Body pediculosis is accompanied by maculopapular rashes in the back and chest

Treatment of pediculosis of the scalp is a lotion of dimeticone


Which of the following are signs and symptoms of scabies?

Maculopapular rashes in the back and chest

Not in scabies. This is a sign of body pediculosis


Which of the following are true about scabies?

True, incubation can range from 5 days to 1 month (2-3 weeks on average)

Treatment is both individual and collective


Which of the following propositions are true about pediculosis?

There are 3 types of pediculosis: neurological, hepatic and splenic

Pediculosis is not a visceral pathology. There are 3 types of pediculosis: body, scalp, and phtiriasis (morpion)

True, it is an ectoparasitosis caused by Phritirus inguinalise also called Morpion in everyday language

The parasites concerned are strictly human

Body pediculosis is caused by Pediculus humanus capitis

This is the case of pediculosis of the scalp


What are the non-drug measures to put in place in case of non-profuse scabies?

Routine treatment of persons who have had prolonged and/or intimate contact with the patient

Useless according to the College of Dermatology (page 184, 2017 edition) unless


Regarding infectious disease surveillance:

In France, in 2021, there are 36 notifiable diseases

A pandemic is an unusual occurrence of a large number of cases in a limited time but in an unlimited geographical space

An epidemic is the existence of a large number of cases in a limited time and geographical space.

Horizontal transmission occurs from mother to child breastfeeding by hematogenous and/or genital transplacental tract or

Prevalence is the proportion of people with a disease in a given population at a given point in time.


Concerning the monitoring of infectious diseases

The incidence rate is the proportion of people in a given population during a given period of time newly reached.

Cumulative incidence is the ratio between the number of new cases that occurred during a given period and the average population to be at risk of illness during that period.

Sensitivity is probability of having a negative test knowing that one is not sick

Specificity • Probability of having a negative test knowing that one is not sick

The predictive value is the Positive probability (PPV) of being sick knowing that one has a positive test

The VPN negative predictive value is the probability of being free of the disease knowing that the test is negative


Concerning the monitoring of transmissible mishelp

Communicable disease control relies on a national and international surveillance system

• There is no single surveillance system but several systems, adapted to the nature of the problem, detection and its health, social or economic consequences

In France, Santé Publique France (ex-lnVS) is at the centre of the surveillance system

The Health Agencies (ARS) define the scoping policies of monitoring and regulation

This is the role of the Directorate-General for Health, the ARS implements the policies decided at central level

The High Council of Public Health is an expert agency to the Ministry of Health


Concerning the surveillance of transmissible infectious malaides

Communicable infectious diseases presenting a high risk of spread and involving public health action around the case must be declared by name without delay to the ARS medical inspector.

These are mainly tuberculosis, invasive meningococcal disease, measles and collective food-borne illnesses.

dCommunicable infectious diseases are defined by: the fact that they are caused by an infectious agent: bacteria, virus, parasite and that they can be transmitted between humans

All infectious diseases are transmissible between humans

Not all of them are transmissible between humans (for example: tetanus, botulism, legionellosis...)

Most transmissible infections are called endogenous

Most transmissible infections are said to be exogenous, i.e. the reservoir of infectious agents is located outside the infected organism.


Which of the following propositions are true regarding droplet isolation?

It concerns pathologies with indirect transmission

It requires the wearing of an FFP2 mask by caregivers

It requires the patient to wear a surgical mask when alone in his room

It requires visitors to wear a surgical mask

It requires limiting the patient's movements outside his room


Which of the following propositions are true about air-type insulation?

It concerns pathologies with direct transmission

It requires, for the patient, the wearing of an FFP2 mask when moving (outside his room)

It requires, for the patient, to limit his movements in his room

Limit his movements outside his room (he is not in prison wesh)


Which of the following proposals require the implementation of "contact" isolation?


It is characterized by tuberculoid granulomas with caseous necrosis in the affected organs

It is characterized by tuberculoid granulomas without caseous necrosis in the affected organs

Mediastinopulmonary involvement is observed in more than 90% of patients and is very useful for diagnosis

Extrathoracic localizations are polymorphic

Lung, ocular, cutaneous, peripheral lymph node and hepatic disorders are very common

Löfgren's syndrome combines febrile erythema nodosum or arthritis of the ankles and bilateral mediastinal and hilar lymphadenopathy


Of unknown cause Characterized by infiltration of organs affected by epithelioid and gigantocellular immune granulomas (also called tuberculoid granulomas) without caseous necrosis

Diagnosis requires having eliminated the known causes of granulomas

Mediastinopulmonary involvement is by far the most common

mediastinopulmonary involvement is isolated in half of the cases

Tobacco is a risk factor for the disease

Tobacco would protect against sarcoidosis


Löfgren's syndrome is self-limiting in more than 90% of cases within 2 to 4 months

Löfgren's syndrome is self-limiting in more than 90% of cases within 12 to 24 months

Significant asthenia may be in the 1st plan including in limited forms of the disease

Fever is rare outside of Löfgren's syndrome, febrile uveoparotitis with or without facial paralysis, liver or kidney damage

Weight loss can be observed in Löfgren's syndrome, or in multi-organ forms

No biological examination is specific for sarcoidosis only histology will confirm granulomatosis


The diagnosis of sarcoidosis is based on 3 elements ine suggestive clinico-radiographic presentation with evidence of tuberculoid granulomatous lesions without caseous necrosis and elimination of other granulomatoses

Recent forms evolving for less than 2 years evolve favorably without treatment in less than 2 years most often

In chronic forms, evolving for more than 2 years, spontaneous regression is less likely

Chest X-ray is a key component of monitoring in combination with RFEs

Relapses occur most often within 2 to 6 months of treatment interruption and are exceptional after 3 years of setback without treatment.


Concerning the dates marking the evolution of the conventional system

The 2 sectors were created in 1995 on the occasion of the election of Jacques Chirac

The coordinated care pathway (with the DMP, the notion of attending physician, etc.) was born in 1975.

2016 is the year of the revaloratization of physician remuneration


What are the main types of consultations set up by the 2016 Convention?

Most common situations of the liberal practitioner

Does not exist. However, there is the very complex consultation: clinical situations requiring very complex management

Management of a complex, unstable pathology or one with a high public health stake"


Which of these specialties are concerned by remuneration based on public health objectives (ROSP)?

Are concerned: attending physicians, cardiologists, vascular physicians, gastroenterologists and hepatologists, and endocrinologists


The price of acts is fixed in the Convention

The lump sum payment is paid by the ANSM for care requiring drug prescriptions

PSRO indicators are independent of each other


What are the proven effects of physical activity?

We cannot, a priori, reduce mortality. It is 100% in the long term

Reduction in the occurrence of colon cancer by 95%


The written medical prescription is mandatory in the hospitalized patient who requires a special diet

It is a medico-legal act engaging the responsibility of medicine

This is a medico-legal act engaging the responsibility of the doctor insofar as certain food textures may be at risk of "wrong route" in the presence of swallowing disorders and where certain diets are essential in the presence of certain pathologies (heart failure, renal, diabetes with risk of hypoglycemia, etc.).

The doctor must record the number of snacks, if any,

Meal assistance (e.g. postural) is prescribed by the dietician


It is advisable to reduce the consumption of unsaturated fatty acids in case of hypercholestereolmia

It is the consumption of saturated fatty acids that must be reduced, especially palmitic acid

The use of margarine rich in phytosterols is advised in case of hypercholesterolemia

Hypertriglyceridemia should lead to a reduction in the consumption of monounsaturated fatty acids

Monounsaturated fatty acids, and especially omega 3, are recommended in this case

Undernutrition worsens respiratory function in chronic respiratory failure


Persistent delusional disorders begin around the age of 20-25 most often

The different types are: erotomaniac, megalomaniac, jealousy, persecution, somatic type

Treatment includes antipsychotic treatment +/antidepressant treatment

Most psychotic disorders were described in Europe in the early twentieth century

The lifetime prevalence of persistent delusional disorders is estimated at 8%

The lifetime prevalence of persistent delusional disorders is estimated to be 0.2% and the annual incidence is estimated to be between 1 and 3 per 100,000


A delusional idea corresponds to an alteration of the content of thought, resulting in a loss of contact with reality.

A delusional idea is an "internal evidence" but one that does not seem plausible from the outside point of view.

This is an "internal evidence" that may seem plausible, but is generally not shared by the subject's socio-cultural group.

The mechanisms encountered are mainly interpretative, intuitive, and imaginative

The hallucinatory mechanism is generally not predominant


Delusions are fuzzy just like in schizophrenia

Delusions are well systematized, that is, they take place in a logical and coherent way

They usually feature convoluted and multiple themes.

The subject totally adheres to his delusions

The emotional and behavioural impact should be assessed systematically, including the level of anxiety

We recognize 2 types of psychoses: paranoid psychoses (purely interpretative mechanism) and paraphrenia (hallucinatory mechanism)

History of psychiatry The French Psychiatric School recognizes three types of non-schizophrenic persistent delusional disorders differentiated according to their main mechanism: * paranoid psychoses (interpretative and intuitive mechanism), * chronic hallucinatory psychosis (hallucinatory mechanism), * paraphrenia (imaginative mechanism)


Regarding the symptomatology of delusional disorders:

The diagnosis is made in front of the presence of delusions evolving for more than six days without interruption

Delusional disorder may contain disorganization syndrome in some cases

To make the diagnosis there must be no disorganization syndrome or negative syndrome

Hallucinations are often associated and disabling by their intensity

If hallucinations are present they are not in the foreground

The different clinical forms of persistent delusional disorders are defined according to the intensity of delusions.

The erotomanic type is characterized by the erroneous belief of being loved by an individual


Regarding the different types of delusional disorders:

The erotomanic type is more common in men

It stems from an intuitive mechanism at first, then interpretative and is more common in women

The megalomaniac type is characterized by the belief of being adored by all.

Persistent delusional disorder of the megalomaniac type is characterized by delusions centered on the belief of being gifted with an unknown talent or power, or having made an important discovery.

