For biopsies of primary and secondary bone cancers, what are the exact answer(s) among the following?

Bone biopsy is an essential act for the characterization and diagnosis of primary bone tumor

True, as with almost any cancer! The biopsy is the heart of diagnosing the type of cancer (primary, secondary) and its grade

In case of suspicion of primary bone cancer, a Multidisciplinary Consultation Meeting must take place, but the latter must be approved of its specialty in primary bone tumors

True, completely convoluted sentence, to say that, since these are rare tumors, CPR must be done in a reference center in the field

Biopsy samples will be frozen and copies will be stored in the tumour database

True, as these are rare tumors, they must be frozen to be references and benefit from additional analyzes

Biopsy alone can diagnose the severity grade of primary bone cancer

True, the gradification of cancer severity is based on cyto and histological elements, so the biopsy alone makes the grade

High-grade osteosarcoma is more deadly than high-grade chondrosarcoma

False, both almost always fatal at 5 years, distractor because it was necessary one


Which of the following are primary bone tumours?

True, to retain malignant tumors benign tumors for bone tumors there is a small and very simple way, namely, all tumors that end in sarcoma or that include sarcomas are malignant tumors (bone sarcoma, leiomyosarcoma, osteosarcoma, Ewing's sarcoma, chondrosarcoma). Everything else is benign

False, small trap this tumor does not exist


Regarding biopsy in the context of lung cancer diagnosis, what are the exact answer(s)?

The biopsy is done under general anesthesia

False, it can totally be considered under local anesthesia

The biopsy is done with a rigid bronchoscope

False, a flexible bronchoscope is indicated to allow better passage through the bronchi

The performance of the biopsy is improved by the realization of a cytological brushing and / or a directed lavage for cytological aspiration

True, it allows for additional cytological analysis and that's just a bonus.

In some cases, cytological analyses of sputum may point to the type of tumor

False, there is no indication and no interest in performing it

Transparietal needle puncture-biopsy is at risk of pneumothorax

True, logically, the pleura is on the way


You are a general practitioner, and you receive Mr PARKER, Peter, 76 years old, for his prescription renewal.
This former repairman on the shipyard, smoking like a firefighter, with a smoking rated at 180PA is at risk of lung cancer. You regularly screen for lung cancer, monitoring its respiratory signs and doing repeated imaging tests, but your external who attends your consultation tells you that you must also watch for paraneoplastic syndromes in this case too...
What paraneoplastic syndromes can be found in lung cancer?

False, this febrile neutrophilic dermatosis is found mainly in hemopathies, and in no case in lung cancers.

Syndrome of inappropriate secretion of anti-diuretic hormone

True, or ex-Schwartz Barttner syndrome, it is characterized by deep hyponatremia

True, or Pierre-Marie syndrome, it will be characterized by a digital hippocratism and pain of the joints of the limbs, with imaging an engainant periodosis.

True, it mimics in every way a myasthenia gravis except that we will not have the antibodies!

False, this hepatomegaly with anicteric cholestasis is found in kidney cancer


You receive in consultation Mr HARKNESS, Jack, 67 years old, completely panicked! Indeed he tells you that his "PSA is much too high" and he thinks he has prostate cancer. You try to reassure him by explaining the possible causes of PSA elevation... What are they?

True, the prostate is bigger, so it produces more PSA! 1ng/mL per cm3 of prostate (volume assessed on MRI)

True, testosterone stimulates prostate cells and therefore the production of PSA

True, prostate irritation transiently increases PSA levels

True, unknown cause, absent from several referentials, but that we must know. Simply because ejaculation stimulates the prostate for protein secretion and therefore stimulates the production of pSA


Regarding the prognostic classification of prostate cancer and the appropriate therapeutic options, validate the corresponding couples.

True, for low risks the possibilities are active surveillance, brachytherapy, radiotherapy, prostatectomy

False, for high risk the only possibility is radiotherapy and hormone therapy for 3 years, or total prostatecomia + lymph node dissection as part of a multimodal treatment

Moderate risk - Radiation therapy and hormone therapy for 3 years

False, for moderate risk the possibilities are prostatectomy and radiotherapy with hormone therapy for 6 months

False, treatment of resistant or metastatic forms


What are the hereditary forms of kidney cancer?

True, one of the two hereditary forms to remember for the ECN, sorry to make a MCQ on it, but it is a small detail to have in mind for a fifteenth question

False, this pathology is at risk of digestive cancer

False, does not exist, but remotely resembles Fitz-Hugh-Curtis syndrome, which corresponds to perihepatic violin strings in advanced C. Trachomatis infections.


What are the risk factors for adenocarcinoma of the esophagus?


True, risk factor for all types of esophageal cancer


What are the possible markers of neuroendocrine tumors?


Adenocarcinomas are classically TTF1 positive

Adenocarcinomas are classically p40 negative

TTF1 stands for: Thyroid Transcription Factor-1

It is relatively specific to squamous cell carcinomas


What is the overall 5-year survival in percentage for all tumours?


True, there are two lobes (upper and lower, distinguishable with the sign of the cardiac silhouette) separated by a "large" split

There are three splits: one large, one medium and one small


Oxaliplatin is used in colorectal cancer

Especially oxaliplatin which gives neuropathies in the cold


What is the leading cause of facial paralysis?


The severity of acute hepatitis is based on the value of transaminases

False: The assessment of the severity of acute hepatitis (HA) is based on clinico-biological signs reflecting a functional impact: the value of TP and/or factor V (hemostasis disorders) and the presence of signs of hepatic encephalopathy (severe prognosis).

A PT < 50% requires hospitalization of the patient in a specialized center close to a liver transplant center

True: acute hepatitis with < PD  50% corresponds to severe HA and requires hospitalization in a specialized center.

The definition of fulminant hepatitis is based on the association of a PD < 50% and the installation of hepatic encephalopathy

True. HA fulminant = TP < 50% associated with signs of hepatic encephalopathies of recent onset < 2 weeks.

Sub-fulminant hepatitis develops within less than 2 weeks

False. HA fulminant = installation < 2 weeks. Sub-fulminant HA = installation 2 weeks-3 months.

All acute hepatitis occurring on a cirrhotic liver is acute alcoholic hepatitis.

False. Acute alcoholic hepatitis is a diagnosis to look for but all causes of acute hepatitis can occur in a cirrhotic patient!


What are the true propositions concerning hypertransaminasemia?

There are extrahepatic causes responsible for elevated BP

True. These are the differential diagnoses to keep in mind: celiac disease, myopathies, hemolysis, heart damage, violent efforts.

The two main causes of BP < 10N (low to moderate) are drug-induced and viral hepatitis.

False. The two main causes of BP < 10N: alcohol and metabolic syndrome.

Hepatic ultrasound is part of the etiological assessment in front of acute hepatitis with BP > 10N.

True. 4 causes to look for acute hepatitis with BP > 10N: viral (=serologies+++), drug/toxic (paracetamol+++), lithiasis (echo+++) and hepatic hypoxia (Budd Chiari, Heart failure, shock...)

Acute hepatitis with a fever > 38.5 should be investigated for acute herpes hepatitis.

The majority of viral algae hepatitis is clinically characterized by Caroli's triad: headache, arthralgia, urticaria.

False. The majority of acute viral hepatitis is ASYMPTOMATIC.


Which germs are gram-positive cocci in chains?

True, all streptococci are chained at ECN


You have in hospital, Mr. Langdon, Robert, 55 years old, who presents for a gout attack occurring on his right knee. Which of the short-, medium- and long-term treatment options will you remember?

True, all non-drug measures are to be preferred because we can always take advantage of them

Colchicine started on the second or third day of hospitalization at a maximum dose of 3mg, to take advantage of the decrease in infection

False, colchicine is to start as early as possible, because it is all the more effective

In case of macrolide treatment for digestive infection, there is a contraindication to NSAIDs

False, a contraindication to colchicine, due to the interaction with cytochromes

The therapeutic target of hypouricemic treatment is 360micromoles per liter

True, which corresponds to the crystallization threshold of sodium urate

The patient will have to curb his consumption of alcohol, fast sugar and offal


What is the chemotherapy of choice for lung tumors?

No, especially since it has pulmonary toxicity type of pulmonary fibrosis


Regarding imaging in the diagnostic assessment:

ATTENTION: the question concerns the DIAGNOSTIC assessment (and no extension)...

To speak of a systematized abnormality, the lesion must be extended to an entire lobe or lung segment

Mediastinal lymphadenopathy can easily be confused with blood vessels

In the extension assessment, we do a TEP. But not in the diagnosis


Which of these proposals designates the most common histological type of malignant renal tumor?


Mr. Williams, Rory, 45 years old, overweight, with a BMI of 27 comes to see you for consultation because "Enough is enough, I want to eat better!". He asks you what he should actually do as a meal and what portion of each food he should put on his plate. What do you say to him?

All-you-can-eat water during and between meals

False, starchy foods are "solid", this is what allows you to stall during meals, so it is to be private for lunch and dinner

True, public health message that everyone knows ;)

Focus on vegetable fats and saturated fatty acids

False, small trap here to insist that it is INsaturated fatty acids that are to be preferred (vegetable fats) rather than saturated fatty acids (cold cuts etc ...)

False, recommendation that has been revised downwards, due to a highlighting of dairy lobby, currently it is 2 per day that is recommended for adults


Regarding dietary modifications recommended in common clinical situations, what are the following exact pathologie/dietary recommendations?

Hypertriglyceridemia and Decreased consumption of simple carbohydrates and alcohol

True, we sometimes make a false amalgam between triglycerides = eat fat, but it is especially sugar and alcohol that causes a peak of hypertriglyceridemia

Osteoporosis and increased vitamin calcium intake

True, in a very logical way, a vitaminocalcium intake improves bone remodeling

Gastroesophageal reflux disease and limitation of alcohol, chocolate and coffee consumption

True, quite logical there too, these are hot drinks that can irritate the esophageal mucosa and promote reflux

Irritable bowel syndrome and diet with FODMAP exclusion

False, quite important point, because if the FODMAPs-free diet has been quite popularized lately it is a very very restrictive diet (with exclusion of many foods) which is very restrictive and which should only be considered in case of drug failure and failure of other dietary care.

Diverticular disease and residue-free diet

False, it is that in the case of acute diverticulitis that a diet without residues is prescribed.


Freshly appointed intern in geriatrics in the department of SSR Geriatric of your municipality, you receive in your department Mr Dicarpaccio, Leonardo, 89 years old, hospitalized for 1 week in acute geriatrics for fall with prolonged ground station, complicated bedsores. You look at the file with your senior and you notice that he has not eaten for 1 week. Your boss then tells you at 5pm to prescribe nutritional supplementation while paying attention to inappropriate renutrition syndrome. Thoughtful, you plunge back into the characteristics of this syndrome. What are the clinical and biological signs and what prevention should be applied in case of risk of this syndrome?

