An 84-year-old man is referred to you after falling from bed. You have an x-ray of the pelvis. What is the real proposal(s)?

There is a fracture of the right femoral neck

There is a fracture of the left trochanterian massif

There is a dislocation of the left coxofemoral joint

There is a fracture of the pubic symphysis

There is a fracture of the right shutter frame


The assessment of a bilateral form of breast cancer in a 42-year-old woman revealed a pathogenic BRCA1 mutation. What is the exact proposal(s)?

High risk of ovarian cancer may warrant oophorectomy

Breast monitoring relies on simple breast ultrasound

The risk of early breast cancer justifies genetic analysis in her underage daughters

The breast risk of recurrence may justify mastectomy


It is necessary to offer an oncogenetic consultation in the following situation(s):

In a patient with a breast tumor at age 35

Faced with the existence of a bilateral breast tumor

In front of the existence of polyfocal colonic malignancies

Faced with the existence of an ovarian tumor in a 74-year-old woman

In a subject with a hundred polyps on the entire colonic frame


A general practitioner is required by a gendarme, a judicial police officer, to note the death of a 62-year-old man, who was not his patient, discovered in the barn of his house, with a ballistic trauma of the cephalic end, with an entrance hole visibly under the chin. A firearm is located along the body. The gendarme found a suicidal writing in the house. The constable informs the doctor that there will be no investigation. Which proposal(s) is the right proposal?

In the absence of an investigation announced by the gendarme, the doctor does not have to check << medical-legal obstacle >> on the death certificate

Checking this box is a medical decision based on medical arguments

The doctor must examine the body for an exit hole for the projectile

The appearance of cadaveric lividities on the body will allow the doctor to support the hypothesis of a suicide

Cadaveric lividities not corresponding to pressure points may indicate secondary displacement of the body

The presence of recent bruises on the wrists and forearms goes against the hypothesis of suicide

We can think that these are traces of fights

An immediate putting in beer in a simple coffin must be requested in this context


The genital lesion that typically occurs at the time of a girl's first sexual intercourse is (only one response):

A contuse laceration of the osterious fork

A complete tear of the posterior part of the hymen

A bilateral contagious wound of the vaginal walls behind the hymen


A judicial police officer takes a victim to a general medical office for the doctor to examine upon request. She says she has been subjected to domestic violence. Which proposal(s) is the right proposal?

The physician may refuse to respond to the requisition if he has no training in forensic medicine

Only a judicial police officer may request a doctor to examine a victim

The refusal to respond to the requisition is likely to engage the administrative liability of the doctor

The requested physician is released from the obligation of professional secrecy in the specific context of the mission entrusted to him

A copy of the report issued is given to the victim in person to assert what is right.


A patient with advanced left gonarthrosis for which a surgical indication has been decided in a CHU, understands upon waking that the knee prosthesis was placed by mistake on the right side. What are the right proposals? (One or more correct answers)

The criminal liability of the surgeon may be engaged

It is not a medical fault because the prosthesis has been positioned according to the rules of the art

This situation may lead to an amicable settlement

The administrative responsibility of the establishment may be engaged for failure to organize the service


The shared medical record can be created by: (one or more exact answers)

The holder of parental authority for a minor patient


A 52-year-old patient is being treated with inhaled corticosteroids (fluticasone) for asthma. Her doctor prescribes antimycotic treatment (itraconazole) and a short course of oral corticosteroids for an asthma exacerbation triggered by an infection. What is(are) the iatrogenic risk(s)?

Increased plasma concentrations of inhaled corticosteroid

Risk of developing a cushingoid syndrome

Increased plasma concentrations of oral corticosteroid

Risk of developing adrenal insufficiency

Low risk of drug interaction with itraconazole


A 75-year-old patient is treated with cholesterol-lowering (simvastatin) and vitamin K antagonist (warfarin). Her doctor prescribed macrolide antibiotics (clarithromycin) for acute bronchitis. What risk(s) can (s) be increased by a drug interaction?