There is a persistent delusional disorder of jealousy type

Persistent persecution-type delusional disorder is called 'paranoid delirium' in ICD-10

Persistent delusional somatic disorder is characterized by delusions centered on sensations or bodily functions


Regarding tobacco addiction and cessation:

Smoking is often linked to behaviour acquired in adolescence

Smoking cessation must be organized without delay and regardless of the motivation of the smoker in case of scheduled surgery

Any medical consultation must be able to be the occasion of a stop advice

Nicotine-related physical dependence is assessed by the Fagerstrom test

Weaning is based on stimulating the patient's motivation through encouragement during consultations every two weeks

Withdrawal is based on a combination of cognitive-behavioural management (CBT), therapeutic education and nicotine replacement therapy.


Tobacco use is the 1st cause of preventable premature death worldwide

The primary current is inhaled by the smoker when he pulls on the cigarette

The secondary current is the passage of smoke through the bronchioles

The secondary current escapes from the cigarette through the glowing end between 2 puffs

The secondary current is the one that causes passive smoking

The tertiary current is the current exhaled by the smoker (cause of passive smoking) / but the secondary current also participates

There are more than 4000 components identified in tobacco smoke


Regarding the composition of the cigarette:

Nicotine is delivered to the brain in 30 minutes

It is sent to the brain by a quick shot (8 seconds) during each puff

Addiction to addictive substances includes the release of dopamine in the midbrain, activating the reward system in smokers

Tobacco smoke particles have an aerodynamic median diameter of 0.3 microns

Broadly similar components are found in cannabis smoke


Regarding the consequences of tobacco and its epidemiology:

The France had nearly 16 million smokers in 2013

Among men, the prevalence of regular smoking has been stable (around 32%) since 1990

Smoking prevalence has increased since 2005

The proportion of ex-smokers is increasing among women

Cancer pathologies: Active smoking is responsible for about 50% of bronchopulmonary cancers

Cancer pathologies:  Active smoking responsible for 90% of bronchopulmonary cancers (nearly 40,000 new cases/year, nearly 30,000 deaths/year)

Passive smoking is responsible for 2% of bronchopulmonary cancers in nonsmokers


Regarding the consequences of tobacco and its management:

COPD: 3.5 million people are affected in France of which 2/3 are unaware

COPD is responsible for 17,000 deaths each year

Tobacco is not a known cause of arteritis

If: ischemic heart disease, thrombosis, arteritis, etc.

The tobacco-atheroma relationship is clearly demonstrative

The measurement of expired CO level is not systematic in a diagnostic context


Which of these proposals correspond to a type of doctor-patient relationship?

The 4 types of relationships are: active/passive, consensual, cooperative and participatory.


Transaction processes are an individual's efforts to adjust to stressful situations.

Transaction processes determine the adjustment strategies that the patient can put in place to adapt to the disease

The doctor-patient relationship is a friendly relationship

The doctor-patient relationship is an interpersonal relationship, involving several people (doctors, caregivers, patients, families, caregivers), which passes through the disease, which is exercised in a socio-cultural, unequal framework, made of expectation and hope.

The doctor-patient relationship is an equal relationship

It is an unequal relationship on the patient's side because his request makes him dependent on the doctor but also because of his suffering, his fear, his uncertainties that handicap him and make him vulnerable

The patient is often passive (especially during acute phases) and often tends to seek the "protection" of caregivers


Regarding the different types of relationships

It is an unbalanced relationship on the doctor's side, because of his supposed knowledge

The increase in the frequency of chronic diseases in the 20th century led to the consideration of new types of doctor-patient relationships

The type of relationship called "active/passive" (or "paternalistic") sometimes adapted to acute serious illnesses, has evolved into a relationship called "participatory" more adapted to chronic diseases, through a "consensual" and "cooperative" relationship.

The active/passive relationship involves the patient speaking and the doctor passively listening

The active/passive relationship does not involve any activity of the patient, it is the doctor who does his therapeutic act

The consensual relationship implies acceptance of care and cooperation between the patient and


In consensual relationships, the patient is already convinced of the need for medical care

The cooperative relationship involves the patient's acceptance and cooperation in the medical gesture.

A gynecological examination is an example of a cooperative relationship

The participatory relationship positions the patient as a passive actor in his care

The participatory relationship positions the patient as the privileged actor of remission and / or recovery who must then change his lifestyle and habits.

The "participatory" relationship requires specific knowledge and skill on the part of the patient

The "participatory" type of relationship requires specific knowledge and skill on the part of the doctor."


The "learned theory" corresponds to biomedical knowledge but is different from the own experience of the disease

The scholarly theory perfectly represents what patients experience, think and feel when they have a disease

It only incompletely represents what patients experience, think and feel when they have a disease.

Medical knowledge confronts a secular theory of disease and health that influences patients' behavior, possible actions and relationships with physicians.

The doctor must therefore take into account scientific knowledge exclusively (= evidence-based medicine) in his doctor-patient relationship.

The doctor must therefore take into account both: his own representations concerning the disease (his scholarly theory), and the representations and values of the patient (his secular theory) during the interviews, but also those of the family environment (interview carried out with the patient in the presence of this entourage)

Patient consent or during an interview is essential to obtain


Regarding the process of empathy in the doctor-patient relationship

The patient's consent during an interview leads to a therapeutic alliance

Validating emotions and patient representation is crucial

Validating the emotions and representations of the patient essentially involves the gaze

In practice, validating the patient's emotions and representations involves reformulation (which mirrors the patient's own emotions and representations and tells him that he has been heard and that he is not alone)

Empathy is the ability to be friendly with others without being friendly deep down.

Empathy is the ability to understand others and make them understand that they have been understood.

Empathy is different from sympathy which is the ability to feel the same as others.


Most patients want caregivers to feel the same way they do.

Most patients don't want a caregiver to feel the same way they do, but to try to understand how they feel.

An important element to which the doctor must remain attentive is the appearance of resistance that can arise

Resistance is a sign of ill will on the part of the patient

Resistance is not a sign of ill will on the part of the patient, but a natural reaction to a change in his or her life: the disorder or illness.

A patient who resists change is a lost cause and no longer needs to be cared for

In the face of resistance, getting angry and scaring the patient is a technique that often works

A calm and serene emotional expression of the clinician in the face of resistance is essential"


Concerning the interview in the doctor-patient relationship

The physician will have to convey to the patient the feeling that he will not be judged, and that no decision will be imposed on him without it making sense to him in his own system of representations.

An important element for each interlocutor is the feeling of freedom

The patient's freedom means that behaviour change cannot be initiated

Appealing to the patient's freedom should not be a way for the physician to abandon any possibility of change with the patient.

Motivation for change is not an immutable "patient trait"

The first step in the empathy process is the patient's expression of a thought (representation) or emotion.


This is a type of participatory interview

It helps to strengthen the patient's own motivation for change

It's about convincing the patient to change

The goal is to explore with the patient the advantages and disadvantages of the problematic behavior and the alternatives available to him.

Exploration must be empathetic and non-judgmental


The physician's recognition of the patient's thought/emotion is accompanied by an understanding of the patient's representations and worldview.

The third step in the empathy process is the physician's expression of recognition and understanding of the patient's thought or emotion.

The fourth step in the empathy process is the patient's acceptance of recognition and the doctor's understanding of the thought or emotion.

The phase of receiving recognition by the patient is independent of the patient's personality

This reception phase is influenced as the expression phase by the symptoms, clinical signs and the patient's situation.

An effective empathic process allows the patient to express in more detail his experience


Concerning the patient in the doctor-patient relationship

From the patient's point of view, a disease is not simply "an underlying organic pathology"

According to the 1946 WHO definition, health is "a complete state of physical, mental and social well-being and not merely the absence of disease or disability."

The disease is a disruption of balance in a biological, psychological and social whole

Transaction processes are the cognitive, emotional, and behavioral efforts made by an individual to adjust to stressful situations, such as illness.

Transaction processes in the doctor-patient relationship determine the outcome of the consultation

They determine the adjustment strategies that the patient can put in place to adapt to the disease, also known as patient coping skills."


Concerning the evaluation phase in the doctor-patient relationship

There are two phases of assessment: primary and secondary

Primary assessment is the "perceived stress" of the subject in the stressful situation

Perceived stress is more predictive of the patient's subsequent health than an objective measure of the stress situation

For the patient, the perceived control refers to social aid and protection

Perceived control corresponds to the inventory of his personal resources and his ability to control the situation and the perceived social support corresponds to the inventory of relational and social aids, protections and valorizations available to him.

"Perceived control" and "perceived social support" are negative (inversely correlated) predictors of later health status

'Perceived control' and 'perceived social support' are positive predictors of later health by reducing the impact of stressful life events and facilitating the adoption of lifestyle changes needed in disease management."


Concerning the adjustment phase and the interview in the doctor-patient relationship

A sense of loss of control or lack of social support proves deleterious for most patients

The adjustment or coping phase is the set of transactional processes that an individual interposes between him and the stressful situation in order to reduce its impact

Whatever the situation, the information provided must be fair, clear, appropriate, appropriate to the situation and understood by the patient.

Patient-patient interviews are always carried out one-on-one to respect medical confidentiality.

The patient may wish his relatives to be present during the transmission of information and this must be accepted

Teenagers and children cannot be seen without their parents

For teenagers in particular, we must not forget to offer a moment of exchange alone without the parents"


Concerning interviews in the doctor-patient relationship

It is necessary to choose a place of quiet information, known to the patient, where the doctor will take the time, as part of a personalized relationship

Information must be communicated to the patient and the entourage if the patient so wishes.

The steps of the medical process can be used to explain to the patient the arguments on which the doctor's decisions were made.

It is essential to use medical terms so as not to make approximations

Giving alternative names that the patient can understand can be helpful

The management of a chronic disease involves a therapeutic patient education (TPE) strategy


Concerning FTE in the doctor-patient relationship

It is an ongoing process, integrated into care and focused on the patient rather than the disease.

It includes organized awareness-raising, information, learning and psycho-social support activities.

