Joint ultrasound is unnecessary in this context

This is very useful in the absence of specific radiographic signs. We can see a "double contour" aspect

The female predominance of chondrocalcinosis decreases with age

Diagnosis is based on cubic deposits in articular cartilage that are not refrigent

In apatitic rheumatism, the diagnosis can be made by anamnesis


The only diet of the baby under 5 months is milk

Breastfeeding strengthens the mother-child bond

For 100 kcal, a 1st age milk contains about 3kg of cow's milk protein

Low sodium is less than 1 mg of salt per 100 kcal


Never force a healthy baby to finish rations if he seems full.

Growth charts for weight and height confirm the baby's good nutrition

During the first three years of life, the child multiplies his weight by 4

The brain grows 30 to 200 grams between 0 and 3 years

During the first three years of life, the child multiplies his height by four


Daily energy requirements vary little in the first 36 months

Diversification is a stage arriving at the third week of life

There are three types of external breastfeeding: 1st age milk, 2nd age milk and growth formulas

Nitrogen absorbed = nitrogen ingested urinary nitrogen

Nitrogen absorbed = nitrogen ingested faecal nitrogen

Nitrogen retained = nitrogen absorbed urinary nitrogen


AaE can be provided by sources with complementary chemical indices

For premature or very low birth weight children, we have milks covering their specific needs such as milk with non-hydrolyzed proteins

Food diversification involves stages of gradual substitution

Like slow-digesting sugars, fiber, different proteins, etc.

The second category of foods to introduce, after slow-digesting sugars, is those rich in fast sugars.

First the fibers. They also provide water, minerals and vitamins


The interest of fiber is also to provide water, minerals, vitamins provided that we respect certain ways of cooking them

Fiber also has the interest of regulating the glycemic response, therefore hunger, and limiting the absorption of cholesterol

At 6 months a baby will be able to receive, instead of a bottle of milk at noon, a vegetable puree and dairy

Cooked cheeses can be introduced around 6 months of age

Around 9 months for cooked pasta, around 12 months for fermented pasta

There is no danger in leaving the bottle for several months or even years as breakfast


With diversification, fat intake increases from 50% to 30-35% of the daily energy intake

Also by fortified cereals or so-called 3rd age or growth milks that are fortified with iron

Eggs are a source of protein but do not contain vitamins

Eggs provide a lot of vitamins, proteins and cholesterol

During diversification, you have to be very careful not to introduce too much protein

What you really need to pay attention to is sugar+sodium+calories

Carbohydrate food excesses have no impact in view of age


Adolescence is a period of nutritional risk

Too often obesity is discovered in adolescents that began long before

Obesity usually begins between 3 and 5 years of age when the child should start to be lean

While the child is normal/coated, and this explains most of the obesity seen in adolescence

It is useful or even imperative to develop the habit of regular physical activity

One in two teenagers admits they don't like looking at themselves in a mirror or having their picture taken

and 63% of girls say they want to lose weight


It is recommended to administer vitamin D supplementation every 3 months during the peripubertal period

It is recommended to provide at least 100g of calcium per day

The recommended intake of iron is in the range of 15 to 22 mg/day

It is recommended to take a dairy product at each meal including snack


Which of the following are risk factors for gestational diabetes?

A first-degree family history of type 2 diabetes


Often, it is a diabetes present before but asymptomatic

It is conventionally revealed in the third trimester

It is conventionally revealed in the second trimester

It is now done on risk factor: age over 35, overweight or obesity, personal or family history of diabetes or macrosomia

There is an increased risk of macrosomia


At what time of pregnancy is OGGH for gestational diabetes indicated?

True, only indicated if fasting blood glucose < 0.92g/L (threshold of gestational diabetes in the first trimester


Breast cancer is the leading cause of cancer death in women

It is a major public health problem for all industrialized countries.

5-year survival rate (all cancers) = 73%

Cancer is the 1st leading cause of death in humans

Lung cancer is the 1st leading cause of cancer death in men


Concerning the epidemiology and prevention of cancer

Prematured mortality from cancer is twice as high in men as in women

Between 1980 and 2015, the overall incidence of cancer has increased since 1980 (+109% in both men and women)

Prevention must contribute to reducing inequalities in the face of cancer

At least 1/3 of cancers are preventable, the main risk factor being alcohol


Alcohol is responsible for 15,000 cancer deaths

The consumption of fruits and vegetables is associated with a reduced risk of several cancers: oral cavity, pharynx, larynx, esophagus, stomach

Eating salt and salty foods increases the risk of stomach cancer

Eating red meat and deli meats is associated with an increased risk of colorectal cancer

Infectious agents are responsible for 76% of cancers worldwide


A 57-year-old patient comes to your office.
Which of the following are screenings that she could have benefited from?


There are two eating disorders: anorexia and bulimia

There are also binge eating, atypical disorders such as nocturnal eating syndrome and food intake disorders such as pica.

It is important to eliminate non-psychiatric medical causes before any TCA

Psychiatric comorbidities are extremely rare and minor in intensity

Suicidal risk should be systematically assessed

TCA are among the psychiatric disorders with the highest mortality (about 10% of patients, half of whom by suicide)

It is never necessary to hospitalize these patients whose care is done on a long-term outpatient basis

Hospitalization criteria, especially for anorexia must be known


Diet belongs to the instinctual functions of mammals

The etiopathogenesis of TCA is still poorly understood

The lifetime prevalence of anorexia nervosa is estimated to be more than 6% in Caucasian women

Its lifetime prevalence is estimated at 0.6% in the Caucasian adult population

The sex ratio of anorexia is 1 man to 8 women


After coronary and cerebral involvement, PAD is by its frequency the third localization of atherosclerosis

It is, in its symptomatic form, 3 to 4 times more common in women than in men

The peak of presentation is between 60 and 75 years in humans

Diabetes is responsible for severe involvement from the outset, with more proximal involvement

Hypertension and diabetes are the two predominant cardiovascular risk factors in PAD


Symptomatic involvement affects 10 to 15% of people over 60 years of age

1-5% of people over 60. Asymptomatic forms affect 10-15% of this population

In the intermittent claudication stage, mortality at 5 years is 15%

It is estimated that for every symptomatic PAD case, there are two to four patients with a subclinical form of the disease.

The Leriche-Fontaine classification is the classification currently recommended to understand the severity of clinical involvement

It is supplanted today by the Rutherford classification.

PAD should be tested for in any patient over 50 years of age with cardiovascular risk factors


Long asymptomatic, due to a moderate hemodynamic impact and the progressive and compensatory development of collateral arteries

During intermittent claudication, symptoms disappear spontaneously within 10 minutes

Claudication is said to be severe if the walking distance is less than 300 meters

The walking distances of claudication can be variable from one day to another, in the same patient

Critical ischemia is a clinical diagnosis exclusively

Clinico-hemodynamics: infusion pressure <50mmHg at the ankle or 30mmHg at the level of the big toe


Leriche syndrome indicates femoral involvement

Aortoiliac involvement. As a reminder, Leriche syndrome associates gluteal claudication or fatigability with walking + erectile dysfunction

Pain at the pressure of the calf muscle masses testifies to moderate ischemia

Pain at the pressure of the muscle masses of the calf testifies to severe ischemia

The ABI is calculated by the ratio of the highest systolic pressure of the two arms to the higher pressure of the two ankles.

It's the opposite (ankle pressure / arm pressure)

Ulcers are generally very algic, small and hollow, on the support areas of the foot


Two causes of medicalcosis arterial stiffness are diabetes and tobacco use.

Diabetes and the dialysis patient. This arterial stiffness results in an IPS >1,4

Trophic disorders are systematically sought especially in interdigital spaces

An abolished pedinous pulse testifies to obliterating arterial disease

Pediose pulse may not be present congenitally, in 5% of the population

SPI <0.9 characterizes critical ischemia

If the ankle infusion pressure is >50mmHg, no. An IPS <0.9 characterizes a PAD

In case of IPS >1.4, ankle infusion pressure should be used to make the diagnosis of PAD

In this case the ankle perfusion pressure is not interpretable: the perfusion pressure at the big toe is used.


To diagnose PAD, injected CT angiography is frequently used

CT angiography is only used if there is an indication for revascularization

Critical ischemia pain is improved in the declivated position

It forces you to get up at night or keep your leg out of bed

In case of discovery of PAD, a resting ECG and ultrasound of the abdominal aorta are systematic

A patient with asymptomatic PAD should receive treatment with a statin and an ACE inhibitor

Revascularization may be offered in case of intermittent claudication

In case of threatening lesions or disabling symptomatology despite optimal treatment for 3 months


Which of the following are true for popliteal artery aneurysms?

They are frequently associated with abdominal aortic aneurysms

The operative indication arises when they are greater than 15 mm

The most common complication is embolism

They can manifest as compression of adjacent tissues


Among the following proposals, which are treatments to be implemented in case of stage I PAD according to the Leriche and Fontaine classification?

Implementation of Statine, and IEC/ARA2 if necessary


Regarding the management of glioblastomas:

Hormone therapy is applicable as a second line

Focal radiation therapy is often offered as a first-line treatment

In all intracerebral tumors, first-line excision is preferred, often supplemented by chemotherapy and/or radiotherapy.

Radiation therapy is often concomitant with chemotherapy


A hypoT1 image without injection of contrast medium


Among these tumor proposals, which are among the 4 cancers that metastasize the most intracranial?


There are many more metastases than primary tumors, from an epidemiological point of view

85% of intracranial tumors are subtentorial

There are more than 15 large entities of intrancranial tumors

There are more than 240 subtypes of intrancranial tumors, almost all of which differ in their management.

There are about 80 subtypes of intracranial tumors. There is a lot of overlap between them.

Glioma types 1 and 2: low grade. Glioma types 3 and 4: high grade. Type 3 glioma is anaplastic. Type 4 glioma is a glioblastoma.


Supratentorial tumors (85% of intracranial tumors) have a temporal commitment. It is the subtentorial tumors that cause tonsillar engagement

It results in hemiparesis, diplopia, ptosis and/or unilateral areactive mydriasis

It can result in stiff neck and torticollis.

It is as serious and urgent as temporal engagement


Intratumoral hemorrhages are more common in primary tumors

They are more common in cases of metastases of kidney or skin tumors.

Lumbar punctures are formally contraindicated in case of hydrocephalus

It depends on the type of hydrocephalus. If it is the tumor that prevents CSF from flowing, then PL is indeed contraindicated because it can cause, by << aspiration>>, occipital engagement. If, on the other hand, it is leptomeningeal proliferation that prevents the CSF from resorbing, then PL is possible.