The syndrome can manifest as edema of the lower limbs

True, edema of the lower extremities is a clinical sign of severe undernutrition, but also a sign of inappropriate renutrition. In short, watch the legs of your at-risk patients!

Biologically, the syndrome is manifested by hypophosphoremia, hypomagnesemia, hypokalemia

True, the cause of inappropriate renutrition syndrome is an acute consumption of electrolyte reserves provided by the diet, namely phosphorus, magnesium, potassium.

In case you decide to implement parenteral nutrition, you should adapt the flow of the nasogastric tube starting at a low flow rate.

False, small trap (because I have often been fooled...) everything is true except that it is ENTERAL nutrition

Routine phosphorus supplementation of at-risk patients is sufficient to correct phosphorus deficiencies and dispenses with follow-up biological assessment

False, preventive supplementation is not like its name... that preventive and does not dispense with biological monitoring every two days of phosphorus

Regular weight gain in the first days of renutrition is reassuring

False, rapid weight gain will most often testify to edema of renutrition raising fears of an inappropriate renutrition syndrome.


Which of the following pathologies are causes of weight loss with hyperphagia?

True, it is even part of the diagnostic criteria for type 1 diabetes. Weight loss with polyphagia

False, there is most often a deficiency of intake related to swallowing disorders

False, there is most often a normal diet, but with deficiencies.

True, Épinal's image of hyperthyroidism shows a skinny woman eating a lot but losing weight!

True, since it is the worm that eats everything in the patient's place, the patient is naturally hungry!


1 gram of carbohydrate corresponds to how many kcal?

True, 1g Carbohydrate and protein = 4 Kcal


1 gram of fat corresponds to how many kcal?


You receive in the emergency room, Zenigata, Koichi, 45 years old, a man brought by the PASS, who explains to you that it is a homeless man who spends most of his nights outside. On clinical examination, you notice a perifollicular petechial purpura, as well as many oral hemorrhages with thickening of the gums leading to dental loosening. What pathology do you suspect?

False, Osler's endocarditis would be evoked before a fever with conjunctival purpura.

False, it is manifested by ligament and cutaneous hyperlaxity with healing disorders

True, here the context of homelessness is favoring vitamin C deficiency. The clinical description shows facilitated bleeding with hyperinfiltration of the gum mimicking a hematological disease with loosening of the teeth.

False, it is manifested by a hematoma in glasses


You receive in general medical consultation, Mrs. Kyle, Selena, 37 years old, who comes to see you for a table of various gastroenterological symptoms (abdominal pain, bloating, diarrhea), which you attach to a possible irritable bowel syndrome. The very concerned patient asks you if she should have a colonoscopy. To answer his request you explain the different indications of colonoscopy in the context of irritable bowel syndrome.

History of colorectal cancer in the father

True, it is quite logical, generally faced with a history of colorectal cancer, we are not cautious, patients usually have an endoscopic examination to eliminate adenomas, polyps and cancers.

True, because we join the, the limit of standard screening. Overall, a complete colonoscopy is done to reassure that the symptoms are of functional origin

Alternating diarrhea constipation at the level of the clinical picture

False, symptom intensity (except recent modification) does not count in the decision criteria for colonoscopy

True, very logically, irritable bowel syndrome does not give rectal bleeding


It corresponds to a renal failure of functioning origin that does not correct itself despite maximum management

It appears at an early stage of cirrhosis

It is most often observed in cases of severe liver failure with significant ascites and a prothrombin level still above 50%

The long-term treatment is terlipressin and adrenaline

These are treatments whose beneficial effect is only temporary. The only long-lasting treatment is liver transplantation

It may be responsible for hepatic encephalopathy


What are the triggers of hepatic encephalopathy?


Presence of a spontaneous portosystemic shunt

Not a triggering factor in itself (but bacterial infection is one), so it's not a direct link (so not to check)

Not a triggering factor in itself (but digestive bleeding is one), so it's not a direct link (so not to check)


You take care of a patient who complains of a "bloated belly".

On clinical examination you find: 130/90 mmHg, 75 bpm, apyretic, 99% in ambient air, G15.

NEUROLOGY: the patient is calm, conscious and oriented. You do not find abnormalities in the cranial pairs or other focal neurological deficits. ROTs are normal. No asterixis found, no tremors of the extremities.

CARDIOVASCULAR: Heart sounds are regular without breaths, no signs of left or right heart failure. Peripheral pulses are perceived, no abdominal beating mass.

ABSTATIC: the abdomen is tense, depressible and painless. BHAs are correctly perceived. You find a hepatomegaly of hard consistency. No perceived splenomegaly. Presence of abdominal collateral circulation. Presence of dullness declive on percussion. Hernial orifices are free.

MUCOSAL CUTANEOS: stellar angiomas, white nails, palmar erythrosis.

What are the exact proposals?

You suspect hepatocellular insufficiency

True, in front of stellar angiomas, white nails, palmar erythrosis

True, in front of the tense abdomen and declivated dullness (= ascites) and collateral venous circulation

You suspect thrombosis of the inferior vena cava


Conjugated bilirubin jaundice is always due to biliary stasis

Many other causes of increased conjugated bilirubin exist. For example, large hemolysis leads to functional cholestasis

Conjugated bilirubin jaundice causes dark urine

Free bilirubin jaundice is conventionally accompanied by clear urine

Free bilirubin jaundice does not conventionally cause pruritus

free bilirubin is eliminated in the urine

It is transformed by hepatocytes, which eliminate it in the bile


A 70% post-bronchodilator FEV1 classifies COPD as stage:


A 10% post-bronchodilator FEV1 classifies COPD as stage:


A 90% post-bronchodilator FEV1 classifies COPD as stage:


A 55% post-bronchodilator FEV1 classifies COPD as stage:


How many possible stages are there in the COPD GOLD classification based on post-bronchodilator FEV1?


What are the risk groups for C virus infection?

Subjects who received blood or blood derivatives before 1992

Subjects originating from a hyperendemic area


Adrenal tumors may be a differential diagnosis

The diagnosis of splenomegaly is mostly ultrasound

Hypersplenism can cause thrombocytopenia

Viral hepatitis be a cause of splenomegaly

A splenic infarction can be revealed by left basithoracic pain associated with hyperthermia


What are the secondary causes of carpal tunnel syndrome?

It is a primitive cause (and not secondary, so does not answer the question) 😊


What parasitosis is associated with eosinophilia?

True, the purpose of this hyper catalog MCQ is twofold: knowing which parasitosis give eosinophilia is hard and complex, better to remember those that do not: Malaria, Giardiosis, Amoebiasis. In addition, it also makes it possible to remember which parasite is associated with which disease.

False, amoebiasis does not give hypereosinophilia.

True, cf A. echinococcosis gives eosinophilia

False, giardiasis gives fatty diarrhea after returning from travel


Cervical lymphadenopathy drains the following territories:


Supraclavicular lymphadenopathy drains the following territories:


Axillary lymphadenopathy drains the following territories:


Inguinal lymphadenopathy drains the following territories:


You have in geriatric hospitalization, Mrs. Everdeen, Katniss, 85 years old, hospitalized for a "difficult home support". During your careful clinical examination you will highlight multiple venous lower limb ulcers. The nurse of the service then asks you "what to do", what do you decide to do as local treatments?

For ulcer cleansing, you prefer the use of hydrogen peroxide after careful antisepsis

False, the "washing" of ulcers is done with simple water, antisepsis is a mistake because it will promote more than prevent infections, by modifying the skin flora. It has an indication only in case of bacterial dermohypodermatitis

To promote skin budding, you use vaseline tulle with lanolin or Peruvian balm

False, then we use vaseline tulles or "greasy dressings" to bring material to the skin to rebuild, but we must avoid in all cases the use of allergens such as lanolin, Peruvian balsam, fragrances, which can lead to contact dermatitis

Hydrocolloid or hydrocellular is a type of dressing that brings "fat" to the wound, promoting budding

False, as seen above, it is the vaseline tulles that have this role. Hydrocolloids are moist dressings with optimal pH that promote budding, through controlled maceration.

Silver dressings are not systematic in the management of ulcers

True, to use only in inflammatory ulcers at risk of becoming infectious

In the case of this patient, in the absence of PAD with IPS <0.7 venous compression will be systematic


Regarding ulcers, what are the main complications of the latter?

True, this is the main complication to look for, it is a wound that can be the gateway to an erysipelas

True, poorly known, but it is a diffusion of inflammation at the level of the underlying periosteum

True, just like protein malnutrition it is a complication to think about in front of any wound, especially in the elderly and dependent

Hemorrhage mainly in the context of an arterial ulcer

False, hemorrhage is mainly observed in front of venous ulcers and not in front of arterial ulcers

Squamous cell carcinoma in front of a chronic ulcer

True, existing chronic complication in front of a resistant chronic ulcer


Which of the following are NOT indicators of secondary Raynaud's phenomenon?

The factors that are in favor of a secondary Raynaud and to know are: male sex, age of onset > 40 years, unilateral involvement, involvement of the thumb, absence of pulse, abnormal Allen, trophic disorders, absence of summer remission, photosensitivity and presence of mega-capillaries to capillaroscopy. As a P1 DOUBLE WOULD SAY: BY PRIMING HEART!


Where is IGF1 mainly synthesized? (> 50% of production)

True. IGF-1 production is virtually ubiquitous, but the main producing tissue is the liver (more than 50% of plasma concentrations)


What are the complications of acromegaly to look for?


What proposals are true about the by-pass?

Vitamin supplementation lasts 6 to 12 months, while the rest of the intestine adapts

It causes malabsorption in 2 out of 10 cases

Always a malabsorption (that's the goal, somewhere)


You check this noon the biological assessment of several of your patients, including that of Mr Ren, Kylo, 65 years old, known by the service for his chronic renal failure at 19mL / min. You then explain to your outpatient that kidney failure is often chronic, when we have arguments for its chronicity such as small kidneys, hypocalcemia and anemia. But the latter tells you that each time in MCQ he is asked for exceptions and that he can never remember them... Can you help?

Chronic renal failure on Sarcoidosis with hypercalcaemia

True, chronic pathologies leading to excess calcium, classically myeloma and sarcoidosis lead to chronic renal failure with hypercalcemia

Chronic renal failure on myeloma with polycythemia

False, there is no polycythemia in myeloma but anemia

Chronic renal failure with increased size of kidneys or kidneys of normal size, on diabetes

True, just like hydronephrosis, autosomal dominant polycystic kidney disease, amyloidosis or HIV-related nephropathy, diabetes does not cause a decrease in kidney size.

Chronic renal failure with increased size of the kidneys or kidneys of normal size, on chronic vesicoureteral reflux

False, it does not cause an increase in kidney size

Acute renal failure with hypocalcaemia on tumor lysis syndrome

True, but generally the context with the history of serum creatinine makes that we will be less wrong ;)


What is the biological sign(s) of functional acute renal failure?

Decrease in plasma urea in favor of plasma serum creatinine

False, in the context of functional acute renal failure, one literally has a drying of the body. As a result, we "no longer urinate" because we have "not enough water". Thus the concentrations of urea and serum creatinine will increase because we have more water.