It aims to help the patient and their loved ones understand the disease and the treatment, cooperate with caregivers in a participatory relationship, live as healthily as possible while maintaining or improving quality of life.

Therapeutic education must make the patient a scientific expert in his disease

Therapeutic education must enable the patient to acquire and maintain the strategies necessary to optimally manage his life with the disease, in the perspective of the WHO definition of health of 1984

In the context of an FTE, the physician must avoid any contra-attitude


Osteoarthritis is the most common chronic inflammatory rheumatism

Osteoarthritis is not inflammatory but mechanical. It is RA that is the most common chronic rheumatism

Most often around fifty years, but it can occur at any age. There are juvenile forms before 16 years

RA is three times more common in women before the age of sixty

The prevalence of RA in the general population is around 8%

Its prevalence in the general population is of the order of 0.3 to 0.8% in adults

The prevalence among first-degree relatives is approximately 2-4%


Regarding pathophysiology and diagnosis:

The pathogen(s) causing RA are unknown to date

RA is characterized by an overflow of pro-inflammatory cytokine production

Osteoclasts are the effector cells of bone erosions seen in RA

As well as biological and radiographic examinations plus an ultrasound if doubt

Treatment of RA only begins when it becomes disabling, from the age of 65-70

Diagnosis of RA should be as early as possible in order to institute background treatment very early


Sex ratio to the disadvantage of women but not exclusive

The picture of acromelic arthritis is extremely rare

evolving in a chronic mode (> 6 weeks) most often

characterized by inflammatory joint pain (waking up at the end of the night and morning stiffness > 30 minutes)

The most frequent location is that of the wrists


Metacarpophalangeal joints and proximal interphalangeal joints are frequent localizations

Spontaneously painful joints are most often painful under pressure

The skin coating is not usually affected

Unlike psoriatic arthritis, septic arthritis or microcrystalline arthritis

Distal interphalangeal joints are usually respected during RA

Tenosynovitis points to differential diagnosis and is incompatible with RA

Possible. Especially around the extensor tendons of the fingers or opposite the ulnar extensor of the carpus


There is an increase in sedimentation rate (ESR) and/or CRP in the majority of patients

Rheumatoid Factor (RF) arrives late in the disease

It is most often present at the first clinical signs of the disease

The positivity of the RF may precede the appearance of clinical signs by several months to several years

It is very possible during Sjögren's disease, systemic lupus, or systemic scleroderma

A positive RF can be found in patients who are not sick


Concerning the analysis of SAEs of therapeutic hazard

The analysis of SAEs involves their detection and reporting to the institution's risk manager.

Safety culture is optional and not paramount in patient care

Need for a culture of safety and risk management: Culture of reporting and positive culture of error (any error, malfunction or failure is an opportunity for individual and collective progress).

For a positive culture of error, "no punishment" or "incentive to report" measures must be put in place.

Data anonymization is a necessity in the conduct of SAE analysis

Analysis of the consequences of the SAE makes it possible to prevent them in the future


Which of these proposals are factors for the success of risk management?

The commitment of the management of the establishment

It's useless. Non-punitive error management is needed

The understanding of the issues by all professionals


Concerning the prevention of damage to second victims

This term was introduced by Claude Bernard in 1849.

The second victim is the person closest to the patient

The second victim is emotionally and professionally impacted

Emotionally: shame and guilt. Professionally: mistrust, damage to reputation, loss of trust, etc.

One of the consequences may be burnout or suicide

The second victim, most often, files a complaint against the hospital for failure to assist a person in danger.

The second victim is the caregiver who made the mistake."


To prevent damage to the second victim, it is necessary to move from the latter to the first actor

The prevention barrier makes it possible to limit the consequences of a mistake already made

They prevent the occurrence of the error and the accident (action on latent and patent errors) PREVENTION Ex: the surgical checklist, which avoids forgetting perioperative antibiotic prophylaxis

The recovery barrier prevents the occurrence of the error and the accident

The error is made but recovered before having consequences Ex: antibiotic prophylaxis is prescribed but the nurse becomes aware of a penicillin allergy in the patient's medical file and alerts the prescriber who changes his prescriotion

The attenuation barrier prevents the consequences of the mistake already made

The accident is proven but the consequences are limited ATTENUATION barrier Ex: a patient who has not benefited from antibiotic prophylaxis is in septic shock, but blood cultures were carried out very early, the germ was identified quickly, a bed in intensive care is immediately available, treatment is initiated quickly.

The root cause is the one that is at the origin of all the effects it is the most undesirable, upstream of the problem.


It corresponds to the first hole of the first plate (in Reason's model)

It is wiser to treat the racid cause than the consequences of the latter

Root cause analysis (RCA) analyzes and treats the causes of a problem rather than treating its symptoms.

The root cause forest is one of the root cause analysis methods


Which of these proposals are compensated under national solidarity?


The therapeutic hazard occurs when the patient suffers a sudden aggravation in connection with the medical act but without there being a medical fault

Therapeutic hazard does not give right to any compensation

As medical risk is no longer accepted by patients, important reforms on damage compensation have been established.

There can be no financial payment for patients suffering from therapeutic hazards

Following the Act of 4 March 2002 on the rights of patients, victims of risk may be compensated under national solidarity. (i.e. the State) when the responsibility of health professionals or institutions is not engaged.

To be compensable, the damages invoked must have three cumulative conditions


The compensation procedure is fast and free of charge

It is only valid for medical accidents occurring after 6 August 1997.

Valid for the victim: fast and free procedure only for medical accidents occurring after 4 September 2001.


Diarrhea is the elimination of at least 3 unmolded stools per day

Febrile diarrhea indicates enterocolic infection

Not necessarily: the acceleration of transit and the emission of liquid stools can be caused by many other infections (malaria, sepsis, etc.)

The majority of acute diarrhoea is of infectious origin

Diarrhoea often progresses to colonic performation and sepsis when left untreated


What are the emergency situations to be identified?

More than 10 trips to the toilet per day

The number of times you have a bowel movement is not a sign of severity


It is indicated in non-febrile diarrhea of the infant

It has many side effects including frequent headaches


What are the indications for a stool culture?


What situations require hospitalization during infectious diarrhea?

Febrile diarrhoea returning from endemic country


From what time frame do we speak of prolonged diarrhea?

From one month, we talk about chronic diarrhea


From what time frame do we talk about chronic diarrhea?

Acute diarrhea is called an episode < 2 weeks


Among the following proposals, what is the main risk in acute diarrhoea in children?

Major risk, to be assessed (CI and EC according to the criteria) upon admission


Childhood strabismus is a symptom of an underlying pathology

There are two types of strabismus: paralytic or normal mobility

It is only indicated in case of persistence of strabismus with the port of total optical correction

Surgical treatment is performed under general anhesis

Strabismus is a lack of parallelism of visual axes


Strabismus is indicative of sensorineural impairment

The motor component involves an abnormal position of the deviated eye relative to the dominant eye

The child's strabismus is essentially the consequence of a disturbance in the interpretation of color

The strabismus of the child is essentially the consequence of a disturbance of the fusion (cortical integration aimed at bringing together the images perceived by each eye in a single image)

The purpose of fusion is to allow a simple perception of any fixed object.

It results as a motor response (contraction–relaxation of the oculomotor muscles of both eyes) to binocular stimulations (vision of one image per eye)


Concerning strabismus and its consequences

Fusion creates the conditions for simultaneous vision of both eyes

Acute strabismus resulting in two different images implies visual confusion

In case of acute strabismus, two images of the same object can be perceived, it is diplopia

Old strabismus without complaints can lead to normal vision by pausing the retina of one of the two eyes

In ancient strabismus or in children who do not express complaints, the doubled image can be suppressed by a cortical phenomenon, neutralization (the image of one of the two eyes is ignored)

Amblyopia is the decrease in visual function due to early impairment of visual experience.


Visual confusion is related to the perception of two objects in the same place

All patients describe stereoscopic vision disturbance

Strabismus most often sets in in childhood

The prevalence of strabismus is estimated at 12% of the population


Strabismus screening should be performed in all children in late adolescence

The early appearance of strabismus determines its impact on binocular vision

The relative risk of strabismus in case of family history is not changed

The prefix "éso" is used for convergent vertical strabisms

For convergent horizontal strabismus (esotropy and esophoria)


The differential diagnosis of convergent strabismus is epicanthus

The prefix "exo" is used for divergent strabismus (exotropy and exophoria)

A phoria is an intermittent strabismus (observed episodically on examination) and can be observed in convergence (esophoria) or divergence (exophoria)

In case of permanent strabismus, binocular vision is absent


Ophthalmological examination in strabique children:

Binocular vision is lost in intermittent strabismus

In intermittent strabismus, binocular vision is often retained when the eyes are aligned

The risk of amblyopia is major when the deviated eye is always the same

The risk of amblyopia is 99% in case of alternating fixation

Concomitant strabismus does not find any systematized deficit of ocular motility

Concomitant strabismus is very rare in children

Concomitant strabismus account for the vast majority of childhood strabismus


Concerning additional examinations in case of strabismus:

The discovery of strabismus requires an urgent ophthalmological examination

Strabismus can reveal a retinal pathology such as retinoblastoma or macular scar

Nystagmus associated with strabismus requires the performance of an EEG

In case of associated nystagmus, an electroretinogram (ERG) will be performed to rule out retinal dystrophy and visual evoked potentials (EPI) and magnetic resonance imaging (MRI) of the optical pathways will be prescribed for the assessment of potential visual tract damage

Any strabic child should benefit from an objective refractive measurement under cycloplegic to determine whether it is an esotropy or an exotropy

Objective refractive measurement is the basic element of screening for ametropia and amblyopia in a child

The measurement of subcycloplegic refraction will look for ametropia


The presence of astygmatism is very common in case of strabismus

The presence of hyperopia is very frequently associated with strabismus

Any accommodation effort is associated with convergence

Objective refraction under cycloplegic makes it possible to measure the visual acuity with correction of a child

Any strabic child must wear total optical correction

The measurement of visual acuity makes it possible to objectify myopia which is frequently associated with strasbism

The measurement of visual acuity will highlight a possible amblyopia (difference in visual acuity between the two eyes of at least 2/10th with correction)


The presence of binocular vision is a major prognosis of treatment

Any strabic patient must wear total optical correction

Treatment of possible amblyopia will be maintained until the age of 2 years

Treatment of possible amblyopia will be maintained until the age of 6 to 8 years, which corresponds to the end of the child's visual development

Indications for orthoptic rehabilitation are marginal in the management of strabismus

The role of the orthoptist is especially major in the measurement of strabic deviations and binocular vision, as well as for the follow-up of amblyopia in support of the ophthalmologist


The main purpose of the medical examination is:

Detect cardiovascular pathologies responsible for sudden death

Discourage the practice of dangerous sports such as climbing or judo

To recall the dangerousness of doping products

This is one of the objectives, but the really main objective is the detection of cardiovascular pathologies, such as BAV or long QT, which can be responsible for sudden death.