Choroidal plexus tumors can cause hypersecretion of CSF

Temporal engagement corresponds to the passage of the uncus and hippocampus in the Bichat cleft

Between the free edge of the cerebellum tent and the brainstem

Meningeal stiffness is rare in tumor meningitis


Which of these tumor biomarkers have a good prognosis in diffuse gliomas in adults?

The codeletion of chromosomes 1p and 19q

Result of an unbalanced chromosomal translocation

Encodes the enzyme isocitrate dehydrogenase involved in the energy metabolism of the cell


Which of the following are signs of intracranial hypertension (ICPH)?


Which of the following propositions concerning gliobastoma are true?

The cell line is astrocytic or oligodendrocytic, not microglial


Which of the following are tumors metastasizing to the brain frequently?

The 4 to know by heart are: lung, breast, kidney, melanoma.


Which of the following proposals manifest itself in an image of a roundel on MRI?

Roundel = MAGIC. Meningioma, abscess, glioblastoma, infarction, contusion


Which of the following are classic signs or symptoms of intracranial hypertension (ICPH)?

True, it is nerve VI, innervating the lateral right. Its involvement is responsible for horizontal binocular diplopia. It is the most 'fragile' cranial nerve

True, aggravated at the end of the night or in the morning


The 4 to know by heart are: lung, breast, kidney, melanoma


Primary cerebral lymphomas occur only in immunocompromised patients.

False, the risk is increased in the immunocompromised patient (untreated HIV, organ transplant) but primary cerebral lymphomas exist in the immunocompetent.

Meningiomas have estradiol receptors. Their discovery should stop all hormonal contraception, THM or cyproterone acetate treatment.

Tobacco is a risk factor for primary brain tumours.

In front of a glial tumor, it is necessary to look for certain molecular abnormalities for diagnostic and prognostic purposes.

True:
-mutation IDH1 and IDH2
- codeletion 1P19Q
-MGMT methylation (better prognosis and sensitivity to temozolomide)

In front of a medulloblastoma, we look for a SHH mutation

True: Prognostic and theranostic value (introduction of SHH inhibitors)


In adults, the most common primary brain tumors are gliomas.

True: gliomas in 42% of cases then meningiomas in 32%

Primary CNS tumors account for 10% of cancers

In adults, the most common brain tumors are gliomas.

CNS metastases are thought to affect at least 20% of cancers.


Regarding the treatment of brain tumors, which proposals are accurate?

In medulloblastomas, prophylactic craniospinal irradiation is performed in addition to irradiation of the tumor area.

True: because frequent intra-neuraxic metastases.

Stereotactic radiation therapy can be performed on brain metastases

True: if small lesions circumscribed < 3 cm

Treatment of glioblastomas relies on chemotherapy alone

False: Surgical resection followed by radiotherapy and chemotherapy with TEMOZOLOMIDE

Treatment of meningioma is based on radiotherapy and chemotherapy.

False: no chemotherapy in meningioma, it is a benign tumor. Treatment is based on surgical resection or radiotherapy if not operable.

Radiation therapy of the brain in toto may be recommended in young patients with primary cerebral lymphoma.

True: primary cerebral lymphomas are chemo and radiosensitive > chemotherapy with methotrexate and consolidation by radiotherapy of the brain in toto or intensification of chemo with HSC transplantation.


Regarding intracranial hypertension syndrome, which proposals are true?

ICH headaches occur at the end of the day.

False: morning headache or second part night

There is classically an attack of the IV which has no localizing value.

In front of any ICH linked to a CNS tumor, it is essential to introduce high-dose corticosteroids.

False: corticosteroids are formally contraindicated in case of primary CNS lymphoma (risk of negativation of the histo diagnosis)

In front of an HTIC, it is necessary to perform a lumbar puncture in first line in order to search for the etiology.

False: Never in first intention! Always perform brain imaging before to rule out an expansive process or hydrocephalus (otherwise risk of commitment)


Regarding pilocytic astrocytoma, which proposals are accurate?

It is a low-grade glioma (grade I astrocytoma)

This tumor usually occurs around 50-60 years of age.

False: pilocytic astrocytoma occurs in young adults. These are grade III and IV gliomas that occur around 50-60 years of age.

True: associated with NF1 or Von Recklinghausen disease

These are well-circumscribed tumors, hypodense in CT, hyperintense in T2 MRI, taking the contrast and having a cystic component.

True, if not operable and progressive, it is possible to offer radiotherapy or chemotherapy.


Regarding carcinomatous meningitis, what are the exact proposals?

It results from the extension of a primary brain tumor to the subarachnoid spaces or the metastatic invasion of a systemic cancer

The diagnosis should be evoked in the face of any neurological symptoms in a patient with cancer

In imaging, there is abnormal meningeal or periventricular contrast taking

Meningeal stiffness is very rare in this type of meningitis.

Lumbar puncture can be used to make the diagnosis

True: the diagnosis can be made on imaging in case of typical image and/or on PL if cancer cells


Acute respiratory failure (AKI) is defined as the inability of a patient to maintain normal haematosis

• The haematosis disorder is accompanied by changes in blood gases with hypoxemia (defined as PaO2 < 90 mmHg), which may or may not be associated with hypercapnia (PaCO2 < 45 mmHg)

• Hypercapnia is not systematic, it may be absent or replaced by hypocapnia depending on the etiology of the AKI

• The appearance of signs of acute respiratory distress indicates the severity of a respiratory condition

An AKI is related to either the failure of the hematosis, or the failure of the acid-base balance function of the lung


Regarding acute respiratory insufficiency

Any situation causing fatigue of the respiratory muscles via an increase in ventilatory work can be a source of acute respiratory failure

Intrathoracic distension ("trapping" phenomenon in chronic respiratory failure) decreases the contraction of the diaphragm by flattening effect

Plasma pH varies between 7.36 and 7.42 at rest

Plasma pH varies between 7.38 and 7.42 at rest

Any pH value below 7.32 indicates the existence of associated metabolic acidosis

Any pH value below 7.30 indicates the existence of associated metabolic acidosis

Aggravaction of disorders of consciousness is an indcation to orotracheal intubation


Severe hypoxemia assessed by PaO2/FiO2 ratio in mmHg

Minimal ARDS: PaO2/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O

An average ARDS PaO2/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O

3/4SDRA severe: PaO2/FiO2 ≤ 100 with PEEP ≥ 5 cmH2O

Average ARDS: PaO2/FiO2 between 100 and 200 with PEEP ≥ 5 cmH2O


Which of the following proposals are additional examinations to be carried out urgently in the event of electrification?


Which of the following are systematic reviews of paraclinical assessment in acute respiratory failure?

False, only in case of obstruction of the VAS


Which of the following are mechanisms involved in hypoxemia where the alveolo-arterial gradient for oxygen is normal?

False, increases the alveolo-arterial gradient for oxygen


Which of these proposals is/are erysipelas risk factors?


First-line antibiotic therapy combines a penicilinase inhibitor

The erisypel is classically Streptococcus A. The first-line antibiotic is amoxicillin, without clavulanic acid


Indeed, its full name is "necrotizing fasciitis"

General signs are marked as well as infectious signs.

The notion of animal bite must point towards a pasteurellosis of inoculation.


Which of these propositions are true about eczema?

Its treatment is based on mid-dose antibiotic therapy

It is based on the eviction of the supposed allergen

The use of local corticosteroids leads to rapid improvement.

It is an immuno-allergic dermatosis due to hypersensitivity to a contact allergen.

The picture is clinically characterized by pruritus, the presence of vesicles on an inflammatory basis and crumbled border. It is usually located in the region of contact with the allergen.


Which of the following are characteristic of syncope?

It is due to global and transient cerebral hypoperfusion


Discomfort is a subjective feeling of malaise

Lipothymia is a decrease in postural tone without loss of consciousness

Syncope is a subjective feeling of malaise


Diagnosis of brutal BAV based on interrogation

The sensation of "flying flies" is myodesopsia

The speed of installation has little semiological value

Its speed of installation is fundamental in the diagnostic algorithm

Vision abnormalities never have associated pain

If. The interrogation specifies the presence or absence of associated pain and its type

Deep pain may radiate into the trigeminal territory


Regarding interrogation and examination:

Superficial pain suggests acute glaucoma

'True' headaches suggest a neuro-ophthalmological cause

Ocular trauma can have an impact on eyesight but only if it is major

Ophthalmological examination concerns only the pathological eye

Measurement of visual acuity from far and near is done without optical correction


Regarding the ophthalmological examination:

examination of the anterior segment includes vitreous and lens

examination of the anterior segment: cornea, anterior and crystalline chamber

Eye tone measurement is only done in rare cases

The measurement of eye tone is systematic

The examination of the fundus after pupillary dilation makes it possible to visualize the cornea

examination of the fundus after pupillary dilation: optic nerve, retinal vessels, retina

Complementary examinations such as OCT have become systematic

Additional examinations are not systematic and are guided by questioning and clinical examination:


In acute keratitis, decreased visual acuity is accompanied by significant superficial pain

Fluids are clear and transparent in acute keratitis

There is a decrease in transparency of the cornea, a perikeratic circle and one or more corneal ulcerations

Acute angle-closure glaucoma is painless in most cases

Acute angle closure glaucoma: The pain is deep, intense, ocular and periocular radiating into the trigeminal territory

Often nausea or vomiting occurs in acute angle-closure glaucoma

The anterior chamber is narrow in acute keratitis

The anterior chamber is narrow in acute glaucoma by closure of the angle


There is a major elevation of eye tone in acute glaucoma by angle closure

The decrease in visual acuity is most often minimal in acute glaucoma by closure of the angle

The decrease in visual acuity depends on corneal edema related to hypertonia and retinal perfusion, it is often significant

Decreased visual acuity and pain is common in iridocyclitis

A perikeratic circle eliminates the diagnosis of acute anterior uveitis


A pupil in miosis by iridocrystalline synechiae is a sign of iridocyclitis

Tyndall's phenomenon is pathognomonic of posterior uveitis

It is in acute anterior uveitis that slit lamp examination reveals the presence of inflammatory cells in the anterior chamber (Tyndall's phenomenon), possibly with retrocorneal precipitates and iridocrystalline synechiae

The most common cause of choroiditis is ocular toxoplasmosis.