About substances used for doping purposes in sport:

Early baldness may be a sign of chronic anabolic androgenic steroid administration

Beta-2 agonists exert an anabolic effect in high doses resulting in an increase in muscle mass

Beta-blockers are prohibited in competition in some sports

The occurrence of a pulmonary embolism in a professional cyclist should be investigated for taking erythropoietin receptor agonist


About the mechanisms of action of antibiotics:

Penicillin inhibits penicillin-binding proteins (PLPs), enzymes of the peptidoglycan biosynthesis pathway

Macrolides inhibit bacterial protein synthesis by binding to the ribosome

Fluoroquinolones inhibit the replication, transcription, repair and recombination of bacterial DNA

Glycopeptides inhibit cell wall synthesis of bacteria

Trimetroprim-sulfamethoxazole is a folic acid inhibitor


An 80-year-old patient is brought by his daughter for consultation for signs of nocturnal agitation attributed to repeated nightmares. He had been treated with bromazepam for several years but he reports that he stopped this medicine two weeks ago. What clinical sign(s) associated with a withdrawal syndrome are you looking for?


Regarding testicular germ cell tumors, it is true that: (one or more answers)

They represent the first solid cancer in 20-year-old men

They may be associated with a serum increase in total HCG.

They are often associated with inguinal lymphadenopathy

They are often associated with lumbo-aortic lymphadenopathy.


You receive a 25-year-old woman for the implementation of estrogen-progestin contraception combining ethinyl estradiol and levonorgestrel. What contraindication(s) are you looking for in questioning and clinical examination?


Regarding the diagnosis of lymph node Hodgkin lymphoma, it is true that (one or more answers):

It usually requires a biopsy removed from a lymph node

The levy must be fixed in full immediately

It is based on the identification of Reed-Sternberg cells

A national pathological network for proofreading has been set up by INCa

it requires immunohistochemical labeling


Among the bone tumors for which a biopsy is necessary for diagnosis there are (one or more responses):


Among the following, which criterion(s) is (are) part of the criteria of fragility of the elderly subject according to Fried?

The other 2 are: decreased muscle strength and decreased physical activity


Regarding the first-line management of urinary incontinence in the elderly, which of the following proposal(s) is (are) correct?

Placement of an indwelling urinary catheter

Transcutaneous electrical stimulation of the pudendal nerve


Ms B., 57, is employed by a taps-making company. She has subscribed to a mutual health insurance. She lives in a rural area in metropolitan France, without the possibility of personal transport. As a general practitioner, you had already referred her to a cardiology consultation in the past. You now consider that a new cardiology consultation is necessary and you refer it to the cardiologist who follows Mrs. B. As the cardiologist's office is located 50 km from the patient's home, the cardiologist offers a teleconsultation. Ms. B. is not recognized as having a long-term illness. This cardiologist is conventionné, sector 1. Which of the following proposition(s) is the exact proposal(s)?

Ms. B. will receive an Internet link inviting her to connect at the scheduled time of the appointment to a secure site or application

The cardiologist must request and obtain Ms. B.'s consent before conducting the teleconsultation

As part of this teleconsultation, the cardiologist will not be able to write a prescription for treatment or additional examination

Mrs. B. will be reimbursed by the Health Insurance

The price of the teleconsultation is freely set by this cardiologist


You take care of a 52-year-old patient in the emergency room of the hospital for right calf pain. Your elements of interrogation and clinical examination lead you to hypothesize a deep vein thrombosis (DVT). As part of your diagnostic approach, you use a simplified clinical prediction model of DVT. The probability of DVT predicted by the model is high at 53 You decide to order an additional imaging test to confirm or refute your diagnostic hypothesis of DVT. Which of the following statements(are) the exact proposition(s)?

The pre-test probability of DVT is implicitly estimated from your subjective impression.

The post-test probability of DVT depends on the pre-test probability and the informational characteristics intrinsic to the prescribed imaging test.

The pre-test probability of DVT is estimated from the positive and negative predictive values of the prescribed imaging examination.

The post-test probability of DVT depends on the likelihood ratios of the imaging test.

The more the plausibility ratio of the exam tends towards O, the more the post-test probability of DVT will tend towards 0


A 65-year-old man has nodular basal cell carcinoma (BCC) of the forehead 1 cm in diameter. What is the exact proposal(s)?

CBC develops on pre-existing actinic keratosis

The evolutionary risk is the appearance of visceral metastases


What is your interpretation of this electrocardiogram recorded in a 50-year-old type II diabetic patient admitted to the emergency room for a sudden onset respiratory gene? (only one answer)


A 75-year-old patient presents to the emergency room for difficulty breathing. Here is his chest x-ray from the front standing. What element(s) are you visualizing?