The medical examination for fitness for sport is not reimbursed by health insurance

According to the College of Endocrinology

There are about 1 to 4 sudden deaths per 100,000 people over the age of 35.

If the sport is considered at risk, the consultation must be made by a sports doctor

Update 2016 on HCSP recos, extract from the College of Pediatrics 2021: A complete clinical examination is usually sufficient. The HCSP recommends that the ECG should not be systematic but left to the judgment of the clinician (2016). Discomfort and/or syncopes occurring during exercise should be considered as a warning sign of cardiac origin: a clinical cardiological assessment with at least one ECG, a stress test and echocardiography is then essential. The item is therefore false. (The item was previously corrected as true. Thanks to the external who reported the error)

Doping contraindicates the realization of a certificate of non-contraindication to the practice of sport

The patient must then be referred to see AMPD


Under what conditions is a stress test indicated?

To detect microangiopathic complications

The presence of 2 cardiovascular risk factors

Alcohol is not a cardiovascular risk factor


Regarding the main generalities about MS:

Multiple sclerosis usually occurs after age 40

The diagnosis is based on the notions of spatial dissemination and temporal dissemination

The lumbar puncture makes it possible to affirm the inflammatory nature of the CNS involvement

The criterion of dissemination over time is mandatory to make the diagnosis of MS

CNS inflammation objectified to CSF analysis may replace the criterion of dissemination over time if it is absent.

There are treatments that aim to speed up symptom recovery, limit the frequency of flare-ups and disease progression, and improve symptoms.


Regarding the epidemiology and risk factors of MS:

MS is more common when moving away from the equator

The prevalence is 5000 people per year in France

Less exposure to certain infections in childhood would increase the risk

Vitamin D deficiency is associated with an increased risk of disease


Progression is defined as the continuous worsening, over a period of at least six months, of neurological symptoms.

The relapsing-remitting form is progressive from the beginning, without flare-up, consistently

It is the primary progressive form, which affects 15% of patients. The relapsing-remitting form is composed exclusively of flare-ups, which can leave sequelae

The secondarily progressive form is the late classical course of the relapsing-remitting form

The primary progressive form begins on average a little later, around 40 years of age

Types of symptoms depend on the clinical phase


In the relapsing-remitting form, there is most often an inaugural flare-up of partial myelitis or NORB

"Partial myelitis" is an MRI term that means that demyelination does not extend to the entire cross-section of the spinal cord.

Partial myelitis is of medullary topography

Motor disorders are never found in partial myelitis

There are sometimes motor and/or sphincter disorders.

The sign of Lhermitte is very evocative: it is an impression of very brief electric discharge along the spine, sometimes limbs, triggered electively at the bending of the head forward


Regarding the analysis of cerebrospinal fluid in the MS:

The presence of oligoclonal bands replaces the criterion of temporal dissemination

Lumbar puncture is mandatory for the diagnosis of MS

Oligoclonal bands are present in only 15% of MS

They are present in more than 90% of MS! An absence of oligoclonal bands should call into question the diagnosis of MS.

A proteinorachy > 1 g/L is suggestive of MS

No, it is suggestive of a differential diagnosis, such as bacterial meningitis, and must call into question the diagnosis of MS.

Intrathecal IgG secretion > 0.7 g/L suggestive of a diagnosis of MS


NORB is also present in neuromyelitis optica (Devic disease), in HIV, in Horton's disease, and also caused by drugs (ethambutol, isoniazid)

It is red-green dyschromatopsia (optic neuropathy). Blue-yellow dyschromatopsia is present in some retinal conditions.

Papillary edema may be observed at the back of the eye

It is an inflammatory attack of the optic nerve. Edema is present in 10% of NORBs.

In the static visual field, there is a central scotoma or caeco-central


What background MS treatment(s) is/are likely to cause progressive multifocal leukoencephalopathy (PML)?

Side effects: flu-like syndrome for ≈ 50% of patients after injection; Skin side effects

Immunomodulatory therapy that may cause skin side effects

Immunomodulatory therapy that can cause flushing, digestive upset and prolonged lymphopenia (occurrence of opportunistic infections such as PML)


The primary progressive form has a poor prognosis

Initiation with NORB is a good prognosis factor, but onset with motor signs is a poor prognosis factor.


Which of the following proposals are frequently included in a first outbreak of multiple sclerosis?

Not brutal (more reminiscent of vascular involvement), no hemiplegia

Paresthesias of a hemibody or lower limbs


Which of the following are additional tests that can lead to multiple sclerosis (MS)?


Which of the following are common features of retrobulbar optic neuritis (NORB)?

A fundus usually normal in the acute phase


Regarding the causes and consequences of spleen pathologies:

Hemorrhagic shock due to rupture of the spleen can result in asplenism

Pneumococcal sepsis may be caused by splenomegaly

Any palpable spleen is pathological except in children

Splenomegaly can cause hemodilution anemia


What can be the consequences of splenomegaly:

No, but celiac disease can cause splenopathy

Inconstant although more or less proportional to the splenic volume, it depends on the etiology of splenomegaly

Rather leukopenia by sequestration. We readily find thrombocytopenia. In extreme forms, this can go as far as pancytopenia.


Vaccinated against all encapsulated germs

Meningoto and pneumo vaccine only. There are many other encapsulated germs, including haemophilius influenzae.

Vaccination against neisseria meningitidis

Bouts of fever are immediately treated with fluoroquinolones


Which of the following are causes of splenomegaly?


Lower part of the face. The two nuclei of the trunk of the facial nerves each receive afferences of 1st corticonuclear motor neurons of both hemispheres. However, the homolateral corticonuclear neuron innervates mainly the upper stage of the face. So in case of damage of the 1st neuron, central, the deficit will predominate on the lower floor.

There is a deletion of the nasolabial fold

It is associated with a motor deficit that is homolateral most often

It always includes automatic-voluntary dissociation

In general, not always. Sometimes dissociation is reversed


The sign of Charles Bell shows a tilt of the eyeball upwards

This switch is physiological. The incomplete closure of the palpebral cleft makes it possible to observe it (by occlusion deficit of the eye) = Charles Bell's sign

There is an erasure of forehead wrinkles

There is an agueusia of the anterior 2/3 of the tongue when the involvement is very proximal

It is a localizing sign of the lesion: upstream of the eardrum cord. So a FP related to a lesion downstream (eg compression by a parotid tumor) will not be associated with ageusia.

Schumascher's test reveals drying up of tear secretions

The face is sluggish in case of facial diplegia


Regarding idiopathic acute facial paralysis:

By far the most common; "very rare" suggests the answer

Recovery is slow and sequelale in very few cases

Prescription of oral corticosteroid therapy (1 mg/kg per day for 10 days). There are symptomatic treatments: eye protection, speech therapy,...


Platinum salts are the basis of chemotherapy

Treatment decisions must be validated in a multidisciplinary consultation meeting with 2 doctors of different specialties

Survival at all stages is < 20% at 5 years

Its main risk factor, tobacco, is clearly identified and preventable

There is no recommendation for screening for CP currently in France


Which of these principles apply to occupational medicine?

Universality: occupational medicine concerns all employees

It must be organized by the ANSM and the HAS

The action of the MT is independent of the employer


Which of these proposals are actions potentially carried out by the occupational physician?

The development and updating of the company file

The role of TM is exclusively PREVENTIVE


It is mandatory in certain cases: after maternity leave, absence due to occupational disease, ...

It concerns in particular workers returning from maternity leave

It concerns in particular workers returning from paternity leave

It may conclude with a notice of incapacity

It can be replaced by the pre-return to work visit

The pre-resumption visit is different, it is organized during the work stoppage and has different objectives


Osteoporosis is a generalized disease of the skeleton, characterized by decreased bone strength predisposing to a high risk of fracture

Bone strength is synonymous with bone density

Bone strength is the result of bone density and bone quality (alteration of bone microarchitecture in particular)"

Biomechanical studies show that bone mineral density (BMD) is the main determinant of bone fragility

The main complication of osteoporosis disease is malignant hypercalcemia

Fractures are "the" complication of osteoporotic disease and constitute the full severity of this disease

The scanner is the reference technique for measuring BMD

This is the DXA: Two-photon X-ray absorptiometry


X-rays should be taken for vertebral fracture(s) in case of significant loss of size (≥ 4 cm)

The realization of a BMD is necessary in front of fractures of the ESF or vertebral only

When an osteoporotic-like fracture occurs (or is discovered on X-rays), or when one or more risk factors for osteoporosis are discovered by questioning, BMD must be performed

Vertebral fractures are osteroporotic only

In case of red flag (context or presentation or appearance rx), it is necessary to fear a secondary fracture (tumor, myeloma, spondylodiscite ..). In case of doubt, the realization of a CT scan and / or an MRI, will confirm the absence of signs suggestive of another origin, in particular tumor

In postmenopausal osteoporosis, serum calcium is increased

Calcium and phosphatemia are normal in postmenopausal osteoporosis. In case of primary hyperparathyroidism, however, there is hypercalcemia and hypophosphoremia

Vitamin D deficiency should be screened for osteoporosis

The dosage of 25 OH vitamin D is part of the assessment of weakening osteopathy to detect osteomalacia.


