Context: You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg/m2). There is no notion of recent genital infection, nor of libido disorder.

Regarding Mr. B, he gives you the results of the spermogram that you had prescribed during your previous consultation. Ejaculate volume: 3 mL (1.5 - 5).  Sperm concentration: 4 million / ml (N>15). Progressive mobile forms: 10% (N>32). Typical forms: 1% (N>4). Living forms: 69% (N>58) Agglutinates: none. Leukocytes: absence. Which of the following characteristics do you retain to describe this ejaculate?


Which of the following clinical situations could explain the results obtained on this spermogram


The clinical examination of Mr. B. notes a penis measured at 6 cm and a testicular volume of 10 and 12 ml. Pubic hair is losangic in appearance. There is no such thing as gynecomastia. Which of the following biological assays do you think is essential to carry out in this context?


The patient gives you a biological assessment that he had carried out before your consultation and which indicates the following results: Hb at 14.3 g / dL, total testosterone at 5.67 ng / ml (N: 2.5 - 10.0), LH at 5.4 IU / L (N: 2 - 6) and FSH at 15.SUI / L (N: 2 - 8). Which of the following clinical situations can (can) give this clinical-biological picture?

Hypogonadism related to si:1ortive intensive activity


You mention a possible microdeletion of the AZ region. F of the Y chromosome. Before prescribing the molecular genetic analysis, you want to confirm the spermogram data on a new collection three months later. The patient takes advantage of this time to ask you for some nutritional advice about his sports practice. Which of the following proposals is (are) accurate about your patient's sports practice?

Protein intake of 1.2 to 1, 4 g / kg / day

Fat intake at 40% of total energy intake

This ratio applies to the general population. It is lower in the athlete.

Favor complex carbohydrates with a low glycemic index before the competition

Addition of NaCl to drinking water during exercise


The molecular analysis of Mr. B.'s spermogram will confirm the microdeletion in the AZFc region of the Y chromosome. With regard to Mrs B., she has just made, at your request, a temperature curve. This one shows anovulatory cycles. Which of the following dosages will you prescribe as a first-line treatment for this patient?


Given the irregularity of the cycles, you mention the possibility of polycystic ovary syndrome. Among the following arguments, which would allow (would) bring this diagnosis to Mrs. 8. ?

Total testosterone at 0.7 ng/ml (N: 0, 1-0.5)

17-hydroxyprogesterone 18 ng/ml (N: 0.2-2)

Ovarian volume assessed at 5 ml on pelvic ultrasound

More than 19 follicles per ovary on pelvic ultrasound


While waiting for the results of the ovarian ultrasound, Mrs. B, worried, calls you to communicate the results of the biological assessment that you prescribed: estradiol 35 pg / ml (N: 20-70), testosterone 0.89 ng / ml (N: 0, 1 - 0.5), LH at 11.4IU / L (N: 2- 6), FSH at 4.8 IU / L (N: 2- 8), prolactin at 15μg / L (N<20). Which of the following clinical situations can (can) give this clinical-biological picture?


You will recover the pelvic ultrasound whose result is compatible with the diagnosis of polycystic ovary syndrome. You therefore refer the couple to a medically assisted procreation center given the diagnosis of microdeletion of the Y chromosome in Mr. and polycystic ovary syndrome in Mrs. Nevertheless, you remind Mrs. B beforehand that she is at risk of developing gestational diabetes. Which of the criteria below makes you make this statement?

The context of medically assisted reproduction care


Four years later, after two pregnancies obtained by in vitro fertilization, Mrs. B. returns to your consultation due to unusual asthenia. She had first put this on the account of the care of her 2 young children and on the resumption of her professional activity. She thinks she has hypothyroidism like her aunt and paternal grandmother. Which of the following signs is compatible with the diagnosis of hypothyroidism?


Which of the following bioassay will you prescribe as a first-line treatment?


The TSH result is given by the laboratory: 52 mUl/l (N: 0.4 - 4). Which of the following exams do you prescribe now?


The assay of anti-thyropxydase antibodies is positive and ultrasound confirms the existence of a goiter compatible with autoimmune thyroiditis with the presence of a left para-isthmian nodular image. Which of the following ultrasound signs is (are) in favor of the benignity of a thyroid nodule?


It is actually a T1RADS 1 cystic nodule, completely benign in appearance. Due to clinical and biological hypothyroidism, you decide to start treatment with levothyroxine. The patient stops you while you are writing your prescription because of the side effects reported recently in the media and possibly related to the molecule. You have read a study on this subject, of which here is an excerpt: << In order to highlight a potential role of the new formulation of levothyroxine, we compared, by consulting the medical records of three centers specialized in thyroidology, the side effects reported by hypothyroid patients treated with levothyroxine old formula (FA; n = 1500) or levothyroxine new formula (NF; n = 1800) over a period of 4 months concomitant with the mediatization. 295 patients reported an adverse event in the NF group and 153 in the FA group. Which of the following proposals for this study is accurate?

The confidence interval for relative risk is +/- 1,800/1,500


Context: You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.

Based on the data you have at the moment, what is the correct answer(s)?

It is very surprising that pulmonary auscultation is really normal.

Clinical examination is normal in asthma apart from attacks. It is a paroxysmal pathology, with brief symptoms (less than twenty minutes).

You start oral corticosteroid therapy of 0.5 mg / kg for 15 days.

You suspect at the interrogation an allergic asthma.

She necessarily smokes a lot more than she admits.

We are not in Dr. House, at EDN we must believe the patients;) (except for very good reason to do the opposite)


For this young patient, what additional tests do you offer?

Achievable from 3 years. A chest x-ray (which is normal in asthma) is also done.


You realize a volume flow loop. The green square and the red triangle correspond to the volumes obtained after the first second of expiration. Which propositions are true? Give the correct answer(s).

Point A is the volume corresponding to the forced vital capacity

Point B (triangle) represents post-bronchodilator FEV1

This is the volume that the patient exhales after one second.

The blue curve represents the pre-bronchodilator inspiratory flow

Expiratory flow (because it is the exhalation at the top, and the inspiration at the bottom, by convention).

Point D corresponds to the functional residual capacity

This is the peak expiratory flow. The colors are not very legible, we grant you. This is unfortunately the official image of the cng.


Attached are the numerical results of the flow-volume loop. Regarding the results presented in the table above, which is (are) the exact proposition(s)?

There is an obstructive ventilatory disorder of significant reversibility

FEV1 increases by 200 mL and more than 12%

Reduction in FEV1 at baseline is not significant

There is a restrictive respiratory disorder (RVC)

There is an obstructive breathing disorder (ORT)


The diagnosis is clearly asthma and most likely allergic asthma. What allergens could most likely be responsible for this asthma when you see it? Give the correct answer(s).

His cat did not cause him problems before but that can change 😉.

There was no contact reported by the patient.


The apartment is dilapidated but there are no cockroaches. To advance in allergy diagnosis, you want to perform prick-tests. Regarding these tests, give the answer(s) that you think is accurate?

They explore immediate IgE-mediated sensitivity

They should be accompanied by patch tests in order to increase the specificity of the result

They will have to be performed when asthma is controlled.

They will have to be carried out in a hospital environment close to intensive care

They can be performed once the patient has taken an antihistamine for 5 consecutive days.


Regarding the technique of prick-tests, give the exact answer(s).

The goal is to put the antigens in contact with the epidermis

Purified and standardized extracts of the most common allergens are used.

Always make a negative control and take into account the diameter of the papule of it when there is one

The reading of the tests is done at 15 min

Unlike patch tests, which are read several days later.

A test is considered positive if the diameter of the papule is greater than or equal to that of the negative control


Here is a photograph of his right forearm on which the prick-tests were carried out 15 minutes before. Other allergens have been tested on the other forearm and are all negative including other tree pollens. What can you deduce from the result of these prick-tests. Give the correct answer(s).

Tests should be interpreted with caution due to significant redness

We do not interpret redness, we interpret induration.

The patient is sensitized or allergic to dust mites

Tests could explain the presence of seasonal rhinitis

The patient is allergic to grass pollen.

The patient is not a priori allergic to the cat


The patient asks you the question of the responsibility of her sculpting activity in the genesis of her symptoms. Give the correct answer(s).

Look for decreases in peak expiratory flow or FEV1 correlated with work

It is necessary to look for an improvement of the symptoms on weekends and their disappearance during periods of leave

The presence of nocturnal symptoms makes it possible to eliminate an occupational origin

The fact that the patient is already sensitized to other allergens eliminates this diagnosis

Woodworking is not one of the occupations at risk of occupational allergy


You find no temporal link between his work on wood and the appearance of symptoms. The patient says, however, that every time she sleeps in older bedding at her grandmother's house, she is terribly embarrassed about breathing with the occurrence of nasal obstruction. There are no animals in his grandmother's house. She also knows that when she shakes a carpet she will sneeze and her nose will run. The clinical history and results of EFRs and prick tests allow you to retain the diagnosis of asthma allergic to dust mites. What therapeutic strategies will you put in place immediately in this young patient besides quitting smoking? Give the correct answer(s).

Allergenic (specific) immunotherapy for dust mites

Treatment of gastroesophageal reflux disease in principle


Treatment for asthma is needed. What do you prescribe to him? Give the correct answer(s).

A nebulizer to make bronchodilator aerosols at home

A rescue treatment based on short-acting B2-mimetics (BDCA) in spray or dry powder

Every asthmatic must have his rescue treatment.

Long-acting B2-mimetic (BDLA) may be immediately combined with low-dose inhaled corticosteroid

The diagnosis of asthma can lead to a direct prescription of level three (BDLA + Low dose inhaled corticosteroids) depending on the severity of the initial symptoms.


Regarding inhaled corticosteroids, what are the classic side effects? Give the correct answer(s).


To prevent the side effects of inhaled corticosteroids, you explain to the patient that it is essential to rinse her mouth thoroughly after each dose. You stress the importance of quitting smoking. You will also explain at length the interest of the eviction of dust mites and you will give the necessary advice to reduce as much as possible the allergenic load of mites at home. Which of the tips are right for this purpose? Give the correct answer(s).

Use of a vacuum cleaner with HEPA filter (High Efficiency for Airborne Particles)

Anti-dust mite covers for mattresses, duvets and pillows

Regular washing of sheets at high temperature (60 °C)

On the contrary, they must be given priority.