>10 urinary urea concentration compared to plasma urea

True, simply because the urine that continues to be manufactured, no longer has all the components. In the urine, we have creatinine, urea, sodium and water to dilute all this among others. If we have more water in the urine, it is because the little we have left, we leave it in the blood to avoid complete dehydration. So more water in the urine, we have a concentration of urea in the urine very intense, more intense than in the blood (or there is still a little water)

<30 concentration of creatinineuria versus serum creatinine

True, you know as well as me, that extracellular hydration is governed by salt, so if we dehydrate, in fact we lose a lot of salt, which carries water with it. Therefore, we will avoid pissing the salt, to reabsorb the water! CQFD!

True, to reabsorb salt, the hormone that makes it possible to do this, is aldosterone!


You are an emergency intern in the emergency department of Ouessant (we can dream a little), and you receive Mr. Jones, Indiana, 39 years old, who back from Peru, did not hydrate well on the plane and has a picture of renal colic with a fever at 39 ° C.  You are looking to do an imaging and you have all the latest devices at home! What do you do?

Couple Abdomen without preparation and Renal ultrasound

False, because here we are in the context of a complicated renal colic (febrile) and in this case there is only one examination to do, cf. C.

False, uro CT is never done in the context of renal colic

True, this is the reference examination in front of complicated renal colic

If you receive his partner Marion Ravenwood, pregnant with 8SA, for the same symptoms, you would only have one imaging choice.

True, namely ultrasound! The rest is irradiating and therefore toxic to the fetus


Regarding the urological treatments of stones what are the exact proposal(s)?

Extracorporeal lithotripsy is contraindicated in case of aortic or renal arterial aneurysm

True, these are wave pulses, so imagine in case of anticoagulant treatment, fetus or arterial aneurysm, the destructive potential that it can have...

Ureteroscopy is the treatment of choice in a patient on antiaggregant or anticoagulant

True, because it is the only one that theoretically does not cause tissue damage

In case of obstructive pyelonephritis, urological treatment takes precedence over antibiotic treatment

Wrong, we are not going to operate in infected urine!

Extracorporeal lithotripsy is not very effective in obese patients

True, because shock waves have a harder time passing

Percutaneous nephrolithotomy is the most common treatment performed today.

False, it is clearly a second-line treatment


DHA (vasopressin) is produced by the hypothalamus

DHA (vasopressin) is produced by the pituitary gland

DHA (vasopressin) is released from the anterior pituitary gland

Diabetes insipidus is central if there is a defect in DHA production


You are in the emergency room and you receive Mr. XU Shang-Chi, 23 years old, for an attempt at drug autolysis with benzodiazepines. While he "slept" well until now he wakes up restless and sweaty and asks you for "something to calm him". In this context, you tell yourself that using a placebo is not a bad idea... But the nurse who is with you, fears a nocebo effect. You scratch your head and try to remember your pharmacology classes on the subject...

If you give the patient PARACETAMOL instead of a benzodiazepine, you are giving an impure placebo.

True, an impure placebo is a placebo that is composed of another active substance.

The placebo effect will have to be re-evaluated over time because it is short and runs out over time.

True, it is very logical because it is related to taking the treatment

Factors that condition the placebo effect include the name of the treatment

False, it includes color, shape, taste but not name

Chest pain, paresthesias and dysgeusia are the most common nocebos effects

False, nasty trap, but if you have understood that it is the administration of the treatment that makes the placebo you will have to logically deduce that the nocebos effects, also related to the taking of the treatment are mainly diarrhea, but also headache and drowsiness.

The nocebos effects are due to the composition of the placebo

False, it is related to the administration of the treatment


What are the different forms of rosacea?


False, topical corticosteroids are contraindicated in rosacea because they aggravate it!!

True, for more diffuse forms and especially ocular


What localizations are classically affected in seborrheic dermatitis?


How many cataract operations per year in France?


What type of cataract can occur as leukocoria?

True, leukocoria is the fact of having the white pupil, and it must worry, especially in the new nose in which it must suspect rare eye tumors


What is the form of cataract that is accompanied by index myopia?

True, involvement of the crystalline nucleus, predominance of a decrease in visual acuity (BAV) by far so index myopia

Saucer opacification in front of the posterior capsule, identical discomfort from far and near. Thinking about the metabolic and iatrogenic origin


Among the following proposals concerning the assessment to be carried out pre-operative of a cataract, which are true?

Mode A ultrasound eliminates retinal detachment

It is the ultrasound in mode B that allows this. See this ultrasound image in mode B: https://www.realites-ophtalmologiques.com/wp-content/uploads/sites/4/2017/02/article-du-27_02-702x336.jpg

Optical biometry is done by ultrasound in mode A

Ultrasound mode A = axial ultrasound biometrics. Used to calculate the size of the implant.
The most recent technique of ophthalmic biometry is axial ultrasound biometrics. Ultra-difficult question but the college makes the difference.

OCT is only useful for retinal conditions

Keratometry measures the refractive power of the cornea

The normal refractive power of the lens is about 20 diopters


Which of the following propositions concerning the mechanisms involved in hypoxemia are true?

The shunt effect is the most common mechanism of hypoxemia.

Obesite-hypoventilation syndrome may be a cause of alveolar hypoventilation

The higher you go, the lower the O2 inspired pressure would be.

A shunt effect corresponds to the presence of well-infused but poorly ventilated lung areas.

A cause of alveolo-capillary diffusion disorder is pulmonary fibrosis

True: diffusion depends on the thickness of the different tissues separating the alveolar air from the capillary blood, and fibrosis increases this thickness


Which of the following propositions regarding post-traumatic rhabdomyolysis are true?

It is linked to the destruction of a large number of myocytes and the release of elements of these myocytes into the circulation.

True! Post-traumatic rhabdomyolysis is, as its name suggests, linked to the destruction of a large number of myocytes in the direct consequences of trauma to the limbs or its complications (compartment syndrome in particular)

The hydroelectric disturbances observed are hyperkalemia, hyperphosphoremia, hypocalcemia

True! Rhabdomyolysis is the bursting of muscle cells. So all the content passes into the blood and we can measure this content via a blood test:
- Increased K+ and phosphorus
- Decrease of Ca++ by transfer from the vascular medium to the muscular environment
- Increased muscle enzymes: CPK, LDH, myoglobin, AST +++, ALT +/-

Acute renal failure complicates about 50% of cases and determines the vital and functional prognosis

Acute renal failure due to post-traumatic rhabdomyolysis is responsible for a sodium ejection fraction < 1% (functional)

True! There are different causes of rhabdomyolysis. Generally we oppose:
- Post-traumatic rhabdomyolysis: Which is mainly related to the destruction of myocytes but also favored by HYPOVOLEMIA !! This explains why the observed ARI GENERALLY has a FeNa+ < 1% (functional)! It is the elderly subject who fell and did not manage to get up for 12 hours: he crushed his myocytes on the ground and did not drink. - Infectious/toxic rhabdomyolysis/by electrification/by taking lipid-lowering agents... etc.: Is related to the destruction of myocytes but here the volume is normal. The observed IRA will therefore have a FeNa + > 1% (organic)

The treatment is based primarily on crystalloid filling

True! Treatment is symptomatic above all (filling, hydroelectric rebalancing, extra-renal purification if indicated). SOURCE: College of Anesthesia Resuscitation 2020 Edition page 346


What clinical signs are found in spondylodiscitis?

False, inflammatory rachialgia, tenacious, without triggering factor and poorly calmed by rest (the suffix "-ite" means inflammation)

False, no effusion in spondylodiscitis, rather in peripheral septic arthritis

True, these are complications of inflammatory spinal pain


What is the reference imaging test in the diagnosis of spondylodiscitis?

False, radio-signs shifted by 3-4 weeks, they are often normal at diagnosis

False, indicated only to guide a puncture-biopsy or if contraindication of MRI

False, lower specificity than MRI. Used if contraindicated to MRI


Syringomyelic syndrome reflects the involvement of spinothalamic fibers that decuss at the level of each metamer

True, they are more sensitive to compression by fluid inside the spinal cord

The initial sensory deficit relates to proprioception

On thermo-algic sensitivity (first involvement of spinothalamic / extra-lemniscale fibers)

Arnold-Chiari malformation is the main cause of synringomyelia

The topography of the lesion syndrome is said to be "cape"

True, cause of upper limb deficit without lower limb deficit (excluding sublesional syndrome)


Which of the following propositions about Willebrand disease are true?

There may be a decrease in factor VIII in Willebrand disease

True because von Willebrand factor transports and stabilizes factor VIII

Willebrand disease is defined by a von Willebrand factor level < 50%

False, by a von Willebrand factor rate < 30%

Willebrand disease is a pathology of coagulation

False, it is a pathology of primary hemostasis

Von Willebrand factor allows platelets to adhere to each other and to collagen under endothelial


Which of the following propositions about hemophilia are true?

The hemostasis assessment finds a prolongation of the TCA and a decrease of the TP

False, only an isolated prolongation of the TCA because only the endogenous pathway is affected

Hemophilia is the most common inherited bleeding disorder

Drugs depressing hemostasis are contraindicated in hemophiliacs

Arthropathy can be a complication of hemophilia

True, it is a hemophilic arthropathy secondary to the aggression of cartilage by blood waste and their degradation


Regarding hypovitaminosis K, what are the true propositions?

Factor V is a vitamin K-dependent factor

False, vitamin K-independent; it is the X, IX, VII, and II (we can retain the year 1972) which are vitamin-K dependent

The majority of vitamin K intake is endogenous via the intestinal flora

False, the majority of vitamin K intake is exogenous via diet (70% intake)

One of the differential diagnoses is hepatocellular insufficiency

True, the 2 diagnoses are differentiated by the determination of factor V, vitamin K-independent

The TCA is lengthened and the PT is decreased at hemostasis

C- and S-clotting proteins are vitamin K-independent


Regarding the assessment to be carried out in case of fever during drug agranulocytosis, what are the true proposals?

It may include stool farming depending on the orientation


You are an intern and your intern has asked you to present a slideshow on the topic of myeloma. By having you recite it asks you what are the clinical forms of myeloma besides symptomatic multiple myeloma. You hesitate, and mentally try to summarize each clinical form in one sentence. Which of the following are the exact proposals?

Indolent multiple myeloma has no clinical involvement and only biological abnormalities

True, as its name suggests, indolent myeloma has no active clinical form, however it has a poor prognosis because it is at risk of progression to multiple myeloma

A solitary plasmacytoma will be associated with a negative myelogram

True, a plasmacytoma is by definition a tumor isolated (like a sarcoma) in a tissue, and therefore without invasion of the spinal cord.