A depressive episode characterized postpartum:

Occurs mainly between 3 and 6 weeks after delivery

Affects nearly 25% of women who have given birth

Is most often associated with psychotic features

Is at high risk of progression to bipolar disorder


Dyspnea with prolonged expiratory time can evoke

An exacerbation of chronic obstructive pulmonary disease


Which clinical and paraclinical sign(s) suggestive of severity in a patient with pneumothorax?

Reduction or abolition of vesicular murmur

Hypotension with systolic blood pressure less than or equal to 90 mmHg


A 65-year-old woman consults for a dry cough evolving for 2 months; This cough wakes her up at night. She has been being treated for high blood pressure for a few months. She never smoked. She has no other history. To specifically explore this cough, which propositions are accurate (one or more exact answers)?

Uncontrolled high blood pressure is a common cause of chronic cough

Looking for the prescription of an ACE inhibitor on its prescription

Looking for gastroesophageal reflux symptoms

Looking for sibilants pulmonary auscultation

Looking for a calcium channel blocker prescription on your prescription


A 16-year-old girl has these facial lesions that have been evolving for a few months (photo). Which of the following proposals, which diagnosis(s) do you retain?


Which of the following proposals regarding the complications of prolonged use of estrogen-progestin contraception is (are) accurate?


Which of the following viruses is sexually transmittable?


A 26-year-old patient presents to the emergency department at 28 weeks of amenorrhea for headache and edema of the lower limbs. His blood pressure checked three times at rest is 160/110 mmHg. You prescribe antihypertensive treatment. Which of the following medicinal products is authorised during pregnancy?


A 75-year-old patient has right papillary edema with a significant decrease in visual acuity. He complains of fatigue and weight loss for 3 months and headaches. Which of the following tests allows you to confirm your main diagnostic hypothesis?

This is the only test that can CONFIRM Horton's hypothesis


Three months after cataract surgery, a 72-year-old patient complains of myodesopsia. Which of the following signs could lead to fear of retinal detachment? (one or more answers are correct)


A young woman has reducible bilateral exophthalmos. In the following list, which examination(s) are necessary for the diagnosis of Graves' disease?

Orbital CT scan without injection of iodinated contrast medium

Graves' disease = Hyperthyroidism by activation of TRAK receptors


What are the possible etiologies of decreased visual acuity associated with eye redness? (one or more correct answers)

Acute glaucoma crisis due to angle closure


Which of the following clinical elements points to adhesive capsulitis of the shoulder?


You examine a 40-year-old patient after the harvest. He complains of a muscle control disorder to raise his right foot to walking. He has a sensory disorder of the first dorsal interosseous space. There is a step to walking, the Trendelenburg test is without abnormality, the fibular muscles are rated at 5/5 in the motor test. What is your diagnosis(s)?


An 80-year-old patient comes to consult because she has left wrist pain for several years but is now very disabling. What is (are) the exact proposal(s) concerning the wrist X-ray that it brings you?

There is an old fracture of the scaphoid


A 20-year-old patient arrives at the emergency room because she had a ski fall the previous weekend and has persistent severe knee pain that prevents support. What is the exact proposal(s)?

A knee effusion on a profile X-ray may suggest an acute rupture of the anterior cruciate ligament

X-rays of a spontaneously reduced patellofemoral dislocation may be normal

A fracture of the tibial plateau visible on the X-ray requires further exploration by an MRI

Arthroscan exploration of a chondral knee injury requires the injection of intra-articular gadolinium salt

Ultrasound is a good examination to study the knee extensor apparatus


During amyotrophic lateral sclerosis, you may observe the following clinical sign(s)


A 3-week-old newborn is brought by his parents to his pediatrician because his stool is discolored. The clinical examination finds jaundice. What is the exact proposal(s)?

There is a risk of neurological complication by nuclear jaundice

Phototherapy should be done as soon as possible

Breastfeeding should be interrupted so as not to aggravate jaundice

Mother-child ABO compatibility must be checked


Which of the following applies(s) to NPH insulin?