You see her again 3 months later. She obviously takes her inhaled treatment very well and conscientiously morning and evening. She quit smoking. She tells you frankly better. His auscultation is always normal. Its volume flow loop is improved. His FEV1 is spontaneously 82% theoretical. There is complete reversibility with an improvement in FEV1 of 13% and 450 ml. Which of the following proposals make it possible to evaluate the quality of asthma control? Give the correct answer(s).

The proper implementation of mite eviction advice

Asthma controlled if: symptoms are controlled (via the 5 questions of the ACT), exacerbations are rare, there is no TVO (FEV> 80%).

The fact that she says she is frankly better

Number of nocturnal asthma-related symptoms per week


Asthma remains poorly controlled despite the increase in inhaled corticosteroid therapy. She wakes up at night. Allergen immunotherapy is put in place and his symptoms of perennial allergic rhinitis will frankly regress or even disappear. You will be able to reduce his inhaled corticosteroid therapy. 4 years later, she comes back to see you for a very disabling rhinitis occurring in the spring during her exam periods. His nose is stuffy. It flows a lot. She no longer smells smells. Her eyes are itchy and scratchy. She had already had the same symptoms last year. The symptoms lasted two months and then subsided. You suspect grass pollinosis. His asthma is not aggravated. What attitude(s) do you recommend? Give the correct answer(s).

You ask him to go out until late at night

You can prescribe a nasal corticosteroid

They are indicated in case of nasal obstruction. It is necessary to respect contraindications, and especially non-indications.

You advise him daily nose washes with saline

According to Wikipedia: 'Sodium cromoglicate is a compound used as a mast cell stabilizer in allergic rhinitis, asthma and allergic conjunctivitis.'


Context: A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime.

Which semiological element(s) do you identify in the photo?


Which diagnostic hypothesis do you prefer in front of this table?


You suspect a bullous pemphigoid. Which of the following characteristics(are) compatible with the diagnosis?

This is found in pemphigus and hereditary epidermolysis bullosa (which is found in children), for example.

A localization at the root of the members


Which of the following laboratory tests do you consider in favor of the diagnosis of bullous pemphigoid? Give the correct answer(s).

Sedimentation rate greater than 100mm at the first hour


What paraclinical examination(s) do you perform to confirm the diagnosis of bullous pemphigoid? Give the correct answer(s).

Direct to the skin. Indirect for blood 🩸 .


The anatomo-pathological examination of a bubble was carried out (photo). Which element(s) is (are) in favor of the diagnosis of bullous pemphigoid? Bubbles

There is no acantholysis, nor Nikolsky's sign, in pemphigoid (unlike pemphigus).

A dermal inflammatory infiltrate with predominance of eosinophilic polynuclear (PNE)


Direct cutaneous immunofluorescence confirms the diagnosis of bullous pemphigoid. Indeed, it highlights (the) following element(s):

Granular deposits of C3 on the dermal-epidermal junction

Linear IgG deposits on the dermal-epidermal junction

Linear deposits of IgA on the dermal-epidermal junction

Linear deposits of C3 on the dermal-epidermal junction


Which of the following serological tests is the one whose positivity can support the diagnosis of bullous pemphigoid?


Immediate management of this patient requires (one or more exact answer(s)):

This would have been true in case of a sign of organic decompensation.

But we put local antiseptics (on the pierced bubbles)

Immediate cessation of treatment for heart failure


The first-line treatment of bullous pemphigoid in this patient, as recommended by the HAS, is based on (one or more exact response(s)):

Local corticosteroids of low activity (level 1) 20 to 40 g per day

No interest, it's a much too weak action

Local corticosteroid therapy of very high activity (level IV) 20 to 40 g per day

Plasmapheresis 1 session per week for 4 weeks


Additional therapeutic and monitoring measures are envisaged. Which of the following proposals do you retain?

The risk of dehydration pushes us to monitor kidney function in front of the risk of functional renal failure.

They are not useful. The best antipruritic is etiological treatment (corticosteroids, with their anti-inflammatory effect, will decrease pruritus).

Substitution of oral antidiabetic drugs with insulin


After several days of hospitalization, the patient goes home. What action(s) should be taken?

We start on a very long care. The ALD will make it possible to cover the many medical, drug and paramedical interventions.


After 3 months of a well-conducted treatment with very strong local corticosteroids, the patient still presents bubbles, severe skin atrophy, many milia grains, extensive erosions in the thighs, heel bedsores, ecchymotic purpura of the arms. Which of the following is(s) induced by very strong prolonged corticosteroid therapy?

Topical corticosteroids are not a priori applied to the heel.


As the patient relapses with each attempt to reduce local corticosteroid therapy, a change in treatment is considered. Methotrexate treatment was then initiated, allowing complete regression of bubbles and pruritus. After 3 months of treatment, the patient presents with a sudden fever at 38.5 ° C associated with a hot and painful edema of the right leg surmounted by a few bubbles. What diagnosis(s) do you mention?


Bacteriological sampling of bubble fluid identifies group B streptococcus. What treatment do you offer as a first-line treatment?

It is the treatment of choice for Streptococcus pyogenes.


Context: Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.

Which of the following questioning elements could (could) discriminate against the cause of the asthenia presented by your patient? (one or more true propositions)

Did your fatigue necessitate a work stoppage?


Your patient reports that this unusual fatigue has been evolving in recent weeks. Weight is stable, sleep is preserved. The patient does not have mood sadness or other elements suggestive of a depressive syndrome. This fatigue increases during the day and with effort, and is associated with dyspnea also with effort. In general, what is the exact clinical element(s)? (one or more true propositions)

Mucocutaneous pallor is specific for anemic syndrome

An asthenia that increases during the day is specific to an organic cause

'Specific' and 'asthenia' are oxymorons 😉

Weight loss with preserved or even increased appetite can lead to endocrinopathy

Melanonychia can lead to a martial deficiency

Melanoderma can lead to adrenal insufficiency


At the interview, the patient described dark urine for about 15 days. Your patient's diet appears to be balanced, and she does not report any recent drug introduction. She describes an old tendency to constipation. Blood pressure is measured at 125/70, heart rate at 100/min. The abdominal examination finds a splenomegaly, without associated hepatomegaly. Which of the following diagnostic hypotheses seems most likely to explain all the clinical elements (a single expected response)?


The patient presents the results of a blood count performed the previous week at the request of her general practitioner: hemoglobin 7.5 g/dL, MCV 102 fL, leukocytes 5.5 G/L, complete blood count with polynuclear (PN) neutrophils 3.8 G/L, eosinophilic PN 0.08 G/L, basophilic PN 0.02 G/L, lymphocytes 1.2 G/L, monocytes 0.46 G/L,  1, blisters 160 g/l.
At this stage of the care, which of the following additional examinations seems to you (seem) lawful to prescribe as a first intention? (one or more exact propositions)

Blood grouping and search for irregular agglutinins


You are looking for arguments for hemolysis, you prescribe: (one or more exact answers)


The patient is hospitalized and additional blood tests are performed urgently, resulting in: hemoglobin 6.9 g/dL, MCV 103 fi; reticulocytes 300 G/L, leukocytes 6, 1 G/L, complete blood count with polynuclear (PN) neutrophils 4.2 G/L, Eosinophilic PN 0.08 G/L, Basophilic PN: 0.02 G/L, lymphocytes 1.3 G/L, monocytes 0.46, platelets 150 G/L, Na 145 mmol/L; K 4.5 mmol/L; Cl 105 mmol/L; urea 3.5 mmol/L; creatinine 74 μmol/L; C-reactive protein 3.6 mg/L; LDH 772 IU/L; total bilirubin 40 μmol/L; conjugated bilirubin 5 μmol/L; AST 50 IU/L (N: 8-35); ALT 45 IU/L (N: 8-25); alkaline phosphatase 54 IU/L; GGT 53 IU/L; Haptoglobin < 0.1 g/L. Apart from the erythrocyte Coombs test (direct antiglobulin test), which of the following tests seems most relevant to you to complete, at this stage, the assessment of your patient (only one expected response)


Against this background of hemolytic anemia, this patient is referred to a colleague internist. He asks the biologist of the hematology laboratory to perform a blood smear. In general, which of the following pathological situations can (or which) be evoked thanks to the blood smear data?

Viral infection with mononucleosis syndrome

Plasma protein electrophoresis (PEP) is done


The blood smear performed on your patient does not find schizocytes or abnormal cells. It is noted the presence of a few spherocytes. You are faxed the first results of the erythrocyte Coombs test (direct antiglobulin test), which are presented below.
In view of the above results, which diagnosis do you think is most likely? (only 1 answer expected)

Warm antibody autoimmune hemolytic anemia

Post-transfusion alloimmune hemolytic anemia


The patient is referred to a colleague internist. The diagnosis of hemolytic autoimmune anemia (AHAI) with hot antibodies is retained. Which of the following pathologies can (may) be associated with hot antibody AIHA?


Which of the following additional examinations will you perform on your patient?

Anti-cytoplasmic antibodies of neutrophils


The additional assessment carried out on your patient is as follows.
The thoraco-abdominopelvic CT scan shows splenomegaly measured at 13 cm, as well as multiple infracentimetric lymphadenopathy cervical, mediastinal, laparomesenteric, retro-aortic and bilateral inguinal.
Blood tests show: negative anti-HBc antibodies (Ac); Ac anti-HBs negative; HBsAg negative; HCV ac positive; HCV RNA testing by negative quantitative PCR; HIV negative serology.
By resuming the interrogation, the patient reports joint pain of the wrists and fingers, predominant in the morning and waking her up at night, evolving for several weeks with episodes of joint swelling. She has developed a rash after exposure to the sun for 2 summers. She also describes dry mouth, and a feeling of grains of sand in the eyes for a few months.
Which of the following diagnoses is compatible with the clinical-biological picture presented by your patient?

We must not forget this proposal! We are guided by SSA/SSB which are positive as well as dry mouth and eyes.

Secondary anti-phospholipid antibody syndrome


You retain the diagnosis of systemic lupus with secondary Gougerot-Sjôgren's syndrome, and complicated autoimmune hemolytic anemia with warm antibodies. Which of the following treatments will you start as part of your patient's care?

