized, antibiotic therapy targeting Haemophilius Influenzae should be prescribed


Which of the following statements about influenza are true?

Direct transmission by air is via aerosols

Contagiousness of the subject is defined as 1 day before the onset of symptoms to 6 days after.

Bacterial superinfection usually occurs between the 5th and 7th day after the onset of symptoms.


Regarding the compression of the optical chiasm:

Pituitary tumor syndrome can compress the optic pathways

Visual acuity is most often normal due to the absence of involvement of the central visual field; sometimes it is reduced in case of very large and long neglected lesions

The study of the visual field with the Goldman apparatus finds a superior temporal quadranopsia

Emergency imaging allows diagnosis by showing an adenoma in the process of necrosis or hemorrhage


Regarding the diagnosis of pituitary adenomas:

The indication of CT scan of the pituitary region is currently limited to bone impact analysis of macroadenomas

Magnetic resonance imaging (MRI) is the gold standard test for exploring the hypothalamic-pituitary region

In T2 weighting, adenomas can be hypo, iso or more often hyperintense

After injection, the microadenoma appears hypointense to the rest of the pituitary gland which takes the contrast homogeneously in T1

Dynamic shots are used to analyze differences in contrast taking


Which of the following are dosages to look for corticotropic insufficiency after pituitary surgery for cortisolic adenoma?

True, there is a physiological peak, which disappears in case of corticotropic insufficiency


Which of the following are pathologies that fall within the scope of an NMS 1?

Pituitary adenomas are part of the MEN1 spectrum


Which of the following are signs or symptoms of Cushing's syndrome?


Which of the following are plasma assays that can confirm Cushing's syndrome?

Test that determines the etiology of Cushing

Not very informative because physiological peak at 8 am


Regarding chronic respiratory failure or CKD

Chronic respiratory failure (CKD) is defined by the inability of the respiratory system to provide haematosis

The main clinical sign of chronic respiratory failure is dyspnea

Chronic respiratory failure is the common evolutionary term for many respiratory diseases

Comorbidities, depending on the etiology of CKD, are common and should be systematically sought


The withdrawal of a possible tobacco intoxication is secondary because the attack is already at an advanced stage

Quitting from possible tobacco intoxication is essential

Patients with chronic respiratory failure are at risk of decompensation (acute respiratory failure), which has significant morbidity and mortality

Assessment of pulmonary arterial pressure should be sought during follow-up

The existence of a decrease in the partial pressure of oxygen (PaO2) in the arterial blood (hypoxemia) is necessary to speak of chronic respiratory failure

 The realization of blood gas is therefore essential to make the diagnosis of chronic respiratory failure (CKD)


The most common cause of CKD (75% of cases) is COPD

Hypoxia is a decrease in the distribution of oxygen to tissues

We speak of shunt effect when certain lung units are ventilated normally but poorly infused

Or when some lung units are infused normally but poorly ventilated

The passage of gases (O2 and CO2) through the alveolo-capillary membrane depends on the thickness of the membrane and its surface but also on the integrity of the pulmonary vascular bed

Polycythemia is an adaptive, inconstant phenomenon that aims to compensate for the decrease in oxygen saturation to maintain arterial content of O2 (CaO2), due to the production by the liver of erythropoietin (EPO),

Polycythemia It aims to maintain normal arterial oxygen transport  adaptive, inconsistent phenomenon  aims to compensate for the decrease in oxygen saturation to maintain arterial O2 (CaO2) content  due to the kidney's production of erythropoietin (EPO), in response to chronic hypoxemia  leads to blood hyperviscosity and an increased risk of arterial or venous thrombosis


Only the presence of chronic hypoxemia is necessary for the diagnosis of CKD but most CKD is complicated in the long term by alveolar hypoventilation and therefore hypercapnia

The capnia of some patients can thus be established, chronically, at high levels (> 60 mmHg)

Hypercapnia is extremely harmful even with normal pH

Hypercapnia is not or only slightly harmful as long as the pH remains normal

CKD is the common evolutionary term for many respiratory diseases

Lung exchanger involvement is by far the leading cause of CKD


Depending on the etiologies, EFRs show obstructive ventilatory disorder (OVD) defined by a FEV1/FVC ratio < 70%, a restrictive ventilatory disorder (RVC) defined by a CPT < 80%) or a mixed ventilatory disorder

The most effective way to correct hypoxemia related to lung exchanger involvement is long-term oxygen therapy (OLD).

Ventilatory pump refers to the different structures surrounding the lung exchanger and involved in chest amplification and therefore lung ventilation.

The operation of the ventilatory pump can be altered by different mechanisms sometimes associated:  decrease in ventilatory control (stroke)  neuromuscular pathologies: spinal lesions, myopathies, amyotrophic lateral sclerosis  increase in the load imposed by the chest wall   chest deformity morbid obesity and obesity/hypoventilation syndrome (increasingly common cause of CKD by damage to the ventilatory pump)An accident cerebral vascular can lead to alteration of the ventilatory pump

The main mechanism responsible for hypoxemia is the reduction of alveolar ventilation (alveolar hypoventilation)


Only the presence of chronic hypoxemia is necessary for the diagnosis of CKD

The operation of the ventilatory pump can be altered by different mechanisms sometimes associated such as the decrease in ventilatory control related to a stroke

In CKD related to ventilatory pump involvement, PaCO2 is increased very early in the course of the disease

The most effective way to correct hypercapnia (and hypoxemia) is oxygen therapy but non-invasive ventilation.