Its duration of action is about 12 hours

It should not be combined with rapid insulin

It should not be prescribed to pregnant women


You refer a 47-year-old patient to the surgeon because of an isolated thyroid nodule, without satellite lymphadenopathy, which measures 38 x 25 x 23 mm in diameter. It is rated TIRADS 3 on ultrasound but interferes with swallowing. A surgical indication is made (right thyroid lobo-isthmectomy). What is (are) the possible event(s) in the postoperative period?

Tabulation of thyroidectomy if the nodule is papillary cancer


A 42-year-old patient consults you for retrosternal chest pain and nocturnal regurgitation. The cardiovascular balance is negative. What is (are) the argument(s) in favor of a primitive achalasia?

Upper gastrointestinal endoscopy revealing stenosis of the lower esophagus

Presence of propagated peristaltic waves with significant hyperpressure of the sphincter on an esophageal manometry


What diagnosis(s) is (are) to evoke in a 2-year-old child who has functional impotence of the lower limb of sudden onset without notion of trauma in a non-febrile context?


In front of a table of acute maxillary sinusitis, which is (are) the element (s) that orient (s) towards a bacterial origin?

Increased infraorbital sinus pain despite symptomatic treatment prescribed for at least 48 hours


A 76-year-old patient is referred for dysphagia. Which element(s) would orient (s) towards the diagnosis of Zenker's diverticulum?

Presence of regurgitation of undigested food

Sign of the << tide >> to nasofibroscopy


A 45-year-old patient consults for persistent low back pain for 3 months with macroscopic hematuria. The following imaging is performed. What is the exact proposal(s)?


On this CT scan of the abdomen: (one or more exact answers)

The structure designated by the number 1 is a hepatic vein

The structure designated by the number 2 is the portal vein

The structure designated by the number 3 is the aorta

The structure designated by the number 4 is the spleen

The structure designated by the number 5 is the stomach


In hepatic computed tomography, in typical forms, after intravenous injection of iodinated contrast medium, which proposal(s) is(are) exact?

A hemangioma becomes opaque through the periphery

Hepatocellular carcinoma increases with arterial time

Hepatocellular carcinoma is the site of late-time wash-out

A metastasis rises intensely at the portal time


Ms. C., with no particular background, is a senior executive, an employee in a company and benefits from a mutual insurance company. Mrs. C. made an appointment directly with a cardiologist in sector 1, outside the framework of the coordinated care pathway. Which of the following is correct?

The Health Insurance will only reimburse 30% of the basic fee of the consultation

Ms C. will have a flat-rate contribution of one euro for this consultation

The Health Insurance will refuse to reimburse the drugs prescribed by this cardiologist

The cardiologist is authorized to practice an excess fee of up to 60 euros

The amount reimbursed by Social Security will be 11.51 euros


What adjuvant therapeutic management(s) will you offer to a 53-year-old patient with invasive adenocarcinoma of non-specific type of right breast, triple negative, pT2N+MO after conservative surgery and right axillary dissection?


A patient is admitted to an identified palliative care bed for the management of amyotrophic lateral sclerosis. The patient is at a terminal stage of his disease. It benefits from nutrition, hydration by a gastrostomy device and non-invasive ventilation. After meeting the patient, the family asks to see you to discuss the principle of deep and continuous sedation until death as described in the law of February 2, 2022. What is the exact information(s) you can give the family about this sedation?

It may accelerate the occurrence of death

Its objective is to accelerate the occurrence of death

It can be implemented at the request of the family under certain conditions

When a patient suffering from a serious and incurable condition decides to stop treatment and this cessation is life-threatening in the short term and is likely to cause unbearable suffering, he may request it.

It is systematic as soon as a patient enters the agonic phase

Not at all systematic. It is the result of a multidisciplinary exchange between caregivers


i You are caring for a 71-year-old patient in good general condition for Gleason 7 (3+4) prostate adenocarcinoma, initial PSA at 8 ng/ml, clinical stage T2NOMO, recently discovered. Which therapeutic option(s) do you choose?