Due to long-term systemic corticosteroid therapy


You are starting treatment with synthetic antimalarials (hydroxychloroquine) and oral systemic corticosteroids at 1 mg/kg/day, with measures associated with usual corticosteroid therapy.
The patient and her entourage ask you about the expected evolution and prognostic elements associated with her autoimmune disease.
Which of the following information(s) will you provide to your patient?

Pregnancies are contraindicated due to the risk of gestational lupus flare-up

The activity of the disease worsens after menopause

Kidney damage should be routinely screened even in the absence of other symptoms of the disease

The risk of atherosclerosis is increased


While corticosteroid therapy has just been started, your patient reports retrosternal chest pain constrictive to exercise. The control of the blood count finds a hemoglobin assay at 4.8 g / dL. You decide to transfuse your patient urgently. Regarding the realization of this transfusion of red blood cells (CGR), which of the following proposals is (are) accurate?

CGR for clinical use are systematically subject to leukocyte removal

The transfusion of a CGR issued must begin within 6 hours of arrival in the clinical department

There is an indication to prescribe irradiated CGR in the case of your patient

It is recommended to use RH-KEL 1 phenocompatible CGRs in the case of your patient

Because it is likely that it is polytransfused

It is recommended to use deplasmatized RGCs in the case of your patient


The transfusion is well tolerated, chest pain regresses and the ECG normalizes after transfusion. Corticosteroid therapy is finally effective, with regression of the biological stigmas of hemolysis in a few days, and gradual ascent of the hemoglobin (Hb) count. However, while a decrease in the dosage of prednisone is achieved, there is a relapse of autoimmune hemolytic anemia 3 months later with resumption of hemolysis markers and further decrease in Hb level below 10 g / dL. Treatment with rituximab is then considered in your patient. Regarding this biotherapy, which of the following proposition(s) is (are) accurate?

It is a targeted therapy against T cells

Against B lymphocytes (it is an anti-CD20)

Pneumococcal vaccination should be performed before the first infusion

Anti-allergic premedication is systematically carried out before infusions

The occurrence of hypogammaglobulinemia should be detected during this treatment


Context: A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:

What clinical data(s) should you particularly research in this context to refine the diagnosis and management of this ENT problem?

Conjunctivitis possibly associated with an ENT problem, which changes its management


The fever is at 38.9 ° C, a blood pressure at 120/75 mmHg, a heart rate at 84 / min, a respiratory rate at 15 / min, laterocervical lymphadenopathy and a rather dry cough with some ronchi on pulmonary auscultation. The dental condition is bad with several teeth to treat or extract. You also notice a lesion at the top of the right thigh, near the groin crease, of which the patient does not really complain, << used to >>. Regarding the skin lesion, what is(are) your diagnostic hypothesis(s)?


It is indeed a boil. What could be the complications of this thigh boil?

The boil can be complicated by lymphangitis, furunculosis, antrax, dermohypodermitis, rare and severe malignant staphyllococcal disease of the face.


Regarding the immediate management of this patient, which of the following proposition(s) is/are accurate: (one or more true propositions)

Mc Isaac's score is strictly less than 3

She has tonsils, lymphadenopathy and fever = Score at 3

A rapid diagnostic test for group A streptococcus is required

Probabilistic antibiotic therapy needs to be initiated quickly

Tetanus gamma globulins should be administered in the absence of information on vaccination status


The rapid diagnostic test for group A streptococcus is positive. What antibiotic treatment do you initiate as a first-line treatment:

We aim for streptococcus, it is the best antibiotic


The clinical course is favorable with amoxicillin. You take the opportunity to check his vaccination status. Which of the following vaccination(s) is (are) recommended in this patient?


You had planned to see the patient again to ensure the evolution, update her vaccination schedule and promote the management of her various comorbidities but the patient never came to your office. She comes to see your colleague at the office almost a year later because she is bothered by a cough evolving for a month, with abundant sputum and night sweats. She has been eating very little for a week because she feels nauseous and very depressed. The temperature is 38.7 °C, blood pressure is 145/85 mmHg, respiratory rate is 22/min, heart rate is 92/min. There are many crackling sounds with a marked decrease in vesicular murmur in the right upper lung field, and the sputum it produces in front of you is greenish and smelly. She has not undertaken any dental care. Which of the following proposals for immediate care is the most appropriate measure?

Initiating probabilistic antibiotic therapy

Have the patient have a chest x-ray performed

Have the patient perform a cytobacteriological examination of the sputum

Have the patient perform a biological assessment (NFR, CRP, PCT, blood cultures in particular)


The patient is hospitalized and you take care of her. In view of the clinical evidence you have, which of the following are you adopting immediately?

Treatment with levofloxacin for pneumococcal purposes


Which of the following exams do you perform quickly?

Cytobacteriological examination of sputum

Search for acid-alcohol-resistant bacilli in sputum

Gastric tubing in search of acid-alcohol-resistant bacilli


A chest CT scan was actually performed. Which propositions are true?


Which of the following infectious agents can (may) classically be involved in abscessed lung damage?

In addition, there is strepto, anaerobes, Pseudomonas, Legionella, ...


In the case of your patient, what biological assessment do you request at this stage? (one or more true propositions)


You also performed a cytobacteriological examination of sputum. Which parameter(s) will make you consider this review to be of quality and reliable?

This question often falls, it is necessary to know these values.


Cytobacteriological examination of sputum reveals an anaerobic flora at 10^8/mL with less than 10 epithelial cells and more than 25 neutrophils per field. The search for acid-alcohol-resistant bacilli is negative on direct examination. Which of the potential gateways do you choose?

Gonococcus, Chlamydia, etc., do not give abscessed pneumonia


If, because of the involvement of this anaerobic flora, you decided to include metronidazole in your antibiotic therapy, what adverse effect(s) would you expose the patient?

Hypokalaemia in combination with a thiazide diuretic

Metronidazole is an enzyme inhibitor but does not interact with diuretics.


Context: You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.

Given the information already available, what symptom(s) will you look for through the interrogation to guide the diagnosis?

Melena 💩 = digestive hemorrhage upstream of the small colon-small junction = super interesting information.


The pain radiates to the back and is increased by food intake. The stool is not black. The patient does not take antacid. What are or would be the elements in favor of a pancreatic pathology? (one or more correct answers)


You suspect chronic pancreatic pathology. You request a biological assessment that shows:

AST 32 IU/L (N < 35);

ALT 80 IU/L (N < 35);

alkaline phosphatases 180 IU/L (N < 110);

total bilirubinemia 25 μmol/L; conjugated bilirubinemia 15 μmol/L;

creatinine 62 μmol/L;

CRP 5 mg/L.

What is the most relevant complementary exam to schedule?

Abdominal-pelvic computed tomography without then with injection

This examination would not allow us to directly visualize the pancreas, unlike the AP-CT.


You have an abdominal CT scan of which here is an image: The numbers represent anatomical structures. What is the exact answer(s)?

The portal vein would be more anterior. This is the inferior vena cava.

You can follow his trajer to the spleen.

3 represents intra-pancreatic calcification

A little too far to the right to be the stomach.

The left colon is just lateral. The 5 represents the stomach.


Computed tomography confirmed the diagnosis of chronic calcifying pancreatitis. There is moderate dilation of the intrahepatic bile ducts, and the main bile duct is measured at 10 mm. What transit or stool abnormalities are you looking for when questioned in this context (one or more exact answers)?

Rectal syndrome is not found classically.

Presence of undigested food in the stool

This would be found in motor diarrhea, for example in case of hyperthyroidism.


The stool is described by the patient as clear, putty, very foul-smelling and floating. An endoscopic ultrasound of the bile ducts and pancreas, performed secondarily, shows that the pancreatic obstacle is related to fibrosis. There is no lithiasis of the main bile duct. The patient suffers daily from epigastric pain that is relieved only by morphine analgesics. He decreased his beer consumption. There has been an additional weight loss of 2 kg over the past month. What is (are) the factor(s) promoting this weight loss?

Morphine-induced nausea/vomiting may contribute to weight loss.


Given this chronic alcoholic pancreatitis, a decrease in daily alcohol consumption of 9 to 3 units was negotiated. What decrease in daily calorie intake corresponds?


The patient reports, in addition to the weight loss occurring for several years, nocturnal urination, the frequency of which is increasing. His fasting blood glucose is 2.2 g/L (12 mmol/L). The rest of the balance sheet shows:

- Ferritinemia 480 μg/L (N: 30-280)

- Albuminemia 27 g/L

- Triglycerides 0.45 g/L (N: 0.7-1.6)

- LDLc 0.55 g/ (N: 0.6-1.6)

- HDLc 0.25 g/L (N: 0.45-0.8)

- Fibrinogen 2.5 g/L (N: 2.2-3.8)

- V factor 65% (N: 65-100).

His urine strip shows: proteins - ; glucose +++; acetone traces; red blood cells -; Leukocytes-; Nitrite-.

About its metabolic situation, what is the preferred statement?

It is not possible to establish the diagnosis of diabetes on the basis of current evidence


Its HbA1c is dosed at 8.6%. You have chosen insulin therapy. Given your HbA1c goals, what factor(s) should you consider when choosing the option between a bolus basal regimen and a slow insulin regimen (simplified insulin therapy)?

Effective nature of partial alcohol withdrawal

Presence of renal impairment with an estimated glomerular filtration rate of 70 ml/


In this context of chronic pancreatitis, what treatment(s) or complementary measure(s) should be added in addition to its low-fat diet:


The patient, motivated, managed his bolus basal regimen with the help of continuous glucose recording and quit smoking. He complains of 6 moderate hypoglycemia weekly badly felt and, over the last month, two episodes of quasi-coma that required a third person for his rejuvenation. Which factor(s) are likely to increase the hypoglycemic risk in him:


Its one-week glycemic record shows the following profile about 3 representative days.
Which therapeutic adaptation do you think is the most relevant? (only one answer expected)

Reduction of glargine dose in the evening

This would allow you to start the day a little higher. Since the morning level and the one to which the patient falls back after taking rapid insulin, this should solve his hypoglycemia 😊 problems

Reduction of the insulin dose of breakfast

Moving glargine injection from evening to morning


As a result of hypoglycemia with loss of consciousness, he fell and complained of acute low back pain leading to the discovery of a wedge-shaped L1 fracture-settlement.
Which factor(s) contributed to his documented osteoporosis during two-photon absorptiometry?