Mild chain multiple myeloma causes monoclonal peak at serum protein electrophoresis

False, light chain myeloma does NOT cause monoclonal spike on serum protein electrophoresis

POEMS syndrome corresponds to a monoclonal gammopathy associated with bone lyses at the punch

Wrong, I admit this question is hard, because most of you will never have heard of POEMS: it is a form of myeloma with osteocondensation associated with splenomegaly, neuropathy and endocrine damage. It is rank C.

Waldenström's disease is a form of myeloma with osteocondensing lyses

False, Waldenström's disease is the MAIN differential diagnosis of myeloma


What is the percentage survival of patients with lung cancer treated at stage I, at 5 years?


What is the survival of patients with lung cancer treated at the metastatic stage (V), at 5 years, in percentage?


True because the molecule does not pass the outer membrane

Penems are useless on Pseudomonas aeruginosa

Only ertapeneme that does not work on enterococci and on Pseudomonas


What is the weekly malaria chemoprophylaxis?


Which of the following proposals for protective measures against Anopheles bites is recommended?

Use of household repellents and insecticides


Against which germs is the hexavalent vaccine, administered in children under 1 year of age at M2 M4 and M11?

It does not fit into the hexavalent (it is all alone)


A patient wants to go to Cameroon for 6 months. What vaccination(s) do you prescribe?


What situations are at risk of invasive pneumococcal disease, and therefore constitute an indication for preventive vaccination against pneumococcus?


For which stays is the yellow fever vaccine mandatory?

Tetravalent meningococcal vaccine ACYW135 conjugate


What is the probability of death during a tropical trip?


What propositions are true about typhoid fever?

The vaccine is in one dose, valid for life

True for yellow fever. The salmonella vaccine is not very effective, and must be redone every 3 years


How many dose(s) for yellow fever vaccine?


Vaccination protects in 100% of cases from the occurrence of salmonellosis

60% effectiveness, than against certain strains

vaccination must be renewed every ten years

vaccination does not protect against Salmonella enterica serotypes of Salmonella enterica paratyphi A and B

Vaccination is mandatory for healthcare workers

microbiology laboratory personnel in contact with stool

Vaccination for typhoid is possible from the age of two


What pathologies do ticks have as a vector?

True, as the name suggests. No trap here


What pathologies do Aedes have as a vector?


In what situations can joint fluid be inflammatory?

True, we also find in the joint fluid micro-crystals (urate, PPCa, Ca phosphate ...)

True. The causes of inflammatory fluid (i.e. with more than 2000 cells per mL) are: septic arthritis, gout, chondrocalcinosis, RA, spondyloarthritis, ... Causes of mechanical fluid: osteoarthritis and meniscus injury


Which of the following can be part of the pre-therapeutic assessment prior to the initiation of targeted therapy?

True, for anti-IL6 and anti-JAK treatment


From what score can we speak of densitometric osteoporosis in adults?

False, the Z score is used in children who have not reached the peak of bone mass.


Which of the following fractures are severe?

Fracture of the upper extremity of the humerus

True. The complete list: vertebral, pelvis / pelvis / sacrum, upper end of humerus, upper end of femur


Which osteoporosis treatments are osteotrainers? (one or more correct answers)

False, it is a selective estrogen receptor modulator (SERM), which slows bone resorption. Contraindicated after 70 years. Not active on peripheral bones

False, it is an anti-osteoclastic treatment, slowing bone resorption

False, it is a treatment that slows bone resorption

False, it is an anti-RANK-L antibody (biotherapy), which slows bone resorption

True, it is a recombinant fragment of PTH, which stimulates bone formation. Trade name = Forsteo. One subcutaneous injection every day at the same time for 18 months


What biological arguments are in favor of osteomalacia?

False, we will rather have hypocalciuria. According to the college: Osteomalacia is a diffuse, rarefizing, weakening osteopathy of bone tissue characterized histologically by a significant delay in mineralization of the newly formed organic matrix, which leads to an accumulation of osteoid tissue. The biological arguments are: a decrease in serum calcium and phosphatemia; an increase in alkaline phosphatase; a collapse of 25(OH)-vitamin D (reserve form) < 5 ng/ml; hypocalciuria and hyperparathyroidism secondary to hypocalcaemia.


What elements are in favor of an inflammatory joint fluid?

Presence of calcium pyrophosphate crystals

True, on direct examination or after cultivation


A DAS28 to 3.0 score defines rheumatoid arthritis:

True, low activity 👉 level 2.6 < DAS28 < 3.2

False, moderately active 👉 3.2 < DAS28 < 5.1


Which of the following are possible extra-articular manifestations of RA?

True, hence a systematic chest X-ray to discover RA

False, osteoarticular manifestation of RA


What can be the extra-articular disorders of spondyloarthritis?

False, joint involvement of the coxofemoral joint

False, pain reflecting joint involvement of the sacroiliac


True, radio-transparent lithiasis with uric acid (represents 10% of urolithiasis)

False, hallux dactylitis should not be confused with gouty attacks of MTP1. Dactylitis is found in spondyloarthritis for example


What elements can be found when diagnosing complex regional pain syndrome (CRPS)?

False, mechanical fluid, with less than 2000 elements (other causes: osteoarthritis, meniscalgia)

False, normal CRP, no biological abnormalities in CRPS

Hyperfixation to the 3 stages of scintigraphy

False, may be normal but sometimes presence of edema especially osteomedullary


Which tumors can classically give paraneoplastic syndromes responsible for autoimmune encephalitis?

True. These are CBPC, testicular and ovarian cancers, and hemopathies and related diseases (thymoma)


What are the 2 most common germs found in meningitis in children under 2 months of age?

True, by contamination by proximity to the digestive tract during childbirth most often

True, also called group B beta-hemolytic streptococcus (SBHB), hence the importance of systematically looking for it before delivery via a vaginal swab

False, it is rather in the child over 2 years old unvaccinated

False, it is rather in children between 1 and 2 years, then in adults over 25 years


You are a country doctor in a very under-endowed area thanks to your CEPA, and you are called for Monique, a farmer, 48 years old, who has been feverish since this morning, and has small crimson spots, all black, hollow, trunk multiplying at high speed. His cat, who is a fine semiologist, has noticed that they do not fade when he presses on them to chase them away. Her husband is warming up the engine of the 308 a little tired to transport it to the emergency room when you arrive aboard your brand new 🛵 Vespa. What are the real propositions?

It is a vital emergency, her husband cannot transport her, medical transport is needed

True, it is a purpura fulminans 👉 we inject the C3G that is in our emergency bag and we call the 15

It is a legal obligation for any liberal doctor to have on him enough to perform an IM injection of C3G in this type of situation

True, even ophthalmologists and psychiatrists!

If you don't have C3G, you can inject amoxicillin IM

True, it's not as good, but it's much better than nothing.

You call the multi-purpose medicine at the nearest clinic to hospitalize the patient as soon as possible

False, this patient must be hospitalized urgently in intensive care or intensive care

You need to put on an FFP2 mask to protect yourself

False, it is an isolation droplets, a surgical mask will be enough


Which of these CSF biochemistries are normal?

Rock water, 0 element, glycorachia at 0.9 x glycemia, 0.20g/L proteinorachia, 0.25mM lactates

True, standards are
a) < 5 figurative elements (without PNN or red blood cells, with 60% lymphocytes and 40% monocytes),
b) glycorachia greater than 2/3 x blood glucose
c) a proteinorachia of less than 0.40 g / L
(d) a lactatorachia less than 3.2 mM

Rock water, 4 elements (1 red blood cell, 3 monocytes), glycorachia at 0.7 x glycemia, 0.5g/L proteinorachia, 0.25mM lactates

False, the presence of red blood cells can make suspect a traumatic PL (bad external bouuuh! [this is not true]). In addition, we have a little too much protein

Cloud, 500 elements (majority of PNN), glycorachia at 0.2 x glycemia, 1.50g/L proteinorachy, 5.43mM lactates

False, and it is even very suggestive of purulent meningitis (in view of PNN, glycorachia, significant proteinorachia and lactates)

Rock water, 500 elements (mostly lymphocytes and monocytes), glycorachia at 0.5 x glycemia, 1.20g/L proteinorachia, 3.2mM lactates

False, and it's quite suggestive of lymphocytic meningitis

Rock water, 4 elements (2 lymphocytes, 2 monocytes), glycorachia at 0.7 x glycemia, 0.35g/L proteinorachia, 3.0mM lactates


What are the two infectious agents that cause rhombencephalitis?

True, children who have chickenpox often walk not straight! It's benign and it regresses alone most often

True: in front of a pregnant woman who does not walk straight, before fetal alcohol syndrome, look for listeriosis!


Which of these patients need a check-up before their lumbar puncture? Which exam is it?

An 18-year-old woman, with no history, with normal clinical and neurological examination other than stiff neck, photophonophobia, and fever

No, it can be assumed that she has a TP > 50%, a TCA < 1.5, and platelets greater than 50G/L since she has no particular history

True, it must be made sure that it has a TP > 50%, a TCA < 1.5, and platelets greater than 50G / L

A 3-month-old child with clonic movements of the right hand since this morning associated with high fever and photophonophobia

False, he has a typical picture of meningitis and, before 5 years, the only signs of localization that should have an MRI performed are hemicorporal crises

A 35-year-old adult with clonic movements of the right hand since this morning associated with stiff neck and fever

True, in humans over 5 years of age, any sign of localization must have a cMRI performed before PL to avoid engagement

A 4-year-old child with twitching of the upper and lower right limbs associated with a sunset gaze

True, it has a sign of localization (clonies of the right hemibody). He also has a sign of HTIC, which must also have an imaging assessment done before the PL


In which cases should a first dose of antibiotic therapy be given before PL in front of a meningitis chart?

Hospital care impossible in less than 60 minutes

True, it sucks, we are close to the cata, we go into cowboy mode (we do hemocs quickly done before anyway)

Known and uncorrectable hemostasis abnormality

True, you need a PT, a TCA, and normal platelets before going

Isolated rapidly worsening alertness disorders

False! Not as long as they are isolated (so not associated with hemodynamic disorders)

True! Always do antibiotics before imaging. Indications for brain imaging:
-signs of HTIC
-hemicorporeal seizures before 5 years
-focal or generalised seizures after 5 years / signs of localization


What elements are part of encephalitic syndrome?

True, these are globally the contraindications relating to PL in front of meningoencephalitis: signs of localization, vigilance disorders (rarely isolated), delirium syndrome, epileptic seizures (most often partial), neurovegetative disorders

Distractor, photophonophobia is in meningeal syndrome


Regarding precautions for meningococcal meningitis:

Caregivers should wear FFP2 before the first dose of antibiotic

Caregivers must wear a surgical mask for up to 24 hours after the first dose of antibiotic. We are on an additional droplet protection

Caregivers should wear FFP2 for up to 24 hours after the first dose of antibiotic

Caregivers should wear FFP2 for up to 48 hours after the first dose of antibiotic

Antibiotic prophylaxis should be available to caregivers who have practiced mouth-to-mouth and those who have spent at least one hour with the patient without a mask

Caregivers must wear a surgical mask until the first dose of antibiotic


In front of a typical picture of pure encephalitis without associated meningitis in pregnant women, probabilistic treatment will include:

We are not trying to cover the CVMP:) It is HSV that gives encephalitis

True, to cover listeria because she is pregnant; If it wasn't, it would be debatable.