Exclusive external beam radiation therapy


A 60-year-old type 2 diabetic patient has mixed dyslipidemia. Its balance is as follows: LDL cholesterol 2.9 g/L (7.54 mmol/L); HDL cholesterol 0.32 g/L (0.78 mmol/L); apo B 1.8 g/L (normal< 1.2 g/L); triglycerides 2.5 g/L (2.75 mmol/L). This lesion located on the major must evoke: (one or more exact answers)

Combined hyperlipidemia entangled with type 2 diabetes

Dysbetalipoproteinemia entangled with type 2 diabetes

Heterozygous familial hypercholesterolemia + type 2 diabetes


A 27-year-old woman is hospitalized urgently for pain in the right flank and nausea progressing for 24 hours. She is at 25 weeks of amenorrhea (AS). When it arrives, you notice a temperature of 38.5 ° C.  The pain radiates into the right lumbar fossa. You must (one or more correct answers):

Make a urine strip to look for an infection

evoke appendicitis because in the 2nd trimester of pregnancy the coecal bottom is repressed in the right flank

initiate non-steroidal anti-inflammatory therapy in principle


Which of the following occupational exposures result in a proven excess risk of lung cancer (one or more possible responses)?


A 41-year-old patient, with no medical or surgical history, has epigastralgia and must undergo a digestive endoscopy. The anaesthetist ordered a blood count and hemostasis tests. Haemoglobin is 12.1 g/dL, platelets 151 G/L. Leukocytes are at 7.5 G/L. The TCA is 1.7 times the control, the TP is 97%. She never had a bleeding episode. These results are consistent with:

A circulating anticoagulant of the lip type


You are called to the neurovascular intensive care unit for a 37-year-old patient who has had a transient ischemic attack. By examining it, you notice lesions on the thighs. These are: (one exact answer)


A 57-year-old man is hospitalized urgently for left iliac fossa pain and hyperthermia. You see it in the emergency room and suspect acute diverticulitis of the sigmoid. You ask: (one or more correct answers)

A picture of the abdomen without preparation standing from the front to visualize the colonic frame and possible liquid levels

An abdominal CT scan without injection because sepsis increases the risk of kidney failure

A water-soluble enema, to eliminate another pathology with similar symptomatology, and avoid a barium in case of diverticular perforation

An abdominal CT scan with contrast medium injection, after checking for severe renal impairment or a history of severe allergy to contrast medium

A rectosigmoidoscopy because the risk of perforation is less than with a long colonoscopy, and this examination makes it possible to formally eliminate the presence of colon cancer


Which of the following antimalarials for prophylaxis should only be continued one week after returning from an area at risk of malaria infection?


Which of the following bacteria has natural resistance to third-generation cephalosporins?

Mnemo: Princess LLEIA (Listeria, Legionella, Enterococcus, Intracellular, Anaerobic)


You are reading an article reporting the results of a randomized, double-blind clinical trial, comparing two groups of patients, treated with either a new or a reference drug

Beyond statistical significance, it is essential to assess the clinical relevance of the observed difference in effect

Randomization increases risk of bias when interpreting results

The double-blind technique is a method that aims to reduce bias in the realization and interpretation of the results of a clinical trial

The Transparency Commission of the HAS (Haute Autorité de Santé) can participate in the statistical analysis of this clinical trial on French territory

The statistical significance of the difference in effect of the two drugs is necessary to establish the superiority of therapeutic efficacy of the new drug


In this family, the diagnosis of cystic fibrosis (frequency 1/3000 in the population) was confirmed and 2 composite heterozygous mutations in the CFTR gene were identified in the young woman 11-2. What is the exact proposal(s)

The risk of cystic fibrosis transmission for couples 11-1 and 11-2 is about 1/60

The future risk for the II-3 free sister of having an affected child is about 1/120

I-4's spouse is pregnant. The a priori risk that the unborn child is affected is about 1/240

The woman II-3 can directly exercise a right of access to the medical file of her sister II-2

The I-1 woman refused the genetic test for heterozygosity for herself. The I-2 subject can directly transmit his own results to the children of I-1


May manifest as delusions of persecution

Can manifest as fear of eating in public

Warrant treatment with antidepressants in severe forms


Regarding urothelial histological bladder carcinomas, which proposal(s) is(are) accurate?

They are detected with good sensitivity by urinary cytology

They are low-grade when they are carcinomas in situ

They are associated with bladder schistosomiasis in Africa

Grade has little interest for tumors infiltrating the muscular.

They can be classified T2 on endoscopic resection chips


Regarding the diagnosis of cirrhosis on a liver biopsy: (one or more exact answers)

This is a stage 4 of the METAVIR classification

Diagnostic performance depends on the size of the sample

Diagnostic performance is better in micronodular cirrhosis


Which of the following treatments may be responsible for delirium by its anticholinergic property?