The most effective way to correct hypercapnia (and hypoxemia) is not oxygen therapy but mechanical ventilation that replaces the "pump function" that is defective.


Cyanosis reflects the existence in the integuments of a high amount of hemoglobin desaturated with oxygen

The diagnosis of CKD is confirmed by the measurement of arterial blood gases showing PaO2 < 70 mmHg twice (steady state)

Pulmonary function tests play a pivotal role in the etiological orientation of a patient with CKD

Obstructive ventilatory disorder (OSVD) is characterized by a FEV1/FVC ratio <40%

obstructive ventilatory disorder (OPT) are characterized by a FEV1/FVC ratio <70%


BCPO is the leading cause of restrctive CKD

A normal ECG does not rule out proven right ventricular failure

The 6-minute walking test and the cardiorespiratory stress test in particular allow a prognostic evaluation of patients with chronic respiratory failure

Right cardiac catheterization confirms PH and the exact level of right pressures


An AKI can complicate underlying chronic kidney disease, for example after injection of iodinated contrast media or taking nonsteroidal anti-inflammatory drugs

Acute renal failure is never accompanied by anemia

AKI may be associated with anemia, in cases of acute hemolysis or hemorrhagic shock themselves causing AKI

Early and sometimes profound hypocalcemia may be present during ARI

In obstructive ARIs, the patient is always anuric

In practice in front of any ARI, imaging of the urinary tract is essential to visualize the pyel-calicial cavities and in case of dilation, look for an obstacle


Which of these pathologies can cause chronic kidney failure without kidneys of reduced size?

The 4 pathologies are: diabetes, amyloidosis, myeloma and autosomal dominant polycystic kidney disease (PKAD)

Be careful, the question is in the plural. A kidney tumor usually involves only one kidney


Which of these pathologies can cause obstructive kidney failure?

One-sided calculation on a single functional kidney

Be careful, in this case, dilation may be lacking because the urinary tract is enclosed in fibrosis


Let PUF be the glomerular transcapillary pressure gradient, and K the filtration coefficient, how is the GFR calculated?


Which of these proposals can cause extracellular dehydration that can induce functional renal failure?

It is a cause of true or effective hypovolemia, but not of extracellular dehydration (the latter are due to losses). See page 221 of the CUEN


Among these proposals, which can cause hypovolemia (real or effective) that can induce functional renal failure?


20% of people over 85 years of age are affected by presbycusis

There are approximately 120,000 hearing-impaired people in France

85% of people over 60 have visual impairments

There are 207,000 blind (or deeply visually impaired) people in France

Total anosmia affects 10 to 15% of people over 80 years of age


There is no drug treatment for taste disorders

There is no drug treatment for smell disorders

The treatment of glaucoma involves the normalization of intraocular pressure by adrenergic agonists for example

The hearing aid is indicated as soon as the loss exceeds 5 dB between 1000 and 2000 Hz

Prevention of diabetic retinopathy requires monitoring of glyccated hemoglobin every 3 months


Infectious pathologies of migrants are all imported pathologies

No. It can also be pathologies acquired on French territory

Prevalences of HPV infection, EBV and hepatitis C are higher in migrant populations than in the general population

No, but this is the case for HIV infection, tuberculosis and hepatitis B.

The metropolitan France has 11.2 million migrants mainly from sub-Saharan Africa

5.3 million migrants mainly from Africa and Europe

Infectious diseases acquired in metropolitan France are linked to changes in environment and unfavourable socio-economic conditions

Infectious diseases acquired in metropolitan France mainly concern political refugees

Infectious import pathologies concern: migrant workers and their families who have just arrived in France, political refugees, illegal immigrants, migrants returning regularly to their country of origin


Pneumococcal infection is particularly serious in sickle cell patients

HIV infection and tuberculosis are often acquired in France

HIV, HBV, HCV serology and the interferon gamma test are to be performed as a first-line

The hemogram looking for eosinophilia is performed in first line

Fasting blood glucose is performed when diabetes risk factors are present


Social Security Health Examination Centers also offer a free health check-up

CeGIDD, CLAT and PASS carry out a large part of the health check-ups in migrants

Hepatitis should be systematically evoked in front of any fever with a history of a stay in an endemic area

Amoebosis can be hepatic (non-febrile diarrhea) or colic (painful and febrile hepatomegaly)

Colic form = non-febrile diarrhea. Hepatic form = painful and febrile hepatomegaly

The colonic form of aemobosis involves PNN hyperleukocytosis


The majority of functional iron is in heme form in hemoglobin (2.5 g)

In the physiological state, the body does not absorb iron

About 10% of dietary iron is absorbed (± 1 mg/d), which compensates for natural losses

Absorption is carried out by the enterocytes of the ileum

Absorption is carried out by the enterocytes of the duodenum and the proximal part of the jejunum

Another route of entry of iron into plasma is the recycling of erythrocytes by macrophages


In the plasma sector, iron is supported by ferritin

In the plasma sector, iron is supported by transferrin

The regulation of iron metabolism is done at the level of absorption

Hepcidin, synthesized by the liver, will inhibit ferroportin inhibiting the export of iron to plasma by enterocytes and macrophages

Iron blocked in intestinal cells blocked by hepcidin will be eliminated by desquamation of enterocytes