Hyperparathyroidism secondary to malabsorption


Context: A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g / d / High blood pressure treated with irbersartan 300 mg / d and hydrochlorothiazide and well controlled under treatment for several years / An episode of left renal colic 2 years ago with spontaneous elimination of the stone / A smoking weaned for 5 years evaluated at 30 pack-years / Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.

What are the elements of the clinical examination to assess the initial severity? (one or more correct answers)


What are the important elements to collect to specifically orient a urological cause? (one or more correct answers)

Irradiation of pain to the external genitalia


The clinical examination finds: temperature 38.2°C, blood pressure 100/45 mmHg, heart rate 120/min. The patient is agitated. He has no pollakiurieni from urination burn. He says he hasn't urinated in 12 hours. He has a lumbar pain predominant on the right without lumbar contact, rapid installation, without irradiation to the genito-external organs. He complains of a transit stoppage. The patient is not icteric. The abdomen is flexible, hydro airy noises are perceived. The urine strip reveals: 2 leukocyte crosses, no blood, 1 proteinuria cross, absence of ketonuriaAmong the following proposals, what are the exact proposals? (one or more correct answers)

The absence of pollakiuria does not eliminate a urinary tract infection

The absence of burning urination does not eliminate a urinary tract infection

The absence of hematuria does not eliminate a urological origin of this pain

The absence of irradiation does not eliminate a urinary origin

The absence of jaundice does not eliminate a hepatic cause


What exams do you perform as a first-line treatment? (one or more correct answers)


What are the 3 most likely diagnoses in front of this table?


The assessment you have carried out shows: Blood biochemistry: creatinine 500 micromol/L, urea 25 mmol/L, potassium 4.9 mmol/L, sodium 138 mmol/L, bicarbonate 18 mmol/L, chlorine 99 mmol/L, blood glucose 12 mmol/L, CRP 120 mg/L.ECBU: leukocytes 20/mm 3, red blood cells 10/mm 3, negative direct examination and culture in progress. Urine biochemistry on sample: sodium 50 mmol/l, potassium 25 mmol/L, urinary urea 150 mmol/l, creatinine 3 mmol/l, proteinuria 0.2 g/l. (one or more correct answers)

The anion hole is at 16 mmol/L (excluding potassium)

The anion hole is compatible with a loss of bicarbonates in the urine

This assessment needs to be supplemented by a lactate dosage

This assessment needs to be supplemented by a dosage of ketone bodies in the blood


An arterial blood gas shows: pH 7.35, PaCO 2 37 mmHg, PaO 2 75 mmHg, alkaline reserve 18 mmol/L, lactic acid 3 mmol/L. What is your initial management? (one or more correct answers)

Alkalinization by sodium bicarbonate 84/1000

Introduction of loop diuretic to revive diuresis


Despite vascular filling, oliguria and renal failure persist. What is the main cause that may explain the acute renal failure of this patient?


The assessment you have made shows: blood count: hemoglobin 12 g / dL; leukocytes 12 G/L, neutrophils 9 G/L, polynuclear eosinophils 0.4 G/L, platelets 500 G/L. ECBU is sterile. AST at twice normal and ALT in normal values. Abdominal and renal ultrasound: right kidney 110 mm, left kidney 120 mm, absence of pyelocalicial dilation, empty bladder, normal sized liver, non-stretched gallbladder and alithiasia. What are the exact proposals? (one or more correct answers)

The presence of urolithiasis can be eliminated


The electrocardiogram performed is as follows: What are the exact proposals? (one or more correct answers)


The ECG shows atrial fibrillation with tachycardia. With the initial treatment, renal function partially improves with serum creatinine stabilizing at 140 μmol/l (DFG CKD-EPI 43 ml/min/1.73m2). Despite the analgesic treatment, the lower back pain remains intense. His blood pressure is 160/80 mmHg, his heart rate is 120/min and his temperature is 38.1°C.  You have recovered a serum creatinine of the patient, performed 2 months ago, which was 90 μmol / L (DFG CKD-EPI 74 mL / min / 1.73 m2). To advance in the diagnosis of this persistent acute renal failure and its clinical picture, what tests could you request? (one or more correct answers)


A pelvic abdomino scan was performed: What are the exact proposals? (one or more correct answers)

examination shows kidney cysts of the right kidney

Examination shows lithiasis enclosed in the right kidney

the right pyelocalcial cavities are dilated

examination shows an area of hypoperfusion of the right kidney

It is a CT scan injected at arterial time


The assessment is compatible with a renal infarction predominant on the right on atrial fibrillation. What assessment is needed in the first place? (one or more correct answers)


What care would be relevant in the immediate future? (one or more correct answers)


Context: You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.

This woman has not had a menstrual period for a year and a half. She complains of crippling hot flashes. She says she is exasperated and can no longer stand her professional activity. After discussing it with her friends, she wants "a blood test" to confirm that she is well menopausal. If she is really menopausal, what are the expected plasma hormonal changes? (one or more correct answers)

an increase in FSH (follicle stimulating hormone) levels

an increase in LH (luteinizing hormone) levels


This woman is indeed menopausal. She wants hormone replacement therapy to relieve her hot flashes. You discuss this treatment with her. What are the exact claims? (one or more correct answers)

Estrogen therapy has no impact on lipid metabolism

Progestogen therapy should be combined with estrogen therapy

Estrogen therapy may limit vaginal atrophy


The complete clinical examination during the consultation is considered normal, apart from obesity. You prescribe a laboratory work:Glycated hemoglobin (HbA1c) 7.9%Hemoglobin 11.2 g/dL (N: 12 - 16 g/dL)GFR (glomerular filtration rate) 55 mL/min (N > 60 mL/min)Creatinine 115 μmol/L (N: 35-90 μmol/L)Plasma urea 7 mmol/L (N: 2.5 - 7 mmol/L)Protein 63 g/L (N: 60-80 g/L)Total cholesterol 3 g/L (N:  1.35 - 2.5 g/L)Triglycerides 3.5 g/L (N: 0.35 - 1.4 g/L)


Her diabetes is therefore poorly balanced, she has mixed dyslipidemia and chronic renal failure. In addition, she is afraid of having osteoporosis because she complains of pain in her right knee, without any notion of trauma. These pains have been progressing for several months, with worsening in recent days. They radiate little, occur at the end of the day and prevent the patient from sitting for a long time. In view of the clinical picture, you suspect right gonarthrosis. What additional tests do you prescribe as a first line? (one or more correct answers)

computed tomography (CT) scan of the knee

magnetic resonance imaging (MRI) of the right knee


Standard knee X-rays have been taken in your patient who suffers from gonalgia. What signs are found on these pictures of the right knee? (one or more correct answers)

osteophytes of the femoro-tibial medial compartment

subchondral bone erosions at the periphery of the joint

a stress fracture of the medial femoral condyle


Gonarthrosis is confirmed, what care can you offer? (one or more correct answers)

Oral nonsteroidal anti-inflammatory drug

moderate physical activity outside of painful periods


You encouraged her to have screening mammograms despite a senological examination considered normal. This examination reveals a 10 mm lesion, spiculated, localized in the inner quadrant (IIQ) of the right breast, classified ACR 5. A mammogram of the left breast is normal. Regarding complementary breast and axillary ultrasound, what are the signs suggestive of malignancy to look for? (one or more correct answers)

clear boundaries of the tumour located in the right infero-internal quadrant

the presence of a right axillary lymphadenopathy of 15 mm

posterior strengthening of the tumour located in the right inferointernal quadrant

a hypoechoic appearance of the tumour located in the right infero-internal quadrant

orientation of the tumor, not parallel to the cutaneous plane


Breast ultrasound showed the existence of a hypoechoic tumor of 10 mm in the right infero-internal quadrant, poorly limited, with a large axenon parallel to the cutaneous plane and without associated axillary lymphadenopathy. What explorations do you prescribe? (one or more correct answers)

A positron emission tomography (PET CT) scan with 18 fluorodeoxy glucose


The patient had microbiopsies of the lesion of the lower inner quadrant. Pathological results revealed invasive carcinoma of non-specific, grade II, estrogen receptors (ER): 20%, progesterone receptors (PR): 0%, HER2: negativeWhat treatments do you prescribe? (one or more correct answers)

removal of the right axillary sentinel lymph node


The patient had a right partial mastectomy with sentinel lymph node retrieval. The pathological results objectified a non-specific invasive mammary carcinoma of 8 mm of the infero-internal quadrant; ER (30%), PR (5%), HER2 negative, Ki 67=10% and an axillary sentinel lymph nodeunharmed. External beam radiation therapy was performed on the right breast. Treatment with anti-aromatase is prescribed. What are the exact statements about this adjuvant drug therapy? (one or more correct answers)

It is associated with an increased osteoporotic risk

It is associated with an increased thromboembolic risk

It is associated with an increased risk of ovarian cancer

It works by blocking the transformation of androgens into estrogens

it is to be continued for at least 5 years


What will your annual monitoring include after the end of treatment for this cancer classified pT1bN0M0 and in the absence of any symptoms? (one or more correct answers)

Clinical examination of the right partial mastectomy scar


This woman is suspected to have a genetic predisposition to cancer. What are the exact statements about an oncogenetic consultation in his case? (one or more correct answers)

His age, on its own, is sufficient to indicate an oncogenetic consultation.

The pathological characteristics of her breast cancer, alone, are sufficient to indicate an oncogenetic consultation.

his family history of breast cancer, on its own, is sufficient to indicate an oncogenetic consultation.

in his case, a BRCA mutation may be present

in his case, a mutation predisposing to familial colon cancer syndrome (Lynch syndrome) may be present


The patient had an oncogenetic consultation and a predisposition to familial colon cancer syndrome (Lynch syndrome) was diagnosed. What are the exact claims about this syndrome (one or more exact answers)?

It is characterized by a constitutional mutation of one of the MMR genes (Mis-Match-Repair)

A prophylactic hysterectomy should be offered

A prophylactic bilateral appendectomy should be offered

A bilateral prophylactic mastectomy should be offered


A patient who is 35 weeks pregnant and 3 days pregnant is admitted to the maternity emergency room for pre-eclampsia: headache, blood pressure at 150/90 mmHg, sharp osteotendinous reflexes, normal biological assessment except proteinuria at one gram per 24 hours. What treatment(s) do you implement?

