Regarding the questioning of the family:

A maternal age > 35 years induces an increased risk of malformation and trisomy 21

Nephropathies and diabetes have no consequences on the fetus if they are balanced

If, in several ways: the drugs used, silent decompensations, the impacts of nephropathies that are difficult to balance, etc.

Feto-pelvic disproportion is a common source of perinatal anoxia

The duration of pregnancy is determined from the onset of sympathetic signs (nausea, breast thickening, etc.)

The duration is arbitrarily determined in completed amenorrhea (AS) weeks


Regarding the postpartum interrogation of pregnant women:

Maternal infection in the 1st trimester puts at risk of malformative embryopathy

Oligohydramnios is a sign of pulmonary hypoplasia or osteoarticular deformity

Hydramnios may be explained by lack of control of gestational diabetes

An anamnios may be a consequence of esophageal atresia

Atresia of the esophagus results in hydramnios


Regarding amniotic fluid and immediate care:

Amniotic fluid is physiologically tinted

Greenish amniotic fluid may indicate meconium emissions in utero

Physiological amniotic fluid has no particular odor

A liquid with a fetid odor can point to a risk of maternal-fetal infection

From birth, it is necessary to assess the condition of the child to initiate adapted resuscitation gestures if necessary


What is the Agpar score of a newborn at 85 bpm, with normal breathing, pink skin color, hypotonic, who screams loudly?

It's 8 (85bpm = 1, breathing = 2, pink = 2, hypotonic = 1, cries = 2)


Morrison's score makes it possible to instantly judge the condition of the newborn

It is the Apgar score that makes it possible to judge instantly the condition of the newborn and guides the action to be taken

Agpar's score is assessed at 1 and 10 minutes postnatal

If the Apgar score is greater than 8 to 1 minute: the newborn is healthy

An agpar score of less than 3 to 1 minute implies emergency management

The assessment of the condition of the newborn and the practice of resuscitation gestures must be done with the child lying on a heated and illuminated table


Checking the permeability of the choanas, esophagus and anus is to be carried out urgently postnatally

Checking the permeability of the choanas, esophagus and anus should be systematic before leaving the delivery room but not necessarily urgently from birth

The verification of the permeability of the orifices is done in particular by flexible probe

Administration of eye drops prevents Staphylococcus aureus conjunctivitis

Administration of eye drops prevents gonococcal conjunctivitis and vitamin K1 2 mg orally prevents hemorrhagic disease of the newborn

The initial examination must be done between the 3rd and 8th day of life

The initial examination must be done during the first hours of life, at best before leaving the delivery room

At birth the skin is covered with an adherent whitish coating called vernix caseosa


Regarding the initial clinical examination of the newborn:

Peeling of the skin during the first few days is a sign of a skin infection that must be treated urgently

During the first days a more or less extensive desquamation appears, its evolution is spontaneously favorable

Simple hydration may be necessary in case of crevices in the folds

A mild rash made of minimal vesicles of the "toxic erythema of the newborn" type may occur within the first 3 days, and disappears spontaneously


What is the threshold for heartbeat APGAR from 1 to 2?


Which of the following are part of the Guthrie test?


Which of the following are part of the APGAR score?

True, threshold at 100 (2 if beyond, 1 if below)

True (Overall blue = 0 / blue ends = 1 / overall pink = 2)

False. Does not fit into APGAR's score. It is one of the 6 archaic reflexes.


Which of the following proposals designate the two germs most often involved in a maternal-fetal infection in a full-term newborn?


Which of the following are risk factors for poor adaptation to ectopic life?

Severe gestational hypertension of the mother


What pathologies are detected at birth by the Guthrie test?


Regarding anti-thrombotics, which proposals are true?

Heparins are sulfated polysaccharides of varying size

Unfractionated heparins (UFH) are of porcine origin

UFHs, like LMWHs, have anti-IIa and anti-Xa action. It is fondaparinux that has exclusive anti-Xa activity

Low molecular weight heparins (LMWHs) consist mainly of short chains


Regarding heparins, which propositions are true?

Treatment with curative doses of UFH should be monitored daily by measuring heparinemia

In case of curative dose UFH, the therapeutic target is 0.3 to 0.7 IU/ml

For UFH monitoring in curative use, TCA is preferred over heparinemia

A factor XII deficiency or the presence of a circulating anticoagulant such as antiprothrombinase makes monitoring by measuring heparinemia essential.

Heparinemia should be performed immediately after the first injection

Heparinaemia should be performed at least four hours after initiation of treatment or dose change and at any time with continuous IV infusion


When is LMWH treatment monitoring necessary?

The College of Hematology indicates monitoring as necessary in obese patients, so BMI > 30 (BMI > 25 indicates overweight)

Creatinine clearance between 30 and 60 ml/min indicates monitoring


During UFH treatment, monitoring of platelet counts is essential

Indeed, and this is in order to detect heparin-induced thrombocytopenia. It is a rare complication (less than 1% of cases) but serious requiring immediate discontinuation of heparin or LMWH and switching to another fast-acting anticoagulant

In the heparin family, only HnF can be injected into IV


Which of these heparins has/have 100% bioavailability after injection?