We do not try to cover streptococcus or meningococcal in encephalitis

True, to cover HSV Let's go IV (and therefore not VALACICLOVIR)

False. Indeed, in the pilly 2021, the indications for corticosteroid therapy are very clear (and do not include HSV encephalitis): diagnosis of pneumococcal or meningococcal meningitis of adults or tuberculous meningoencephalitis. (This proposal was counted true by mistake until May 14, 2022, when an external reported the error, thanks to her!)


What statements are true about Listeria monocytogenes?


It is a bacillus with facultative intracellular development

It is able to multiply at low temperatures (4°C).

It has natural resistance to cephalosporins

Yes, this bata**🙄. But it can be beamed with amox (+genta, for good measure). Germs naturally resistant to C3G are LLEIA (as in Star Wars): Legionella, Listeria, Enterococci, Intracellular (-> macrolides) and Strict anaerobes (-> metronidazole)

It can colonize food and contaminate the cold chain


Immunosuppression worsens Listeria infection

True, at the same time it's pretty much always true, huh, "immunosuppression worsens..."

Mortality can reach 45% in Listeria septicaemia


How do you get contaminated with Listeria?

Cheeses made from raw milk except pressed pasta

Listeria does not alter the taste of food


Which of the following are sequelae of herpetic meningitis? (one or more true propositions)

True, it is most often secondary to a viral infection (reminder: hyperorality, hyperphagia, hypersexuality)

True, memory disorders in general, which can go as far as Korsakoff with anterograde amnesia and fantasies


Which tests concern the subspinatus and small round muscles? (one or more correct answers)


What tests can highlight an acromioclavicular conflict?


What tests concern the subscapularis muscle? (one or more true answers)


What tests concern the supraspinatus muscle? (one or more correct answers)


Regarding knee ligaments, which proposals are true?

It prevents internal rotation. Valgus is countered by the LLI


What are the complications of acromegaly to look for?

Secondary diabetes or glucose intolerance

It is multinodular goiters that are common


What are the etiologies of white scintigraphy with increased T4L?


What propositions are true about ARI therapy?

It allows the targeted destruction of thyroid residue

Thyroid residues are able to selectively capture iodine-131

Treatment is indicated in all patients who have undergone total thyroidectomy

Treatment is only indicated in patients who have undergone total thyroidectomy and are at high risk of recurrence


You explain to your patient the need for thyroid surgery (total thyroidectomy), and inform them of the potential complications of the procedure:

The phrenic nerve originates from C4 and innervates the diaphragm. Not to be confused with laryngeal nerves


From what size, in centimeters, is a thyroid nodule rather suspicious?


Who is the definitive host of Toxoplasma gondii?


What are the typical aspects of brain toxoplasmosis on MRI?


What are the possible clinical forms of toxoplasmosis in immunocompromised people?


What elements are part of the table of primary toxoplasmosis infection of the immunocompetent subject?


Regarding HIV testing in pregnant women:

The risk of transmission is 0.3% if the mother's viral load is undetectable

No damage to the fetus but possible contamination


In how many cases, in general, is the primary toxoplasmosis infection of the immunocompetent subject symptomatic?


What meningitis causes normoglycorachic CSF?


Anissa, 12, is on holiday in Corsica when she is hospitalized in intensive care for meningococcal meningitis. With regard to public health aspects, which proposals are true?

Her nanny, who looks after her 4 hours a day, and who last saw her 12 days ago, must benefit from antibiotic propylaxis.

His mother, who is allergic to quinolones which are the antibiotic of choice, may receive cefotaxime instead.

His father, who is allergic to quinolones and C3G, will receive the last line of antibiotic prophylaxis: rifampicin.

His brother, who is allergic to rifampicin which is the antibiotic prophylaxis of choice, may receive a single dose of C3G or quinolone.

True, antibiotic prophylaxis of meningococcal meningitis:
1) Applies to individuals who have spent more than one hour within one metre of the case in the 10 days prior to diagnosis
2) applies to caregivers who have practiced mouth-to-mouth, or have intubated/aspirated the patient without a surgical mask

and

3) consists of RIFAMPICIN 600mg x 2 per day for 2 days (or 10mg/kg per dose but not exceeding 600mg per dose) as a first line
4) may consist of CEFTRIAXONE 250mg IV single dose (125mg in children) or CIPROFLOXACIN 500mg PO single dose (20mg/kg in children)

Children in the household will be offered to vaccinate them, but not adults because catch-up only takes place until 25 years of age.


List: Japanese encephalitis
Tick-borne Encephalitis
West-Nile encephalitis
Dengue fever
Chikungunya
Zika
Yellow fever


What are the diseases with faecal-oral transmission?

Virus encapsulated and therefore fragile in the external environment (just like HCV and VHD)


What is the clinic of the typhoid fever invasion phase?

State phase: Plateau fever at 40°C, Tuphos, dig disorders, rash, Duguet's angina (ulcerations)


What are the infectious etiologies to evoke in case of diarrhea in return from tropical countries if the patient is apyeric?

Febrile diarrhea: Salmonellosis, Shigellosis, Campylobacter, Clostridium difficile, Viral hepatitis, Malaria, Primary HIV infection


West-Nile viral encephalitis / Japanese, bites at night

Borreliosis, Rickettsia, Tick-borne viral encephalitis


What are the two mandatory vaccinations for travellers that can be requested at customs when travelling to endemic areas?

True, in intertropical Africa and the Amazon

True, during a pilgrimage to Mecca (recommended otherwise)


What are the two leading tropical causes of fever after returning from a stay in the tropics?

Cause of diarrhea without fever during travel


What is the most common cause of non-febrile diarrhea when returning from a trip to tropical countries?

Diarrhea from primary HIV infection is febrile

True, test treatment with Metronidazole, diagnosis with EPS

Febrile arbovirus, no diarrhea classically


What are the infectious agents that can give acute encephalitis accompanied by single nucleosic syndromes?

HHV6 does give a mononucleosis syndrome but classically no encephalitis.


The mother of 8-month-old Josephine wants to take her on a pilgrimage to Mecca. What can you tell him about vaccination?

Her daughter may be offered a meningococcal C conjugate vaccine

Yes, absolutely. Mandatory vaccination for children born since January 1, 2018 is also mandatory, with a dose at the age of 5 months and a booster at the age of 1 year. Catching up until the age of 24 is possible.

Her daughter may be offered a polysaccharide vaccine against meningococci A and C

Yes, because the area it crosses also has a circulation of serotype A, and this from 6 months

Daughter may be offered a meningococcal B protein vaccine

False, only in immunocompromised patients (allogeneic HSCT, asplenia, properdin deficiency, terminal complement deficiency)


The value of creatinine in plasma is inversely related to the Glomerular Filtration Rate

The more kidney function increases, the more serum creatinine increases

Increased creatinine signs a deterioration in kidney function

The value of creatinine in plasma depends only on renal function

Creatinine is a perfect marker of kidney function

Very imperfect because dependent on muscle function, very variable from one individual to another

A value of 150 μmol/L is normal in women

Acceptable values: between 50 and 90 μmol/L in women and between 80 and 115 μmol/L in men


Regarding the estimation of creatinine clearance:

The formula of Cockcroft and Gault was established in antiquity

Renal physiology was still largely unknown until the Renaissance. Cockroft and Gault's formula was published in 1976.

The Cockcroft and Gault formula allows direct estimation of GFR

It is an estimate of creatinine clearance which is itself an estimate of GFR

The Cockcroft and Gault formula takes as a parameter the rate of muscle mass and the height of the patient

4 parameters of age, sex, weight and serum creatinine

The result obtained through the Cockcroft and Gault is not indexed to body surface area

The formula of Cockroft and Gault is recommended in the elderly

Poor performance in the elderly and obese subject


The MDRD and CKD-EPI formulas estimate a GFR that is indexed to body surface area

MDRD and CKD-EPI include weight, sex, age and serum creatinine

CKD-PPE is more recommended than MDRD for high serum creatinine values

This is the case for low values of creat

note that they cannot be used: in children (use Boyd's formula)

It should be noted that they can not be used: in children use Schwartz's formula!

Chapter 15): GFR is normal between 90 and 120 ml/min/1.73 m2; Between 60 to 89 ml/min/1.73 m2, chronic renal failure is mild


The Cockcroft formula takes into account:

True: serum creatinine, age, sex and weight


Mass cancer screening in France is justified if:

As a result, we would not have time to detect him that he would already be there

the cost of testing is considered acceptable by society

And more precisely, by the representatives of the company

The overall survival gain has been proven in France by serious studies

Not in France. Most often, these are international studies


You receive in general medical consultation, Mr BINDINGOF, Isaac, 83 years old, who has just moved into France, so this is the first time you see him in consultation. He presents you with a prescription "as long as the arm" including no less than 18 drugs. Among these are 5 anti-hypertensives, 3 analgesics, 4 psychotropic drugs, creams / ointments, a statin and so on! You break your head and decide to review this prescription a little... What do you do?

Check that the patient is taking his treatments and following non-drug measures

True, this is the MAIN measure to be carried out before prescribing "triple therapy for everything" as we often say in general medicine. In addition, the patient will not often spontaneously say that he does not take his treatments... It must be seen that a prescription with 18 drugs is an ordeal for the patient who will often take according to his moods! (Situation experienced during internship)

Spontaneous discontinuation of benzodiazepines due to low level of evidence in the elderly

False... Even if we do not like benzodiazepines too much (and rightly so!) for their risk of sedation, falling, in the elderly, we must not make a sudden stop! It is necessary to reduce the doses, space the doses, in short to make a long and tedious weaning but it must be done!

Check the dosages of treatments, to look for a minimum effective dosage

True, some drugs require dosage adjustment due to the physiological aging of the body. We will therefore think about evaluating kidney function with a small blood test well felt, and liver function also, even if it is more complicated.

Do not prescribe tablets in the face of the risk of false routes

False, even if often true in geriatrics or nursing homes, advanced age alone is not a contraindication to taking tablets! The risk of false routes and swallowing disorders must be assessed before

Check the MA of treatments to avoid off-label therapies

True, it is better to prescribe "safe" treatments in the elderly and not to try too much off-label or off-recommendations. In fact, at ECNs, it is always true that one should not prescribe off-label.


It is not necessary to remove or treat all modifiable risk factors

Aspirin and statins help reduce inflammation.

Statins reduce the accumulation of LDL but not stabilize plaques.

False, they are used to reduce the accumulation of LDL, stabilize plaques, regression of the volume of plaques.

Antihypertensive treatments reduce mechanical stress.

True, blood pressure puts mechanical stress on blood vessels

When rupture of plaque, antiplatelet and heparin drugs must be used, but not urgently.


What arguments are in favor of an arterial leg ulcer?