Posterior uveitis is responsible for recurrent retinochoroiditis


Treatment of ocular toxoplasmosis based on antibacterials

Treatment is based on the antiparasitic drugs – pyrimethamine (Malocide®) and sulfadiazine (Adiazine®) – prescribed if there is a threat to visual acuity

Neovascular glaucoma is seen in unbalanced diabetes

The postoperative context is suggestive of endophthalmitis

The hypopion has anterior chamber fibrin visible to the slit lamp


Ultrasound B is contraindicated when the hemorrhage is massive because the retina is then not very visible

Ultrasound B is anyway always indicated when the retina is not visible to eliminate the presence of retinal detachment (+++)

Proliferative diabetic retinopathy is a cause of intravitreal hemorrhage

A retinal tear causes intravitreal hemorrhage only when there is retinal detachment

Terson syndrome is a genetic condition affecting chromosome 6 that increases the risk of intravitreous hemorrhage and subarachnoid hemorrhage.

Terson syndrome: unior bilateral intravitreal hemorrhage associated with subarachnoid hemorrhage due to intracranial aneurysm rupture (Terson syndrome may also be associated with traumatic subarachnoid hemorrhage)

Intermediate uveitis is a subgroup of uveitis where the vitreous is the main site of inflammation


Metamorphopsies concern patients with color blindness

Dyschromatopsias are a distortion of the image

Diploplolia has a purely central neurological origin

Can also be peripheral (oculomotor nerves)


Which of these pathologies can cause monocular involvement?

Rather binocular. On the other hand, TIAs by unilateral carotid stenosis can cause monocular involvement.


What are the recommendations in terms of daily calorie intake for adult men?


What are the recommendations in terms of daily calorie intake for adult women?


A diet that is too salty is a risk factor for high blood pressure

A diet that is too fat is a risk factor for type 2 diabetes

It is a risk factor for high cholesterol

A diet rich in protein promotes colon cancer

A diet that is too sweet is a risk factor for type 2 diabetes

An unbalanced diet is a risk factor for osteoporosis in the elderly


What are the recommended proportions of nutrients in a meal?

50% carbohydrates, 30% fat and 20% protein


Ischemic heart disease is the world's leading cause of death

In Europe, cardiovascular diseases are responsible for about 40% of deaths before the age of 75

Even imperfect CPR is always better than no CPR, even in children

See College Emergencies and Acute Failures, page 326

CPR should be initiated 30 seconds after loss of consciousness, in case the patient wakes up on his own

CPR should be initiated as early as possible and continued with the minimum of interruption by the first witness(ies) pending the arrival of specialized assistance

Any victim who is unconscious, not breathing or breathing abnormally, should be considered in CA


Regarding cardiopulmonary resuscitation and circulatory arrest:

The presence of agonic "gasps" at a frequency of 5-6/min can be misinterpreted as ventilatory movements

Taking the pulse at the carotid level is the most reliable method to confirm the absence of circulation

Taking the pulse (at the carotid level or any other site) is an unreliable method to confirm the absence of circulation, even for healthcare professionals, and is therefore no longer recommended for diagnosing CA.

There is no specific recommendation on the content or form of the alert to be given to the emergency services

In adults, the origin of CA is most often cardiac

The recommended optimal technique for chest compressions requires a frequency of at least 180/min

The recommended optimal technique for chest compressions requires a frequency of at least 100/min, with an amplitude of compressions of at least 5 cm in adults (not exceeding 6 cm), or at least one third of the anteroposterior diameter of the chest in infants and children


The number of chest compressions per minute during CPR is an important determinant of return to spontaneous circulatory activity (RACS) and survival without sequelae

Total chest relaxation after each compression must be ensured with an equal time between compression and relaxation

CPR plus mechanical ventilation is much more effective than CPR with chest compressions alone in the first 5 minutes

CPR by chest compressions alone is as eective as CPR plus artificial ventilation in the first minutes after the onset of non-traumatic and non-asphyxia CA in adults

Numerous and serious cases of transmission of viral diseases such as HIV have been reported during artificial ventilation, which requires the use of protective devices.

Very few cases have been reported. The use of simple protective devices can reduce the transmission of diseases, but in practice it is only recommended if the victim is known to be carrying a serious infection.

VF is the most common etiology among non-traumatic CA etiologies


Priority to defibrillation over CPR is confirmed

In hospitals, oxygen should be given as early as possible during CPR

Tracheal intubation is the gold standard technique for airway control

Pulmonary resuscitation is useless in hospital since a defibrillator is always present

You have to control the airway in less than 10 seconds

Once tracheal intubation is performed, chest compressions are continued continuously at a frequency of 100/minute, regardless of insuations which are performed at a frequency of 10/minute


Regarding specialized cardiovascular resuscitation:

Sternal punching should no longer be used to treat out-of-hospital KT

Sternal punching may be considered in a patient with atrial CA fibrillation

It may be considered in a patient with unstable ventricular tachycardia (TV) (including pulseless TV), occurring under the supervision of a specialized first aider, only if a defibrillator cannot be used immediately

Standard CPR allows coronary and cerebral perfusion equal to 100% of its physiological value

At best, standard CPR allows coronary and cerebral perfusion equal to 30% of its physiological value

The small-axis parasternal window is the one recommended in ETT to identify a reversible cause of CA

However, the performance of an ETT should not result in a prolonged interruption of the CPR, and the subcostal window, which seems to best meet this requirement, is the one recommended.

The recommended position for the electrodes is anterolateral, with a subclavicular electrode


Which of the following proposals are shockable rhythms?


Which of the following propositions are true about the person of trust?

Anyone around you can take on this role.

It has veto power over medical decisions

His role is to be consulted by the medical team if the patient is no longer able to clearly express his will

It is consulted when the patient is no longer able to clearly express his will


Palliative care is only for the sick patient

To the patient and all loved ones who need it

Palliative care is mandatory for patients at the end of life

They are proposed according to the context

Palliative care is contraindicated in children

Palliative care can only be introduced with the patient's consent when possible


Thus, the presence of bleeding during defecation is an alarm sign requiring a colorectal screening exploration

The treatment of hemorrhoidial thrombosis is based on the simple incision or excision of the thrombosed area that immediately relieves the patient when the patient is seen in the rapid aftermath of the constitution of the thrombosis

Hemorrhoid hemorrhages result in the emission of gleaming red blood in the immediate course of a defecatory episode usually mixed with the materials

Hemorrhoid hemorrhages They result in the emission of gleaming red blood in the immediate course of a defecatory episode usually not mixed with the materials

The presence of a permanent perianal swelling may be sequelale (marisque) but must evoke a benign associated condition (fistula, abscess) cancer

A manually reducible externalized procidence represents grade 3 hemorrhoids


The diagnosis of hemorrhoidal disease is based solely on the data of the interrogation and clinical examination

In case of isolated bleeding, the hemorrhoidal origin can be affirmed after ensuring that there is no other colo-rectal cause for the described bleeding (colonic endoscopy)

Drug treatment relies on antibiotics, transit retarders and local topicals

Drug treatment is based on hygiene-dietary rules, control of transit disorders and local topicals

Endoscopic techniques are reserved for patients suffering regularly from procidence or bleeding related to medium-sized hemorrhoids

The instrumental method that seems to offer the best benefit/risk ratio today is the elastic ligation.


Traditional surgical treatment of hemorrhoidal disease is based on excision and/or pedicle resection of vascular tissue and support of hemorrhoidal plexuses

Surgical treatment is usually offered after instrumental treatments have failed or because the anatomical disease is too severe.

Anoscopy should be done in all patients with hemorrhoidal symptomatology

The hemorrhoidal symptomatology remains very specific

The patient should be informed of the deleterious effects of long-term surgery as continence disorders.


Which of the following are true about hemorrhoids?

Treatment concerns only symptomatic forms

Non-symptomatic hemorrhoids are not treated +++

Hygyieno-dietary rules and endoscopic gestures (elastic ligation, photocoagulations, etc.). Surgery is really a last resort

An anoscopy should be done in any patient with hemorrhoidal symptomatology

The risk of recurrence after surgery is zero


Headaches perceived by the patient as recent and unusual ("acute") are by definition essential headaches

These are secondary headaches until proven otherwise and require emergency examinations

Headaches recognized by the patient as old and usual ("chronic") are usually primary headaches and are managed without urgency.

They can be paroxysmal (seizures) or permanent

Any recent change in an old and usual headache leads to suspicion of a secondary headache

Meningeal syndrome and intracranial hypertension syndrome are life-threatening emergencies


Concerning additional examinations of headaches and neuralgia:

Any recent and unusual headache should be considered secondary until proven otherwise.

In front of a first episode, the key examinations are brain imaging (CT and/or MRI), cerebral and/or cervical angiography (CT angiography, MRI-angiography) and lumbar puncture

In front of a first episode, the brain scan without injection looks for spontaneous hyperdensity (presence of blood)

Sections on the sinuses look for ethmoiditis

Ethmoiditis is technically sinusitis (but not the most common)

A CT scan without normal injection eliminates a cause of injury

A CT scan without normal injection does not rule out a lesional cause: CT scan is normal in 7% of subarachnoid hemorrhages after 24 hours, 30% of cerebral venous thrombosis, in almost all cervical artery dissections at the stage of local signs and in almost all meningitis


Brain MRI is more sensitive than CT scan for all parenchymal or pituitary lesions

T2 FLAIR coronal cervical MRI sections are needed to look for arterial dissection

Axial cervical MRI (T1 FAT-SAT) sections are needed to look for arterial dissection

MRI is the most common examination in emergencies

MRI often remains unavailable in emergency

The lumbar puncture does not highlight a hemorrhage

The lumbar puncture makes it possible to highlight a subarachnoid hemorrhage not visible in imaging (xantochromia) (but also meningitis and to measure the pressure of the cerebrospinal fluid (CSF) in search of intracranial hypertension)

PL is to be performed as a first-line treatment in case of suspected meningitis, after eliminating contraindications

Contraindications include suspicion of commitment or intracranial hypertension, too much blood fluidity


There are no contraindications to PL in case of emergency

Contraindications include local infection at the puncture site, severe hemostasis disorder, signs of intracranial hypertension with threat of engagement pointing to a lesion with mass effect. Imaging is therefore necessary when the lumbar puncture is performed for isolated headaches

In case of PL, the use of an atraumatic needle of the smallest possible caliber (25 G) minimizes the risk of headache by dural breach

An inflammatory syndrome can evoke Horton's disease or an infectious syndrome

Ophthalmological examination looks for bilateral papillary edema that is indicative of type 2 diabetes

Bilateral papillary edema = intracranial hypertension

Any sudden headache must suspect a vascular cause and in the first place a serious epistaxis

Suspect subarachnoid hemorrhage in the first place


Tension headaches can last from 30 minutes to 7 days

Cluster headaches can last between 3 and 14 days

Duration of the order of the hour: between 15 and 180 minutes in general

A migraine usually lasts between 4 and 72 hours

They are also unilateral, periorbital, frontal or temporal.