The bioavailability of HnF is highly variable from patient to patient. For this reason, surveillance of heparinemia, or failing that, ACT, is necessary.

Their bioavailability is high, but not 100%. The college of hematology indicates 90% (table 22.1 on page 264)

Be careful, these are not heparins. They are anti-platelet agents.


Which of the following are true about DRESS?

Regression is always rapid after early discontinuation of the drug

Rarely, slow regression can be observed.


It was initially provided for in a regulatory and mandatory framework 6 months before any marriage

Initially planned in a regulatory and mandatory framework 2 months before any marriage

It was to be officially handed over to the parents of the bride and groom.

to be handed over by each of the bride and groom to the civil registrar

Without this examination, historically, the civil registrar could not celebrate a marriage.

It was to allow the future spouses to take stock of their state of health.

It was an opportunity for information on lifestyle and family planning.


It was suppressed at the liberation of 1945 due to the change of morals.

It was abolished by Law No. 2007-1787 of 20 December 2007 on the simplification of the law, partly because of the scarcity of married couples at the time of the first pregnancy, but also because of the cost

The interest of such a consultation is currently nil.

However, the interest of such a preconception approach as a mode of prevention for the health of young couples is highlighted in the information document for professionals entitled "Pregnancy project: information, prevention messages, examinations to propose" published in September 2009 by the High Authority of Health (HAS)

The consultation must be conducted by a doctor

The consultation can be conducted by a doctor (general practitioner, medical gynecologist, gynecologist-obstetrician), or a midwife, whether or not this professional follows the pregnancy afterwards.

The future spouses are the main targets of this type of consultation, but not the only ones

Questioning relies almost exclusively on family history to screen for genetic diseases in the family.

This is the family and personal history, as well as the consultation of the health record"


Regarding the conduct of the pre-conception examination:

Addressing individual cardiovascular risk factors is not of interest in this type of consultation.

In case of family history or person of genetic damage, genetic counseling should be considered.

A conization or myomectomy are examples of gynecological history to look for

The gynecological examination focuses on the reproductive system

In case of positive rhesus, it is proposed to inform the woman of the interest of determining the blood group of the future father

in case of negative Rhesus, it is proposed to inform the woman of the interest of determining the blood group of the future father"


Regarding the interrogation and clinical examination during the pre-nuptial consultation:

Rubella serology is prescribed if there is a notion of previous negative serology (even if two vaccinations have been performed)

The benefit/risk balance of any drug prescription should be carefully evaluated in a woman who expresses a desire for pregnancy

Pregnancy should be anticipated as much as possible

If pregnancy is desired, folate should be prescribed up to the 24th week of amenorrhea at a dose of 5 micrograms per day.


A catch-up/booster of the DTP and pertussis vaccine should be offered in adults likely to become parents soon

Pertussis vaccination is crucial because of the vulnerability of children up to 1 1/2 years

Pertussis vaccination is particularly important, given the vulnerability of newborns during their first two months

Varicella vaccination is possible if the pregnancy test is negative, and effective contraception for 3 weeks is recommended by the HAS

Vaccination is possible if the pregnancy test is negative, and according to MA (marketing authorization) data, effective contraception for 1 month is recommended after each dose of vaccine. According to this document from the transparency commission of the HAS (https://www.has-sante.fr/upload/docs/evamed/CT-17743_VARILRIX_PIS_RI_Avis2_CT17743.pdf), << Vaccination against chickenpox is contraindicated during pregnancy. Pregnancy should be avoided within one month of vaccination: women intending to start pregnancy should be advised to postpone their project.>>

Meat must be cooked to control the risk of toxoplasmosis

This consultation is an opportunity to highlight the risks of self-medication and remind that taking medication without a prescription is not recommended in case of pregnancy planning


Regarding preconception questioning in women:

Alcohol withdrawal is unnecessary unless chronic alcoholism is well documented

If consumption is occasional, it is advisable to stop taking alcohol as soon as pregnancy is proven by an ultrasound

In case of occasional consumption, stop drinking alcohol early in pregnancy

The medicine can offer help with smoking cessation if necessary

Tobacco has a negative effect on fertility and child development during pregnancy

All elements that relate to the patient's work concern the occupational physician only

Determine possible exposure to teratogenic products by contacting the occupational health physician if necessary"


Regarding the generalities of the preconception examination:

A cervical screening smear is to be performed again if the last one is more than 2 to 3 years old.

Folic acid supplementation in women who want pregnancy is a prophylactic procedure

The health record must be up to date, otherwise, reminders or catch-ups must be carried out, with caution

This consultation is an opportunity to raise awareness of the effects of smoking (decreased fertility, delayed child development, ...)

The preconception examination concerns exclusively married couples with a plan to become pregnant

The "preconception examination, formerly a premarital examination, must be conceived in the more general context of information among women or couples planning to become pregnant, given the number of couples who currently conceive outside marriage."