True, skin coloration depends on the oxygenation of the blood, therefore arterial blood

True, in obliterating PAD the limbs are cold because they are not vascularized (they are also very painful and hard, and there is no pulse, but we go astray)


What arguments are in favor of a venous leg ulcer?


It is used for the classification of aortic insufficiency.

Type I corresponds to mitral valves that remain in the same plane as the ring.

Type II corresponds to at least one valve exceeding the plane of the ring, the valve play is then decreased.

False, valve play is increased in type II.

Type IIIa corresponds to a valve set decreased in systole and diastole.

Type IIIb corresponds to a valvular set decreased in systole and diastole.

False, type IIIb = systolic restrictive.


Which of the following proposals about Horton's disease or giant cell arteritis is true?

Horton's disease affects the large vessels, including the carotid vessels, aorta and femoral vessels.

False, large vessels are represented by the carotids, aorta and iliac arteries.

Horton's disease headaches are temporal, beating, with hyperesthesia of the scalp

True, this is also called the comb sign (when patients paint themselves, it hurts, because of hyperesthesia)! To look for during the clinical examination

A decrease in visual acuity occurring during headache should suggest a CRAO

False! It's NOIAA! To better remember:
- OACR is an ischemic occlusion of the vessel responsible for the vascularization of the retina, the central artery of the retina, completely painless because the retina is not sensorily innervated,
-NAOA is an acute ischemia of the head of the optic nerve, by occlusion of the posterior ciliary artery which is also a terminal branch of the internal carotid artery. It is also painless. The BAV is always total ("blackout"), while the OACR can sometimes leave a very diminished vision.

Remember the NOIAA because it is the real emergency in Horton's disease (general corticosteroid +++)

Corticosteroid therapy is imperative after biopsy of the temporal artery, because the latter may be negativated by the treatment

False, even if corticosteroid therapy may negative the biopsy, in case of strong clinical suspicion, or clinical emergency, treatment should be initiated

The biopsy conventionally finds a giganto cell epitheloid granuloma without caseous necrosis with edematous panarteritis and rupture of the internal elastic limiting

True, to know by heart in detail, because this item falls ALL the time


What are the biological signs in favor of a PAS?

VDRL positive (contains phospholipids) and TPHA negative


Which of the following are the causes of polyclonal hypergammaglobulinemia?

True, proposition of rank C (the rest is rank A)

No hypergamma + autoantibodies (therefore monoclonal)


Which of the following tests are useful for suspected dermatomyositis?

True, allows you to look for cancer. About 20% of dermatomyositis are paraneoplastic

Antibodies for primary biliary cirrhosis


What are the clinical symptoms of allergic rhinitis?

PAREO symptoms:
-Itch
-Anosmia
-Rhinorrhea
- Sneezing
- Nasal obstruction
+ possible eye symptoms (conjunctivitis)


What are the infectious agents responsible for infective endocarditis?

False, second at 20% behind Staphylococcus aureus.

Enterococci and coagulase-negative Staphylococci equal (10%).

Blood cultures are negative in only 2% of cases.

False, in 5-10% of cases. It is necessary to specify "endocarditis research" on the request to the lab so that the culture is prolonged!


Among these pathologies, which belong to group A of infectious endocarditis said to be at high risk of infective endocarditis?

A history of 1st degree infective endocarditis.

False, NOT cyanogenic = NOT high risk (except atrial septal defect).


What are the extrahepatic complications of HCV?

This is one of the possible complications of HBV infection

HCV is not accompanied by extrahepatic involvement


What is the treatment to be systematically initiated in a child born to an HIV+ mother?


Which infectious pathologies are favored by the AIDS stage?

The full list: Pneumococcal pneumonia, influenza, STIs in general, HBV and HCV


For which germs is the addition of clavulanic acid useless?

True, because modification of the target (not a production of penicillinase)

Pneumococcus of decreased sensitivity to penicillins

Pyo never sensitive to either amox or augmentin so adding unnecessary clavulanic acid


Which bacteria are most sensitive to amoxicillin?

Susceptible to augmentin and cephalosporins


What are the modalities of vascular filling?

Colloids have no demonstrated efficacy in this indication but an increased risk of acute renal failure. We NEVER tick colloids at the ECN (they are almost no longer used in practice, except by people very specialized in very specialized indications)

True, in adults. In children, 20mL/kg is retained in the syringe.

True in adults. A filling (unlike hydration) is done in free flow on a track of good caliber. This makes about 500mL of solute pass in 15 minutes


How long is eviction in impetigo after starting treatment?


Neurology intern brilliantly received at ECN, you receive a 40-year-old patient with fibromyalgia, irritable bowel syndrome, and psychogenic non-epileptic seizures. She consults you for a heterogeneous table. It reports:
-severe pain in the territories C7 left, T10 bilateral, L3 right, S1 right;
-bilateral facial paralysis;
-a history of red ring that spread quickly following a walk in the forest in Alsace 6 months ago.
She is convinced she has Lyme disease. What do you propose to him?

In view of the field, it is very likely that his symptoms are part of a somatoform disorder, so you refer him to a specialized psychiatrist colleague and avoid multiplying unnecessary examinations because it increases the symptoms

False! It's a typical picture! Multiradicular involvement + bilateral FP in the aftermath of erythema migrans!
If we should not multiply the examinations in a patient with a somatoform disorder, most patients with this type of disorder also have poorly managed organic comorbidities, and rectifying these treatments reduces psychiatric symptoms!

You offer to perform a lumbar puncture, and you expect to come across normoglycorachic lymphocytic meningitis

You propose to perform a Lyme serology and a PCR on CSF + blood

True, that's how secondary phase diagnosis is made.

Neurological damage to Lyme is conventionally installed in the tertiary phase, it's too early


Regarding the treatment of bacterial meningitis:

Probabilistic treatment of meningitis depends on direct examination of the PL

If direct examination for PL is negative, dexamethasone + C3G + amoxicillin + gentamicin is most often offered

Ohla, the Sécu is good, but the selection of resistant germs, less! This is what is proposed in case of strong suspicion of listeriosis. For "simple" meningitis, we are satisfied with C3G + dexa, it covers pneumococcus and meningococcal

If direct examination of PL finds diplococci, regardless of their Gram, we will propose a C3G IV for 14 days and dexamethasone 4 days

It's almost true:
-Gram-negative diplococcus: meningococcal -> C3G IV 4-7d + dexa 4d
-Gram-positive diplococcus: pneumococcus -> C3G IV 10-14d + dexa 4d
And if you ever get it out (unlikely):
-gram-positive bacillus: listeria -> amoxicillin 21d + gentamicin 5d

In the presence of a C3G-resistant pneumococcus, potentiation with vancomycin

True, we speak of resistance when the MIC is greater than 0.5

The doses of C3G are: Cefotaxime 300mg/kg/day IVSE after a bolus of 50mg/kg over 1h, or in 4 IVL Ceftriaxone 100mg/kg/day in 2 IVL


What are the risk factors for impaired pneumococcus for penicillin (PSDP) in children?

Easier to be in contact with a resistant germ in community (in the same way, there are more MRSA in hospitals than in the Aveyron countryside [heart on it by the way])

Reinfection with treatment-resistant germs given at previous AOM

taking penicillin less than 3 months ago

Selection of the resistant strain that took a few months to reproduce and give the new otitis

taking fluoroquinolones less than 3 months ago


Which bacterial infections are not responsible for neutrophil polynucleosis?

Conventionally, bacterial infections are accompanied by a reaction of the innate immune system that recruits neutrophils to fight bacteria. However, in some cases (tuberculosis, brucellosis, syphilis, whooping cough or thyphoid fever infections), there is no polynucleosis but rather hyperlymphocytosis. This is an interesting feature to keep in mind, both for the NEC and for future clinical practice.


What are the national structures for the control of nosocomial infections?

It is he who implements the plan to fight against NI

The National Institute for Health Surveillance is a network for the Alert, Investigation and Surveillance of nosocomial infections

The Centre for Coordination and Control of NI is a regional network.

The Hospital Hygiene Operational Team acts, as its name suggests, at the local level

The ANSM's mission is not to fight against nosocomial infections.


At what age is the pertussis vaccine booster?

True, and then we reassess if the patient is in a cocooning (takes care of a child under 6 months)


Live vaccines contraindicated in immunosuppression

Live vaccines contraindicated in pregnancy


What is pneumococcal polysaccharide vaccine?


What does Caroli's triad contain, which corresponds to the pre-icteric phase of infection with a hepatotropic virus?


Loperamide, anti-diarrheal retarder, is contraindicated below:

True, it is also contraindicated in case of invasive diarrhea (dysenteric syndrome) because it decreases the elimination of the bacteria


Which specific vaccine should be recommended when travelling to Eastern European countries (especially Austria) and Asia?

Adventurous stays in Asia, Africa including North Africa, South America...

Precarious hygiene conditions in an endemic country


Regarding the nasogastric tube in case of occlusion:

The nasogastric tube most often suppresses nausea

The nasogastric tube most often suppresses vomiting

The nasogastric tube does not contraindicate oral hydration

Nasogastric tube contraindicates oral liquid feeding

The nasogastric tube does not contraindicate hydration or oral fluid feeding, but occlusion may contraindicate them depending on its severity

The nasogastric tube should always be placed if the patient pulls it off.

Not systematically: we must first understand the reason for the patient's reaction and reassess the benefit/risk ratio


Everything is explained here 👉 https://www.researchgate.net/figure/Croisement-entre-lAICA-gauche-fleche-rouge-et-le-paquet-acoustico-facial-fleche_fig3_281713908


What is (are) the clinical sign(s) of hypercapnia? (one or more propositions are true)

This is a sign of struggle. Signs of struggle are: tachypnea, pulling (supraclavicular, sussternal or intercostal), abdominal exhalation and flapping of the wings of the nose. More than their presence, it is their intensity that makes the seriousness of the attack.

This is a sign of bankruptcy. The signs of bankruptcy are: thoraco-abdominal swing, bradypnea (therefore hypercapnia and hypoxemia), neurological involvement (confusion, asterixis), hemodynamic involvement (cyanosis, paradoxical pulse, hypertension).


What is the main infectious agent of winter bronchiolitis, involved in 60 to 90% of cases according to the authors? (one or more propositions are true)


What treatments are not indicated for bronchiolitis?


The duration of treatment for pneumococcal pneumonitis is classically : (one or more propositions are true)


At what age is the first booster of pneumococcal vaccine in children?

Third reminder. The next ones are at 25, 45, then every ten years from 65.


In case of bronchiolitis, what are the systematic complementary examinations?

Non-severe form without sign of severity = no additional examination.


Which of the following germs are responsible for atypical bacterial pneumonitis? (one or more true propositions)

It is not an atypical germ. The picture is close to that of pneumococcus.