Which of the following are radiographic criteria for benign vertebral fracture?


Which of the following are radiographic criteria for malignant vertebral fracture?

Rather, there is a recoil of the posterior arch


Which of the following proposition(s) is true about asthma?

Pulmonary function tests (RFEs) find a reversible restrictive ventilatory disorder

EFRs regain reversible obstructive ventilatory disorder

The severity of asthma is defined by the number of annual exacerbations

It is defined by the necessary therapeutic level

Asthma contraindicates underwater scuba pongey


What is the prevalence of asthma in France? 🤔


Which of the following are signs of severity during an asthma exacerbation?

True, any hemodynamic instability is a sign of severity

True, like all acute neurological instabilities


What is the prevalence of rhinitis in France? 🤔


Any patient with acute fever is contagious until proven otherwise.

A diastolic BP < 100 mmHg is a sign of severity

Each degree above 37°C increases water loss by 400ml/d

Fever and chills increase oxygen requirements

Social isolation is an indication for hospitalization for acute fever


The core temperature considered normal is ≤ 37.5°C in the morning and ≤ 37.8°C in the evening.

Fever classically refers to a body temperature ≥ 38 ° C in the morning (38.3 ° C in the evening)

The term "feverish", imprecise, usually refers to a temperature > 37.5°C and < 36°C

The term "feverish", imprecise, usually refers to a temperature > 37.5°C and < 38°C

Rectal temperature measurement is the most used because it is extremely precise

Rectal intake is no longer used (risk of thermometric ulceration)


Acute fever especially if associated with dyspnea is a decantant factor of acute coronary syndrome

Pyelonephritis is systematically sought in women especially in the 3rd trimester

Lung, urinary and digestive infections dominate in the elderly

In valve prosthesis wearers, blood cultures are systematic before any antibiotic therapy to look for infectious endocarditis


Faced with a fever without a precise diagnosis, which of these situations are indications for probabilistic antibiotic therapy in emergency?


Which of these proposals fall within the definition of an MPA technique?

This is the IAD: artificial insemination with donor sperm


Regarding general information on the GPA:

Assisted reproduction procedures allow in vitro conception in particular

Assisted reproduction (ART) procedures are "all clinical and biological practices allowing in vitro conception, conservation of gametes, germinal tissues and embryos, embryo transfer and artificial insemination" (Article 31 of the Bioethics Act of 07/07/2011)

These techniques have the sole purpose of fighting proven infertility

The pathological nature of infertility must be medically diagnosed before requiring ART

The indication for ART techniques has extended to the field of oncofertility during the decade 2010

The therapeutic management of couples most often begins with a simple induction of ovulation with scheduled sexual intercourse


Among these proposals, which impede embryo insemination or transfer:

The death of one of the members of the couple

Especially if cessation of cohabitation, or petition for divorce

This is not an obstacle at all, but will require a verification of serology and multidisciplinary care in a specialized center.


HIV 1 and 2, hepatitis B and C, syphilis should be checked

In case of STIs, MPA techniques are contraindicated

No, but the care is multidisciplinary and carried out in a specialized center

A consultation with a psychiatrist or psychologist must eliminate any contraindications of a psycho-social nature

ART is proposed as a first-line treatment in cases of confirmed infertility in all couples, in France

The AMP requires an investment of time, effort and emotions. If the couple does not seem to be able to assume this, the ART may not be proposed as a first line

Infertility is not managed (considered comfort care)

100% support. It is not at all a comfort, but a real pathology with psychosocial implications sometimes strong


Intrauterine insemination gives good results only in combination with stimulation of the ovary

Ovulation stimulation is passive and requires no supervision

Yes, monitoring by hromonal assays + repeated ultrasounds

The timing of insemination is one of the essential success factors

Insemination is ideally performed 36 hours after the artificial onset of ovulation, or the day after a spontaneous LH spike

Artificial insemination is concocted whatever the cause of infertility

The tubes must be permeable and the sperm must be of good quality


At least 1 million motile sperm must be deposited in insemination

Infertility of cervical origin is a great indication of artificial insemination

Infertility of cervical origin is mainly due to the HPV virus

Nothing to see: it is due to the asbence of mucus or mucus hostile to the passage or survival of spermatozoa

Ejaculatory mascular infertility is an indication for IAC

female permeable tube infertility is an indication for IAC


The first indication of IAD is the sterility of the spouse

The average pregnancy rate is 17.3% with donor sperm

The result of the IAD depends on the rank of the attempt, including

Artificial insemination is always associated with ovulation stimulation


Which of the following dosages can be used to assess the follicular ovarian reserve?


What are the particularities of AMH dosing?

Achievable only in the first part of the cycle


What should the FSH assay be coupled with to interpret follicular ovarian reserve?

Estradiol provides feedback to FSH and may distort its dosage.


He must be re-examined with each new situation

It can be written as well. When it is oral, the discussion should be mentioned in the medical record. Some cases must be written: "This written consent concerns acts related to fertility or pregnancy (for example, voluntary termination of pregnancy), acts of removal of tissues, cells and collection of products from the human body, clinical research, examination of genetic characteristics. The law does not require written consent for surgery, but the physician is advised to obtain such consent in writing whenever it is an important decision."


Among these proposals, which are major principles of medical ethics:


Among these proposals, which are criteria for brain death:

A single EEG showing an absence of brain activity

It takes two EEGs 4 hours apart to be able to conclude

An angiogram showing an absence of brain activity


Concerning the generality of medical ethics

A pregnant woman can ask a doctor for an abortion at 24 weeks of amenorrhea

A medical termination of pregnancy after the 12th week requires the authorization of a multidisciplinary diagnostic center which has competence to decide which diseases justify it or not.

Prenatal diagnosis concerns only genetic analyses to verify chromosomal diseases

The absence of all brainstem reflexes is a criterion for brain death

Biomedical intervention research and research on healthy volunteers is governed by the Huriet-Sérusclat law


Regarding the application(s) of medical ethics

The Huriet-Sérusclat law implies obtaining the agreement of the HAS

This law requires the sponsor to take out insurance, to obtain the favorable opinion of a committee for the protection of persons [CPP] and the authorization of the national agency for the safety of medicines and health products [ANSM]

No medical procedure may be performed without free and informed consent on the part of the patient, except in cases of emergency.

The physician must respect the wishes of the person who can refuse care

When the person is unable to express his will, no act can be carried out, even in an emergency.

When the person is unable to express his will, no act can be carried out, except in an emergency, without the person of trust, or the family, or failing that, one of his relatives maintaining close and stable links with the person having been consulted (law of 4 March 2002, known as the Kouchner law)

You can test a patient for a serious genetic disease without warning them to avoid scaring them


Consent must be free, informed, special and revocable at any time

Legal protection only applies to patients whose mental faculties are impaired

The conditions for deciding to limit active therapies are defined by the Geneva Convention

The Clayes-Leonetti law obliges the doctor to stop treatment if the chances of survival are deemed low by an independent medical committee

It gives the right to interrupt or not to undertake treatments deemed useless, disproportionate or having no other purpose than the artificial maintenance of life and the possibility of using treatments with the intention of relieving the lady, even if they risk shortening life (principle of double eect)

In the event of a decision to limit treatment, the patient or his representatives will be informed and the decisions will be clearly recorded in the medical record.


The decision to limit treatment is made by the attending physician

The word ethics comes etymologically from the Greek ETHOS which means way of being and behaving according to morals

Ethics can be thought of as the science of morality

We can envisage an "applied ethics" for each field of human activity, and therefore a "medical ethics"

Medical ethics is closely related to bioethics (biomedical ethics), but not identical to it.


The first principle of medicine is to do everything for the good of the patient without harming him.

Autonomy consists in saying that everything must be done so that the patient can move autonomously

Autonomy: The patient is the only one (provided he is in perfect lucidity) to be able to give his opinion and agreement to the treatments that are proposed and explained to him

The principle of justice requires us to refer to the court any criminal or penal information issued by the patient

Justice: all patients must be treated with the same care and respect

Voluntary termination of pregnancy (IVG) is an induced abortion, decided for non-medical reasons within the legal framework established by the Veil law of 1975

The law sets at 12 weeks of pregnancy (14 weeks of amenorrhea) the period during which a woman can request an abortion.


Medical abortion (medical termination of pregnancy, IMG) is possible when the pregnancy endangers the woman's life

The IMG after 12 weeks of pregnancy requires the authorization of multidisciplinary diagnostic centers that have competence to decide which diseases justify it or not (notion of particular seriousness)

The costs of care and hospitalization related to a voluntary termination of pregnancy are covered by the patient or her family

Covered by social security Care and hospitalization costs related to a voluntary termination of pregnancy are 100% covered by health insurance (for all women since 2014)

The consent of the spouse is mandatory for an abortion to be done

The consent of the spouse must be as far as possible to the maximum sought, but is not mandatory

A minor woman may not have an abortion without the consent of her parents or legal guardian.

A minor woman may have an abortion without the consent of her parents or legal guardian, provided that she is accompanied by an adult."


Concerning abortion, contraception and PND

A psycho-social interview, conducted by a marriage counsellor, is offered to any woman who is considering an abortion.

The interview with a marriage counsellor is optional for minors who wish to have an abortion

There is a conscience clause whereby a doctor can refuse to participate in an abortion.

Ultrasound is not an examination that is part of the prenatal diagnostic process

This diagnosis can be made non-invasively (ultrasound, analysis of DNA fragments of the fetal placenta contained in small quantities in the maternal blood) or invasive (amniocentesis or choriocentesis with a risk of miscarriage of about 1%) for chromosomal or molecular biology study"


The main indication for PGD is to prevent couples with or carriers of a rare and serious genetic disease from passing it on to their child.