Regarding folic acid supplementation. Which of the following are true?

Folic acid helps reduce the risk of neural tube closure abnormalities

For primary prevention, the dose of folic acid is 0.4 mg/d

For secondary prevention, the dose of folic acid is 5 mg/d

Folic acid should be taken 2 months before and 3 months after conception


Which of the following are indications for prescribing 5 mg/d of folic acid?

History of non-closure of the neural tube in a previous pregnancy

True. Increased risk of neural tube closure abnormality due to anti-epileptic therapy

False. This is a dose of 0.4 mg/d as it is not an indication for a dose of 5 mg/d.


The prenuptial certificate is always mandatory

False. The requirement for a prenuptial certificate for civil marriage was abolished in 2007. 50% of children are born out of wedlock.

Toxoplasmosis and rubella serologies are part of the pre-conception assessment

True. On the other hand, rubella serology is not routine in a woman who has received 2 doses of the vaccine and who has proof of this vaccination.

CMV serology is systematically part of the pre-conception assessment

False. It is indicated in women in contact with children under 3 years of age.

For diabetes screening, the OPGH is done as a first-line

False. For diabetes screening, fasting blood glucose (normal threshold < 0.92 g/L) should be done first in the first trimester, and if it is negative, test at the OPGH in the second half of the year.

Vitamin folic acid supplementation is routine up to 12 SA to prevent the risk of neural tube defect closure


Regarding vaccination in pregnant women. Which vaccine(s) are not recommended during pregnancy?

True. It is not a live vaccine so it is not contraindicated during pregnancy, but it is not recommended to vaccinate pregnant women in France. On the other hand, it is desirable to vaccinate women before or after childbirth.

True. It is a live vaccine and therefore contraindicated in pregnant women. On the other hand, it is recommended to vaccinate all women with rubella-negative serology pre-conceptional. Women who have received 2 prior vaccinations should not be vaccinated, regardless of the result of serology if it is performed. Due to the teratogenic risk, it is necessary to ensure the absence of an early pregnancy and to avoid any pregnancy within one month of vaccination.

True. It is a live vaccine with a teratogenic risk. Women of childbearing age who have no history of chickenpox should be vaccinated. Vaccination is possible if the pregnancy test is negative. Effective contraception for 1 month is recommended after each dose of vaccine (2 doses in total).

The flu vaccine is recommended for pregnant women because they are a population at risk of severe influenza (fetal death and maternal death, refractory hypoxemia, etc.).

True. It is a live vaccine, therefore teratogenic.


Trisomy 21 is the leading cause of hereditary intellectual disability

T21 is the leading cause of intellectual disability (ID). Comes in 2nd the fragile X syndrome which is the 1st cause of hereditary ID

Prenatal diagnosis is proposed to couples at risk of transmitting a genetic disease to their offspring

Proposing is different from obliging, of course.

Fragile X syndrome is an incomplete mutation of the TIRx2 gene

Complete mutation of FMR1 with expansion of CGG triplets more than 200 times. Premutation ("incomplete" mutation) does not give fragile X syndrome.

The CFTR gene, present on chromosome 7, has many known mutations including F508 del, the most commonly involved in cystic fibrosis. FYI CFTR is involved in the flow of Cl ions and the acronym "cystic fibrosis transmembrane conductance regulator" makes it easy to find the English (and Quebecois) name of the disease, cystic fibrosis.

2/100,000 births are affected by cystic fibrosis


Regarding cystic fibrosis and trisomy 21:

Cystic fibrosis transmission is autosomal recessive

2 pathogenic variations in the CFTR gene are needed

The most common mutation in the CFTR gene that causes cystic fibrosis is C19947del

It is F508del whose exact nomenclature is c.1521_1523delCTT or p.Phe508del

The main risk factor for trisomy 21 is paternal age

The management of trisomy 21 also involves the psychological care of the family

and the subject reaches of course. This is the case for the majority of rare diseases.


General information on mucovisciod, fragile X and trisomy 21:

The karyotype is of no interest in fragile X syndrome

Helps identify an additional cause of intellectual disability

The diagnostic triad of fragile X (intellectual disability, macro-orchidism and craniofacial dysmorphism) is pathognomonic and very constant

Trisomy 21 is a chromosomal disease linked to the presence of a single chromosome 21

Chromosome 21 supernumerary, three in total although it is not always "isolated" (free and homogeneous)

Antenatal screening occupies an important place in terms of diagnostic circumstances in trisomy 21

This does not prevent postnatal diagnoses whose management must be attentive

The realization of a karyotype with parental consent allows the confirmation of the diagnosis of cystic fibrosis

Useless because it is not visible by the karyotype (mutation in the CFTR gene). Except very rare case of break point in the CFTR gene which is not on the program of ECN


The risk of giving birth to a child with T21 is 1/700

Maternal age and the existence of chromosomal variation involving chromosome 21 in one of the 2 parents

The risk of T21 is schematically 1/50 when the mother is 42 years old

The clinical phenotype associates morphological abnormalities and intellectual disability

A disabled child requires careful medical follow-up and psychosocial measures


Which of these proposals correspond to serum markers measured in the first trimester?