During a migraine, the headache is often accompanied by photo-phonophobia and nausea

Nausea can induce vomiting. In case of migraine with aura, we will also observe transient visual, sensory or language disorders, of progressive and successive installation, preceding or accompanying the headache


Which of these proposals can result in a normal non-injected CT scan?

Cerebral infarctions appear on CT scan after 3 hours

It is seen on a scanner without injection


Which of these proposals are visible on the non-injected scanner?

Brain infarctions give signs on CT scan after 3 hours


Any "explosive" headache with normal brain imaging requires a lumbar puncture to look for xanthochromia

An aneurysm-free SAH may correspond to reversible cerebral vasoconstriction syndrome (SVCR)

SAH (or subarachnoid hemorrhage) accounts for 10 to 30% of sudden headaches

Reversible Cerebral Vasoconstriction Syndrome (SVCR) is over-diagnosed

Underdiagnosed because it is a syndrome of recent description (2007)

SVCR accounts for 10 to 45% of "thunderclap" headaches


The restriction of participation expresses the impact in social life

The concept of incapacity has given way to the notion of restriction of participation

The inability to read is a restriction of participation

Loss of employment status due to impairment is a restriction of participation

An evaluation that is too difficult that puts the patient in check is useful to show him his limits

Absolutely useless and counterproductive! Evaluation must be conducted with tact and, above all, must be adapted


Which of these proposals are restrictions on participation?


Declarative memory engages explicit processes

Episodic memory refers to facts and knowledge

Episodic memory referring to experiences that fit into a spatial context

Episodic memory is that of 'where? when? how?'

The memory of a birthday meal that took place with such protagonists will bring procedural memory into play

Semantic memory refers to facts and knowledge


Which of these proposals are causes of mental disability?

Cognitive disability (cf. College of Psychiatry page 565: mental disabilities are from birth)

Mental disability: begins in adolescence or adulthood, progressive, possible or even essential drug treatments.

Mental disability: early onset from birth, stable, infrequent medical care


According to the WHO, an IQ of 58 corresponds to:

Mild mental retardation: between 55 and 70 IQ points

Severe mental retardation: between 20 and 34 IQ points


From which cell does Reed Stenberg's cell derive?

Let's remember that a platelet is not a cell. It is a fragment of the Megakaryocyte


A lymph node biopsy in a 26-year-old woman, with no history, who has supradiaphragmatic lymphadenopathy, shows a lymph node architecture modified by broad bands of fibrosis delimiting cell nodules. Binucleolate giant cells of CD20-, CD30+, CD15+ phenotype are identified.

Which of the following are true?

This description is in favor of the diagnosis of diffuse large cell malignant B-cell lymphoma

Hodgkin lymphoma (phenotype corresponds to Hodgkin cells and binucleolate giant cells correspond to Reed-Sternberg cells)

CD20- phenotype supports T-cell lymphoma

Binucleolate giant cells correspond to Sternberg cells

This description is typical of Hodgkin lymphoma of the "mixed cellularity" subtype.

Scleronodular (because clears the lymph node architecture and has wide bands of fibrosis)

EBV virus expression can be found in 20% of cases


A PET-CT scan regains intense hyperfixation of right jugulo-carotid lymphadenopathy and an anterior mediastinal mass, without other hypermetabolism.

Which of the following is Ann Arbor Stadium?

True, 2 lymph node areas affected on the same side of the diaphragm


Which of the following are characteristics of the Hodgkin cell?


Renal failure is found in about 50% of symptomatic cases

Fanconi syndrome is a distal tubulopathy

Fanconi syndrome is proximal tubulopathy


A woman may have ovulatory cycles without periods

For example in case of absence of uterus

The presence of menstruation affirms the presence of ovulatory cycles

It is possible to have anovulatory cycles with menstruation

The only physiological circumstance of amenorrhea is menopause

Primary amenorrhea is defined as the absence of menarche at age 12

Secondary amenorrhea is defined by stopping menstruation for more than 3 months without previous irregularities


Among these proposals, which are signs of accompaniment of primary amenorrhea that must be specified during questioning?

Not an interesting sign in this context, although it can orient in specific cases


Regarding the interrogation in case of primary amenorrhea:

Infectious pathologies such as meningitis are to be specified during questioning

A history of appendicitis is important to specify

Inguinal hernia cures are not relevant given their location in the iliac fossa

Very important because can affect the ovaries

Corticosteroid therapy can cause primary amenorrhea

The interrogation must go back to the circumstances of pregnancy and childbirth


Regarding the gynecological examination:

Gynecological examination is performed with empty bladder

Inspection of the vulva makes it possible to specify the degree of hair

As well as the appearance of the labia, the size of the clitoris, etc.

The appearance of the labia minora and labia majora does not matter

It is inspected and provides interesting information

The classification of pubertal stages is Turner's

Speculum examination can detect the presence of the uterine tubes


Among these proposals, which are signs of hyperandrogenism?

Especially if it goes down on the thighs


The first test to order in case of secondary amenorrhea is the LH/FSH to rule out pituitary adenoma

This is the plasma assay of βHCG in order to eliminate a pregnancy

The objective of the first examinations is to find the exact cause of amenorrhea

The first objective is to specify the level of amenorrhea, not its exact pathophysiology

Menothermic corube is required in all women

It is performed if secondary sexual characteristics are developed

The menothermic curve must be carried out over 1 month

Ovulation occurs at the highest point of the temperature curve

Ovulation occurs at the lowest point of the menothermic curve before the temperature rises (thermal shift of about 0.5 °C)


Radiography of the hand helps define bone age

It is prescribed in case of impubertism + primary amenorrhea

Sesamoid of the thumb appears for a bone age of 16 years

The involvement is ovarian in case of low FSH and high LH

The involvement is ovarian in case of elevated FSH

After checking the integrity of the genitals, the progestin test is offered as a first-line


Secondary amenorrhea is much more common than primary amenorrhea

The first cause of primary amenorrhea is the impermeable hymen

In front of a primary amenorrhea, the first examinations are the assay of FSH and prolactin, in particular

As well as hand X-ray and pelvic ultrasound

In case of secondary amenorrhea, a progestogen test is performed as a first-line

ATTENTION, we first eliminate a pregnancy

Turner syndrome is an important etiology of primary amenorrhea without secondary sex characteristics


Regarding psychiatric care without consent:

There are two distinct constraint procedures

By decision of the Prefect or at the request of a third party

They may be practised by decision of the Prefect.

They can be practiced at the request of a third party (=SDRE)

There are 5 conditions that can motivate them

2: mental disorders that make consent impossible and a condition requiring immediate care


Concerning the admission procedure under ordinary law:

3 documents: 2 medical certificates and 1 application for admission from a third party

Medical certificates must be made by psychiatrists

Verification of the patient's identity is carried out by the intake officer

By the director of the institution prior to any admission of the patient

Medical certificates must be less than 15 days old

Or if it can justify the existence of relationships with the patient that make him act in his interest


The pigmented appearance of the areola is strengthened during pregnancy

During pregnancy, the areola loses its sensitivity to tactile stimulation

It is more sensitive to tactile stimulation

During pregnancy, the areola completely loses its thermal sensitivity

Davatange sensitive to thermal stimulation

Montgomery's glands participate in the secretion of an odorous liquid

The odorous liquid is a powerful olfactory landmark for the newborn


The areola is a cone in the center of the nipple

It is of course the opposite: the nipple is a small cone in the center of the areola that contains many smooth muscle fibers and at its top, many pores to release milk

The mammary gland is composed of two lobes on the left and three on the right

Let's not confuse with the lung: the mammary gland consists of about fifteen lobes on the right and left

Each lobe behaves like an independent gland with its own excretory duct

The milk ducts have a very sinuous path and open at the top of the nipple through the pores

More than half of the mammary gland is 3 cm from the base of the nipple


Prolactin has a negative lactogenic action

Prolactin has a positive lactogenic action!

Feeding causes elevated prolactin and oxytocin

Breast milk only has a nutritional function for the child

Breast milk has two main functions: nutritious and immunological

Its composition and quantity are constant over time but there is a small interindividual variation

Its composition and quantity are variable: water and trace elements, high lactose content, low casein but rich in soluble proteins (α-lactoglobulins), etc. Also, there is a modification of content from the 15th day to go towards a higher fat composition

The first breastfeedings are composed of 99% lactose

The first breastfeedings are composed of collostrum, a substance rich in IgA, glycoproteins, oligosaccharides, immune cells and low in fat


There is a change from the 15th day in transition milk increasingly rich in fat

Breastfeeding has little effect on immunity

It brings to the newborn passive immunity against certain infections

The composition of milk is common to all mammals and falls within the definition of these

Milk is a species-specific substance, each with milk of different content

Breast milk is translucent and relatively low in vitamin D

Infant formula is obtained by processing beef milk

Infant formula is obtained by processing cow's milk. The boeur being the male, it does not produce milk


Among these proposals, which are a contraindication to breastfeeding:

Synthetic antithyoids taken by the mother


Artificial breastfeeding is in every way equivalent to breastfeeding

Artificial breastfeeding does not have the immunoprotective function of breastfeeding because it is derived from cow's milk while the immunological elements are species-specific.

Breastfeeding should not begin before 12 p.m. postpartum

It is advisable to breastfeed immediately, if possible in the labor room

It usually takes one feeding every 12 to 24 hours at the beginning

Far too long! Every 2 to 3 hours at the beginning

Prohibiting smoking during breastfeeding is necessary

The only complication of breastfeeding is engorgement


Which of the following proposals designate the advantages of growing up milk over cow's milk?

Growing up milk has about half as much protein as cow's milk


Which of the following are the benefits of breastfeeding?

It is adapted to the nutritional needs of the newborn

It is deficient in vitamin K. If it is exclusive, vitamin K 2mg PO should be supplemented at 1 month (after routine supplementation at birth)


Most pregnancies are normal and can be managed by a doctor or midwife

For these pregnancies without a risk situation or a low level of risk (follow-up A of the HAS), the management is medical and psycho-social with a screening and prevention approach.

Pregnancy monitoring aims to assess the only fetal risk of developing diseases

Pregnancy monitoring aims throughout pregnancy to assess fetal and maternal risk in order to prevent, screen, diagnose and manage by specialized teams abnormal situations detected

Pregnancy monitoring is the responsibility of a medical gynecologist

Pregnancy monitoring is a team effort that combines: medical and psycho-social problems

Pregnancy monitoring requires the collaboration of all specialists involved


Regarding pregnancy monitoring and the choice of maternity:

Pregnancy monitoring can call on the services of PMI (maternal and child protection), CAF, psychologists, dieticians, etc.