The iron reserve in the body is between 0 and 1 g of iron, stored as transferrin

The iron reserve in the body is between 0 and 1 g of iron, stored in the form of ferritin, mainly in the liver, bone marrow and spleen


Transferrin testing is the first-line test for assessing iron stock

It is the determination of ferritin that is the first-line examination to evaluate the iron stock

The transferrin saturation coefficient is calculated from serum iron and transferrin

Under normal conditions, more than 80% of transferrin binding sites are occupied by iron

Under normal conditions, 20-45% of transferrin binding sites are occupied by iron

The transferrin saturation coefficient increases earlier than ferritin in hemochromatosis


Iron deficiency affects nearly 10% of people in industrialized countries

Iron deficiency is marked by several successive stages: depletion of the iron stock, alteration of erythropoiesis resulting in microcytosis without anemia, then hypochromic and microcytic sideropene anemia

Microcytic = > mean corpuscular volume [MCV] < 80 μ3/fl

Iron deficiency can result from 3 mechanisms, which can be associated: malabsorption, lack of intake, excessive losses

In menopausal men and women, the origin of bleeding explaining iron deficiency is essentially digestive

In premenopausal women, the origin of the bleeding explaining the iron deficiency is primarily gynecological


Regarding digestive explorations as part of the assessment of iron deficiency anemia:

In the absence of signs of orientation, it should include upper endoscopy at any age and systematic colonoscopy after 50 years.

Duodenal biopsies should be routinely performed if gastroduodenal endoscopy is unremarkable.

Exploration of the small intestine by enteroscopy is systematic in case of colonoscopy without particularity

As a first line, the hail will be explored by videosendoscopic capsule.

The endoscopic capsule is considered only after performing one or two upper endoscopies and a total colonoscopy

Total colonoscopy is contraindicated in subjects under 50 years of age


In the physiological state, the body absorbs 3-4 grams of iron every day

The body absorbs almost no iron (1mg). It is the iron stock that is 3-4 grams.

Produced by the liver and allows the homeostasis of iron metabolism by inhibiting the absorption of iron in the body. It blocks ferroportin, which normally allows iron to pass from the intracellular space of the enterocyte to the plasma sector.

This is ferritin. Transferrin transports iron in the plasma sector

Iron absorption occurs in the duodenum and proximal jejunum


At what stage is hemocromatosis treated?

Hemocromatosis is started at stage 2. The treatment is done by blood subtraction with an induction phase (frequency up to 1x / week) then a maintenance phase (every 1, 2, 3 ... month)


What are the non-sideric causes of hyperferritininemia?


Which of the following foods provides the most iron in the same amount ingested?

Contains a lot of iron but very little is absorbed


High blood pressure is the leading cause of death worldwide

Only 50% of hypertensive patients have their hypertension controlled under treatment

Much less: 50% of hypertensive patients know this, of which 80% are treated, and among treated patients, only 50% achieve their goals

A blood pressure of 166/94 corresponds to moderate high blood pressure

Either a grade 2: PAS 160-179 or PAD 100-109 (between PAS and PAD, the highest grade is retained)

A blood pressure of 135/83 is considered optimal

A voltage is optimal below 120/80, the proposed voltage is considered "normal high"


A blood pressure at 181/99 should be confirmed by ambulatory self-measurement before a consultation at 1 month, in order to confirm the diagnosis before initiating treatment

In case of grade 3 hypertension (>180/110), treatment should be initiated promptly

Blood pressure norms measured in MAPA at night are <130/80

A measurement by MAPA is systematically indicated to confirm hypertension

Only in cases of BP variability, inconsistencies between clinical involvement and measurements, resistant hypertension, suspected sleep apnea syndrome, pregnant woman or suspected episodes of orthostatic hypotension

The systematic secondary HTA research assessment includes a 12-lead ECG

The ECG is performed as part of the impact assessment of hypertension: search for left ventricular hypertrophy

In patients over 65 years of age, hypertension is more common in women


The assessment carried out systematically upon discovery of hypertension includes a fundus

This is only performed in case of hypertensive emergency, grade 3 hypertension or diabetes

High blood pressure is the leading cause of AF

It also increases the thromboembolic risk associated with AF

A Sokolow index > 45 mm on the ECG indicates left ventricular hypertrophy

High blood pressure can lead to chronic kidney failure, which itself aggravates hypertension

In the assessment of arterial hypertension, the measurement of albuminuria should only be performed in non-proteinuric diabetics


In case of NOIA (anterior ischemic optic neuropathy) due to arteriosclerosis (hypertension among others), fluorescein angiography shows associated choroidal ischemia

This sign is in favor of an arteritic cause: gigantocellular arteritis (Horton's disease, to be evoked absolutely in case of NOIA)

Hypertensive retinopathy is minimally symptomatic, except in cases of severe or prolonged hypertension

Late visual acuity decrease/ only if hypertensive flare-up

Hypertensive choroidal disease is detected in particular by the presence of a sign of crossing at the fundus

This sign concerns arteriosclerosis. Hypertensive choroidopathy is characterized in particular by Elschnig's spots (small deep pigmented spots)

In ocular involvement of arterial hypertension, retinal hemorrhages correspond to grade II of arterial disease

In case of hypertension, aspirin is recommended for primary prevention for all patients

Recommended only for primary prevention or diabetes, not recommended for severe uncontrolled hypertension (risk of cerebral hemorrhage)