Pre-implantation diagnosis only concerns couples where both parents are carriers of a genetic problem

It also applies when one of the partners of a couple is a carrier of a chromosomal abnormality

Pre-implantation diagnosis poses in itself a problem of eugenics

The attestation of the irreversible nature of the brain destruction is by a clinical examination only

Medical ethics ¡ The attestation of the irreversible nature of the brain destruction must be by a paraclinical examination: * either two electroencephalographic (EEG) tracings without activity (isoelectric maximum amplification) for 30 minutes at 4-hour intervals

The removal of organs from a person whose death has been duly certified may be carried out if the latter has not made known during his lifetime his refusal of such removal (presumed consent)


Such refusal may be expressed by any means by any person over 13 years of age, in particular by entry in an automated national register provided for that purpose.

In the case of organ donation, the collection from relatives of the opposition expressed by the deceased during his lifetime must be systematic

The law on the modernization of the health system strengthened the principle of presumed consent as well as the role of the National Register of Refusals (main, but not exclusive, means of expressing refusal) of organ donation

Relatives must be informed of the purpose of the samples taken


The removal of an organ for the purpose of donation to others exposes the donor to risks to his health, he must be clearly and fairly informed

The removal of an organ from a living person, who donates it, can only be carried out in the direct therapeutic interest of a recipient

No organ removal for donation may take place from a living minor or from a living adult subject to a legal protection measure.

No payment in any form may be made to a person who takes parts from his body.

The Agency for Biomedicine must be informed prior to its realization, of any removal of organs for therapeutic purposes from a living person


The CPP gives its opinion orally to the investigator on the conditions of validity of the research

The committee gives its opinion in writing to the investigator on the conditions of validity of the research, in particular the protection of individuals (information given, methods of obtaining consent, respect for autonomy) more particularly if they are vulnerable and on the general relevance of the project (objectives, means, experimenters)

The safeguards imposed and the type of consent vary depending on the level of risk to the patient

The Data Protection Act applies to all research projects that collect patients' personal data.

In the case of collection of digital patient data, research can only start after agreement of the EMA

The research can only start after authorization from the National Commission for Informatics and Liberties (CNIL), according to variable modalities depending on the complexity of the project and the nature of the data collected

Research on human beings must have a general purpose which aims to improve scientific knowledge without the interests of science and society taking precedence over the interests of individuals.


The thirst for knowledge or to develop knowledge must not be exercised without limits or precautions.

The rules of scientific validation of an experiment can be exceeded in case of emergency (research on covid19 for example)

The rules of scientific validation of an experiment must be strictly respected as well as the independence and safety of patients included in the studies

No biomedical research may be carried out on human beings if the foreseeable risk to the persons taking part in the research is disproportionate to the expected benefit to those persons or the interest of such research.

Respect for human dignity and human autonomy are core values


Normal hemoglobin varies with sex (in adults) and age

Clinical anemic syndrome may be latent and only discovered on blood count

Anemia is not a diagnosis but a symptom requiring etiological research

Central anemias show too much elimination of red blood cells produced

Central anemias testify to an attack on production either by damage to the hematopoitic cell or by damage to its environment

All central anemias have one biological sign in common: a reticulocyte count greater than 150 G/L


Regarding peripheral anemia, which proposals are true?

In cases of peripheral anemia, bone marrow production is normal or even increased

These peripheral anemias have in common a biological sign: the high number of reticulocytes, greater than 150 G / L

Hemolysis induces a decrease in free bilirubin

Hemolysis induces an increase in free bilirubin reflecting the catabolism of hemoglobin and a low or even collapsed haptoglobin

High LDH and serum iron are indirect signs of hemolysis


Regarding sickle cell disease and thalassemia syndromes:

Sickle cell disease mainly affects people from South America

Sickle cell disease mainly affects people from black Africa and is linked to mutation of the beta chain of globin

Only sickle cell homozygotes are symptomatic and present with hemolysis from childhood associated with thrombotic manifestations in the form of joint or abdominal pain

Thalassaemic syndromes are characterized by an increase in the production of normal alpha globin chains

thalassemia syndromes mainly affect subjects around the Mediterranean basin and South-East Asia

The diagnosis of thalassaemic syndrome is based on bone marrow aspiration

Diagnosis of thalassemia syndrome is based on hemoglobin electrophoresis


Biermer's anemia occurs in women most often, it is due to a lack of secretion of intrinsic factor

Biermer's anemia is a common cause of vitamin deficiency

Concurrent diabetes eliminates diagnosis of Biermer's anemia

It is frequently associated with diseases such as vitiligo, autoimmune thyroiditis, diabetes

The picture is very clinically polymorphic, but medullary megaloblastosis is constant

The prognosis is sap even under lifelong vitamin therapy

Prognosis is benign under lifelong vitamin therapy


Without proper treatment, neurological complications are irreversible

Biermer's anemia is accompanied by atrophic glossitis and sensory disturbances in the absorption of hot or spicy dishes

Skin disorders can be observed: dry, flaky skin, brittle nails, hair loss

In its advanced form, the neurological picture is that of combined sclerosis of the spinal cord with quadriparesis associated with incontinence

It is macrocytic with MCV, usually greater than 110 fl


Troponin elevation is non-specific to heart tissue

Troponin is a cardiac enzyme released in myocardial necrosis, it is specific to heart tissue and is therefore not elevated by other muscle damage.

During a myocardial infarction, troponin rises about 3 hours after the onset of chest pain.

Myoglobin is a myocardial marker whose elevation persists up to 15 days

Myoglobin is an early marker that rises in about 2 hours, peaks between 8 and 12 hours and normalizes between 24 and 36 hours.

LDL is one of the myocardial markers that rises during an ACS

It is the LDH (LDH1 +++) that will have an elevation (peak in 3-4 days) and normalization in 6 days

Myocardial markers are essential for the diagnosis of SCA ST+

The diagnosis is established by the clinic (prolonged chest pain > 30 minutes) coupled with the ECG


ST myocardial infarction is a reflection of transmural myocardial involvement

STEMI occurs during total occlusion of a coronary artery

STEMI = SCA ST+ = total occlusion by rupture of atheromatous plaque most often

On ECG, a Q wave of necrosis directs us to transmural myocardial involvement

The critical oral ECG should be obtained less than 10 minutes after the first medical contact when the patient presents to an emergency department

The presence of a ST segment shift is pathognomonic of a STEMI

An ST segment elevation can be found in various pathologies: SCA ST +, pericarditis, Brugada syndrome, aortic dissection, Prinzmetal's angina, left ventricle aneurysm, early repolarization, BBG


A parietal hernia occurs when a peritoneal sac crosses the transverse fascia.

Congenital hernias account for more than 55% of hernias in children

Congenital hernias account for more than 95% of hernias in children

There is a swelling of the inguinal region appearing at prolonged standing during an inguinal henrni

The examination should be carried out lying down, without then with pushing efforts, then standing


The diagnosis of uncomplicated groin hernia is clinical by palpation of painless, impulsive and expansive cough swelling

Among the risk factors for hernia have found chronic obstructive pulmonary disease, chronic cough, constipation, dysuria

In case of direct hernia, the hernia is reduced by a direct antero-posterior path, and the beats of the epigastric vessels are perceived outside

Coral hernia accounts for 30% of groin hernias

Coral herenia almost always occurs in humans


Lipoma and inguinal lymphadenopathy are other causes of inguinal swelling but unlike unstrangulated hernias are irreducible

Eventration is a parietal complication following a wound, most often of surgical origin

Transillumination and non-reducible character allow differential diagnosis between hydrocele and internal oblique hernia

Transillumination and non-reducible character allow the differential diagnosis between hydrocele and external inguinal hernia

All hernias can be complicated by strangulation

Strangulation is more common in coral hernia than in inguinal hernia


It is a common pathology with about 150,000 cases per year in France

The treatment of hernias is surgical and most often performed on an outpatient basis

Due to the risk of high strangulation, crural hernias must all be operated on.

Incinquinal herenia in a child less than 6 years younger is a formal indcation to surgery

In case of asymptomatic inguinal hernia the risk of strangulation is extremely low


Which of the following is needed to confirm the diagnosis of a hernia of the groin?

An abdominopelvic CT scan with injection of contrast medium (after checking for contraindications, including renal)


Irritation on the path of the spermatic cord is classic of an inguinal hernia

True. In addition, coral hernia is very rare (90% of hernias are inguinal) and affects 10 women for 1 man

Coral hernia is more common in men than in women

It is an impulsive cough injury when not strangled.

A reducible lesion has no indication for surgery

Coral hernia = surgery in all cases. Painful inguinal hernia/child over 6 months = surgery.

They can be acquired (coral hernia in elderly women)


Pneumothorax (PNO) is defined by the presence of air in the pleural space

Spontaneous PNO in young people affects women more frequently than hommzq

Slender morphotype and smoking are risk factors for spontaneous PNO

The entry of air into the pleural space via the visceral pleura results either from the rupture of peripheral alveoli, blebs, or emphysema bubbles


Traumatic PNOs are iatrogenic or caused by penetrating or non-penetrating chest trauma

Chest pain: pleural type, constant, sometimes violent in "stabbing", to type of side stitch, inhibiting breathing, radiating to the shoulder, unilateral supsected a pneumothorax

– Dyspnea is often associated, of varying intensity depending on the terrainA dry cough of pleural origin is common

– On physical examination: tympanism, abolition of vocal vibrations, decrease or disappearance of vesicular murmur on the side of the PNO


• X-ray Chest X-ray (RT) is the key examination

RT makes it possible to visualize a bordering line or pleural line delimiting the pulmonary parenchyma, sometimes reduced to a stump

• RT makes it possible to highlight signs of compression: contralateral displacement of the mediastinum

A complete detachment corresponds to the complete detachment corresponds to the detachment of the lung over its entire hatuer

• The RT in forced expiration (which aims to aggravate the PNO) is to be requested only in a second step, when the PNO is not visible on the radiograph in standard inspiration


Chest drainage is necessary in the first instance in case of underlying pulmonary pathology

The risk of homolateral recurrence is 15%

It is necessary to inform the patient about the need to consult urgently in case of a new painful episode

It is necessary to prevent the effors glottis closed

During a first episode of spontaneous PNO pleural symphysis is indicated if bubbling persists beyond 14 days


Which of the following are possible etiologies of agitation or delirium?