Pregnancy monitoring includes 9 consultations per pregnancy covered 100% by the Health Insurance

There are two consultations per month between the 5th and 7th month normally scheduled

From the 7th month, it is preferable that it is the team that will ensure the birth that does the surveillance

Expectant parents always turn to the maternity wards of their choice


Level I maternity wards account for 80% of maternity wards

The three types of maternity are: • Level I maternity wards (49% of maternity wards): − management of low-risk pregnancies

Level 1 maternity wards have neonatal units with fewer than 6 beds

Level II maternity wards are intended for high-risk deliveries

Level 2a maternity wards have a neonatal intensive care unit

these maternity wards have: − a neonatal unit (level II a) (23%)

49% of maternity hospitals in France have a neonatal intensive care unit


Which of these proposals refer to the objectives of the first pregnancy consultation?

Making the diagnosis of pregnancy exclusively clinically

Determine clinical term via ultrasound only

Talking about screening for trismia risk 13


23% of maternity hospitals in France are level 3

Level 3 maternity wards have a neonatal resuscitation unit within a CH with an adult resuscitation unit

The first consultation of the pregnancy follow-up must take place in the first month of pregnancy

The first consultation of the pregnancy follow-up takes place before 3 months of pregnancy (the HAS in its recommendations of 2007 proposes two consultations in the 1st trimester one to 10 SA and one before 15 SA), the Health Insurance reimburses one at 100%

The diagnosis of pregnancy is based on the clinic and complementary examinations most often

The vaginal touch shows the increase in volume of the uterus which thickens from front to back giving a spherical shape


Which of these additional tests can be used to diagnose pregnancy?

Ultrasound of the uterus. Pregnancy is then visible only from 5 SA and cardiac activity from 5.5 SA on vaginal ultrasound


Regarding the duration of a normal pregnancy:

Fetal heart sounds can be heard by the fetal Doppler apparatus at the end of the 1st month

Fetal heart sounds (BDC) can be heard with the fetal Doppler machine at the end of the 3rd month (sound signal heard at the 10th SA, sometimes as early as the 9th)

The duration of pregnancy varies between 280 and 290 days

The duration of pregnancy varies between 40SA and 41.3SA

The average length of pregnancy is 284 days


Among these proposals, which designate a cranio-caudal length in the standards:


Among these proposals, which designate tests not recommended in patients during pregnancy?


Concerning the course of a non-pathological pregnancy

For a woman who has a regular 28-day cycle and a last menstrual period on January 1, the beginning of pregnancy is January 14 and the expected term is August 14.

For a woman who has a regular 28-day cycle and a last period on January 1, the beginning of pregnancy is January 14 and the term is October 14.

In case of IVF, the date of pregnancy is the date on which the sounds of the heart are observed with Doppler, minus 3 months

In case of IVF, the date of onset of pregnancy is defined by the date of puncture (professional agreement)

Ultrasound dating is based on the antero-posterior length of the fetus

To reduce the risk of prolonged pregnancy, the CNGOF in its 2011 CPR recommends ultrasound dating of early pregnancy using ultrasound measurement of craniocaudal length, which ideally should be done between 11 and 13.6 SA (CCL between 45–84 mm): • CCL at 11 SA = 45 mm

Interrogation alone will define the mode of obstetric monitoring


Which of these proposals are oligatory biological examinations during normal pregnancy?

Not if there are written results that allow immunity to be considered acquired


Regarding the follow-up of type B pregnancy

In type B follow-up, regular follow-up can be done by an authorized midwife

Regular follow-up should be provided by an obstetrician gynecologist

If the patient does not have a complete blood group card, a double determination is mandatory

Screening for syphilis TPHA-VDRL is mandatory in all cases

Rubella serology is mandatory in all cases


Concerning the follow-up of non-pathological pregnancy

Irregular antibody testing (IAR) is mandatory in all cases

The search for antibodies A and B is mandatory

excluding antibodies to A and B antigens

Toxoplasma serology is repeated every month from the 2nd prenatal examination in all cases

Toxoplasma serology is repeated monthly from the 2nd prenatal examination if immunity is not acquired

The search for albuminuria is to be done at the 3rd and 6th month only

The search for albuminuria is to be done every month during pregnancy

Obstetric ultrasound is a mandatory examination

Obstetrical ultrasound is not a mandatory examination but it is necessary for a good obstetrical follow-up


From the following proposals, check the exact answer(s):

The responsibility for whether or not to prescribe a rehabilitation program rests with the physician

The realization of rehabilitation is a prerequisite for the establishment of a

The legislation distinguishes 84 rehabilitation professions

Seven: masseurskinesitherapists, occupational therapists, speech therapists, psychomotor therapists, orthoptists, pedicures-podiatrists and dieticians

There are 13 different rehabilitation programs that are chosen for each patient according to their situation

The rehabilitation program is adapted and personalized for each patient

A rehabilitation programme must be followed by the evaluation of results; involving the doctor and paramedics


Simple rehabilitation programs involve the collaboration of the doctor regardless of his specialty and a medical assistant, physiotherapist or speech therapist mainly

Complex rehabilitation programs require the collaboration of MPR and several rehabilitation auxiliaries

Treatment of urinary incontinence in women requires complex rehabilitation

1st line treatment of UI in women: rehabilitation and treatment of contributing factors

The overall goals of rehabilitation can be anatomical or functional recovery, maintenance or compensation for a disability.

Edema and trophic disorders are indications for massage physiotherapy


It is necessary to distinguish true hypercalcemia, with elevation of ionized calcium from false hypercalcemia by increase in the protein-bound fraction

Hyperalbuminemia, by severe dehydration for example, leads to an increase in total calcium, but without an increase in ionized calcium

The assessment of hypercalcemia must therefore include an ionized calcium assay or an albuminemia assay

Severe or rapid onset hypercalcemia is accompanied by general signs, digestive disorders and often confusing neuropsychic manifestations

Signs of hypercalcemia are very specific


Neuro-psychic signs are common (memory problems, depression or anxiety)

Digestive disorders (anorexia, nausea and vomiting) are common when serum calcium is > 2 mmol / L

Digestive disorders Anorexia, nausea and vomiting are common when serum calcium is > 3 mmol/L

Hypercalcemia leads to a decrease in QT space and rhythm disorders

Chronic hypercalcemia can lead to renal lithiasis and chronic renal failure

Calcemia is regulated by two hormones: parathyroid hormone (PTH) and vitamin D, which control digestive calcium absorption, bone formation and renal excretion.


10 to 20% of cancer patients will have at least one episode of hypercalcemia during the course of their disease

Primary hyperparathyroidism results in 20% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands

Primary hyperparathyroidism results in 80% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands

Parathyroid carcinoma (malignant form of primary hyperparathyroidism) is exceptional (< 1%) and is accompanied by severe hypercalcemia (> 3.5 mmol / L) poorly tolerated

Parathyroid adenoma mainly affects women after 40 years

Primary hyperparathyroidism can be the consequence of chronic lithium intake


Which of the following are ECG signs of hypercalcemia?


Which of the following are signs related to hypercalcemia?


Ionized serum calcium varies between 1.15 and 1.3 mmol/L

The determination of ionized calcium can be disturbed by pH and phosphate

Calcium homeostasis is essentially based on three key organs (intestine, kidney and bone) and two regulatory hormones.

Digestive inputs are regulated by active vitamin D, also known as calcidiol (25-[OH]-vitamin D2), which promotes calcium absorption

The active vitamin D is calcitriol (1,25-[OH]2-vitamin D3)

Urinary excretion is regulated by renal reabsorption in the distal tubule which is promoted by PTH


PTH is the key hormone that supports serum calcium

PTH then stimulates the distal renal tubular reabsorption of calcium, the conversion by 1α-hydroxylase, of 25-OH-vitamin D3 into active vitamin D

Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 6 mmol/L or an ionized serum calcium greater than 1.5 mmol/L

Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 2.6 mmol/L or an ionized serum calcium greater than 1.35 mmol/L

The discovery of hypercalcemia requires a second confirmatory test, without delaying treatment if there are threatening signs

It is estimated that 40% of hypercalcemias are asymptomatic and incidentally discovered.


Chronic hypercalcemia is often complicated by phosphate lithiasis or calcium oxalate (renal colic, hematuria or urinary tract infection), nephrocalcinosis, obstructive renal failure

Acute hypercalcemia is a medical emergency with a risk of death from heart rhythm disorders

An emergency ECG should be performed to look for rhythm disorders (tachycardia, QT shortening, early onset T waves) because there is a risk of ventricular fibrillation and sudden death.

The discovery of malignant hypercalcemia requires hospitalization to carry out emergency treatment

Calcitonin should be given urgently in acute hypercalcaemia

It includes the following measures:Calcitonin no longer has a place in the treatment of hypercalcemia


Most heart conditions if not detected or treated in time can lead to heart failure

HF is a syndrome that can be defined as the combination of symptoms and signs associated with cardiac dysfunction

The diagnosis of HF is, in most cases, easy to make

Relatively difficult generally. In doubtful cases, the clinical response favorable to appropriate treatment (diuretic) may be an argument in favor of the diagnosis

It is estimated that the prevalence of heart failure in the general population is between 15 and 20% in France

That would be far too much. It is estimated that the prevalence of heart failure in the general population is between 1 and 2%

The average age of diagnosis in Europe is around 40 years


Population aging explains why the prevalence of HF tends to increase

Ejection fraction is the most widely used parameter to characterize diastolic function

In case of cardiac dysfunction, the body will react by bringing into play a number of compensatory mechanisms

Tachycardia under the dependence of the activation of the parasympathetic system helps to maintain cardiac output

Tachycardia is dependent on the activation of the (ortho)sympathetic system. It helps maintain cardiac output (DC = VES × HR)

Vasoconstriction in response to activation of the sympathetic system and renin angiotensin system helps maintain perfusion pressure


Exertional angina is often indicative of the disease

It is rather the dyspnea of effort that reveals the disease. There is rarely angina at the beginning of the disease

The degree of effort at which dyspnea appears makes it possible to quantify the functional tolerance of the disease

In severe or end-stage heart failure, respiratory disorders such as Cheynes-Stokes breathing sleep apnea syndrome may be observed.

Apart from an acute flare-up of the disease, the physical examination of the heart failure is often quite rich (dyspnea, pallor, edema, etc.)