Nothing to do with maternal serum markers


Regarding the screening and diagnosis of trisomy 21:

The calculation of the combined risk is based on ultrasound measurement of neck clarity and determination of maternal serum markers of the 1st trimester

Neck clarity measurement should be performed between 11 SA + 0 days and 13 SA + 6 days

Maternal serum markers should be measured 14 days after ultrasound

Performed at the same term as neck clarity measurement

This examination is not mandatory but the information must be given to all pregnant women, regardless of their age


Cystic fibrosis is the most common serious autosomal recessive disease affecting the Caucasian population

Incidence in France = 1/4500 births. It is not considered a rare disease!

Cystic fibrosis is linked to a mutation in the CFTR gene, the most common of which is G18463del

Newborn screening is performed with the so-called Guthrie test at 3 days of life

Newborn screening has been widespread since 1975

The saliva test is the complementary reference test for diagnostic confirmation


Management is based in particular on daily chest physiotherapy

And the treatment of bronchopulmonary superinfections

Cystic fibrosis affects 1/10000 births in France

The frequency of heterozygous subjects is estimated at 1/30

Cystic fibrosis is caused by mutations in the CFTR gene located on the long arm of the X chromosome

This condition is caused by mutations in the CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) gene, located on the long arm of chromosome 7.


In France, in 70% of cases, the mutation is the deletion of the 508th amino acid (F = phenylalanine), called F508del

It is a disease of the respiratory system only

The mucus clogs different sites of the body, including the respiratory system but not only: also the digestive tract and its appendages (pancreas, bile ducts and liver), sweat glands and genital tract

Cystic fibrosis is a disease that does not impact life expectancy

Cystic fibrosis is a chronic disease that remains particularly severe

Follow-up is carried out by the pulmonologist and the general practitioner only

Multidisciplinary follow-up in specialized centers called Cystic Fibrosis Resource and Skills Centers (CRCM) is the rule, in order to best care for these patients and improve their prognosis and quality of life.

Antenatal screening for cystic fibrosis is offered to all pregnant women

"Generalized" antenatal screening is not recommended to date by the National Consultative Ethics Committee (CCNE)


Which of the following are true about enterovirus infections?

They are found especially during the winter

Relatively more frequent during the summer


Which of the following are true about measles?

It is not sanguine, it is saliva, nasal, and urinary

True, they are bluish-white "grains of salt" on a red background near the molars.

The bacterium involved is Coxiella burnetii

Coxiella is the agent of Q fever. The virus involved in measles is Morbillivus


Which of the following are possible complications of measles?

Rather encephalitis. Neurological complications are rare


With regard to eruptive diseases of childhood, what are the right proposals?

Diagnosed with megalerythema, the child should avoid contact with pregnant women because the virus in question can give birth defects such as cataracts and glaucoma.

False, parvovirus B19 (agent of epidemic megalerythema) in pregnant women gives fetal anemia or fetoplacental anasarca. It is rubella that gives these birth defects.

Chickenpox can be transmitted through the respiratory route

True, transmission is respiratory before the eruptive phase

Clinically, infectious mononucleosis gives high fever, erythematopultaceous angina often associated with splenomegaly and lymphadenopathy.

True, biologically there is also leukocytosis, and hepatic cytolysis is also possible

During the eruptive phase of measles, a Köplick sign can be found

Köplinick's sign (white-blue punctiform spots on an erythematous jugal mucosa) is found during the invasion phase (with fever and cattarhe)

This is the case for measles and rubella


Which of the following definitions is true?

Mononeuropathy is the involvement of a nerve trunk

Multiple mononeuropathy is multineuritis

Multiple mononeuropathy is the involvement of several nerve trunks

Polyradiculoneuropathy is damage to the cell body of sensory neurons

It is defined by the involvement of all the sensory and motor nerve roots and nerve trunks (example of Guillain-Barré syndrome)

Guillain-Barré syndrome is polyradiculoneuropathy


Motor neuronopathies are often asymmetric

Length-dependent axonal polyneuropathies result from diffuse and symmetrical involvement

Length-dependent axonal polyneuropathies begin in the hands

They start at the feet (longest nerve fibers)

In long-term-dependent axonal polyneuropathies, subjective disorders affecting the extremities of the lower limbs are permanent, diurnal and willingly nocturnal

In length-dependent axonal polyneuropathy, the onset of motor symptoms are brutal and consist of permanent paralysis within a few weeks.

At first, the patient reports difficulty walking, abnormal fatigability


Which of the following proposals for length-dependent axonal polyneuropathy is true?