Regarding the treatment of hypertension, verapamil bisoprolol is a possible dual therapy

Verapamil is a bradycardial calcium channel blocker: it is contraindicated in combination with beta-blockers. Only the combination between dihydropyridine calcium channel blockers and beta-blockers is possible

During the first 6 months of hypertension management, until the blood pressure goal is reached, a monthly consultation is recommended

An early sign of renal involvement secondary to hypertension is the appearance of microalbuminuria (> 300 mg/24 h)

High blood pressure can lead indirectly to renal failure via atheromatous stenosis of the renal artery or cholesterol embolisms

In a patient over 80 years of age, the recommended blood pressure goal is a PAS < 150, or <145 in blood pressure self-measurement


Dual antihypertensive therapy is possible from the outset in case of grade 2/3 blood pressure

In case of blood pressure objectives reached, follow-up consultations are recommended every year

Resistant hypertension should be verified by ambulatory blood pressure self-measurement or ABMD

A resistant hypertension can be explained by a poor measurement, for example a cuff too small on a large arm

Renal Doppler ultrasound is part of the systematic review of secondary hypertension

It is made in case of suspicion of secondary hypertension only (resistant hypertension for example)


Black patients are more sensitive to beta-blockers

More sensitive to thiazides or calcium channel blockers, less sensitive to beta-blockers

In case of albuminuria, the blood pressure objective to be achieved is <130/80

And an RAS blocker is routinely recommended

Secondary hypertension concerns 5-20% of hypertension, and the majority are curable

Less than half of the causes are curable

A resistant hypertension must be suspected in case of severe hypertension from the outset, hyperkalemia, clinical sign (para-umbilical murmur for example)

Dysthyroidism is a rare cause of secondary hypertension


Renal parenchymal causes constitute the 1st cause of secondary hypertension

A renovascular hypertension should be evoked especially in case of unexplained flash OAP

Flash OAP = abrupt, rapidly evolving, with preserved systolic function and little impaired heart on post-crisis cardiac ultrasound

In case of secondary renovascular hypertension, revascularization is systematically indicated

Only if fibrodysplastic origin, non-systematic if atheromatous origin !!

Hypokalemia is constant in primary hyperaldosteronism

The combined dosage of aldosterone-renin should be done in situation of normovolemia, normokalemia, fasting, at 8-10am (among others)


In case of bilateral adrenal hyperplasia, treatment includes high-dose spironolactone

Renin tumors give a picture of secondary hyperaldosteronism

That is to say with a high renin (primary = low renin while high aldosterone)

Cushing's disease may be secondary to a secreting adrenal tumor

Cushing's syndrome (hypercorticism) may be due to an adrenal tumor, but Cushing's disease characterizes a corticotropic pituitary adenoma!

A pheochromocytoma can be integrated into a genetic syndrome, including neurofibromatosis type 1

A hypertension with a continuous left mesodiatostolic parasternal murmur should suggest an aortic coarctation


Regarding malignant hypertension and acute hypertensive crisis

A hypertensive crisis is defined as a > 180 SBP or > 120 PAD with life-threatening organ involvement

The item concerns hypertensive urgency. A hypertensive crisis is a BP >180/110 in a normothendu subject, without visceral impact: it is not an emergency

Malignant hypertension with stage 3 or 4 hypertensive retinopathy is a hypertensive emergency

So with hemorrhages, exudates, or papillary edema at the back of the eye

Malignant hypertension can be complicated by CRVO (central retinal vein occlusion) or acute renal failure, among others.

Malignant hypertension can be caused by a bladder globe

In the treatment of hypertensive emergency without OAP, filling is indicated in combination with antihypertensive therapy

There is extracellular dehydration with hyperaldosteronism secondary to hypokalaemia: filling (cautious: 500-1500cc of ISS) breaks the vicious circle


Regarding acute abdominal and lumbar pain

• Abdominal pain is said to be acute if it elapses less than 24 hours between the onset of symptoms and the first consultation

Any acute abdominal pain can be a symptom of a life-threatening surgical emergency.

Transfixing epigastric pain suggests hepato-biliary origin

Pain relief through diet evokes an ulcerative origin

Pain relief by vomiting suggests a pacreatic origin


In women, it is always necessary to think about an ectopic pregnancy (and, more generally, gynecological conditions)

The diagnosis of acute pancreatitis is made in front of amylasemia greater than three times normal

The clinical examination should look for an interventional scar, defense or contracture

Abdominal CT scan should be preferred to any other radiological investigation in case of unexplained acute abdominal pain


Regarding acute abdominal and lumbar pain, which propositions are true?

Blood cultures should be performed in case of fever with chills or greater than 39 ° C

Urine strips (± ECBU) are used to rule out a urinary cause

In front of any acute epigastric abdominal pain, an ECG should be performed

Ultrasound is useful in case of suspected biliopancreatic, gynecological or urinary cause

The site of hepatobiliary pain is hypogastric or hypochondrical right


Ascites is defined as peritoneal fluid effusion

The formal argument of the positive diagnosis is the demonstration of fluid by the puncture of the abdominal cavity

An increase in volume of the abdomen with a declivable abdominal dullness, mobilizable, drawing a concave curve at the top on the subject in supine position strongly evokes ascites

The puncture of ascites fluid should be done at a point at the junction of the outer third and the middle third of the line joining the left anterosuperior iliac spine and the umbilicus, and in full dullness

Puncture fluid can be made bloody by accidentally passing through a blood vessel from the wall


Ascites fluid from a breach of the hepatic lymphatic ducts is low in protein and chylomicrons

Ascites fluid from a breach of the hepatic lymphatic ducts is rich in protein (> 30 g/L) but not in chylomicrons

Cancers of the digestive system (with the exception of hepatocellular carcinoma) and ovarian cancer are common causes of peritoneal carcinomatosis

Ascites fluid contains only cells, in case of peritoneal carcinomatosis

Ascites fluid is often rich in protein (> 25 g/L) and cells

Peritoneal mesothelioma is a very rare cause of ascites

The main factor promoting peritoneal mesothelioma is exposure to asbestos fibers


Ascites is a cardinal manifestation of peritoneal tuberculosis that may be associated with digestive or other organ tuberculosis.