Apart from an acute flare-up of the disease, the physical examination of heart failure is often quite poor, especially when HF is treated and controlled.

At the cardiac level, palpation sometimes makes it possible to note a spike shock deviated at the top and right, related to left ventricular dilation

In case of dilation of the LV, the tip shock is deflected at the bottom and left, in the axis of the heart


At a very advanced stage, heart failure can be accompanied by an alternating pulse, oliguria, muscle wasting, sometimes achieving a real cachectic state.

Cheynes-Stokes dyspnea is sometimes noted in patients with heart failure during sleep

Especially in cases of severe or terminal HF

ECG is low contributory to the diagnosis of heart failure

The existence of a branch block in particular left (duration of the QRS > 120 ms), is an important element to take into account given the current therapeutic implications

It is essential to appreciate the pleuropulmonary impact


BNP or NT-proBNP can help in the diagnosis of heart failure, with good positive predictive value.

BNP or NT-proBNP can help in the diagnosis of heart failure, with a good negative predictive value; thus, normal values of BNP (< 100 pg/mL) or NT-proBNP (< 125 pg/mL) make the diagnosis of heart failure very unlikely in the presence of acute dyspnea with a good negative predictive value

There are values of BNP/NT-proBNP for which the diagnosis is uncertain, the interpretation must imperatively take into account the clinical data

Transthoracic echocardiography (ETT) coupled with Doppler is the essential key test in case of suspected heart failure

Coronary angiography is a key test for suspected primary heart failure

Coronary angiography is usually offered in case of impaired systolic function (decreased ejection fraction [EF]) to rule out coronary artery disease.

Ischemic heart disease is the leading cause of heart failure.


Pulmonary arterial hypertension is defined as a mean PAP greater than 25 mmHg

Normal cardiac output is 5 L/min, cardiac index is 3 L/min/m2

All heart conditions can lead to heart failure

High blood pressure is also an important factor or cofactor in heart failure

Dilated cardiomyopathies (DCM) are defined by damage to the heart muscle that results in dilation and decreased LV ejection fraction.


All left valvular heart disease can be complicated by heart failure (mitral or aortic insufficiency, mitral or aortic stricture)

Ventricular or supraventricular rhythm or conduction disorders can cause heart failure

Pulmonary oedema in a young migrant, especially if it is associated with atrial fibrillation, should suggest the diagnosis of rheumatic valvular disease, especially mitral valve disease.

mortality remains high in heart failure, averaging 50% at five years but can reach up to 40-50% per year in severe heart failure (NYHA IV)


HF is considered the leading cause of hospitalization after age 65

Hospitalization for cardiac decompensation is always a severity factor

Heart failure can be accompanied by anemia, iron deficiency, sleep apnea syndrome

Prevention of heart failure begins with management of cardiovascular risk factors

The success of treatment depends closely on the patient's education and understanding of the disease.


Which of the following are true about the NT proBNP?

Faced with acute dyspnea, he directs to a cardiac origin

It is a prognostic marker of heart failure

It is increased in case of heart failure


Which of the following are early complications of triple-chamber defibrillator implantation?


The incidence of epilepsy is higher in children and after 60 years

About 1% of epilepsies begin before the age of 5

About 50% of epilepsies begin before the age of 10

EEG during juvenile myoclonus is characterized by generalized, bilateral, symmetrical and synchronous polyspikes-waves

EEG during the typical absence is characterized by a generalized, bilateral, symmetrical and synchronous paroxysmal discharge of wave-peaks at 3 Hz, abruptly beginning and ending, of a few seconds, interrupting normal background activity

Disorders of consciousness during focal seizures do not have a precise localizing value


When faced with an epileptic seizure in a known epileptic, it is necessary to do a brain imaging in first line

No. Antiepileptic drugs must be dosed as a first-line measure.

The most common cause of seizures in an epileptic is lack of sleep

It is the lack of adherence, hence the fact of dosing antiepileptics in the first-line assessment in the known epileptic

Prevalence is about 1% in the general population

In 50% of cases, no cause of the seizure is found

The tonic phase of a tonic-clonic seizure lasts 30 seconds

It lasts 10 to 20 seconds. The clonic phase lasts about 30 seconds.


Mental confusion persisting for more than 15 minutes


Which of these proposals are suggestive of an epileptic seizure?

Recovery is slow, often in transport to the hospital. Confusion can last a long time

Often due to the fall and does not portend the character of the crisis

Fever is a criterion of severity of the seizure, but is not in itself an element pointing to an epileptic seizure


These are two different syndromes, although their clinical impact is close

It is characterized by generalized EEG discharge

Wave peaks usually have a frequency of 3hz


Regarding treatments in a woman of childbearing potential:

In patients of childbearing potential, enzyme inducer treatments are preferred to be avoided

They decrease the effectiveness of oral contraception

Levetiracetam does not present an over-risk of malformation compared to the general population

Valproic acid should not be prescribed to a woman of childbearing age

Oxcarbazepine is contraindicated in Wilson's disease

It is contraindicated in case of porphyria


Among these anti-epileptic molecules, which are also indicated for bipolar disorders?

Broad-spectrum molecule whose main EI is asthenia. The route of elimination is renal and has a half-life between 7 and 11 hours.

Also indicated in bipolar disorder, lamotrigine is a broad-spectrum anti-epileptic whose main AE is to aggravate myoclonus, Lyell's syndrome, insomnia and headache. Its elimination pathway is hepatic (it is an enzyme inhibitor) and has a half-life of about 1 day (25 hours)

Narrow-spectrum anti-epileptic drugs with hyponatremia, rash, dizziness, and diplopia as main ARs. Its elimination pathway is mixed (hepatic and renal). It is an enzyme inducer

Broad-spectrum anti-epileptic drugs with urolithiasis and weight loss as AEs. It is also used in migraines (not in bipolar disorder)

Absolutely contraindicated in women of childbearing age. This question is based on this table: https://www.cen-neurologie.fr/sites/www.cen-neurologie.fr/files/files/capture_decran_2019-12-19_a_14.41.14.png


Which of the following proposals regarding electroencephalogram (EEG) are true?

An epileptic seizure is a clinical manifestation of the hyperactivity of a group of cortical and/or subcortical neurons

A normal EEG rules out an epileptic cause

During epileptic seizures, we can find at the EEG paroxysmal activities of the poly-peak wave (PPO) type.

EEG may reveal paroxysmal intercritical activities

EEG abnormalities can be activated by sleep deprivation


Regarding gastroesophageal reflux disease or GERD

Gastroesophageal reflux refers to the passage through the cardia of gastric contents into the esophagus

The key element of the RGP is the failure of the anti-reflux barrier forged by the lower esophageal sphincter (SIO) and the diaphragm

The combination of pyrosis acid regurgitations are almost pathognomonic of GERD


Regarding epidemiology in the general population, which propositions are true?

10% of people describe a pyrosis at least weekly

60% of people are subject to monthly GERD

No data in the college on monthly frequency

2 to 5% of people experience GERD a daily pyrosis


Which of the following refers to the main mechanism of GERD in very young infants?

Inappropriate and transient relaxations of ORS

True, with 5-second episodes of relaxation ≥ independent of swallowing


Which of the following proposals are part of the management of simple gastroesophageal reflux disease in small children?

Reassure parents about the benignity of regurgitation

Putting the child to bed in the supine position

Never advise this is a high risk factor for sudden infant death syndrome.
According to the college, the inclination of the cradle (proclive) as well as the eviction of passive smoking have no proven effectiveness.

This is not at all a contraindication to breastfeeding, which is on the contrary advisable.
If hygiene-dietary rules are not enough, it is possible to express milk and thicken it.


Which of the following are possible treatments for simple gastroesophageal reflux disease in a bottle-fed infant?

Alginates and other esophageal dressings are a controversial adjuvant measure of efficacy, especially in infants

They have an antisecretory action acids. They are therefore only effective in case of acid reflux only. They have no effectiveness on regurgitation and are not used in simple GERD.

Contraindicated in children under 18 years of age because risk of extrapyramidal syndrome.


Which of the following are complications of GERD?


It is a chronic inflammation of the pancreas resulting in progressive fibrosis of the pancreatic parenchyma

Chronic pancreatitis first affects exocrine tissue, then endocrine tissue

• At the initial stage, the disease is characterized by outbreaks of acute pancreatitis, and by chronic pain that represent the main clinical translation of the disease

• Prevalence of about 1/1,000,000 inhabitants in Western countries


Excessive alcohol consumption is the cause of the majority of chronic pancreatitis (CP) in the West

Tobacco is a risk factor present in more than 80% of cases

Hypercalcemia is a rare cause of chronic pancreatitis

hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 30 years

hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 15 years

Transfixing epigastric pain relieved by alcohol intake is a main sign of chronic pancreatitis


A pseudocyst is a fluid collection containing either pure, clear pancreatic juice or liquefied pancreatic necrosis.

A pseudocyst: • complicates 20 to 40% of PCs; • can form as a result of an acute flare-up (necrosis) or by ductal retention (clear liquid); • may remain stable, regress or become complicated: compression of a neighborhood organ (bile duct, duodenum, splenoportal axis), (resulting in a pancreatic abscess), hemorrhage or rupture in a nearby hollow organ or in the peritoneal cavity or in a serous (pleura, peritoneum)

Stenosis of the main bile duct most often results in anicteric cholestasis

Digestive bleeding occurs in 10% of chronic pancreatitis

During CP, exocrine pancreatic insufficiency occurs almost inevitably after an average of ten years of evolution


Chronic pancreatitis is a chronic inflammation of the pancreas that results in the death of the patient in the majority of cases

Migration of a gallstone into the wirsung is the main cause of chronic pancreatitis

The main cause of CP is acute pancreatia

Stenosis of the main bile duct is a cause of CP

Diabetes mellitus is one of the complications of chronic pancreatitis

Pain management in a specialized unit is essential


Concerning reasoning and decision in medicine

The medical decision precedes the decision

It is the medical reasoning that precedes the decision

The decision engages the responsibility of the doctor

The diagnostic approach corresponds to choosing the best therapy for the patient

The therapeutic approach corresponds to the fastest and most effective way to arrive at the diagnosis

The medical decision engages the responsibility of the hospital

The medical decision engages the responsibility of the one who makes it, therefore the doctor"


From the clinical signs will be built the diagnostic approach

Following the clinical interrogation, the doctor develops hypotheses based on his physiopathological clinical knowledge, in particular

Diagnostic hypotheses should always be verified by examinations such as imaging or biology.