Antihypertensive treatment with calcium channel blockers


Which of the following should be included in the clinical examination of a patient with acute low back pain?


Which of the following statements is (are) accurate? Chronic kidney disease is associated with an increased risk of:


A monoclonal gammopathy of undetermined significance:

Is usually discovered during an anemia check-up

Is usually discovered during a hypercalcemia assessment

Must be monitored due to the risk of malignant transformation


A 78-year-old patient complains of right hip pain after a fall. Here is the x-ray performed, you identify:


An isolated prolongation of the TCA is observed in the following situation(s):

Preventive treatment with low molecular weight heparin


A diet rich in polyunsaturated fatty acids


Which of the following proposals evokes the secondary character of a Raynaud's phenomenon?


Regarding open-angle glaucoma, what is (are) the exact proposal(s)?

CAPM is a chronic progressive neuropathy

The incidence of CAPM increases with age

Normal intraocular pressure is defined as less than 25 mmHg

The decrease in visual acuity is early at the first signs of visual field damage

Treatment of CAPM is first-line surgical


Hydroxychloroquine is (one or more exact answers):

Treatment of joint flare-ups of systemic lupus erythematosus

A background treatment for systemic lupus erythematosus

Indicated in low-intensity early rheumatoid arthritis


You perform blood gases in ambient air to a 68-year-old man who presents to the emergency room for increased dyspnea. The results are as follows: PaO2 58 mmHg; PaCO2 64 mmHg; pH 7.35; HCO3- 35.3 mmol/L. What is (are) the mechanism(s) of hypoxemia?


Have a significant anticoagulant effect from about 12 h after taking

Are indicated in wearers of mechanical prosthetic valves in AF

Require regular dosing of anti Xa activity


What is (are) the possible cause(s) of metrorrhagia in the 3rd trimester of pregnancy?

Marginal abruption of a normally inserted placenta


A 45-year-old man consults in front of the appearance of erythematous lesions infiltrate of the right cheek appeared for a few weeks. The general state is preserved. What diagnoses can you evoke in front of this table?


In a patient in suicidal crisis, what symptom(s) is(are) in favor of a characterized depressive episode?


Hypereosinophilia at 1800 / mm3 evolving for 1 month may be due to:

Eosinophilic granulomatosis with polyangiitis


Which of the following biological explorations explores exocrine pancreatic function?


A 22-year-old woman consults for this facial dermatosis evolving for several years with recent worsening since the modification of her oral contraception. What diagnosis do you mention?


Which of the following infectious agents is responsible for blood culture negative endocarditis:


In a patient treated for 2 days for proximal pulmonary embolism with unfractionated heparin (UFH), the TCA ratio is 6 and anti-Xa activity is measured at peak activity at 1.2 Ul/mL, in the absence of bleeding, which measure(s) do you take immediately? (one or more possible answers)

A TCA ratio of 6 is very (too) high! We do not want to exceed 3 as a general rule.


Regarding osteoarthritis of the knee, what is (are) the true answer(s)?

Joint puncture is essential for diagnosis

Infiltrations by visco-supplementation are indicated in flare-ups with effusion

Surgical indication depends on the extent of joint pinching

It depends on the symptomatology (Lequesne index), which has no connection with radiology

A genu varum predisposes to medial femoro-tibial gonarthrosis

The effectiveness of corticosteroid infiltrations is limited in time


A 78-year-old former mechanic comes to consult for significant febrile inflammatory low back pain that has appeared for 10 days. You suspect spondylodiscite and decide to prescribe a lumbar MRI. This patient has a total hip replacement placed 8 years ago and a valve prosthesis for 2 years. He benefited from the placement of a coronary stent 3 months ago. It has a glomerular filtration rate of 48 ml/min. During the interrogation, he tells you that he received shrapnel in his right eye and right cheek 40 years ago. Which proposal(s) contraindicate(s) the injected MRI?


Which of the following foods contains more than 5% carbohydrates?

20% carbohydrates, for your general culture;)


A 32-year-old patient visits the emergency room for asthenia. There are no other abnormalities on clinical examination. An increase in transaminases was observed on biological examinations with AST = 1,362 IU (N<40), ALT = 2,348 IU (N<40). What is (are) the possible cause(s)?


What are the elements that guide you towards the occupational origin of allergic contact eczema in a plastics worker working in the manufacture of pleasure boats (one or more possible answers)?

The symptomatology that improves during the holidays

Localization of lesions on the backs of the hands and wrists

The presence of several simultaneous cases in the same workshop

Eczema (atopic dermatitis) should not be confused with contact dermatitis


What hygiene measures should be taken when entering the room for the management of a patient with pulmonary tuberculosis?

Wearing a respiratory protective mask (type FFP2)

Hand rubbing with a hydroalcoholic solution


A patient presents with claudication for a distance estimated at 400 meters and which results in pain in the right calf. At the clinical examination you note: the absence of edema of the lower limbs, the presence of all peripheral pulses in the lower left limb. The popliteal pulse is however ample and very easy to palpate while on the right only the femoral pulse is perceived. There is no sensory or motor disorder in the lower limbs. You finally find a left iliac murmur. Which arterial injury(s) should you suspect?


Measures of association that can be estimated in a cross-sectional etiological epidemiological study include

We are cross-sectional: we can only measure prevalence (but the two are not measures of associations).

And not the relative 👀 risk. These are the only two measures of association.


Which of the following parasitosis is transmitted through skin contact (barefoot walking, swimming) with water or moist soil?


The medical certificate describing injuries secondary to violence: (one or more exact answers)

Must mention the psychological impact of the violence on the victim

May be handed over directly to a judicial police officer if the total incapacity for work exceeds eight days

Always to the patient directly, unless minor (given to an adult) or requisition (given to the OPJ)

May be handed over directly to a third party provided that he provides proof of his link with the victim

Is handed over to the holder of parental authority if the victim is a minor

Allows to see on the medical level the credibility of the victim's remarks


You receive a consultation with a pregnant woman for the morphological ultrasound of 22 weeks of amenorrhea. Her couple has no family history. Fetal growth is normal. She received combined screening in the first trimester with a risk of trisomy 21 calculated at 1/10,000. The only peculiarity is fetal intestinal hyperechogenicity. What is the exact proposal(s)?

This is a call sign of a viral infection

This sign is frequently encountered in heterozygous fetuses for a severe mutation of the CFTR gene.

Priority is given to heterozygosity testing for 2 parents

Priority is given to amniocentesis for testing for mutations in the CFTR gene in the fetus


Cite the potential consequence(s) of a drug combination with a cytochrome P450 3A4 inducer drug:

Rhabdomyolysis in the presence of certain statins


Molecular biology analyses as part of the histopathological diagnosis of a tumor (one or more exact answers)

Can be taken from tissue samples fixed and included in paraffin

can be made on non-fixed tissue samples coogeled at - 80 ° C

can be done on cell smears in liquid medium

Require morphological control of tissue sampling

require a signed authorization from the patient


Adenocarcinomas are a common histological type of cancer: (one or more exact answers)


Regarding generalized amyloidosis it is true that: (one or more possible answers)

Accessory salivary gland biopsy is a preferred biopsy site

Transparietal liver biopsy is a preferred biopsy site

The coloring by congo red is done on fixed fabric

AL amyloidosis is linked to lambda light chain deposits

AL amyloidosis may be related to monoclonal gammopathy of undetermined significance (MGUS)


You take care of Mrs. D., 28, who consults for febrile meningeal syndrome without signs of neurological focus. As part of your diagnostic strategy, you decide to perform a lumbar puncture. As an operator, which proposal(s) is(are) accurate?

Wearing gloves is a measure to prevent accidents involving exposure to blood or body fluids

A disinfection of your hands must be carried out after the performance of the gesture

⚠ Recurrent trap: only inert surfaces are DISINFECTED. For living surfaces, ANTISEPTIC or STERILIZED. It is not the same term. The proposal is therefore false.

The disposal of the needle in a container for a puncture, cutting or cutting object is a risk prevention measure a posteriori

Here is the memo sheet of the HAS concerning the lumbar puncture where we find the answers to this IQ: https://www.has-sante.fr/upload/docs/application/pdf/2019-07/fm_ponction_lombaire.pdf 👉 It is advisable to read it ++


Regarding septic arthritis on native joint (without prosthesis), which is (are) the true proposition(s)

The germ most often involved is streptococcus

Joint lavage is systematic in therapeutic management

Antibiotic therapy often involves a combination of 2 antibiotics

Bacteriological diagnosis can be made on blood cultures

The duration of antibiotic therapy is 12 weeks

3 months is a little bit much 😯. Most often, the total duration is around a month and a half (4 to 6 weeks).


A 27-year-old patient has an abnormal blood count. The results of this report are as follows:

Hb 13 g/dL;
 VGM 86;
 blisters 310 g/L -
 leukocytes 12 g/L -
 neutrophils 3.7 g/L -
 eosinophilic polynuclear 6 g/L -
 basophil polynuclear 0.08 g/L -
 lymphocytes 1.6 G/L
 monocytes 0.5 G/L.

The patient has never travelled and has no significant history. She complains of pruritus that has been progressing for a few weeks, without associated skin lesions. There is no other functional sign at the interrogation. Which diagnostic hypothesis(s) should you mention in front of this clinico-biological picture? (one or more expected answers)

Hypereosinophilia atopy 👉 less than 1.5G/L.

Common cause of autochthonous eosinophilia.


You see a 38-year-old patient who would like to be able to quit smoking cIgArettes. His father has just died of bronchial cancer. The patient started smoking at the age of 14. He studied at a vocational high school. He currently smokes 2 packs a day. Its overall smoking is estimated at 40 pack-years. In the morning as soon as his alarm goes off he turns on a cIgArette. He sometimes smokes in the shower which is not easy. He drinks alcohol only occasionally. He would like nicotine substitutes that he has heard about. Which proposals are correct? (one or more correct answers)

The patient has a strong pharmacological dependence on nicotine

The notion of 40 smoked pack-years (PA) indicates that weaning will be difficult

There is no demonstrated link between APs and difficulty weaning.