The fluid is frequently rich in protein (> 25 g/L) but low in leukocytes (< 100/mm3) in peritoneal tuberculosis

The fluid is frequently rich in protein (> 25 g/L) and leukocytes (> 1,000/mm3)

The search for BK by direct examination is usually negative

Determination of the enzyme adenosine deaminase in ascites may be useful

The diagnosis is made by biopsy of the peritoneum under laparoscopy on possible peritoneal granulations with evidence of tuberculous granulomas and culture revealing BK


In case of infected ascites, antibiotic therapy with quinololes or beta-lactam should be urgently started

Isolated left heart failure, peritoneal carcinomatosis and cirrohsis are the 3 main causes of ascites

Right heart failure or global heart failure

Effective treatment of ascites fluid infection should decrease the level of PNN by at least 25% in the ascites fluid

Ascites complicating heart failure is rich in protein > 25 g / L and low in leukocytes


Regarding pulmonary arterial hypertension (PH)

PH is defined by a mean mPAP pulmonary arterial pressure of 15mmHg or higher

PAH corresponds to group 2 PH in the WHO classification

PAH corresponds to group 1 of this classification

Pulmonary PH is PH with an OPAP (pulmonary arterial pressure occlude) of 25mmHg or less

Group 5 of the WHO classification corresponds to a precapillary PH

All PH is precapillary except group 2 (left heart disease)


PAH (PH group 1) may be associated with connective tissue disease, e.g. Eisenmenger syndrome

Eisenmenger syndrome is not connective tissue disease, it is severe cyanogenic heart disease (which may also be associated with PAH)

The spontaneous course of PAH, if left untreated, is fatal in 60% of cases

Tricuspid valvular heart disease can be complicated by group 2 PAH

Aortic or mitral valve disease, but not tricuspid

Group 3 consists of chronic post-embolic PH


Pulmonary artery arteritis gives group 4 PH

Pulmonary arterial endovascular obstacle

The most common call sign of PH is cough

Auscultation is normal for a long time in PH

Analogy with pulmonary embolism: dyspnea with normal auscultation


The breath associated with PH is a protosystolic murmur

Has a holosystolic murmur (tricuspid insufficiency) increased on deep inspiration = sign of Carvalho

If PH is suspected, B4 noise on auscultation should be sought for a differential diagnosis

A B4 (straight gallop) suggests right heart failure that may be due to PH

HTP is particularly associated with negative T waves in V1-V2

Routine screening for PH in patients with diffuse lupus erythematosus is recommended

Maximum tricuspid regurgitation rate > 3.4m/s on cardiac ultrasound supports PH


Postitive NO vasomotricity test is an indication for oral calcium channel blockers

It predicts a favorable therapeutic response to these

For PH, transthoracic cardiac ultrasound is indicated only if left cardiopathic etiology is suspected.

Baseline non-invasive examination, systematic if PH is suspected

In the diagnostic approach of PH, etiological groups 2 and 3 should be sought as a priority.

These are the most frequent: we then look for group 4, then finally 5/1 (elimination diagnostics)

In case of PAH, at EFR, flow rates and volumes are normal but the DLCO is lowered

3 causes of lowering DLCO: emphysema, PAH and thromboembolic pulmonary vascular involvement


The PAH assessment includes HBV/HCV/HIV serology and an autoimmune assessment

Arterial gas is often normal or with very moderate hypoxemia; Hypocapnia is quite common due to alveolar hyperventilation; Deep hypoxemia is possible in severe or complicated forms (e.g. reopening of the foramen ovale with right-left shunt or interatrial septal defect)

A typical sign of PH in an 8-year-old child is oxygen-refractory cyanosis

This is typical in newborns: in children, the signs are syncope, dyspnea, behavioral disorders or malaise

PH with dyspnea that slightly limits usual physical activities but does not persist at rest corresponds to NYHA grade 1


ƒAngina is a benign pathology of spontaneously favorable evolution in the vast majority of cases

ƒƒAntibiotic therapy is indicated in group A streptococcal tonsillitis

ƒIn practice, group A streptococcus should be tested for when the MacIsaac clinical score is ≥ 4 in adults

ƒƒ Antibiotic therapy is indicated in case of streptococcal infection detected in RDT: augmentin in 1st line

It is an inflammation of infectious origin of the tonsils (tonsillitis) and / or the entire oropharynx (pharyngitis)


Group B ß-hemolytic streptococcus is the first bacterial agent responsible for angina

This is Pyogenic Streptococcus (group A)

ƒThe diagnosis of diphtheria requires mandatory reporting to the ARS, additional droplet-type precautions and eviction from the community