These hypotheses will have to be verified by a guided clinical examination and possibly additional examinations

The choice of a complementary diagnostic (or therapeutic) examination must always be justified

The doctor is the one who makes the diagnosis


If there is a diagnosis, the doctor must assess its seriousness

When the diagnosis is made, the doctor should always propose a curative treatment if it exists

Situations where the proposal of a curative treatment is not a solution

The doctor usually has to inform the patient about his illness

When the main symptom does not correspond to any disease, the doctor should dismiss his patient and not prescribe anything

The doctor must try to find the motivation of the request for consultation for two reasons: to avoid medical nomadism and the prescription of unnecessary check-ups

Incidentalomas are a type of medical error

This is the detection of abnormalities unrelated to the main symptomatology"


Diagnosed pathologies should always be treated

Only when the benefit/risk balance is in favor and the treatment is the patient's will

There are 5 possible reasonings that dictate the decision to treat

There are 3: analog reasoning, pharmacological reasoning, and evidence-based reasoning.

Automatic reasoning is very common in internal medicine

It is common in medicines where the speed of action is important (eg emergency medicine, resuscitation, etc.)

Habit reasoning is an analogical type of reasoning

Reasoning by dictated behaviour is evidence-based


Medical knowledge has slowed down in recent years (few major discoveries)

The number of publications reaches peaks year after year, with great discoveries such as artificial intelligence, hepatitis and HIV treatments, CRISPR-Cas9, etc.

EBM is a conscientious use of the best current evidence from basic biological research

According to the Public Health KB, EBM is the use of clinical research data (not basic research)

4 steps: question formulation, literature review, outcome assessment and application to the patient

Literature review must follow PICO criteria

The PICO criteria concern the formulation of the question (Patient, Intervention, Comparator and Outcome)

Patient decision making (step 4) should be based on the patient's experience

As well as patient preferences and available resources"


Among these proposals, which are not components of the HBS:

The 3 components of HBS according to the KB of Public Health and the Cochrane French Centre: Clinical expertise, patient preferences and research data


Regarding the levels of evidence of the HAS:

Level 1 = Grade A = established scientific pereuve

Grade C corresponds to Level 3 and Level 4

Level 2 is that of scientific presumption

Level 3 is a low level of scientific evidence


Regarding the levels and grades of proof of the HAS:

High-powered randomized controlled trials are grade C

Grade A = Level 1 = scientifically established evidence

Grade B = Level 2 = Scientific presumption

Low-powered randomized controlled trials are grade B

As well as cohort studies, and well-conducted non-randomized controlled studies

Retrospective studies are grade C and level 3

Only case-control studies are level 3. Retrospective studies are Grade C and Level 4


The collegiate procedure may be requested by:

4 possibilities: the doctor, the family/relatives, the person of trust and the patient himself by his advance directives


Most often, it is triggered by the person of trust

By the doctor most often (cf. KB Public Health, page 35)

Only the opinions of doctors are taken into account

The entire healthcare team, the support person, etc.

The final opinion is taken by the family

The procedure is notified in the medical record

An external doctor is called in as a consultant


Which of the following proposals regarding cryptorchidism is (are) accurate?

Cryptorchidism describes an abnormal location of the testicle

Hernia / cryptorchidism association is not uncommon

Cryptorchidism is bilateral in 75% of cases

The origin of cryptorchidism is genetic most often

The scrotal migration phase is testosterone-dependent

While the intra-abdominal migration phase would be dependent on the hormone INSL3


At full-term birth, a penis smaller than 4 cm is a micropenis

Micropenis (penis < 2 cm in a term newborn)

Hormonal exploration is considered if cryptochidism persists at the end of puberty

It must be taken care of well before, from birth to find the etiology and the impact

When cryptorchidism is bilateral, the urgency is to eliminate an abnormality of the enzyme block type 21-hydroxylase

The most common abnormality of normal karyotype sexual development is the 21-hydroxylase block.

A 17-hydroxyprogesterone assay allows screening for congenital hyperplasia of the spleen

17-hydroxyprogesterone assay allows screening for congenital adrenal hyperplasia


Regarding cryptorchidism and anorchidism:

AMH testing can assess the existence of testicular functional tissue

Ultrasound can detect Müllerian derivatives if the cryptorchidism is bilateral

Anorchidism is rare and affects only one in 40 newborns

Anorchidism is much rarer and its pathophysiology is poorly understood

Surgical exploration in case of anorchidism makes it possible to look for the testicles in the abdominal area

Surgical exploration is, most often, not useful


Cryptorchidism is a call sign of a hypogodatrophic pathology that is a diagnostic emergency in the newborn

Cryptorchidism is a developmental anomaly very often found in polymalformative syndromes

There is a risk of ischemic necrosis by traction of the vascular pedicle during surgical lowering of the gonad

Two-step surgical lowering reduces the risk of necrosis

Surgical management must wait until puberty

The first consultation with a pediatric surgeon should ideally take place within the first six months of life.


In front of cryptorchidism in adults, hormonal exploration looks for type 1 diabetes

We look for hypogonadism (FSH, LH, total testosterone assay)

The determination of hCG is indicated in front of a testicular mass

A spermogram is performed to look for azoospermia or oligospermia

Testicular microlithiasis is indicative of malignant pathology

Their number greater than five should encourage vigilance given their frequent association with malignant testicular lesions.

Any cryptorchidism requires early endocrine exploration


According to a 2018 HAS care relevance report, it is preferable to perform this surgery between 6 and 12 months (spermatogenesis optimization). However, surgery should not be performed before the age of 6 months (apart from an inguinal hernia cure) because the testicle can descend spontaneously during the first months of life.

Cryptorchidism surgery patients in childhood do not need special follow-up

They must be monitored and reviewed at puberty to assess the impact on gonadal functions

Cryptorchidism may be associated with infertility

The search for cryptorchid atcd is essential during infertility consultations. It can also be associated with hypogonadism.

The relative risk of testicular cancer is zero with cryportchidism

Cryptorchidism increases RR of testicular cancer

Gynecomastia accompanying cryptorchidism points instead to hormonal dysregulation


Amyloidosis is a set of diseases characterized by extracellular tissue deposits of insoluble, fibrillar proteins, organized in folded, antiparallel beta sheets

The diagnosis of amyloidosis is histological

By biopsy of an affected organ, or, due to the dissemination of deposits, by biopsy of subcutaneous fat or accessory salivary glands

In amyloidosis, a normally insoluble protein will become soluble and form extracellular aggregates.

In amyloidosis, a normally soluble protein will become insoluble and form extracellular aggregates organized into folded, antiparallel beta sheets (amylose deposits or amyloid substance)

Some amyloidosis are acquired diseases, others are hereditary (amyloidosis by mutated transthyretin ATTR deposits)

Amyloidosis deposits are composed of 95% fibrillar proteins, and 5% glycoproteins


The biochemical nature of the amyloid fibrillar protein gives the name of the type of amyloidosis (example: amyloidosis type AL = immunoglobulin light chain)

Example: amyloidosis type AL = immunoglobulin light chain

Many proteins can cause amyloidosis deposits

Serum amyloid protein in AA amyloidosis, Ig light chains in AL amyloidosis, e.g.

The histological aspect varies according to the type of amyloidosis

Regardless of the type of amyloidosis, the histological appearance is the same: fibrils in beta-pleated sheets. They are highlighted by the Congo Red, and are birefringents to polarized light

These extracellular deposits may affect only one organ (localized amyloidosis as a single mass) or several organs (generalized amyloidosis which can be life-threatening)

They can also affect several organs (generalized amyloidosis which can be life-threatening)

The organs preferentially affected depend on the type of amyloidosis

AL amyloidosis: renal (65%), cardiac (61%), and in about 20% of cases hepatic, neurological, soft tissue or digestive system involvement. AA amyloidosis: mainly renal and hepatic damage


Kidney damage results in proteinuria, nephrotic syndrome, and renal failure

There is, classically, neither HTA nor hematuria

In case of suspicion of amyloidosis, a sample is sent to the laboratory, fixed in formalin for inclusion in paraffin for the detection of deposits, accompanied by a second sample sent fresh to be frozen for the typing of deposits

Deep rectal biopsies have a sensitivity of about 80%

They highlight gastrointestinal involvement of AL amyloidosis

Accessory salivary gland biopsies have a sensitivity of 80-85%

In case of amyloidosis, transparietal liver biopsy has a very high diagnostic interest

Frankly no interest. A blood enzyme assay is sufficient (greater increase in PAL than GGT). No cytolysis (normal TGO and TGP) and no jaundice (except in very rare cases, poor prognosis)


Regarding the skin involvement of AL amyloidosis:

They sit preferentially at the level of the legs

The preferred seat is the trunk and face

They may be accompanied by the sign of the shoulder pads


Regarding renal involvement of AL amyloidosis:

Renal failure appears in about half of cases

Kidney damage is very common: in more than 70% of cases (according to the College of Internal Medicine)

Proteinuria is mainly composed of light chains

Proteinuria is part of a glomerular syndrome (in a third of cases). It is therefore mainly composed of albumin and relatively abundant.


It is present in 10% of patients at diagnosis

It is present in 60% of patients at diagnosis

Cardiac involvement is the major prognostic factor

It is manifested by ischemic cardiomyopathy

It is a restrictive hypertrophic cardiomyopathy

It evolves towards adiastolia: the heart can no longer relax

It progresses to restrictive heart failure


What is the organ with the most severe prognosis?

True, mortality from amyloidosis is largely linked to cardiac involvement (restrictive cardiomyopathy). The appearance is brilliant in ultrasound. There is a QS V1-V3 microvoltage on the ECG.


The Medical Psychological Centre (CMP) is the pivotal structure of the sector

The Medical and Psychological Centres (CMP) offer outpatient care

Liberal psychiatrists are very much in touch with the actors of general medicine

Multidisciplinary health homes are time-full hospitalization structures

Ambulatory. We also talk about a multi-professional health home.

The financing of the health care system is provided by health insurance


Health insurance is based on a logic of compensation for illness

In general, health insurance guarantees the reimbursement of care provided as part of the "Coordinated Care Pathway".

In case of consultation with a medical specialist, the maximum reimbursement rate is guaranteed to the insured if the pathology is serious

If he is referred by his "attending physician"

A patient between 16 and 25 years of age can consult a psychiatry without losing the usual rate of reimbursement

The use of the psychiatric care system is declining sharply


Regarding the organization of psychiatric care in France:

The prevalence of mental disorders in the general population in France is about 3%

The fight against stigmatization of people with psychiatric disorders is still relevant

The HSPT law of 2009 provides for the creation of ARS responsible for defining new health territories relevant to fight against health inequalities.