Hyperparathyroidism can cause agitation. Hypothyroidism, on the contrary, can cause symptoms mimicking sadness.


From what time frame is a delirium no longer considered acute?


Agitation accounts for 10-15% of emergency room visits

True. often via the entourage 👨 👩 👧 or the police. 🚔

Agitation is defined by excessive, often unproductive and stereotyped motor activity related to internal tension.

The biological 🩸 assessment is systematic

True. NFS-P, BES, Calcemia, Blood glucose, CRP.

This is an emergency 🚨, which must be hospitalized 🏥


Acute bronchitis is the most common lower airway infection: several million/year in France

It is a viral infection in almost all cases

An upper airway infection may precede the symptomatology (rhinitis, pharyngitis)

The secondarily purulent character of sputum is a sign of bacterial superinfection

The chest X-ray should be performed systematically

No additional examination is justified to make the positive or etiological diagnosis 4


The course is favorable spontaneously and no antibiotic therapy is indicated in acute bronchitis

The lack of improvement should reconsider the diagnosis of simple acute bronchitis

Tobacco is the most common cause of COPD

The clinic and the parameters of pulmonary function tests allow to classify COPD into 6 stages

The clinic and the parameters of the pulmonary function tests allow to classify COPD into 4 stages (classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD)

The exacerbation of COPD corresponds to the increase in dyspnea, cough, sputum volume and / or purulence


Frankish greenish purulence of sputum is in favor of a bacterial origin

Exacerbations are infectious in 50% of cases

The risk of this exacerbation is severe acute respiratory failure

Cough suppressants moderate exacerbation of COPD

Reassessment of antibiotic therapy if initiated is essential at 48-72 h


Concerning community-acquired acute pneumonia (CAP)

Community = acquired in an out-of-hospital setting ("city") or occurring less than 48 hours after admission

Auscultation finds a condensation syndrome (crackling, tubal murmur)

Main risk factors: smoking, age > 65 years, comorbidities

The terrain is the essential element of the prognosis


Community-acquired lower respiratory infections (BRIs) in adults include three entities: acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease (COPD), and acute community-acquired pneumonia (CABG).

The absence of antibiotic therapy is the rule in healthy adults


The evolution is spontaneously favorable with disappearance of fever in 3 days and respiratory signs in about ten days in acute bronchitis

1 An infection is community-acquired if it is acquired outside a hospital facility or occurs within the first 48 hours of admission to hospital.

Chest ultrasound may help diagnose pleural effusion associated with acute community-acquired pneumonia

The search for soluble urinary antigens (legionella & pneumococcus) is not decapitated by prior antibiotic therapy

Microbiological investigations should not delay antibiotic therapy in cases of acute community-acquired pneumonia


Concerning acute community-acquired pneumonia

The CRB 60 score is a useful score for the diagnosis of acute community-acquired pneumonia

Streptococcus pneumoniae is the most frequently isolated pathogen in CABG patients

Streptococcus pneumoniae and Legionnella pneumoniae are the 2 agents most frequently responsible for serious PAC in intensive care

Legionella antigenuria is an examination of good sensitivity and specificity

These infections are sometimes complicated by a pleural effusion that will have to be punctured to specify whether it is an aseptic parapneumonic effusion (reactive) or purulent pleurisy


The best way to limit the impact on the communication of deafness is to make early diagnosis

Deafness screening is done if there is a family history only

Infant hearing loss is diagnosed in a few minutes

Chronic ear infections can cause deafness in children or adolescents


The outer ear consists of the pinna and the external auditory canal

In the absence of the tympanossicular system, about 5 decibels are lost.

Pathology of the outer ear can give conductive hearing loss

A pathology of the middle ear will give conductive hearing loss

Hearing loss is mild or moderate hearing loss


Which of the following are for mild hearing loss?

Between 0 and -20 dB: normal or subnormal hearing

True, between -20 and -40 dB: slight loss


At what threshold of auditory stimulation can we speak of 'supraliminal stimulation'?

True. It makes it possible to collect the stapedial reflex


Which of the following corresponds to average hearing loss?

True. Between -40 and -70 dB: average loss


Which of the following is severe hearing loss?

True. Between -70 and -90 dB: severe loss


In France, the incidence of Streptococcus B infection is 0.23 per 1000 pregnancies

In France, the prevalence of toxoplasome, per 10000 birthsm, is 3

Less than 20% of CMV infections are symptomatic

Congenital toxoplasmosis is linked to primary infection during the first days of life

TOXOPLASMOSIS Congenital toxoplasmosis ƒƒ Linked to primary maternal infection during pregnancy

In France, the seroprevalence of toxoplasmosis in pregnant women is 1%


The risk of transmission increases with the term while the severity decreases with the term

The serology of toxoplasmosis is systematic in the 1st trimester

There is no hygiene rule, apart from the eviction of cats, which exists to prevent the risk of toxoplasmosis

In immune women, serology should be re-monitored in the third trimester

Immune woman: no supervision or precautions

In case of confirmed primary infection, treatment is done with metronidazole and follow-up by the general practitioner


Malaria during pregnancy can lead to abortion

In pregnant women, uncomplicated P. Falciparum malaria indicates hospitalization

In the first trimester, uncomplicated access to P. Falciparum can be treated with quinine

From the second trimester, in case of uncomplicated malaria attacks of Falciparum, atovaquone-proguanil should be preferred

From the second trimester, artemether-lumefantrine should be preferred

Pregnant women should be advised to avoid travel to malaria-endemic areas


Regarding rubella infection during pregnancy:

Primary rubella infection in the first trimester is teratogenic

General population: mandatory immunization for infants of both sexes (MMR)

If serology is negative, vaccination is indicated in newly pregnant women

Performing rubella serology is mandatory in the 1st trimester of pregnancy

In non-immune women, serological control at 20 SA is indicated


Regarding maternal-fetal infections (MFIs):

Some infections in pregnant women can be transmitted to the fetus and are called maternal-fetal infections.

Most of the time, it is impossible to prevent maternal-fetal infections

These infections and their impact on the fetus and newborn can be prevented through prevention, monitoring and treatment.

Prevention involves routine screening of pregnant women for toxoplasmosis, rubella, syphilis and HIV

Maternal-fetal infections (MFIs) result from vertical transmission from mother to fetus


The impact on the fetus depends only on the type of infection

These infections have a more or less important impact on the fetus or newborn depending on the gestational age at which the infection occurs.

Infections that cause miscarriage attack embryonic tissue

In a non-specific way, any infection leading to fever may be responsible for a spontaneous miscarriage, especially in early pregnancy, even if it did not directly affect the embryonic tissue.

MFIs are protozoan (toxoplasmosis, malaria), viral (rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), chickenpox, HIV, HBV, parvovirus B19, Zika), or bacterial (listeriosis, streptococcus B, syphilis, Q fever)

MFIs contaminate offspring only by hematogenous route

The mechanism of contamination is then by ascending route (HSV, streptococcus B) or by hematogenous route (rubella, CMV, chickenpox, HIV, parvovirus B19, listeriosis, syphilis, Q fever, toxoplasmosis) before birth

Contamination during childbirth concerns in particular bacteria of the vaginal commensal flora

Keep in mind that contamination during childbirth also concerns hematogenous bacteria such as hepatitis B, HSV, streptococcus B, HIV


Which of these proposals are possible consequences of MFIs?


ƒƒ Severe toxi-infection with a lethality of 30%

ƒƒ Prevention is based on vaccination and administration of human-specific immunoglobulins

ƒƒ Indications for vaccine and immunoglobulins depend on tetanus vaccination status is routine

1 Basics to understand ƒƒ Tetanus is a serious acute toxi-infection due to CloThe tetanus germ is clostridium tetani, strict aerobic bacillus Gram positive, telluric

ƒƒ The neurotoxin induces muscle spasms, predominant in the jaw initially (trismus not painful, without fever), then generalized


The association of a non-febrile trismus after a soiled wound (rusty nail, etc ...) should make the disease considered and prescribe vaccination and serotherapy (immunoglobulins specific for tetanus toxin) immediately without waiting for biological confirmation

ƒƒ Non-immunizing disease (–> need to vaccinate patients at the end) and non-contagious disease (no additional precautions)

ƒƒ Contamination by tetanus spores following mucocutaneous intrusion in an unvaccinated or poorly vaccinated subject

Trismus corresponds to a generalized tetanus excluding a pure cephalic form on local wound (localized tetanus = single limb or pure cephalic tenanos)


In a person up to date with his vaccinations with a wound of major gravity it is necessary to administer, in a low dose of vaccine and in the other arm immunoglobulin

It is the in the person not up to date in his vaccinations with a major wound

In a person who is not up to date with a minor wound a dose of vaccine should be administered immediately

Wound treatment consite in trimming, disinfection and dressing

Never sutuer or put a thought on the wound

Neonatal tetanus causes 150,000 deaths per year in non-developed countries


AF is an irregular tachycardia of supraventricular origin, anarchic at the level of the atria with preservation of their hemodynamic efficiency

Atrial fibrillation (according to international nomenclature) or "auricular" or AF is an irregular tachycardia (arrhythmia), of supraventricular origin, due to rapid electrical activity (400–600/min) anarchic of the atria with loss of their hemodynamic efficiency

In principle, AF is when the duration of the episode is greater than 30 seconds

AF is responsible for one-sixth of all strokes by cerebral embolism

AF may follow or be associated with typical or atypical atrial flutter.


Heart rate in AF depends on the effectiveness of filtering the beam of His

The bundle of His does not filter. It is the AV node that has this role

Cardioversion or AF reduction are the medical actions that restore sinus rhythm.