No clinical sign is strictly discriminating between viral or bacterial etiology

Only SBHA angina is common, other bacterial causes are exceptional

Symptomatic treatment with analgesic and antipyretic is to be considered in all cases


In adults, the MacIsaac score has a good positive predictive value

In adults, the MacIsaac score has a good negative predictive value

In adults, a clinical score of Mac Isaac < 2 has a negative predictive value > 95% to eliminate the streptococcal origin of angina

All strains of SBHA have rheumatogenic or nephritogenic potential

Only certain strains of SBHA have rheumatogenic or nephritogenic potential

Scarlet fever is one of the toxic complications

There is no indication for antibiotic therapy for acute tonsillitis in children under 3 years of age


Antibiotic therapy is only of interest in SBHA angina

The goal is essentially to prevent complications

ƒƒ The strains of SBHA responsible for RAA are very rare in metropolitan France, but more frequent in the DOM-TOM

Antibiotic treatment involves individual and collective risks: adverse effects and bacterial resistance in particular

The risk of AAF is prevented even in case of late antibiotic therapy (up to Day 9 after the onset of symptoms)

Only documented SBHA tonsillitis should be treated with antibiotic therapy


Regarding angina in children, which is the exact proposal(s)?

In front of angina, it is necessary to perform an RDT because no clinical sign allows to move towards a bacterial or viral etiology

False, clinically bacterial angina is more brutal, painful, gives a higher fever and more extra ENT sign than viral angina. But only a microbiological examination can conclude.

RDT should always be performed in children

False, <3 years the etiology is mainly viral. The RDT is only performed above 3 years

Extra-ENT symptoms of group A streptococcus infection include: abdominal pain, vomiting, non-painful ADP

False, infectious lymphadenopathy is painful

Faced with a suspicion of angina, look for signs of locoregional complications such as torticollis.

True, torticollis would sign a retropharyngeal abscess. It is also necessary to look for a trismus that signs an amygdala phlegmon.


Which of the following are the objectives of antibiotic treatment for strep throat?

No antibiotic therapy is indicated in this case

We do not prescribe antibiotics because the patient asks us to, but because it is justified:)


What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with positive RDT, in first line?

2nd intention, if allergy to amoxicillin (risk cross-allergy <5%)

3rd intention, if allergy to beta-lactam (<10% resistance)


What is the recommended average duration of eviction from the community in case of angina?


Which of the following is a reportable cause of pseudomembranous angina?


Which of the following proposals are indications for making a TDR?


What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with positive RDT, in case of true allergy to amoxicillin?

Allergy to amoxicillin. No indication of this association in tonsillitis (SBHA sensitive to amoxicillin alone)


Which of the following are viral causes of angina?


The term 'use' corresponds to abstinence

It is recommended to consume no more than 21 drinks on average per week for men

It is recommended to consume no more than 5 drinks on average per week for women

ATTENTION: new recommendation in 2019 -> single use = no more than 10 drinks per week for everyone (woman and man)

Simple use: one alcohol-free day per week

Be careful though, if the patient drinks a bottle of wine a day except Wednesday (a day without alcohol) it is not simple use

A standard glass of France corresponds to bar doses and contains 10 grams of pure alcohol


Risky use (risky consumption) corresponds to consumption above the recommended thresholds, likely to cause physical, psychological or social damage

Harmful or harmful use refers to consumption that has adverse consequences for health, physical or mental, but in the absence of criteria of dependence.

Addiction defines a type of relationship marked by an inability to reduce consumption and a behavioral obligation

Signs of withdrawal are mostly psychological

The signs are psychological and physical

Harmful health consequences sign alcohol dependence

Addiction can lead to®negative (harmful) consequences, but not necessarily, especially at the beginning / I formulated it backwards


Alcoholism is an outdated term that often corresponds to severe addictions

We talk about alcoholism when we exceed 3 drinks a day

It is estimated that in France 6 million people consume alcohol daily.

Regular alcohol consumption decreases in France but occasional alcoholization increases


What test(s) are used to screen for alcohol addiction?

Framingham is an overall coronary risk score

Fagerström's test can detect tobacco addiction


What signs accompany a delirium tremens?

Rather a agitation with incoherent remarks


What signs or symptoms are consistent with Korsakoff's Syndrome?

Anterograde memory loss (almost) exclusively

Not classically: damage to the mammillary bodies (structures that are part of the hypothalamus and involved in memory, especially in the Papez circuit)

Often in the "young" subject (can start in the forties)


Most Korsakoff syndromes are due to untreated (or poorly) Gayet Wernicke's encephalopathy

There is a cerebellar syndrome explaining frequent nystagmus

Cerebellous syndrome (which is static) explains the problems with walking and coordination. Nystagmus, like oculomotor palsy or diplopia, are separate signs found in Gayet-Wernicke encephalopathy.

Carbohydrate recharge must be done urgently

Glucose promotes B1 deficiency (alcohol is sweet)


A significant proportion of patients do not experience withdrawal syndrome

Not depression but anxiety, frustration, etc.


Which of the following are included in healthy alcohol consumption? 🍷

True. Attention ⚠, new recs in 2019: more distinction man 👨 woman 👩, 2 drinks max per occasion of drinking, no alcohol every day, and no more than 10 🔟 drinks per week.