There are no vegetative disorders in length-dependent axonal polyneuropathies

Yes, vegetative disorders are related to damage to amylin fibers: orthostatic arterial hypotension, vesico-sphincter disorders, sexual (impotence), digestive disorders (diarrhea, constipation)

Clinical examination does not find amyotrophy

He finds: abolition of calcaneal reflexes (Achilles), motor deficit affecting the lifters of the foot, amyotrophy, sensory deficit that can be discreet, vegetative involvement (skin and appendages, hypotension)

There is no known etiology to length-dependent axonal polyneuropathies

Many etiologies. In children: rare and hereditary. In adults: nearly two hundred causes

The geographical focus of familial amyloidosis is Portugal

Diabetes is one of the most common causes of peripheral neuropathy


Which of the following propositions are true in the context of a right Brown Sequard?

Thermo-algic sensory disorders on the left

Thermo-algic sensory disorders on the right


Which of the following propositions about Brown Sequard syndrome are true?

Spinal cord involvement is transverse and total

Only half of the bone marrow is affected

There is an engine deficit in homolateral

There is a proprioceptive deficit in contralateral

The motor and proprioceptive deficit is homolateral. In contralateral, there is a thermoalgic hypoaesthesia

There is a homolateral thermoalgic hypoesthesia

Thermoalgic hypoaesthesia is contralateral. In homolateral, there is a motor and propriceptive deficit


Pruritus is a functional sign that is defined as "a sensation that causes the need to scratch"

Pruritus is always localized because it concerns a particular nervous territory

Skin + some mucous membranes or semi-mucous membranes

There is a pruritus that can be described as physiological

Physiological pruritus is major at birth


Histamine is the key element in the pathophysiology of any pruritus

Histamine may be involved but not always

Pruritus can sometimes start higher in the transmission routes (central or peripheral nervous system) or its origin can be cutaneous

Diagnosis of pruritus requires ultrasound of areas rich in sebaceous glands

The diagnosis of pruritus is clinical and on the interrogation

Excoriations may be consecutive to scratching

Prurigo may be secondary to chronic pruritus


Regarding scratching lesions and etiologies of pruritus:

Chronic pruritus can lead to lichenification

It can lead to impetigo and pyoderma type superinfection

Scabies is responsible for morning recrudescence pruritus sparing the back

Scabies: nocturnal pruritus sparing the face

Body pediculosis is the cause of diffuse pruritus, predominant on the trunk and root of the limbs

Psoriasis lesions are almost never the cause of pruritus

Contrary to a classic notion, psoriasis lesions are itchy in more than half of patients and reworked by scratching.


Pruritus often telltale in primary biliary cirrhosis

Pruritus is very common in acute renal failure

Chronic renal failure where it is common in hemodialysis patients

Pruritus is very common in hemodialysis patients

Any naked and chronic pruritus in a young adult must suggest lymphoma

Polycythemia vera causes pruritus after contact with water


Which of these proposals designates the main ectoparasite of scabies?


Which of these incubation periods are compatible with scabies?

The incubation period is from 5 days to 1 month


Which of these areas are spared from scabies?

The only areas spared are the face and back


Which of these signs are in favor of Sarcoptes Scabei Hominis infection?


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

Treatment of pediculosis of the scalp is a lotion of dimeticone


Which of the following are signs and symptoms of scabies?

Maculopapular rashes in the back and chest

Not in scabies. This is a sign of body pediculosis


Which of the following are true about scabies?

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

Treatment is both individual and collective


Which of the following propositions are true about pediculosis?

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

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

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

The parasites concerned are strictly human

Body pediculosis is caused by Pediculus humanus capitis

This is the case of pediculosis of the scalp


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

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

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


Regarding infectious disease surveillance:

In France, in 2021, there are 36 notifiable diseases

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

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

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

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


Concerning the monitoring of infectious diseases

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

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

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

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

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

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


Concerning the monitoring of transmissible mishelp

Communicable disease control relies on a national and international surveillance system

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

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

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

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

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


Concerning the surveillance of transmissible infectious malaides

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

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

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

All infectious diseases are transmissible between humans

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

Most transmissible infections are called endogenous

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


Which of the following propositions are true regarding droplet isolation?

It concerns pathologies with indirect transmission

It requires the wearing of an FFP2 mask by caregivers

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

It requires visitors to wear a surgical mask

It requires limiting the patient's movements outside his room


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

It concerns pathologies with direct transmission

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

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

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


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


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

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

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

Extrathoracic localizations are polymorphic

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

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


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

Diagnosis requires having eliminated the known causes of granulomas

Mediastinopulmonary involvement is by far the most common

mediastinopulmonary involvement is isolated in half of the cases

Tobacco is a risk factor for the disease

Tobacco would protect against sarcoidosis


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

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

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

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

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

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


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

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

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

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

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


Concerning the dates marking the evolution of the conventional system

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

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

2016 is the year of the revaloratization of physician remuneration


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

Most common situations of the liberal practitioner

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

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


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

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


The price of acts is fixed in the Convention

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

PSRO indicators are independent of each other


What are the proven effects of physical activity?