The amount of tobacco smoked per day is the main risk factor for bronchial cancer

Alcohol consumption, even controlled, is a risk factor for relapse of smoking

The prescription of nicotine substitutes will require a dosage close to 40 mg / day


Regarding myasthenia gravis, which is (are) the exact proposal(s)?

Involvement of the oculo-palpebral musculature is usually asymmetrical

The fatIgAbility of the cervical muscles is classic

Motor involvement predominates on the distal muscles


A 67-year-old patient, type 2 diabetic, is followed in nephrology for diabetic nephropathy. Her ambulatory blood pressures are 151/89 mmHg on average (diurnal). She has edema of the lower limbs. Its biological balance finds a serum creatinine 2), a serum potassium level of 5.1 mmol / L, an alkaline reserve of 170 μmol / L (DFG CKD EPI 25 ml / min / 1.73m to 19 mmol / L, proteinuria at 1 g / g creatinineuria. She is treated with metformin, ramipril and cholecalciferol. What therapeutic measures should be taken in this patient? (one or more correct answers)


You ask a 63-year-old patient, whose BMI is 29 kg/m^2, to reduce his dietary intake of saturated fatty acids because he has just been diagnosed with type 2 diabetes.
Which of the following foods should be targeted for to reduce daily intake of saturated fatty acids?


You are called as an expert in a potentially criminal story of hypoglycemia in a type 2 diabetic patient, who was found in a coma at his home and eventually died in hospital of a massive stroke. The SAMU doctor had taken a sample which could be technical later, the results of which are as follows: • blood glucose: 2.2 mmol / L - • insulinemia: 50 μU / ml (normal values on an empty stomach: 5 to 15 μU / ml); • C-peptide: 3 nmol/L (normal fasting values: 0.4 to 1.2 nmol/L).

His wife is suspected of having caused this coma. Given the elements at your disposal, which of these therapeutic classes could have been used to obtain this biological and clinical assessment?

Glucazides (sulfonamides) are hypoglycemic insulin-secretors. They cause an endogenous release of insulin, which corresponds well to this situation.


A 32-year-old patient, with no history, a dynamic executive leaving for a business trip to the United States in 48 hours, complains of heartburn. He is seeing a gastroenterologist today. The clinical examination is unremarkable. Upper gastrointestinal endoscopy is indicated. The patient wants it to be performed under general anesthesia. What is the true proposal(s) if the anaesthetist is immediately available to see the patient?

Endoscopy can be performed the day after tomorrow early in the morning before travel

Endoscopy can be performed the day after tomorrow if the trip is cancelled

Endoscopy can be performed within 72 hours


Which teeth can cause chronic right purulent maxillary sinusitis? (one or more expected answers)

It is a bit far from the maxillary sinus! Only the molars and premolars are close enough to be able to give maxillary sinusitis.


Regarding osteoporotic fractures, which proposal(s) is (are) right?

The decrease in the height of the individual may be the only witness of osteoporotic vertebral fractures

Vertebral fractures are often very symptomatic

Femoral neck fractures are associated with significant excess mortality


Regarding hemorrhoidal pathology, which proposal(s) is(are) true?

Hemorrhoidal prolapse corresponds to the externalization of internal hemorrhoidal packages through the anus

Symptomatic hemorrhoids are a risk factor for degeneration into squamous cell cancer

Whether they are symptomatic or not does not come into play.

Acute hemorrhoidal thrombosis can be incised urgently to evacuate a clot

In case of hemorrhoids responsible for rectal bleeding evident on clinical examination in a 65-year-old man, colonoscopy is not essential

It is necessary to operate all symptomatic hemorrhoids


This 5-year-old child is taken by his parents to the pediatric emergency room for a rash that appeared for 2 days and has since spread. The lesions are present all over the body, they are itchy. There is hyperthermia at 38°5C.  The examination of the health record is without particularity and the mandatory vaccinations are up to date. What is your diagnosis?


A young patient of 28 years comes to see you for consultation. He is of Malian origin, arrived in France 2 years ago. He consults for pain at the time of urination radiating to the anus evolving for 6 months. It also exhibits diurnal and nocturnal pollakiuria at more than 20 urinations per day. He occasionally describes right lower back pain. The clinical examination does not find any abnormality on inspection or palpation. The digital rectal exam is normal. He is 1m94 tall and weighs 79 kg. Heart rate is 62/min and BP is 110/78 mmHg. Cytobacteriological examination of urine reveals: white blood cells 10/mm 3, red blood cells 25,000/mm 3, no bacteria on direct examination or culture. What is your main diagnostic hypothesis?


You are reviewing the publication of a double-blind, multicenter randomized clinical trial. The objective of this trial was to evaluate the efficacy and safety of a novel monoclonal antibody, directed against a pro-inflammatory cytokine produced by neutrophils, in subjects hospitalized with SARS-CoV-2 infection, oxygen-dependent but not in the context of resuscitation. Which of the outcomes assessed is which one do you think is clinically relevant?

Evolution of the viral load measured on nasopharyngeal swabs between the 1st day and the 10th day of hospitalization

Evolution of the blood neutrophil level between the 1st day and the 10th day of hospitalization

Transfer to intensive care for acute respiratory distress syndrome at 30 days


A doctor tells a patient about metastatic cancer. Throughout the constutiation, he held a very technical speech, rich in medical terms preventing a real dialogue with the patient. What "psycho-adaptive" mechanism does this doctor's behavior correspond to? (only one answer expected)


You come back to see at his home Mr G, 83 years old, for whom you had already been asked for a rebellious cough. Mr G lives with his 56-year-old daughter, a switchboard operator, and his 26-year-old grandson, a mechanic. Mr G and his daughter have not received a vaccine for at least 20 years. Her grandson is completely up to date with his vaccination schedule. Mr G plays belote at the senior club on Thursday afternoons with a 79-year-old friend with respiratory insufficiency who has always refused vaccinations. You had thought of the possibility of whooping cough, which has just been confirmed while it has now been 2 weeks that he coughs. You decide to treat Mr G with 3 days of azithromycin. In addition to this treatment, what proposal(s) do you retain?

Prescription of 3 days of azithromycin to her daughter

Prescription of 3 days of azithromycin to his grandson

Prescription of 3 days of azithromycin to his belote partner


You receive a 35-year-old patient with facial pain and left purulent rhinorrhea. What associated signs or symptoms would be in favor of frontal sinusitis? (one or more expected answers)

filling of the inner angle of the eye (eyelid edema)


A 16-year-old girl expresses suicidal thoughts. Which of the proposals concerning these suicidal ideation expressed is(s) the exact proposal(s)?

they are an indication for antidepressant treatment

they often indicate a personality disorder

they specifically affect adolescents in precarious social situations


Mrs. O, aged 32, is hospitalized in intensive care at the request of her obstetrician whom she has just consulted for marked edema of the lower limbs of progressive installation over a week. She complains of shortness of breath when she goes to bed at night for 72 hours. It is primiparous, at 32 weeks of amenorrhea. His vital parameters when he arrived in the department are as follows: blood pressure at 170/130 mmHg, heart rate at 110/min, respiratory rate at 20/min for ambient air saturation at 92%. The urine strip performed in obstetrics consultation showed proteinuria +++. She complains of frontal bar headache and blurred vision. The osteotendinous reflexes are lively and polykinetic to the 4 limbs. You do not yet have the results of the biological work-up taken in obstetrics. The fetal heart rhythm is normal. Regarding the management of this patient, which proposal(s) is (are) accurate?


Which symptom(s) can (can) lead to a diagnosis of amyotrophic lateral sclerosis?


You receive a 17-year-old girl who has no particular history in consultation for information on contraception. During your clinical examination, you note the following: height 156 cm, weight 52 kg (BMI 21.4 kg/m2). Its pubic hair is not very abundant and its breast bud is not developed. There is no axillary hair, no acne or hyperseborrhea. She tells you she never had her period, but hasn't worried about it so far because her mom got her period late. Which diagnostic hypothesis(s) do you think are compatible with this table?


The management of a steady-state COPD patient with FEV1 at 65% of the predicted value and daily exercise dyspnea and no history of COPD exacerbation is based primarily on: (one or more exact answers)


You are taking care of a 27-year-old patient, a community cook, who has suffered a severe trauma responsible for a serious head trauma, a multifragmentary fracture of the right femoral diaphysis osteosynthesized by a centromedullary nail. He has complete stiffness in his right knee. He has right hemiparesis without hypertonia but can mobilize his hemibody without much difficulty. The rating according to the MRC scale (medical research council) is generally between 3 and 4 on the right hemibody. On the other hand, he has cognitive impairment and remains very confused. It is still mainly fed by nasogastric tube. Initial feeding tests were attempted by the nurse. Which proposal(s) is (are) the exact proposal(s)?

After the care phase in neurosurgery and orthopedics, you feel that the optimal orientation is in neurological follow-up care.

The recovery of knee flexion is essential for its walking autonomy especially for stairs

If he has to work again, the recognition "disabled worker" is to be requested from the vocational training center for adults

The swallowing assessment requires the expertise of a speech-language pathologist

Muscle strengthening of the thigh is essential to recover knee mobility


A 42-year-old woman consults for meno-metrorrhagia evolving for several years. Adenomyosis was diagnosed. Various treatments have been tried without success (oral progestogens, levonorgestrel-releasing intrauterine device, hysteroscopic endometrectomy). Laparoscopic hysterectomy is considered. What information(s) do you give him about this intervention?

bilateral oophorectomy should be combined


About fragile X syndrome, what are the exact answers? (one or more correct answers)

Fragile X syndrome is a cause of intellectual disability in boys

It is a disease related to an expansion of trinucleotides in the non-coding region of the FMR1 gene

The diagnosis of certainty of fragile X syndrome is made on a chromosomal analysis

Clinical expression results from overexpression of the FMR1 gene


A 70-year-old patient presents to the emergency room with chest pain and dyspnea. The imaging examination performed is:

Magnetic resonance imaging after iodinated contrast medium injection

Magnetic resonance imaging without iodinated contrast medium injection

A CT scan after injection of iodinated contrast medium

CT, unlike MRI, allows you to see the bones much more strongly. The injection is recognized because there is a difference in density between the arteries and veins.