Acetylcholine esterase inhibitor donepezil


For vesicular or follicular thyroid carcinomas: (one or more exact answers)

They account for less than 5% of thyroid cancers

They are frequently associated with multiple endocrine neoplasia type 2 (MEN-2)

The sensitivity of the diagnosis of malignancy by cyto-puncture is good


Regarding confusion, which proposal(s) is(are) right?

It is most often linked to an organic cause

It can manifest itself only in the form of drowsiness

It corresponds to the acute decompensation of brain function


Perinatal psychiatric disorders are mainly characterized depressive episodes

Seeking and preventing a risk of suicide and/or infanticide is an imperative

In cases of severe postpartum depressive episode, the use of a joint mother-child hospitalization unit is currently recommended.

* In cases of depressive episodes with psychotic symptoms, management may be close outpatient

* In case of serious maternal failure or in case of immediate danger to the baby (risk of infanticide), hospitalization of both must be carried out urgently


Regarding mental disorders of pregnancy and postpartum:

Postpartum blues is a condition that we do not know how to treat at present

Psychotropic treatments should be prescribed with caution

Pregnancy and the arrival of a child are essential stages in a woman's life and involve profound physiological and psycho-social changes, which are to be considered as major stressors.

The perinatal period is a period of particular vulnerability for psychiatric disorders

They exist and must be evaluated and detected as early as possible by the various partners in care in the perinatal period (attending physician, gynaecologist-obstetrician, midwife, maternal and child protection services, psychiatrist)


Regarding the management of per-pregnancy disorders:

An "early prenatal interview" is systematically offered in the 4th month of pregnancy

Every pregnant woman should be informed about the risks of taking addictive substances during pregnancy

Blame for risky behaviour allows for more effective cessation and should be preferred in emergency cases such as pregnancy.

We must avoid any guilt and stigmatization that only have opposite effects to those sought

Treatment of a maternal addictive disorder involves evaluating the benefits of withdrawal versus psychotropic treatment

The evaluation of associated psychiatric comorbidities must lead to a proposal for specialized follow-up


Regarding the management of anxious trooubles:

Pregnancy anxiety disorders are often the expression of pre-existing anxiety disorders

The postpartum period is a period conducive to the physiological compensation of anxiety disorders thanks to the major release of endorphins

The postpartum period is a period conducive to their aggravation, especially regarding obsessive-compulsive disorder (OCD)

Consultation with the Reference Centre for Teratogens will allow a safer prescription in case of need for psychotropic treatment

Abrupt cessation of treatment upon discovery of pregnancy is not recommended

The possible occurrence of transient neonatal disorders will be systematically taken into account when examining the newborn of each patient who has received psychotropic treatment during pregnancy.


Regarding the treatment of psychiatric disorders in pregnant women:

The prescription of benzodiazepines is totally contraindicated in pregnant women

Anxiolytics The prescription of benzodiazepines is to be avoided if possible, but if the clinical situation requires it then benzodiazepines with short half-life are to be preferred in particular Oxazepam (Seresta®)

Benzodiazepines also contraindicate breastfeeding

Breastfeeding is possible with these molecules prescribed in low doses

Serotonin reuptake inhibitors (SRIs) in pregnant women should be preferred over other anti-depressants

Both first and second generation antipsychotics can be used

No thymoregulators can be prescribed in pregnant women

The most documented thymoregulators, recommended and can be prescribed in pregnant women are: olanzapine (Zyprexa®) and lamotrigine (Lamictal®)


Which of these proposals are behavioral addictions?

Behavioral addiction is not defined by a lack of behavior

Simple gambling is not an addiction. It is the repetition of behavior despite negative consequences and the inability to control it that make it an addiction.

Uncontrolled and negative sexual activities


General information on behavioral addictions:

The only behavioral addiction found in the DSM-5 is sex addiction.

Only one is officially defined in international classifications: gambling disorder also called "pathological gambling" (ICD-10, DSM-IV) or "pathological gambling" (DSM-5)

The mechanisms of behavioural addiction share the pathophysiological basis described in illicit substance use disorders

One of the main systems involved in these disorders is the serotonin reward system.