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

Reduction in the occurrence of colon cancer by 95%


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

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

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

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

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


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

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

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

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

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

Undernutrition worsens respiratory function in chronic respiratory failure


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

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

Treatment includes antipsychotic treatment +/antidepressant treatment

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

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

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


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

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

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

The mechanisms encountered are mainly interpretative, intuitive, and imaginative

The hallucinatory mechanism is generally not predominant


Delusions are fuzzy just like in schizophrenia

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

They usually feature convoluted and multiple themes.

The subject totally adheres to his delusions

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

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

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


Regarding the symptomatology of delusional disorders:

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

Delusional disorder may contain disorganization syndrome in some cases

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

Hallucinations are often associated and disabling by their intensity

If hallucinations are present they are not in the foreground

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

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


Regarding the different types of delusional disorders:

The erotomanic type is more common in men

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

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

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

There is a persistent delusional disorder of jealousy type

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

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


Regarding tobacco addiction and cessation:

Smoking is often linked to behaviour acquired in adolescence

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

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

Nicotine-related physical dependence is assessed by the Fagerstrom test

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

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


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

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

The secondary current is the passage of smoke through the bronchioles

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

The secondary current is the one that causes passive smoking

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

There are more than 4000 components identified in tobacco smoke


Regarding the composition of the cigarette:

Nicotine is delivered to the brain in 30 minutes

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

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

Tobacco smoke particles have an aerodynamic median diameter of 0.3 microns

Broadly similar components are found in cannabis smoke


Regarding the consequences of tobacco and its epidemiology:

The France had nearly 16 million smokers in 2013

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

Smoking prevalence has increased since 2005

The proportion of ex-smokers is increasing among women

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

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

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


Regarding the consequences of tobacco and its management:

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

COPD is responsible for 17,000 deaths each year

Tobacco is not a known cause of arteritis

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

The tobacco-atheroma relationship is clearly demonstrative

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


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

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


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

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

The doctor-patient relationship is a friendly relationship

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

The doctor-patient relationship is an equal relationship

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

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


Regarding the different types of relationships

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

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

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

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

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

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


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

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

A gynecological examination is an example of a cooperative relationship

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

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

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

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


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

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

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

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

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

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

Patient consent or during an interview is essential to obtain


Regarding the process of empathy in the doctor-patient relationship

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

Validating emotions and patient representation is crucial

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

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

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

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

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


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

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

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

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

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

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

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

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


Concerning the interview in the doctor-patient relationship

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

An important element for each interlocutor is the feeling of freedom

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

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

Motivation for change is not an immutable "patient trait"

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


This is a type of participatory interview

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

It's about convincing the patient to change

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

Exploration must be empathetic and non-judgmental


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

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

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

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

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

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


Concerning the patient in the doctor-patient relationship

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

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

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

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

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

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


Concerning the evaluation phase in the doctor-patient relationship

There are two phases of assessment: primary and secondary

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

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

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

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

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

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


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

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

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

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

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

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

Teenagers and children cannot be seen without their parents

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


Concerning interviews in the doctor-patient relationship

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

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

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

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

Giving alternative names that the patient can understand can be helpful

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


Concerning FTE in the doctor-patient relationship

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

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

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

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

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

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


Osteoarthritis is the most common chronic inflammatory rheumatism

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

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

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

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

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

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


Regarding pathophysiology and diagnosis:

The pathogen(s) causing RA are unknown to date

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

Osteoclasts are the effector cells of bone erosions seen in RA

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

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

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


Sex ratio to the disadvantage of women but not exclusive

The picture of acromelic arthritis is extremely rare

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

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

The most frequent location is that of the wrists


Metacarpophalangeal joints and proximal interphalangeal joints are frequent localizations

Spontaneously painful joints are most often painful under pressure

The skin coating is not usually affected

Unlike psoriatic arthritis, septic arthritis or microcrystalline arthritis

Distal interphalangeal joints are usually respected during RA

Tenosynovitis points to differential diagnosis and is incompatible with RA

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


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

Rheumatoid Factor (RF) arrives late in the disease

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

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

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

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


Concerning the analysis of SAEs of therapeutic hazard

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

Safety culture is optional and not paramount in patient care

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

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

Data anonymization is a necessity in the conduct of SAE analysis

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


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

The commitment of the management of the establishment

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

The understanding of the issues by all professionals


Concerning the prevention of damage to second victims

This term was introduced by Claude Bernard in 1849.

The second victim is the person closest to the patient

The second victim is emotionally and professionally impacted

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

One of the consequences may be burnout or suicide

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

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


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

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

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

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

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

The attenuation barrier prevents the consequences of the mistake already made

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

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


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

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

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

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


Which of these proposals are compensated under national solidarity?


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

Therapeutic hazard does not give right to any compensation

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

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

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

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


The compensation procedure is fast and free of charge

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

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


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

Febrile diarrhea indicates enterocolic infection

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

The majority of acute diarrhoea is of infectious origin

Diarrhoea often progresses to colonic performation and sepsis when left untreated


What are the emergency situations to be identified?

More than 10 trips to the toilet per day

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


It is indicated in non-febrile diarrhea of the infant

It has many side effects including frequent headaches


What are the indications for a stool culture?