No more than 6 glasses per drinking occasion

No more than 26 drinks on average per week for men

The new recs do not make a distinction M/F. No more than 10 drinks per week

No more than 10 standard drinks per week

The links of the new reco: https://www.drogues.gouv.fr/actualites/sante-publique-france-presente-nouvelles-recommandations-lalimentation-y-compris-lalcool


The active substance in cocaine is tetra-hydrocannabinol (THC)

Withdrawal syndrome is a disorder related to the use of an addictive substance

Cannabis can induce a psychotic disorder, an anxiety disorder, and even a delirium

For cannabis, treatment of intoxication and withdrawal are symptomatic

Both are uh yes it's not very discriminating


The action of cannabis is mainly the rapid and fleeting over-release of serotonin

It acts on the cannabinoid receptors CB1 and CB2 that regulate glutamatergic and GABA neurotransmission and also potentiates dopamine release

Marijuana is the most THC-laden presentation

In order of increasing concentration of Delta9-THC: * herb (marijuana), resin (hashish), * * oil, rarer

Cannabis is mostly smoked in the form of cigarettes mixed with tobacco

Cannabis is the most commonly used illicit substance in France

Regular consumption is mostly female, regardless of age group


The effects of cannabis appear about 15 to 20 minutes after consumption if smoked

The effects fade in several hours: about 4 hours for the consumption of a conventional dose

The extent of cannabis' effects depends on tolerance, age, sex and individual genetic susceptibilities

The extent of the effects of cannabis depends on the dose used, the mode of consumption and individual factors such as the rate of absorption, tolerance

Acute cannabis intoxication can lead to conjunctival hyperemia

Regular use of cannabis leads to a tolerance phenomenon that decreases the feeling of well-being and forces to increase doses


Which of these proposals are symptoms of cannabis withdrawal syndrome?


Regarding withdrawal syndrome and the consequences of cannabis:

Complications related to cannabis use cannot occur with the first dose

The dose threshold defining risky consumption is more than 3 joints per week (two days apart on average)

90% of cannabis users report cannabis withdrawal symptoms

The withdrawal syndrome more often concerns heavy and regular consumption

Most symptoms appear within 24 to 72 hours after stopping consumption


Sleep disorders related to withdrawal syndrome can last a month

Cannabis poisoning delirium sets in just at the end of the withdrawal syndrome

It settles in a few hours or days and tends to have a fluctuating evolution throughout the day.

A psychotic disorder may develop during or shortly after acute intoxication

The clinical symptomatology of cannabis-induced psychotic disorder is similar to that of psychotic disorder

Treatment of induced psychotic disorder involves stopping intoxication only (antipsychotics are contraindicated)

Treatment involves stopping intoxication and possibly treatment with antipsychotics


Chronic intoxication can lead to impaired cognitive performance, social disinterest, decreased performance at work or school.

A cannabis-induced psychotic disorder may develop during or shortly after acute intoxication (and up to a month after)

The management of dependency is comprehensive: psychiatric, general medical, school and social

Cognitive-behavioral and family psychotherapies have shown their effectiveness

Fewer than one million people are regular cannabis users in France


There are 400,000 people affected by a cocaine use problem in France

The onset of effects and felt effects is 2 to 4 hours in all cases

The onset of effects and the effects experienced depend on the route of administration, the individuals and the dose consumed

Complications related to cocaine use can occur from the first dose

There is no known dose threshold below which there is little or no risk

The dose threshold below which there is no risk is one intake per year, which is very difficult to respect given the addictive potential of cocaine.


The performance of an ECG and echocardiography is systematic in the face of suspicion of pericarditis

The key symptom is prolonged chest pain, resistant to trinitrine, increased in decubitus, deep inhalation and coughing, calmed by sitting forward (anteflexion)

The absence of pericardial friction eliminates the diagnosis of pericarditis

Its absence does not eliminate the diagnosis. In practice, it is actually very rare to hear it.

An associated pleural effusion may be found.

Holzman's stage II corresponds to negative T-waves

Stage I: concave ST elevation upwards, positive T waves on the first day. Stage II: flat T-waves between the 24th and 48th hours. Stage III: negative T-waves in the first week. Stage IV: normalization in the first month


Echocardiography assesses the abundance, topography and hemodynamic tolerance of pericardial effusion and confirms the diagnosis of possible tamponade

Echocardiography makes it possible to visualize, if necessary, a possible mass localized in the pericardial cavity

MRI has the advantage of visualizing the pericardial cavity without injection of contrast medium or irradiation

Pericardial puncture is to be considered in the presence of abundant pericardial effusion, symptomatic, despite a well-conducted medical treatment for a month


Surgical pericardial drainage is preferred in case of suspicion of acute purulent pericarditis

Pericardial fluid is collected for cytological and microbiological analysis

Once the diagnosis is established, hospitalization is systematic

Once the diagnosis is made, hospitalization should not be systematic and depends on the case

Hospitalization is done in case of predictive factors of a non-idiopathic origin or risk of complications

In nine out of ten cases, the cause is viral or unknown (acute idiopathic pericarditis)


During HIV infection, the occurrence of pericarditis with pericardial effusion is common

The progression is common to tamponade, recurrence or pericardial constriction in case of tuberculous pericarditis

In case of tuberculous pericarditis, treatment is symptomatic

Treatment is etiologic (anti-tuberculosis)

Primary pericardial tumours (primary pericardial mesothelioma) are 4 times more common than metastases

Primary pericardial tumours (primary pericardial mesothelioma) are rare, 40 times less common than metastases

The most common secondary tumours are bronchial cancers, breast cancers, melanomas and leukemias.