AF is said to be isolated when it is without underlying heart disease

AF is often revealed by a complication (stroke, heart failure flare-up)

It is often necessary to use ECG monitoring to make the diagnosis


Cardiac auscultation regains regular heart sounds and a more or less rapid rhythm

Initial management should assess AF tolerance

The diagnosis of AF can only be confirmed on an ECG trace documenting it (ECG, Holter or monitoring)

AF with slow and regular QRS is indicative of an associated second-degree Mobitz 2 atrioventricular block

AF with slow and regular QRS: in this case there is an association between AF and complete atrioventricular block

The etiological assessment should include an ECG and an ETT only

As well as a standard laboratory workup and chest X-ray


Objectifying paroxysmal AF may be impossible despite the use of Holter's method

Cardioversion is done by Flecaine as a first-line treatment in most cases

Cardioversion is done urgently and in first line in front of a paroxysmal AF

It must be ensured that there are no thrombus in the OG. Often, a period of anticoagulation is required

After reduction of persistent AF, maintenance of sinus rhythm is ensured by digoxin

Maintenance of sinus rhythm is provided by amiodarone

In case of retroversion failure, AF is adhered to with frequency control by calcium channel blockers

In case of failure, AF is respected with frequency control by beta-blockers


The embolic risk is high, justifying long-term VKA in all cases in AF on valvular pathology

Cardioversion should be preceded by three weeks (usually four weeks) of effective anticoagulation documented by weekly INRs

It is followed by 4 weeks of effective anticoagulation most often

This rule can be circumvented in case of prior ETT or if the onset of FMD is perfectly datable and less than 24–48 hours

This rule can be circumvented in case of prior ETO or if the onset of FMD is perfectly datable and less than 24–48 hours (which is rarely possible)

The elements of CHADS2VASC are used to assess the need for anticoagulation of AF

The assessment of this risk determines the acute prescription of oral anticoagulants

The assessment of this risk determines the long-term prescription of anticoagulants: • • if low risk, no anticoagulant; if very high risk (AF valvular) or high CHADS2 score > 1, then indicated anticoagulants; • if intermediate risk (CHADS2 = 0 or 1), then discussion on a case-by-case basis by weighing the benefit/risk ratio


Prevention of thromboembolic risk is mandatory in case of persistent AF

Cardioversion is immediate in case of persistent AF

Place of cardioversion: • it should be immediate by electric shock only in case of vital emergency (shock)

cardioversion is delayed after three weeks of effective oral anticoagulation

It is performed by electric shock under general anesthesia or by antiarrhythmic drugs (amiodarone) or both actions combined.

If it is a first episode, no long-term chronic antiarrhythmic treatment once sinus rhythm is restored


The effectiveness of VKAs is monitored by INR, their antidotes are vitamin K dependent factors (II, VII, IX and X) as well as vitamin K

The effectiveness of new oral anticoagulants is monitored by INR

Monitoring is clinical. There are no specific antidotes.

The most recommended VKA for prescription is fluindione

Fluidione is no longer recommended as an initial prescription. Coumadin/warfarin is the most recommended molecule.

In valvular AF, only VKAs are recommended with a target INR of 2.5 (between 2 and 3), unless mitral mechanical valve or disc valve (in this case target INR 3–4.5)


In nonvalvular AF, VKAs or other oral anticoagulants are mandatory for preventive purposes.

The CHADS-VASc score is useless in case of mitral narrowing (AVK from the outset)

Oral aspirin dose ranging from 75 to 325 mg / day (most often 75 mg / d) is a questionable alternative in case of low risk

In coronary patients, only amiodarone and sotalol can be used

Similarly, newer oral anticoagulants should be used with caution and at reduced doses after age 80.

Precautions or contraindications are frequent for these new molecules in case of renal failure


Which of the following proposals for atrial fibrillation (AF) is true?

Cardiac auscultation finds irregular heart sounds and an ever more or less slow pace

AF is tachycardia, the heartbeat is fast. It should be noted that there are, however, "slow AF" (case of an AF with high-degree BAV for example) but do not constitute the classic framework of an AF.

It is responsible for one-sixth of all strokes by cerebral embolism.

The diagnosis of AF is clinical and can only be confirmed by stethoscope auscultation.

The diagnosis of AF can only be confirmed on an ECG trace documenting it.

The embolic risk is very low not justifying long-term anticoagulants

The embolic risk is estimated by the CHAD2S-VASc score. A score >1 requires the implementation of anticoagulation

Cardioversion or AF reduction are medical actions that restore sinus rhythm


Which of the following are included in the management of rapid non-valvular AF in case of CHADS-VASc score greater than 1?

Direct oral anticoagulant (DOAC) anticoagulation

VKA in valvular AF (regardless of CHADS-VASc)


Double anti-platelet aggregation by clopidogrel and Aspirin

Anticoagulation with anti-vitamin K (VKA), fluindione (Previscan) as a first-line

Antihypertensive treatment if hypertension duly diagnosed


Which of the following are included in the calculation of the CHADS2-VASc score?


Which of the following are procedures to be performed before an external electric shock (ECC) before 3 weeks of effective anticoagulation?


Which of the following are possible complications of atrial fibrillation?


Loop diuretics work by inhibiting sodium reabsorption in the ascending branch of the loop of Henle

Hydroxychlorothiazide inhibits sodium excretion through the distal tube

It is a thiazide diuretic. It therefore inhibits sodium reabsorption on the proximal part of the distal tube

Cortical collecting tube diuretics oppose Na/K exchange

All sodium-carrying cells have NaK-ATPase-dependent pumps on their basolateral membrane


It is a diuretic of the cortical collecting tube

Like hydrochlorothiazide and chlortalidone, it is a thiazide diuretic. Proximal diuretics are mannitol and acetazolamide

In the physiological state, most of the filtered Na is reabsorbed at the proximal bypassed tube and the loop of Henlé

Loop diuretics directly inhibit the reabsorption of Na, K, and Cl


Which of the following are possible side effects of thiazide diuretics?

Like loop diuretics, they are hypokalaemic (but much less)


Which of the following propositions regarding thiazide diuretics are true?

This is the case of anti-aldosterone (aldactone, spironolactone)

They allow sodium excretion of 20 to 25% of the amount of filtered Na

They are contraindicated in severe renal impairment


Concerning general information about disability

Very few people will face disability in their lifetime (<10%)

Disability is part of the human condition – virtually everyone, at some point in life, will have a temporary or permanent impairment and those who reach old age will experience increasing functional difficulties

Disability is complex and interventions to overcome disadvantages are multiple and general, varying with the context

The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term for impairments, activity limitations and participation restrictions.

The ICF gives a definition of disability based on positive characteristics (which is)

it refers to the negative aspects of the interaction between an individual with a health problem and personal and environmental factors (such as negative attitudes, inaccessibility of transport and public buildings, and limited social supports)

Disability being multifactorial and dependent on the countries where the populations studied are located, this synthesis has two parts: the first is quite general and deals with disability in the world, the second is more precise and focuses on the French population (adults and children)"


Regarding population health measurement tools:

In countries with life expectancy over 70 years, each individual will spend an average of 8 years or 11.5% of their life living with a disability.

YLDs are the average number of years lived with disability (disease-weighted) under current mortality and health conditions.

Disability-free life expectancy is defined as the average number of years lived without disability

Life expectancy depends very little on the region where one lives

These studies have also shown a wide variety of results between the Member States of the European Union.

The DALY is a measure increasingly used in public health, particularly for the evaluation of health care systems


On general information on disability in France

The DALY is a measure that does not take into account the functional impact of diseases

This measure has the merit of taking into account mortality and the functional impact of diseases

The origin of the main pathologies causing disability depends on the environment and health policies of the countries

In developed countries, disability is most often born

In developed countries, it is pathologies due to aging, and in particular cardio-neuro-vascular pathologies that are most often at the origin of a situation of disability (Table 7

Disability is usually the direct consequence of illnesses

Finally, more than the diseases themselves, personal and environmental factors are often at the origin of disability situations.

The HID survey estimates that around 3 million people are affected by disability in France

The HID survey estimates that around 23 million people are affected by disability in France"


Regarding the epidemiology of disability in France:

The most common cause of impairment is old age

The most common causes of impairments are illness (about a quarter of the disabled population suffers from an impairment due to illness), socio-family problems (13%) and old age (11%)

Impairments due to disease increase steadily with age

The accidental origin of the disability of young people is the most frequent

In general, the impairments that most affect the population are motor and intellectual impairments.

Overall, women are less affected than men

Overall, women are more affected than men."


Regarding impairment and disability in France:

Motor impairments in children or adolescents are rare (1% and 3%, respectively)

In general, it can be seen that young people tend to suffer from multiple impairments, and older subjects from monodeficiency

It is young people who tend to suffer from monodeficiency, and older subjects from multiple disabilities

Impairments can lead to activity limitations

This is part of the definition of impairment

The inability to hear is the one most often reported among the French population

The inability to carry out activities related to effort (such as those related to distant travel) is the one most often reported among the French population

2.11% of the population has difficulty washing


Regarding the impact of disability on personal life, in France:

Difficulties in participating in social life have little impact on the quality of life of people with disabilities

This has a direct impact on the quality of life of people with disabilities.

25% of people reporting at least one disability almost never or never go on vacation

Disability has no impact on professional integration

With regard to the professional integration of people under 60, here too, those who declare a disability have a significantly lower employment rate compared to the rest of the population.

In 2009, there were 322,300 workers with disabilities working in the regular workplace.

Jobseekers with recognition as disabled workers represent 6% of all jobseekers


The unemployment rate for persons with administrative recognition of disability is 22%, more than double that for all persons aged 15 to 64.

Disability-related social protection benefits account for about 26.6% of all social benefits

F Medico-economic data Disability-related social protection benefits accounted for 6.6 per cent of total social benefits in 2007

Private insurance pays the majority of disability-related benefits

Social security schemes paid the majority of disability-related benefits (fig.

In the general population, congenital malformations affect 12 to 13% of live births

In the general population, congenital malformations affect 2 to 3% of live births. a minority of these children (about 20%) will have severe impairment (less than 1% of all births)

The prevalence rate of severe disability in the eighth year of life is estimated to be between 6.2 and 6.6 per 1000 children


The ventricular T wave is a repolarization wave

A normal T-wave has the same polarity as the QRS

When a wave leaks the collecting electrode, it is positive

Electrodes from V1 to V9 explore the transverse plane