Psychiatry is the only medical discipline that can provide care without the consent of the person

The different types of care without consent can only be provided by public structures

The different types of care without consent (full inpatient or outpatient) are most often provided by public psychiatric services, but some private institutions may also provide this type of care.


Sequential care occurs after the CMP for the follow-up of the compensated patient

Part-time therapeutic reception centres (CATTP) provide therapeutic and occupational activities

Full-time hospitalization corresponds to "traditional" hospitalization within the hospital (24 hours a day), during the acute phase of the disease

The after-care centers are very short-stay units to ensure the compensation of the disease in 48 hours

After-care centres are medium-stay units, transitional units between hospital and return home

Care aims to limit disability and support the return to independence


The most used care structure in child psychiatry is the HDJ

The most widely used care structure in child psychiatry is the CMP


Multidisciplinary structure (doctors, nurses, social workers, psychologists, ...) public.

They allow hospital care of decompensated patients

The reimbursement of consultations is made within 72 hours


Regarding the epidemiology of the impact of mental disorders:

Mental disorders account for 15% of disabilities

Mental disorders cause more disability than cardiovascular disease

Mental disorders cause more disability than cancers

About 2% of the French population suffers from mental disorders

Mental disorders account for 30% of life days lost through preventable mortality or disability


There are three main somatoform disorders

The distinction between somatoform disorder and psychosomatic disorder is clearly identified and clinically important

The distinction between somatoform disorder and psychosomatic disorder is not always easy and repeated changes in nosographic classifications have contributed to the confusion.

The prevalence of somatoform disorders is around 0.1% in adults in the general population

The prevalence of somatoform disorders is difficult to identify and depends on diagnostic tools and context: it is probably in the range of 5 to 10% for all somatoform disorders in the general adult population (and much more so in a population of medical consultants)

Somatization disorder typically begins in late adolescence or young adulthood, at any age for conversion disorder and pain disorder

The ratio by sex is 2:1, with a more frequent presence in women


The prevalence of suicide attempts is a function of the depressive psychiatric comorbidity to be systematically sought

The association of multiple polymorphic and long-lasting functional complaints has been called Lighter syndrome

Symptoms and signs do not respect the anatomical organization of the central or peripheral nervous system in conversion disorder

In the case of the painful symptom, it is pain whose intensity must be evaluated by a visual analogue scale

We speak of acute painful symptoms if the duration is less than 6 months


A prolonged fever is defined as a temperature above 38°C for more than 3 weeks.

10% of prolonged fevers remain without identified etiology, and then require patient monitoring

The temperature is taken, at best, just after the meal

The temperature is taken away from meals and after 20 minutes of rest

The axillary or oral routes are usually used and the measured temperature must be increased by 2°C to obtain the core temperature.

The axillary or oral tract is usually used: the measured temperature must be increased by 0.5°C to obtain the core temperature

The drugs mainly involved in prolonged fivres are antibiotics (ßlactams, rifampicin ...), antiepileptics and antiarrhythmics

Iatrogenic etiology is one of the elimination diagnoses


It will be necessary to look for a dental or sinus focus

Malignant diseases are responsible for 20 to 30% of prolonged fevers

"HORTON's disease is the most common immunoinflammatory cause"

In case of drug cause, fever usually occurs between 7 and 28 days after the introduction of a new treatment

Hypereosinophilia is present in only 20% of drug-induced fever cases


What is the threshold for defining the prolonged nature of a fever?

True. A prolonged fever is defined as a body temperature above 38.3 degrees Celsius for more than three weeks.


Regarding the inflammatory reaction in general:

Inflammatory diseases are the leading cause of death

It is the third leading cause of global mortality, after cancer (1) and cardiovascular disease (2)

About 30% of hospitalized patients have a general inflammatory reaction

Inflammatory diseases are often accompanied by AEG

The 4 clinical signs of inflammation are: redness, warmth, pain, effusion

The 4 cardinal signs are rougueur, pain, edema and heat

Hypotermia eliminates the possibility of an inflammatory reaction

Some inflammatory diseases are accompanied by a body temperature < 36 degrees Celsius


Which molecules are classically increased during an inflammatory reaction?

Albumin is decreased. This is clearly seen in protein electrophoresis


What can be the causes of a normal ESR inflammatory syndrome?

Renal failure increases ESR (even without inflammatory syndrome)

Polyclonal hypergammaglobulinemia increases ESR, even in the absence of an inflammatory syndrome


Which of these proposals concerning cardiovascular prevention are true?

A risk factor is a clinical or biological element associated with an increased risk of developing a disease, with a causal relationship between the factor and the disease.

In the case of a statistical association without a causal relationship, we speak of a risk marker

Removal or reduction of a risk marker does not change the course of a disease

A risk marker is not causally linked to the disease

Framingham study estimates cardiovascular mortality at 10 years

Risk of cardiovascular events, not mortality

In individual prevention, the effect of a prevention program is all the greater the higher the risk of the disease

Aspirin is systematically indicated for secondary prevention of cardiovascular risk

After a vascular event, the risk is considered very high, aspirin has a benefit


An absolute risk makes it possible to estimate the risk of an event in an individual over time

While relative risk allows for comparison

Absolute cardiovascular deaths lower in women than in men

The absolute number of cardiovascular deaths is higher in women (54%), but before age 65 the cardiovascular mortality of men is 3 to 4 times higher than that of women

The SCORE depends among other things on the LDLc level

The SCORE is valid for any adult under 65 years of age

The SCORE is valid between 40 and 65 years only

Dairy products are associated with increased cardiovascular risk


Smoking lowers LDL-cholesterol levels and increases HDL-cholesterol levels

Lowering of HDL-cholesterol levels and increased oxidation of LDL-cholesterol, which participates in atherogenesis

SCORE tends to underestimate cardiovascular risk in desocialized patients

Sleep apnea syndrome increases cardiovascular risk by 70%

Erectile dysfunction is a cardiovascular risk factor


The share attributable to smoking in the occurrence of myocardial infarction is all the more important the younger the subjects

The risk of developing an abdominal aortic aneurysm is significantly increased in smokers

A high cardiovascular risk corresponds to a SCORE of 5-10%

Elevated fibrinogen is associated with coronary cardiovascular excess risk

High blood pressure exposes more to cerebrovascular risk than coronary risk


Dyslipidemia is a minor cardiovascular risk factor

An EAL includes a determination of TG, LDLc and HDLc

LDLc is calculated, according to Friedewald's formula

Hypercholesterolemia is mainly due to too high intakes of unsaturated fatty acids

The diagnosis of hypertension is made on a single measurement when the blood pressure is greater than 180/60 mmHg

The diagnosis of hypertension should not be made on a single measurement

A normal EAL should be rechecked at 5 years in the absence of an intercurrent event


The ambulatory measurement of blood pressure (MAPA) eliminates a "white coat" effect related to the presence of the doctor

A screening EAL is recommended for an 85-year-old smoker

A 45-year-old type 1 diabetic with no other cardiovascular risk factors or organ damage has a moderate cardiovascular risk

Abdominal obesity is an indispensable criterion in the diagnosis of metabolic syndrome

It is no longer an indispensable criterion

About 20 million French people are overweight, including 6 million obese


Which of the following are non-modifiable cardiovascular risk factors?

Modifiable because it can be taken care of and made sure that it is no longer a risk factor

Non-pharmacological and pharmacological management


Which of the following designate situations in which the SCORE table is not usable?


Which of the following proposals fall within the scope of metabolic syndrome?


A rise in cortisol levels can precipitate or maintain delirium

It is believed that the cholinergic system is largely involved

It corresponds to acute and severe brain dysfunction

It is responsible for an increase in morbidity and mortality in the following year.


Which of these proposals are part of the DSM-V diagnostic criteria?

It is the decrease in the ability to lead, focus, support and shift attention.

The installation is on a short time, from a few hours to a few days

It is necessary to highlight a break with the previous state

In particular through the interrogation of a relative

No biological criteria. The diagnosis is purely clinical


Regarding 5-FU, which propositions are true?

It is an analogue of pyrmidines (bases C, T and U)

It is an inhibitor of topoisomerases type II

Toposiomerase type 2 inhibitors are etoposide and anthracycline


Which of these proposals is, or are, type 2 topoisomerase inhibitors?

It is an antimetabolic (analogue of pyramidin)


Which of these propositions is, or is, or is, true with respect to platinum salts?

The three platinum salts are: cisplatin, oxaliplatin and carboplatin

These compounds are DNA alkylating agents

Cisplatin has renal toxicity that may cause acute tubular necrosis


Which of these proposals are, or are, expected adverse effects of hydroxyurea?

Hydroxyurea is a myelosupressor: penias can be observed (leukopenia, thrombocytopenia, or even macrocytic anemia)


Which of these proposals are, or are, folic antimetabolics?

It is a pyrimide antimetabolic, along with gemcitabine


Which of these proposals are, or are, stabilizers of the spindle?


Which of the following are true about Denosumab?


Platinum salts block chromosome depolymerization

This is the case with depolymerase inhibitors (taxanes such as Paclitaxel)

Platinum salts cause adducts with DNA inhibiting its replication

This is the case of Tecans (irinotecan and topotecan)

Platinum salts inhibit the action of topoisomerase II

This is the case for anthracyclines and etoposide


Which of the following are the toxicities of platinum salts?

This is the case of 5-FU (coronary spasm) and anthracyclines (dilated cardiomyopathy)


Which of the following are recommended before starting Denosumab therapy?

True, in front of the risk of hypercalcemia


Which of the following are complications of an autologous transplant?


Anthracyclines have cumulative cardiac toxicity

Trastuzumab poses risk of myocardial toxicity

Anti-pyrimides are topoisomerase inhibitors


Which of the following are true for bentuximab?

False, this is the case of Jakavi for example

There is a risk of peripheral neuropathy


Which of the following proposals regarding the adverse effects of brain radiotherapy are true?

True, due to transient diffuse demyelination


Which of these proposals make it possible to study isolated cells?

Biopsies of solid tumours extract tissue, not isolated cells.

Biopsy of a gastric tumor induced by H. Pylori

While the BOM makes it possible to study the fabric


Among these colorations, which one or which ones make it possible to highlight Iron?

It makes it possible to highlight the iron fixed in hemosiderin colored blue by Prussian blue; The nuclei are highlighted by nuclear red.

Be careful, it does not count as a coloring. This is a different microscopy technique

It is used in histology for the visualization of fungi, certain pathogens, basement membranes