What situations require hospitalization during infectious diarrhea?

Febrile diarrhoea returning from endemic country


From what time frame do we speak of prolonged diarrhea?

From one month, we talk about chronic diarrhea


From what time frame do we talk about chronic diarrhea?

Acute diarrhea is called an episode < 2 weeks


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

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


Childhood strabismus is a symptom of an underlying pathology

There are two types of strabismus: paralytic or normal mobility

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

Surgical treatment is performed under general anhesis

Strabismus is a lack of parallelism of visual axes


Strabismus is indicative of sensorineural impairment

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

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

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

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

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


Concerning strabismus and its consequences

Fusion creates the conditions for simultaneous vision of both eyes

Acute strabismus resulting in two different images implies visual confusion

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

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

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

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


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

All patients describe stereoscopic vision disturbance

Strabismus most often sets in in childhood

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


Strabismus screening should be performed in all children in late adolescence

The early appearance of strabismus determines its impact on binocular vision

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

The prefix "éso" is used for convergent vertical strabisms

For convergent horizontal strabismus (esotropy and esophoria)


The differential diagnosis of convergent strabismus is epicanthus

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

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

In case of permanent strabismus, binocular vision is absent


Ophthalmological examination in strabique children:

Binocular vision is lost in intermittent strabismus

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

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

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

Concomitant strabismus does not find any systematized deficit of ocular motility

Concomitant strabismus is very rare in children

Concomitant strabismus account for the vast majority of childhood strabismus


Concerning additional examinations in case of strabismus:

The discovery of strabismus requires an urgent ophthalmological examination

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

Nystagmus associated with strabismus requires the performance of an EEG

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

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

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

The measurement of subcycloplegic refraction will look for ametropia


The presence of astygmatism is very common in case of strabismus

The presence of hyperopia is very frequently associated with strabismus

Any accommodation effort is associated with convergence

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

Any strabic child must wear total optical correction

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

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


The presence of binocular vision is a major prognosis of treatment

Any strabic patient must wear total optical correction

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

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

Indications for orthoptic rehabilitation are marginal in the management of strabismus

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


The main purpose of the medical examination is:

Detect cardiovascular pathologies responsible for sudden death

Discourage the practice of dangerous sports such as climbing or judo

To recall the dangerousness of doping products

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


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

According to the College of Endocrinology

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

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

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

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

The patient must then be referred to see AMPD


Under what conditions is a stress test indicated?

To detect microangiopathic complications

The presence of 2 cardiovascular risk factors

Alcohol is not a cardiovascular risk factor


Regarding the main generalities about MS:

Multiple sclerosis usually occurs after age 40

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

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

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

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

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


Regarding the epidemiology and risk factors of MS:

MS is more common when moving away from the equator

The prevalence is 5000 people per year in France

Less exposure to certain infections in childhood would increase the risk

Vitamin D deficiency is associated with an increased risk of disease


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

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

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

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

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

Types of symptoms depend on the clinical phase


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

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

Partial myelitis is of medullary topography

Motor disorders are never found in partial myelitis

There are sometimes motor and/or sphincter disorders.

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


Regarding the analysis of cerebrospinal fluid in the MS:

The presence of oligoclonal bands replaces the criterion of temporal dissemination

Lumbar puncture is mandatory for the diagnosis of MS

Oligoclonal bands are present in only 15% of MS

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

A proteinorachy > 1 g/L is suggestive of MS

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

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


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

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

Papillary edema may be observed at the back of the eye

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

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


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

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

Immunomodulatory therapy that may cause skin side effects

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


The primary progressive form has a poor prognosis

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


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

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

Paresthesias of a hemibody or lower limbs


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


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

A fundus usually normal in the acute phase


Regarding the causes and consequences of spleen pathologies:

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

Pneumococcal sepsis may be caused by splenomegaly

Any palpable spleen is pathological except in children

Splenomegaly can cause hemodilution anemia


What can be the consequences of splenomegaly:

No, but celiac disease can cause splenopathy

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

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


Vaccinated against all encapsulated germs

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

Vaccination against neisseria meningitidis

Bouts of fever are immediately treated with fluoroquinolones


Which of the following are causes of splenomegaly?


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

There is a deletion of the nasolabial fold

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

It always includes automatic-voluntary dissociation

In general, not always. Sometimes dissociation is reversed


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

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

There is an erasure of forehead wrinkles

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

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

Schumascher's test reveals drying up of tear secretions

The face is sluggish in case of facial diplegia


Regarding idiopathic acute facial paralysis:

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

Recovery is slow and sequelale in very few cases

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


Platinum salts are the basis of chemotherapy

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

Survival at all stages is < 20% at 5 years

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

There is no recommendation for screening for CP currently in France


Which of these principles apply to occupational medicine?