In obstructive CKD, the indication for long-term home oxygen therapy is based on the result of 2 blood gas measurements performed at rest, in ambient air, in a steady state, at least 2 weeks apart. Which of the following are indications for long-term oxygen therapy reimbursed by social security? (one or more propositions are true)

PaO2 at 68 mmHg with a hematocrit of 58%

PaO2 is greater than 60 mmHg, so no indication.

PaO2 between 55 and 60 mmHg with the presence of polycythemia (hematocrit > 55%)

PaO2 at 58mmHg with signs of right heart failure

PaO2 between 55 and 60 mmHg with clinical signs of right ventricular failure


What are the 4 germs responsible for post-influenza pneumonia?

The clinic corresponds to an influenza episode followed by worsening after 5-7 days.

It is therefore necessary to initiate active antibiotic therapy on staphylococcus, such as Augmentin or C3G IV.


Reassessment is systematic after 48-72 hours of antibiotic therapy

If worsening or no improvement, look for a loco-regional complication

It is mandatory and systematic to test for HIV for pneumonia, especially if pneumocystosis

No. It is mandatory to PROPOSE screening. This is different

The three nosological entities of bronchopulmonary infections are nasopharyngitis, acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease

Acute bronchitis / COPD exacerbation / CABG


What are the physical signs found classically during a PAC? (one or more propositions are true)

All these signs are markers of alveolar condensation (the alveoli fill with pus from bacteria).


What is lingula? (one or more propositions are true)

The lingula is part of the upper lobe of the left lung. It is located in the caudal (lower) part of this lobe and is ventilated by the lingular bronchus, a segmental (3rd generation) bronchus that branches off from the upper lobar bronchus of the left lung.

It corresponds in a way to the topographical situation of the middle lobe of the right lung. Unlike the right lung, which has 3 lobes (upper, middle and lower), the left lung has only two lobes (upper and lower). This is due to the presence of the heart which occupies a large volume on this side of the rib cage. However, the upper lobe of the left lung is anatomically divided into two subsets.

(According to Wikipedia, content shared without modifications, licensed under CC https://creativecommons.org/licenses/by-sa/3.0/deed.fr)


What are the two treatments of choice for inhalation pneumonitis?

Anaerobes and Enterobacteriaceae should be targeted.


What are the additional examinations carried out on an outpatient basis during a CAP? (one or more true propositions)

Chest X-ray is necessary for the diagnosis of CAP

Unlike legionella antigenuria (which is performed upon hospitalization), pneumococcal antigenuria is reserved for hospitalization in intensive care.


What is the classic clinical presentation of acute bronchitis? (one or more propositions are true)

Which are not synonymous with bacterial superinfection

No crackling, no fireplace. We can have some aspecific bronchial rales.


Which of the following proposals are part of the amoxicillin/clavulanic acid spectrum?

The entire spectrum of amoxicillin (pneumococcus, enterococci faecalis, listeria, meningococcus, borrelia, group 1 enterobacteriaceae) and the addition of a penicillinase-sensitive inhibitor (methicillin-sensitive staphylococcus, haemophilius, moraxella, E. coli, group 2 enterobacteriaceae)

Chlamydia is a bacterium sensitive to macrolides (clarithromycin, erythromycin), tetracyclines, fluoroquinolones

The three families used for the treatment of legionellosis are macrolides, fluoroquinolones, and rifampicin (never monotherapy)


What evidence supports idiopathic thrombocytopenic purpura (ITP)?

the non-infiltrated nature of purpuric lesions

What we do not have in an ITP: organomegaly, abnormality of the blood smear, DIC, Hepatocellular insufficiency, ... Immunological thrombocytopenic purpura (ITP) is an autoimmune pathology characterized by isolated thrombocytopenia of < 100 G / L. It is a diagnosis of elimination, but also the first to evoke in front of isolated thrombocytopenia.

Peak between 2 and 5 years. Second peak, less important, after 60 years.


What tests are unnecessary in the diagnosis of ITP?

True, Table IV, page 291 of the College of Internal Medicine, 3rd edition

Systematic review, with: CBC, Pap smear, PPE, HIV HBV HCV serology, liver test, ANA, Creatinine, PT TCA Fibrinogen, RAI grouping


Mrs. Minerva McGonagall has dyspnea when she puts on her cape but also permanent fatigue of rest. What is its NYHA stadium?

True, dyspnea of rest and for minimal effort.

False, only 4 stages in the NYHA classification.


What is the main risk of seborrheic dermatitis?


In opioid substitution therapy, discontinuation of buprenorphine for pregnancy is not warranted

Buprenorphine can be used regardless of the term of pregnancy

The amount of buprenorphine ingested via milk is too much for the newborn

It is very weak, it can be used during breastfeeding without worry, unlike opiates, which it helps prevent the consumption ;)

Published data in women exposed to buprenorphine during pregnancy are numerous and reassuring

Neonatal opioid withdrawal syndrome is rare with chronic buprenorphine use until delivery

It is common but not serious most of the time


What are the risk factors for pathological bereavement?

Repetition of deaths of loved ones in a short time

True - basically, anything that makes you say "Ouch, this is even worse than I imagined", is worth


A non-smoker has smoked less than 100 cigarettes in his lifetime

The withdrawal period allowed to define an ex-smoker is 6 months

False, commonly accepted time = 12 months

An active smoker is a smoker who has not been weaned for 12 months

An ex-smoker is a smoker who has totally and permanently quit smoking for a certain period of time.


What are the 2 most important questions of the Fagerström test?

Which cigarette would you give up the hardest?

Do you smoke at shorter intervals in the early morning hours than in the rest of the day?

How many cigarettes do you smoke per day?

These 2 questions are the most important because they are the most sensitive and specific, and constitute the simplified Fagerström test.

How soon after waking up do you smoke your 1st cigarette?

Do you find it difficult to abstain from smoking in places where it is prohibited?


Concerning the epidemiology of tobacco consumption

The proportion of smokers increased between 2016 and 2018

The decrease in smoking prevalence is faster among women

Tobacco experimentation is done for the first time around 12 years old


Regarding the physiology of GH, indicate the exact answers:

Secretion is constant and mainly diurnal

The secretion is pulsatile and mainly nocturnal

True, hence the myth (not so mythological as that) that we grow up at night 😊
This myth is also due to the fact that the intervertebral discs decompress at night which makes it possible to gain a few centimeters.

True, produced by the stomach (when we eat, we grow!)

True, produced at the hypothalamic level. It is decreased by somatostatin. According to Wikipedia: Somatostatin, also called GHIH or SRIF, is a protein hormone that inhibits growth hormone. It exists in two active forms, produced by an alternative cleavage of the same pre-protein: one of 14 amino acids, another of 28 amino acids.


Which of the following are sulfonamides?

Analogue of GLP1, like all drugs that end in -tide.

Gliptins are inhibitors of DPP4 (they are, like GLP1 analogues, incretins).


Which anti-diabetic treatments are incretins?

Glinides are insulin-secreting hypoglycemic secretors.

Thomas Marc and Redwane Rakza made an excellent recap:

Insulin-sensitizer:
• Biguanides = Metformin

Insulin secretors hypoglycemic agents:
• Sulfonamides = Gliclazide, Glimepiride, Glibenclamide
• Glinide = Repaglinide

Incretins:
• GLP-1 analogues = Liraglutide, exenatide, dulaglutide
• IDPP4 = -gliptin

A-glucosidase inhibitors:
• Acarbose, Miglitol


What symptoms are adrenergic signs in hypoglycemia?

Adrenergic signs are also those found in stressful situations;)


What are the etiologies of white scintigraphy?

True, the thyroid is homogeneously destroyed

True, the thyroid cannot bind labeled iodine, since its receptors are saturated


What are the etiologies of white scintigraphy with normal TSH and T4L?

Fake thyrotoxicosis by hidden intake of levothyrox


What does not cross the blood-placental barrier?


What are the positive signs of death among the following propositions?


What are the possible complications of high myopia?

Myopic are rather protected from early presbyopia


What is a rupture of the Bruch membrane?

True, another guy who liked his last name too much


What is the definition of iridodialysis?

It is the disinsertion of the base of the iris

This is the rupture of the iris sphincter

It is a rapid increase in the iridocorneal angle


What are the essential documents for the establishment of an ASPDREu?

1 certificate or medical opinion outside the premises

1 certificate or medical opinion within the establishment

2 off-site medical certificate or opinion


The employer has the obligation to reclassify a pregnant woman if she is exposed to certain occupational risks

The employer cannot dismiss an employee during pregnancy

The employer cannot dismiss an employee during the 3 months following the maternity leave

During the month following maternity leave

The pregnant woman is obliged to inform her employer of the pregnancy

No, but it is advisable to do so if there is a need to arrange the workstation

The employer may dismiss a pregnant woman if there is serious professional misconduct. The dismissal then takes effect as soon as protection ends.


Regarding chronic pancreatitis, which propositions are true?

About 80% of heavy drinkers will develop chronic pancreatitis

False, less than 5%. On the other hand, 80% of chronic pancreatitis is linked to excessive alcohol consumption for more than 10 years.

True, by dietary restriction because diet triggers pain

Pain is often present in the early phase of the disease

True, and it tends to disappear in the evolution towards the late phase.

Pancreatic exocrine insufficiency leads to diabetes

False, diabetes is secondary to pancreatic endocrine insufficiency

Exocrine pancreatic insufficiency involves steatorrhea confirmed by a lowered assay of fecal elastase on a stool sample


What are the criteria for poor prognosis for Guilain-Barré syndromes?

True, and always true, regardless of the disease


True, always in real, because limits stiffness and, once the patient is conscious, atrophy


What is the percentage of PRNAI deaths in studies?


What propositions are true regarding lumbar puncture in PRNAI?

Meningitis on Lyme disease or HIV can give a similar picture

Lumbar puncture may show albuminocytological dissociation

True (this is a significant increase in albumin levels while cytology is normal)

There are between 4 and 50 nucleated elements per mL of spinal fluid

There are oligoclonal bands with normal glycorachia


True, because myelin participates in the conduction velocity but not in the amplitude of the signal

Normal amplitudes are found in the demyelinating form

Decreased amplitudes are found in the AMAN form

There is a decrease in conduction velocity


What is just in front of the fourth ventricle?


What are the causes of painful III paralysis?


What does the famous midbrain aqueduct, also called Sylvius Aqueduct, do?

A bit of jokes in this world of bullies 😂😂

Exactly. It connects the 3rd ventricle, which is in the brain, to the fourth ventricle, which is in the cerebellum. To do this, it navigates to the posterior part of the midbrain.

It connects the occipital lobe to the cerebellar hemispheres

It connects the vermis to the cervical marrow


What is the definition of a tonic crisis?

Repetitive and rhythmic segmental muscle twitches

Contraction of agonist and antagonist muscles, alone or in bursts


What is the definition of a myoclonic crisis?


Which of the following are true about herpetic meningoencephalitis? (one or more propositions are correct)

It is exceptional in an immunocompetent subject

Quite common (in the rarity of meningitis): this is the first cause of clear fluid meningoencephalitis.