A CT scan without injection of iodinated contrast medium


A 71-year-old patient, hypertensive, hypothyroid receiving opo replacement therapy, consults you for significant pain of the right hemiface. You suspect neuralgia of the right trigeminal. What is (are) the proposal(s) evocative of the diagnosis?


Regarding this chest X-ray of a 6-month-old child performed due to a febrile cough, what is (are) the exact proposal(s)?

It is the thymic lodge that gives this opacity


Mr. X., 66 years old, is a carrier of a subrenal abdominal aortic aneurysm measured 3 months ago at 40 mm anteroposterior diameter. He presents to the emergency room for the occurrence of acute abdominal pain. On clinical examination, the pulse is 88 bpm, blood pressure is 134/68 mmHg in both arms. What action do you propose to take in this patient? (Only one exact proposal)

Arteriography of the aorta and lower limbs in emergency

Emergency exploratory laparotomy without prior imaging

X-ray of the abdomen without emergency preparation


Researchers are interested in the relationship between disease M and exposure E. To this end, they constitute a cohort representative of their population of interest. At the end of the 10 years of follow-up, 300 subjects became ill. The results are summarized in the contingency table below. About this study: (one or more correct answers)

The risk in exposed is increased by 100% compared to the risk of non-exposed

The cumulative incidence of the disease is equal to 0.15 in the sample


Which of the following clinical signs is a criterion(s) for hospitalization of a 15-year-old girl with anorexia nervosa?


You see in consultation a 32-year-old man who has a complete sensorimotor paraplegia of level T6 following a bicycle accident dating back several years. He is concerned about a right ischial redness present for 3 weeks. Regarding this lesion:

A preventive surgical procedure is recommended


In children, antibiotic prophylaxis in infective endocarditis is recommended in case of ?


X-ray of the front chest performed as part of an asthenia assessment in an 11-year-old child. What is the exact proposal(s)?

There is a systematized alveolar opacity


A 52-year-old patient consults you for diarrhea consisting of 6 to 8 watery stools per day, including two nocturnal ones, associated with urges. Since the onset of these symptoms 6 months earlier, the patient has lost 3 kg. There is no abdominal pain. The patient has pyrosis treated with lansoprazole, high blood pressure treated with amlopidine and diabetes treated for 2 years with glibenclamide. Which factor(s) may be responsible for this diarrhea?


Regarding the pre-resumption visit carried out by the occupational physician, it can be carried out on request (one or more possible answers):


About trisomy 21 syndrome: (one or more exact answers)

His diagnosis is usually carried out in the balance sheet of a delay in school acquisitions.

Intellectual disability is usually profound

A majority of patients are able to acquire reading

The most common digestive malformation is atresia of the duodenum


Psychiatric comorbidities affect 50 to 75% of patients with behavioral addictions

Behavioral addictions are disorders of multifactorial origin most often

There is no known therapeutic management today, apart from benzodiazepines

The therapeutic management of behavioral addictions must be multidisciplinary, involving doctors, psychologists and social workers

Behavioral addictions are characterized by the inability to control a behavior despite the occurrence of negative consequences

Given the recent and emerging nature of these disorders, the diagnostic criteria for most of them are currently not defined in a consensual manner.


Benign prostatic hyperplasia (BPH) is a common pathology favored by aging

The digital rectal examination (DRE) finds a large prostate (> 20 g), firm, very painful, smooth, irregular, with disappearance of the median fold

There is a large prostate (> 20 g), firm, INDOLORE, smooth, REGULAR, with disappearance of the median sulcus

TR is also an opportunity to screen for prostate cancer

The main chronic complication is erectile dysfunction

No report. Chronic complications are chronic bladder retention, bladder lithiasis and chronic obstructive renal failure.

A PSA level > 4 ng / mL is an indication to perform prostate biopsies with histopathological examination unless the TR finds a prostate > 20 g

Despite the increase in PSA with prostate volume, a PSA level > 4 ng/mL is an indication for prostate biopsies with histopathological examination


Which of the following are true about basal cell carcinoma?

These are indeed carcinomas (= cancer = malignant tumor)

They can be fatal depending on the area where they are located. Their complications (ulceration, bleeding, ...) are not to be taken lightly and require treatment.

The most common treatment is excision surgery


Which of the following is the main precursor of mucosal squamous cell carcinomas?

It is the main precursor of cutaneous squamous cell carcinomas

True, by keratinization of the mucosa (especially the lower labial). These are very limited whitish lesions, asymptomatic, adherent and not bleeding on contact 💉. Curative treatment is surgical.

Bright red erythematous lesion of the glans, well limited, sometimes discreetly erosive ➡ it is a carcinoma in situ

Papular lesions localized on the genital areas and related to HPV. So these are STIs. They promote the development of mucosal carcinomas when it is bound to oncogenic papillomaviruses.


Which of the following are true about ventricular septal defect?


Regarding the murmur of the ventricular septal defect. Which of the following are true?

The breath is more intense if the CIV is large

The breath is more intense if the CIV is small.

Mesosystolic murmur is characteristic of aortic stricture


Which of the following are contraindications (IC) to the insertion of an intrauterine device (IUD)?

No longer an IC (watch out for possible consequences, including ectopic pregnancy)

Valvular heart disease at risk of endocarditis


Seizures can start at any age, but 90% start before age 40

The pathophysiology of migraine involves complex genetic factors

Migraine with aura has no impact on comorbidities

Migraine with aura is an independent risk factor for cerebral infarction especially in women under 45 years of age

Migraine without aura is never preceded by prodromes

The crisis is often preceded by prodromes: irritability, asthenia, drowsiness, hunger, yawning

Migraine with aura is preceded or accompanied by transient neurological symptoms that gradually set in


Sexual exhibition is the act of imposing a sexual exhibition/genitals in the public view of a person or group

The competent court is the criminal court

Limitation period: 3 years 2. SUPPORT 2.1. GENERAL Emergency:


Vulnerability to a disorder is a characteristic of a social group

It is an individual characteristic, linked to the fact that the so-called "vulnerable" person has or has been exposed to one or more genetic and/or environmental risk factors.

Some risk factors for psychiatric disorders are more particularly related to the age of the individual

Adolescence is a particularly critical period

There are no known risk factors for schizophrenia

Several risk factors are associated with an increase in the prevalence of schizophrenia such as the age of the father at birth, social and economic status, maternal stress during pregnancy, child abuse, etc.

Relatives of patients with schizophrenia are more sensitive to risk factors


What are the factors of psychiatric pathologies?

However, sports hyperactivity can be concomitant with certain pathologies, such as TCA, without these being recognized risk factors


What are risk factors for schizophrenia?


The choice of treatment used depends on the cause and type of pain

Neuropathic pain and nociceptive pain are of the same type

Analgesic drugs are used only to treat neuropathic pain

Analgesic drugs (or analgesics) are used to treat nociceptive pain are classified into three levels by the World Health Organization. Tramadol & morphine can be used also (https://www.sfetd-douleur.org/wp-content/uploads/2019/06/main.pdf)

The term 'analgesic' is frequently used for level 1 drugs available in self-medication by the patient (paracetamol, nonsteroidal anti-inflammatory drugs)

The term "analgesic" (etymologically "pain-suppressing") refers to WHO Level 3

The term "analgesic" (etymologically "pain-suppressing") can be used for any analgesic drug, even if the etymology sometimes lacks "modesty"


Among these proposals, which correspond to elements of the standard etiological assessment of precocious puberty:

Thumb sesamoid of the non-dominant hand = puberty

As well as a GnRH stimulation test that is possible in girls


Morsier's Kallmann syndrome is associated with impaired sense of smell

A hypothalamic-pituitary MRI is necessary in the etiological assessment to rule out an organic cause

The cause of delayed puberty is always organic

The cause of delayed puberty may be functional, e.g. nutritional

Respiratory failure can lead to delayed puberty

Celiac disease cannot cause delayed puberty


Impetigo is an infection of the epidermis due to a streptococcus most often

The diagnosis of impetigo is microbiological

Grouping multiple lesions can result in polycyclic closets with circined contours

The classic localization is, in children, the perimeter of the mouth, but all areas of the skin can be affected


Among these proposals of histological types, which correspond to malignant tumors?


The Bosniak classification makes it possible to differentiate benign cysts from malignant cysts

The Bosniak classification has 5 categories

4. The first two tend towards benignity (and the last two tend towards malignancy)

The resulting grading greatly influences the action to be taken

Ultrasound is the reference examination for the extension assessment

Kidney tumors are discovered by chance in 50% of cases

According to the College of Urology, in about 80% of cases


Interesting radiological signs can be found

Endoscopy is the second-line examination, after CT angiography


Which of the following proposals regarding screening are true?

Screening should only be carried out systematically when the patient discovers a suspicious mass on self-examination.

They are proposed in the absence of clinical signs, on criteria of sex and age

Organized mass screening is offered every two years to women aged 50 to 74 when they are at high risk for breast cancer

Organized mass screening is for all women aged 50 to 74, even without risk factors. In case of risk factor (high risk), patients should be screened individually.

Individual screening is for women who are at high risk of breast cancer

Organized mass screening is for patients with a BRCA1/2 mutation

For the latter, it is an individual screening that is indicated

Organized mass screening is performed by bilateral mammography, with a minimum of two incidences and with double reading


Adjuvant radiation therapy increases overall survival in patients

The goal of radiotherapy is to reduce the risk of loco-regional relapse

Skin cancers are among the acute side effects

Telangiectasias may appear several years later


Which of the following proposals should be sought for clinical examination in glomerular nephropathies?

Vascular involvement would rather point to vascular nephropathy

True, may suggest GI/rheumatoid purpura nephropathy (GNRP type 2)

True, may suggest rheumatoid purpura or lupus (GNRP type 2)


Mycobacterium tuberculosis is an acid-alcohol-resistant cocci

Mycobacteria of Mycobacterium tuberculosis complex (MTBC), acid-alcohol-resistant bacillus (BAAR)

Transmission of tuberculosis is air-to-human.

Histology contains an epithelioid and gigantocellular granuloma with caseous necrosis

The main lung lesions are pulmonary cave type

Additional droplet precautions should be applied in case of suspected tuberculosis

Additional precautions "AIR", single room


Which of the following propositions are true regarding the onset of abdominal pain and vomiting in a patient treated with IREP for 6 weeks?