Universality: occupational medicine concerns all employees

It must be organized by the ANSM and the HAS

The action of the MT is independent of the employer


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

The development and updating of the company file

The role of TM is exclusively PREVENTIVE


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

It concerns in particular workers returning from maternity leave

It concerns in particular workers returning from paternity leave

It may conclude with a notice of incapacity

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

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


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

Bone strength is synonymous with bone density

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

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

The main complication of osteoporosis disease is malignant hypercalcemia

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

The scanner is the reference technique for measuring BMD

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


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

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

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

Vertebral fractures are osteroporotic only

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

In postmenopausal osteoporosis, serum calcium is increased

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

Vitamin D deficiency should be screened for osteoporosis

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


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


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

Rather, there is a recoil of the posterior arch


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

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

EFRs regain reversible obstructive ventilatory disorder

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

It is defined by the necessary therapeutic level

Asthma contraindicates underwater scuba pongey


What is the prevalence of asthma in France? 🤔


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

True, any hemodynamic instability is a sign of severity

True, like all acute neurological instabilities


What is the prevalence of rhinitis in France? 🤔


Any patient with acute fever is contagious until proven otherwise.

A diastolic BP < 100 mmHg is a sign of severity

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

Fever and chills increase oxygen requirements

Social isolation is an indication for hospitalization for acute fever


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

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

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

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

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

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


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

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

Lung, urinary and digestive infections dominate in the elderly

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


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


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

This is the IAD: artificial insemination with donor sperm


Regarding general information on the GPA:

Assisted reproduction procedures allow in vitro conception in particular

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

These techniques have the sole purpose of fighting proven infertility

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

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

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


Among these proposals, which impede embryo insemination or transfer:

The death of one of the members of the couple

Especially if cessation of cohabitation, or petition for divorce

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


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

In case of STIs, MPA techniques are contraindicated

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

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

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

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

Infertility is not managed (considered comfort care)

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


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

Ovulation stimulation is passive and requires no supervision

Yes, monitoring by hromonal assays + repeated ultrasounds

The timing of insemination is one of the essential success factors

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

Artificial insemination is concocted whatever the cause of infertility

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


At least 1 million motile sperm must be deposited in insemination

Infertility of cervical origin is a great indication of artificial insemination

Infertility of cervical origin is mainly due to the HPV virus

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

Ejaculatory mascular infertility is an indication for IAC

female permeable tube infertility is an indication for IAC


The first indication of IAD is the sterility of the spouse

The average pregnancy rate is 17.3% with donor sperm

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

Artificial insemination is always associated with ovulation stimulation


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


What are the particularities of AMH dosing?

Achievable only in the first part of the cycle


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

Estradiol provides feedback to FSH and may distort its dosage.


He must be re-examined with each new situation

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


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


Among these proposals, which are criteria for brain death:

A single EEG showing an absence of brain activity

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

An angiogram showing an absence of brain activity


Concerning the generality of medical ethics

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

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

Prenatal diagnosis concerns only genetic analyses to verify chromosomal diseases

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

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


Regarding the application(s) of medical ethics

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

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

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

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

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

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

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


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

Legal protection only applies to patients whose mental faculties are impaired

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

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

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

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


The decision to limit treatment is made by the attending physician

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

Ethics can be thought of as the science of morality

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

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


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

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

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

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

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

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

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


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

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

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

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

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

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

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

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


Concerning abortion, contraception and PND

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

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

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

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

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


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

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

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

Pre-implantation diagnosis poses in itself a problem of eugenics

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

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

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


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

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

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

Relatives must be informed of the purpose of the samples taken


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

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

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

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

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


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

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

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

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

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

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

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


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

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

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

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

Respect for human dignity and human autonomy are core values


Normal hemoglobin varies with sex (in adults) and age

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

Anemia is not a diagnosis but a symptom requiring etiological research

Central anemias show too much elimination of red blood cells produced

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

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


Regarding peripheral anemia, which proposals are true?

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

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

Hemolysis induces a decrease in free bilirubin

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

High LDH and serum iron are indirect signs of hemolysis


Regarding sickle cell disease and thalassemia syndromes:

Sickle cell disease mainly affects people from South America

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

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

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

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

The diagnosis of thalassaemic syndrome is based on bone marrow aspiration

Diagnosis of thalassemia syndrome is based on hemoglobin electrophoresis


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

Biermer's anemia is a common cause of vitamin deficiency

Concurrent diabetes eliminates diagnosis of Biermer's anemia

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

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

The prognosis is sap even under lifelong vitamin therapy

Prognosis is benign under lifelong vitamin therapy


Without proper treatment, neurological complications are irreversible

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

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

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

It is macrocytic with MCV, usually greater than 110 fl


Troponin elevation is non-specific to heart tissue

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

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

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

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

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

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

Myocardial markers are essential for the diagnosis of SCA ST+

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


ST myocardial infarction is a reflection of transmural myocardial involvement

STEMI occurs during total occlusion of a coronary artery

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

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

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

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

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


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

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

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

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

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


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

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

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

Coral hernia accounts for 30% of groin hernias

Coral herenia almost always occurs in humans


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

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

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

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

All hernias can be complicated by strangulation

Strangulation is more common in coral hernia than in inguinal hernia


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

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

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

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

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