Treatment is based on IV aciclovir for 5 days

T1 and T2 hyposignals are found on temporal MRI


➡ By temporal lobe injury: Herpetic meningoencephalitis +++

Hypersomnia is found in Kleine-Levin syndrome, of unknown cause.


We often hear that clear fluid meningitis is not serious. Nevertheless:

40% of patients will have neuropsychological sequelae

The causative agent is not found in one out of two cases

No, 25% are related to HSV, remember that 90-100% of adults are infected with HSV


Which of the following are signs of seriousness requiring hospitalization in intensive care in case of meningitis? (one or more propositions are correct)

It's called a purpura fulminans, it falls every year, and it's the only thing that can take you to court as an outsider if you don't think about it. All right? 0:)

All meningitis is managed in intensive care

Benign viral meningitis is usually managed on an outpatient basis. Bacterial meningitis can be managed in conventional medicine, intensive care unit, or intensive care.

Thrombocytopenia with platelets below 100G/L


What are the notifiable etiologies of meningitis or meningoencephalitis?

Syphilis has been a long time since 😊 OD

The complete and up-to-date list is available here: https://www.santepubliquefrance.fr/maladies-a-declaration-obligatoire/liste-des-maladies-a-declaration-obligatoire


What elements are part of the semiology of autoimmune encephalitis?

Yes, they are also called limbic encephalitis because they mainly affect the internal temporal lobe (so also give visual hallucinations, such as frontotemporal dementia :) )


Which of the following proposals promote invasive pneumococcal disease? (one or more propositions are correct)

Sickle cell disease is a cause of functional asplenia by multiple spleen infarction leading to either splenic sequestration of immune cells or cessation of their splenic production/maturation

Only the cochlear implant is a risk factor


The allowance for the supervision of a disabled child (AEEH) is allocated by the MDPH

ADHD is statistically linked to the occurrence of OCD and ASD

TBI (conduct disorder) and/or OD (Defiant Opposition Disorder) can be found in children
In adults, there is an increased risk of other pathologies such as mood disorders and delusional disorders, but this is outside your program.

Methylphenidate is the standard drug treatment for ADHD

Yes, it is an amphetamine derivative prescribed on secure prescription for 28 days, with a prescription limited to certain professionals: psychiatrists and child psychiatrists, neurologists, and pediatricians

Educational assistance in an open environment is provided at the parents' home, at home


Not necessarily, but at least moderate, because a history of TS is a major FdR of suicide, so increases the R


Delusional idea, often present in melancholic depressions


Regarding generalized anxiety disorder (GAD):

Frequency is higher in men than in women

We can find difficulties of an intellectual nature

It's hard to perform intellectually when you're anxious, remember your last staff presentation...

Anxiety is anticipatory between paroxysmal episodes

There are no paroxysmal episodes. Anxiety is continuous, not associated with identified triggering events, excessive and uncontrollable.


Everything is true except sputum (page 78 of the pneumo college).


What is the definition of RPM (premature rupture of membranes)?

Rupture of membranes occurring before the start of labour

Rupture of membranes occurring before release

It doesn't make too much sense, right? 😅 How can the baby get out without breaking the membrane?

Rupture of membranes occurring before engagement

Rupture of membranes occurring for more than 12 hours before delivery

Rupture of membranes occurring for more than 24 hours before delivery


Regarding eyelid pathologies, what are the exact proposal(s)?

A stye usually manifests as a painful pustule, centered on an eyelash.

Chalazion usually manifests as inflammation of the Meibomus gland

True, this is the definition of chalazion

Chalazion or stye does not cause decreased vision

Blepharitis or dacryocystitis is a differential diagnosis

Treatment of chalazion is based on antibiotics


Regarding acute pancreatitis, which propositions are true?

Acute pancreatitis is a common digestive emergency

The most common form of acute pancreatitis is acute necrotizing pancreatitis

False, 80% of cases of acute pancreatitis are benign and are described as edematous

They may be accompanied by vomiting related to a reflex ileus

Lower myocardial infarction may be a differential diagnosis of acute pancreatitis

Diagnosis is based on a combination of suggestive abdominal pain and lipasemia > 3N


Which of these proposals are not risk factors for peptic ulcers? (three proposals expected)

It is indeed a risk factor for ulcers. Other risk factors to be aware of are: H. pylori, NSAIDs and Aspirin, Zollinger-Ellison Syndrome, genetic predispositions and certain vasculitis

Gastrinoma 👉 gastrin 👉 hypersecretion decrease in pH (which therefore becomes more acidic) 👉 multiple and recurrent ulcers


Acute gastritis due to H. pylori is most often: (only one response expected)


Zollinger-Ellison syndrome is secondary to:

It is an endocrine tumor that lowers the pH of the stomach and can cause recurrent postbulbar multiple ulcers.


In what proportion of cases, on average, does H. pylori infection progress to acute gastritis?

Almost all HP infections progress to acute gastritis


Zollinger-Ellison syndrome is accompanied by a: (only one expected response)


Which gastritis are at risk for gastric adenocarcinoma?

Only atrophic gastritis is at risk of gastric adenocarcinoma

Biermer's disease (autoimmune atrophic gastritis)


An ulcer, by definition, reaches up to: (only one expected response)


What is the preferred location of H. pylori in the stomach? (only one answer expected)


H. pylori infection in childhood occurs mainly by: (only one response expected)


In addition to evacuative punctures, the treatment of ascites is based on:

to avoid because promotes undernutrition

Spironolactone, or even furosemide in case of insufficient response

True, to decrease gradually when ascites is controlled, until a complete stop. To be resumed if ascites reappears.


In xxx of the cases, cardiocirculatory arrest is related to a ventricular rhythm disorder. xxx corresponds to:


What are the different clinical signs of struggle to look for in favor of ARD?

Recruitment of accessory respiratory muscles

= Suprasternal, supraclavicular and intercostal draw

Not to be confused with signs of bankruptcy:
- Paradoxical abdominal breathing (= thoraco-abdominal swing);
- Hypoxemia with cyanosis;
- Hypercapnia with neurological impact (G < 15)


What advice should I give to patients with pneumothorax?

For flights in pressurized aircraft, a delay of 2 to 3 weeks is recommended after a PNO

without, however, formal proof of this period

definitive contraindication of diving if detection of bullous lesions in spontaneous PNO ATCD lengths


What are the treatments of a coronary patient after revascularization of an ST+ SCA?

Not indicated: we are talking here about the famous C-BASIC ☺


Regarding Ring and Meisner's classification:

Grade II = Mucocutaneous signs (urticaria, angioedema)

Grade III = Moderate multi-organ involvement (mucocutaneous signs, respiratory tightness, tachycardia, hypotension < 20 mmHg)

Grade IV = Severe multi-organ disease (respiratory distress, severe bronchospasm, laryngeal oedema, collapse, bradycardia)


What signs are in favor of a hypovolemic cause?

polytraumatized with abdominal pain and defense


What are the clinical signs consistent with heroin poisoning?

Hypotonic calm coma. Tight miosis. Bradypnea. This is common to benzodiazepine or opioid poisoning (such as heroin).
Conversely, SSRIs/Tricyclics/Atropine/Cocaine/Amphetamines cause restless coma with mydriasis, hypertonia and ROT vivid


The hemodynamic profile of a severe burn is close to shock:


It's 4am and you're called by internal medicine for a 50-year-old patient, with chronic alcoholism being weaned improvised by the patient.

The patient has rapidly deteriorated neurologically (GSC 4), he presents with respiratory failure with PaO2 52 mHg pCO2 60.

On biology you note:
- Hb 7 g/dL, VGM 93 fL,
- Platelets 25 g / L,
- Schizocytes with a smear,
- LDH 245, collapsed haptoglobin,
- Acute renal failure with serum creatinine 235
- Normal vitamin B12, slightly decreased B9

You take him in intensive care and do the necessary resuscitatory measures
At D+2, while you are trying to lift the sedations to assess neurological functions, the patient has a seizure

TRUE. Mechanical hemolytic anemia with thrombocytopenia and acute renal failure + neurological picture. So it's quite possible!

A dosage of complement and ADAMTS13 is relevant

TRUE! - Supplement to know if it is consumed or not (especially in atypical HUS): mutations will cause endothelial lesions by deposition of pieces of supplements that wander.

- ADAMTS13 is a metalloprotease that cleaves the Willebrand factor that wanders in small pieces in the microcirculation of organs. The problem... it is that these small pieces of Willebrand factor attach the platelets nearby --> Obstruction of the lumen of the vessels

Thrombotic microangiopathy is characterized by obstruction of the lumen of capillaries and arterioles

HUS is characterized by a neurological picture in the 1st plane

TTP is characterized by a neurological picture in the 1st plane


What is found in the laboratory workup of primary hyperparathyroidism?

True, phosphatemia is low because PTH decreases phosphate reabsorption

True, because it is adapted to hypercalcemia caused by primary hyperparathyroidism

False, in primary hyperparathyroidism, serum calcium is elevated


What disorders of phospho-calcium metabolism can be found in chronic renal failure?

False hypocalcemia leading to secondary hyperparathyroidism

True, by decreasing renal excretion of phosphates


What can be the heart damage of chronic renal failure?


The CKD-EPI and MDRD formulas take these factors into account:

False, it is the Cockcroft that takes into account the weight. Cachexia or obesity are not factors that are taken into account for the calculation of GFR by the CKD-Epi or MDRD formulas

False, for the same reason that weight is wrong


What are the arguments in favor of an AKI in the face of elevated serum creatinine?

Normochrome normocytic aregenerative anemia

False, rather in favor of CKD except in the case of hemolytic uremic syndrome or hemorrhagic shock


What parameters are taken into account in the calculation of GFR by the CKD-PPE formula?

False, not used for MDRD and CKD-PPE, but it is used in Cockcroft and Gault's formula


What CKDs can occur with large or normal sized kidneys?

False, cause of acute renal failure with anemia


In which cases can I have CKD without hypocalcemia?

False, gives rather CKD with large kidneys but with hypocalcemia


In which cases is it not possible to estimate GFR by MDRD and CKD-PPE?

True, use of Schwartz's formula up to about 15 years (the exact age varies in practice depending on the morphology)

In a subject with decompensated hepatic cirrhosis

This situation is conducive to acute renal failure (first functional and then organic if not managed) which makes the calculation of GFR not recommended

True, because significant muscular atrophy

The GFR is physiologically changed in pregnant women, the calculation by these formulas will find an underestimated result


What are the causes explaining, between them, 80% of hypercalcemia?


Edema are markers of extracellular hydration status (HEC: extracellular hyperhydration). Since natremia is an indicator of intracellular hydration status, it is not influenced by the absence or presence of edema.

Is increased in case of intracellular dehydration

Is decreased in case of intracellular dehydration

Provides information on extracellular osmolarity

Indeed, to calculate the extracellular osmolarity, the formula is used: Osm = 2Na + Glucose (normal: 285 mOsm / L)


False, is not responsible for ketoacidosis