The determination of ALT/AST is essential

Isoniazid may be responsible for hepatic cytolysis, peripheral neuropathy and mental disorders

Oral should be replaced with intravenous

Pyrazinamide may be responsible for symptoms

True. Hepatic toxicity and possible hyperuricemia


There is no correlation between serum lipasemia levels and pancreatitis severity

The diagnosis of BP is considered certain when a combination of typical pain and elevation > 3 N of lipasemia

If the lipasemia test is performed 48 hours after the onset of pain, it may be less than 3 N

In case of diagnostic certainty, imaging makes it possible to assess the immediate severity

In case of diagnostic certainty (association pain and typical biological abnormality), no imaging examination is useful for the positive diagnosis and imaging will be performed within 48 to 72 h

Only a CT scan should be done in case of diagnostic doubt in the absence of contraindication


If the patient is dehydrated, the injection of contrast medium should be avoided and a CT scan should be done without injection

the CT scan with contrast injection should be done a few days later to assess the severity of BP (cf.

Abdominal ultrasound is of interest for the diagnosis of severity

Abdominal ultrasound has no interest for positive diagnosis or severity

Ultrasound for the diagnosis of vesicular lithiasis and must therefore be done very quickly (as soon as the patient is admitted), and systematically

Abdominal X-ray without preparation has no interest


• Severe AP is associated with significant mortality

Multidisciplinary management involving the emergency physician, surgeon, anaesthetist-resuscitator, radiologist and microbiologist is necessary

BP is defined as acute pancreatic inflammation that can affect nearby or distant organs.

Lesions are associated with interstitial oedema, cytosteatonecrosis, necrosis of the pancreatic parenchyma or surrounding tissues

The severity of pancreatitis is defined by the existence of at least three organ failures or a local complication such as necrosis, abscess or pseudocyst

The severity of pancreatitis is defined by the existence of one or more organ failures or a local complication such as necrosis, abscess or pseudocyst


Antibiotic therapy targeting commensal bacteria of the digestive tract (mainly enterobacteriaceae, streptococci and anaerobes) has an adjuvant role and may be brief once the surgical procedure has been performed.

Antibiotic therapy is to be started as soon as blood cultures are carried out

Enterococci is not taken into account in the probabilistic treatment of community peritonitis, its pathogenic role is not formally demonstrated

Whatever the result of microbiological samples, the spectrum of antibiotic therapy must always include anaerobic bacteria, because of their frequency and their difficulty of isolation in the laboratory.

Amoxicillin – clavulanic acid probabilistic monotherapy is the treatment of choice

Amoxicillin – clavulanic acid has no place in probabilistic monotherapy, because of the frequency of acquired resistance of enterobacteriaceae (a quarter of E coli)


Concerning venous surroundings and their complcations

The number of manipulations of the injection routes and aseptic errors on these routes protects against infection

Obviously the number of manipulations of the injection routes and the aseptic errors on these routes or worse during the preparation of injectable drugs will promote this contamination.

On the other hand, the catheter cannot be contaminated by hematogenous route during a bacteremic episode

Finally, the catheter, like any device implanted in the body, can be contaminated hematogenous during a bacteremic episode.

These central line infections are serious since it is estimated that mortality attributable to intensive care units is in the order of 30%.

These central line infections are serious as mortality in intensive care units is estimated to be in the order of 3%.

An infection can occur early in the subcutaneous compartment of the chamber catheter box which will require its replacement


Antibiotic treatment uses C3G as a first-line treatment, which is the most active molecule on pneumococcus

Antibiotic treatment uses first-line amoxicillin, which is the most active molecule on pneumococcus

Except the rare necrotizing otitis externa due to Pseudomonas aeruginosa (mainly on diabetic ground)

Cholestomatous otitis is most frequently of infectious origin

Management of cholestoma ear infections is surgical

Purulent acute otitis media corresponds to acute bacterial superinfection of the middle ear


Which of the following is the recommended duration of antibiotic therapy for acute otitis media in children over two years of age (with severe symptoms)?


Regarding walking disorders in Parkinson's disease:

It is not specific to Parkinson's syndrome. It is also found in chronic hydrocephalus in adults and in incomplete conditions.

Feast = when the patient runs after his center of gravity

Freezing (trampling on the spot) appears at the beginning of the evolution of Parkinson's disease


Is or are causes of walking disorders with small steps:

In a person with careful walking and phobia of falling


What anomaly(s) is/are likely to cause lameness by greeting?

By a loss of strength of the quadriceps muscle

Because it is impossible to control the active extension of the knee

This causes a hip extension defect (need for a 10° extension for normal walking)


20% of patients who are admitted to intensive care die

17 25% of deaths according to the College of Pain Pal Care

A quarter of patients who die are due to a decision to limit/stop active therapies

Basic comfort and supportive care should be discontinued at the same time as active therapies

If it is possible to interrupt certain active therapies (curative or substitute), basic comfort and supportive care should always be continued.

Unreasonable obstinacy is defined as the initiation or continuation of a curative therapy or a diagnostic strategy that is unnecessary and/or unjustified.

Palliative care has no place in intensive care because patients are unconscious


The intention of the decision is not to cause death but to let the physiological process take place without technical or drug intervention deemed of no benefit to the patient.

The cessation of active therapies is defined by the interruption of one or more treatments including organ replacement techniques ensuring artificial life support

The decision to limit or stop active therapies is a cessation of care

The decision to limit or stop active therapies is in no way a cessation of care and abandonment of the patient: comfort care, pain management, etc.

Financial or structural arguments (need for resuscitation space) have no place in decision-making


Regarding vestibular nystagmus and vestibular examination:

Vestibular examination is based on the detection of oculomotor abnormalities and vestibular ataxia

Nystagmus is a totally irregular eye movement back and forth of the eyes

It is regular and composed of at least one slow phase

The direction of beating of a nystagmus is given by that of the rapid phase

Convention because more instinctive under consideration

Vestibular nystagmus appears only in the eccentration of the gaze

Vestibular nystagmus may be spontaneous in the position of the gaze straight ahead, or appear only under certain search conditions: eccentration of the gaze: peripheral vestibular nystagmus is often found in the direction of the rapid phase

Peripheral vestibular nystagmus is attenuated by eye fixation


Which of the following proposals can confirm the diagnosis of chronic lymphocytic leukemia?

True, essential for diagnosis in addition to NFS

Lymphocyte analysis by molecular biology


Which of the following are possible evolutions of CML (Chronic Myeloid Leukemia)?

True, after 12-18 months of chronic phase

Transformation to acute lymphocytic leukemia

In MLL most often. But ALL is also possible

Transformation into myeloid splenomegaly


In CML, there is no increase in hemoglobin

There is polycythemia in essential thrombocythemia

No, it is a criterion of distinction with primary polycythemia (or polycythemia vera)

Sedimentation Rate (ESR) is falsely zero or very low in polycythemia vera

True, because of the large excess of red blood cells and the hyperviscosity induced by them

Hydroxycarbamide gives quite frequently mucocutaneous lesions

Ruxolitinib is a kinase inhibitor targeting JAK1 and JAK2


Regarding carbohydrate metabolism hormones:

Insulin is the main hyperglycemic factor

Insulin is one of the only hypoglycemic hormones, its concentration rises after the meal and decreases during fasting

iGF 1 and iGF 2 are growth factors with hypoglycemic properties when their concentrations are very high (pharmacological or tumoral)

IGF2 is hypoglycemic at supraphysiological concentrations


Regarding the assessment of the severity of impairments:

During paraplegia, the functioning of the upper limbs is preserved, but depending on the level of the lesion, the trunk, lower limbs and pelvic organs can be affected.

Standardized assessment of incomplete lesions based on ASIA standard

The rating (from 0 to 5) of each muscle/key function is done according to the motor testing of the Medical Research Council or MRC is part of the ASIA standard

– grade B: preservation of a sensory function but not of the motor function at the level of the last sacral segments (S4-S5)

– grade D: motor preservation below the neurological level of the lesion with at least half of the key muscles with a rating greater than 3


Diarrhoea occurring during antibiotic treatment is by definition antibiotic diarrhoea

More than 10% of subjects receiving antiobiotics have transit changes

In front of a dysenteric syndrome, it is necessary to prescribe a CRP, a stool culture and a blood count

In front of any diarrhea the signs of dehydration should be sought

Acute diarrhea is nosocomial when it occurs within 2 days of admission

must occur more than three days after admission


Which of the following proposals are part of the initial management of common low back pain?

No additional examination in the absence of a red flag

No rest to prescribe. The latter only seems to increase the duration of low back pain


Which of the following are differential diagnoses of coma?

True, lesions of the foot of the protrusion

True, bilateral internal or peduncular frontal lesions

Post-critical phase of a comitial crisis

True, << the simulation of disorders of consciousness is not exceptional >> according to the college, but it is necessary to be << extremely rigorous>>


From what value of the Glasgow score are we talking about Coma?


Which of the following proposals regarding Renal Puncture-Biopsy (PBR) are true?

Severe hypertension is a contraindication to PBR

Always indicated, unless typical presentation

This is an emergency in rapidly progressive glomerulonephritis (GNRP)

Complications of PBR can, very rarely, go as far as the death of the patient


Taste, smell and vision are achieved with the same intensity with aging

Anorexia, then Weight loss, then Asthenia

A hearing impairment can lead to cognitive disorders

Vision impairment can lead to depression

There are no effective treatments for these neurosensory disorders


Which of the following are complications of nasopharyngitis?


Alcohol increases the epileptogenic threshold

Alcohol lowers the epileptogenic threshold

Gayet-Wernicke encephalopathy is due to vitamin B1 deficiency

Wernicke-Korsakoff encephalopathy is due to vitamin B1 deficiency

Be careful, Gayet-Wernicke encephalopathy is also called Wernicke-Korsakoff (not to be confused with Korsakoff syndrome)

Myelinosis centropontin is due to vitamin B9 deficiency

Centropontin myelinosis is due to too rapid correction of deep hyponatremia

Pellagrean encephalopathy is due to vitamin B12 deficiency

Pellagrese encephalopathy is due to vitamin PP deficiency (= Vitamin B3)