Hemorrhagic pericardial effusion is extremely rare

Hemorrhagic pericardial effusion is common, as is tamponade in neoplastic pericarditis

The diagnosis of neoplastic pericarditis is confirmed by imaging

Ultrasound, CT and/or MRI = evoke the diagnosis. Confirmation is pathomopathological/biological

Analysis of pericardial puncture fluid or pericardial biopsy are essential for diagnosing malignancy

In case of tamponade, emergency pericardial puncture is necessary

Recurrence of pericardial effusion is frequent and requires clinical and echocardiographic follow-up


Regarding the treatment of acute pericarditis

Nonsteroidal anti-inflammatory drugs are prescribed in benign acute pericarditis

Colchicine alone or in combination with ibuprofen, calms pain and reduces recurrence

Colchicine is contraindicated in severe renal impairment

NSAID/Aspirin treatment is stopped after 14 days if there are no complications

The cessation of NSAID or aspirin treatment is done gradually after one month, preferably after performing an echocardiogram that ensures the absence of pericardial effusion

Corticosteroids are not indicated in acute benign pericarditis due to the risk of viral replication


The prevalence of ADHD in the general population is 5%

These disorders have a high prevalence in the pediatric (and not general) population: 5% for ADHD, 3% for TOD and 1.5% for TBI.

Normal adolescence is defined primarily by endocrine criteria (puberty)

Puberty is earlier in boys than in girls

As a reminder: at 10-11 years for girls, and at 12-13 years for boys

The integration of body changes due to puberty is not always obvious


ADHD (Attention Deficit Hyperactivity Disorder) is considered a neurodevelopmental disorder

The TOP is the Opposition Disorder with Provocation

"Adolescent Behavioral Disorders" begin around puberty

Although the title of the item is "Adolescent behavioural disorders", these behavioural disorders usually begin in childhood

ADHD affects 5% of children and adolescents

Inattention syndrome is only visible in a school setting

It is visible from the age of walking and in private life situations. But it is true that the syndrome of inattention becomes more visible in elementary school, when the child is confronted with situations requiring an effort of concentration.


When inattention syndrome is predominant, diagnosis is often late

The disorder usually begins in childhood

The sex ratio of ADHD is about the same as that of conduct disorders.


Regarding risk factors and protective factors:

Smoking during pregnancy is a risk factor for behavioural disorders

Alcohol use during pregnancy is not a recognized risk factor

Alcohol consumption during pregnancy is totally a risk factor

Home placement or educational neglect are protective factors

Negative life events during early childhood: sexual abuse, educational and emotional neglect, physical and/or psychological maltreatment, foster care, etc. are all risk factors for the development of TBI

Overly rigorous and rigid educational rules are mainly associated with TOPs and TCs.

Dating other adolescent offenders is a risk factor for TC


Which of these proposals fall within the framework of a hyperactivity syndrome?

Falls within the framework of an impulsivity syndrome

Falls within the framework of the opposition-provocation syndrone


Which of these proposals fall within the framework of an inattention syndrome?

Falls within the framework of an opposition-provocation syndicate

Falls within the framework of an antisocial behaviour syndrome


It is set up in first intention most often

As a second line, except in cases of emergency

MA risperidone = from 5 years. AMM Cyamémazine = from 3 years.

Short treatment for persistent aggressiveness in a patient with 'below-average intellectual functioning'

Cyamémazine is contraindicated in children (before puberty)


Which of these proposals correspond to normal parameters?

Height at 2 years is double height at birth


The head circumvention at 4 years is around 50 cm

Weight at 1 year is triple the weight at 4 months


Weight at 4 months: double the birth weight


Infants gain about 25 cm in the first year

Height, weight and PC parameters should be measured at each consultation


What proposals fall within the definition of stunting in stature?

Statural growth less than or equal to -1.5 SD (relative to genetic target size)


Regarding the etiologies of failure to thrive:

Congenital hypothyroidism is routinely screened at 3 days of life

The screening test for congenital hypothyroidism is the Tanner test

Congenital GH deficiency is not symptomatic at birth

Simple delay in puberty is the most common cause of statural delay in adolescence

Pituitary imaging makes it possible to confirm the diagnosis of craniopharyngioma


Which of these proposals can cause statural stunting?


It is the estrogen replacement that is prescribed around the normal age of puberty

Diagnostic confirmation is done by karyotype

Diagnostic certainty is done on X-chromosome sequencing

No sequencing. Turner syndrome is the absence of the X chromosome


Around 4 years: about 16 kg for a child with a birth weight of 3.5 kg


The best assessment of pain remains the patient's self-assessment

Self-assessment or hetero-evaluation requires the rigorous use of validated scales

Hetero-assessment is used routinely in all patients

Hetero-assessment is only used if the patient cannot communicate

Pain is an important clinical sign and should never be masked by the use of analgesics

Pain must be treated effectively as soon as possible

Chronic pain is a real disease with considerable health and economic repercussions


Chronic pain is defined as a course greater than 1 month

We talk about chronic pain, when it has been evolving for more than 3 months

Neuropathic pain is secondary to nerve damage and is often chronic

Mixed pain accounts for 25% of chronic pain

Pain is a dynamic phenomenon that evolves over time

In communicating adults, acute pain is assessed using quantitative self-report scales