In addictive disorders, the homeostasis of neurotransmission networks is disrupted

Behavioral addictions are of multifactorial origin


Regarding risk factors and the impact of behavioral addictions:

Behavioral addictions have a zero genetic component in view of the almost total impact of the environment

There are genetic predisposing factors (estimated heritability of 40-60% for addictive disorders), but also other individual risk factors (gender, age, sensation-seeking personality traits or impulsivity)

Psychiatric comorbidities are an important risk factor

Anxiety disorders are a risk factor for behavioral addictions

Attention deficit disorder predisposes to behavioral addictions only when there is hyperactivity

Definition Games of chance and gambling are games for which the subject irreversibly bets a good based on chance


By definition, it is impossible to predict or control the outcome of a JHA.

There are phenomenological similarities, neurocognitive, neurobiological and therapeutic similarities between pathological gambling and other addictive behaviors

Gambling behavior is motivated solely by the hope of making money

Gambling behavior is motivated by different reasons: hope to earn money, search for thrills (especially feeling the "thrill", or thrill), desire to relieve negative emotions, search for social connections

A pathological gambler is invaded by urge to play, called "craving"

JHA is very unpopular and not very present in France because it is associated with alcoholism

In France, in 2014, three-quarters of French people between the ages of 15 and 75 said they had already played a JHA in their life, with just over half saying they had played it in the year.


Expenditures related to the practice of JHA represented 0.8% of annual household expenditures in 2012, in France

More than half of players spend less than 100 euros per year

The most represented games are blackjack and poker

Online games are mainly about horse betting

Online games (7.3% of players, a third of whom are mobile) are more concerned with poker and sports betting.

The prevalence of pathological gambling in France is estimated to be 0.5% in the general population


The practice of anesthesia is governed by the decree of 5 December 1335

December 5, 1994: it is a relatively recent specialty

Anesthesia consultation, pre-anesthetic visit and immediate post-operative monitoring are mandatory

General anesthesia is defined by irreversible loss of consciousness

The loss is reversible, otherwise it would be problematic x)

GA is broken down into 4 phases: falling asleep, unconscious, waking up, opening the eyes

3 phases: induction, maintenance and awakening

The purpose of locoregional anesthesia (ALR) is to transiently interrupt the transmission of nerve conduction while preserving the state of consciousness.


They are subject to the same regulatory obligations

A distinction is made between perimedullary ALR (around the peripheral nerve) or peripheral ALR (around the spinal cord)

IN ALR, the local anesthetic is injected by MI, SC or IV

Local anesthesia is defined as the administration of a local anesthetic by infiltration or topically (by contact) in relation to the area to be operated or analgesive. IV injection is at risk of cardiology or neurological disorders.

Transdural analgesia is the gold standard technique for ensuring quality analgesia during obstetric labour

In 2010, more than 11 million procedures of anaesthesia were recorded in France


About 2% of anhestesic procedures are treated on an outpatient basis

In case of unscheduled intervention (emergency), the pre-anesthetic visit replaces the consultation

The purpose of the consultation is to carry out a medical evaluation of the patient

Anaesthetic risk is assessed according to the ASA (American Society of Anesthesiologists) classification

Patient information is an issue in consultation so that the patient can formulate informed consent


The pre-anesthetic visit takes place a few days (maximum 7) before the scheduled procedure under anesthesia

A few hours before. The objective is to confirm the information

General anesthesia (GA) is defined as a reversible loss of consciousness induced by the administration of a hypnotic often combined with an analgesic agent

A benzodiazepine is frequently used to cause muscle paralysis facilitating tracheal intubation and surgery.

ALR techniques are indicated in the surgical setting only

ALR techniques are indicated in the anesthetic context (allowing surgical intervention) but also for analgesic purposes (intraoperative, post-operative, obstetrical, etc.)

Local anesthesia is defined by the administration of a local anesthetic either by infiltration (intradermal, subcutaneous or diusion plane) or topically (by contact) in relation to the area to be operated or analgesia


A delay of a few hours is recommended between the anesthesia consultation and scheduled surgery

There are 3 phases in general anesthesia: Maintenance -> Induction -> Awakening

Well 3 phases, but the order is: Induction -> Maintenance -> Awakening

Curare allows relaxation of all the muscles of the human body.

Trap;) not of the heart (which is a skeletal muscle but not governed by the motor plate)

A passage to the SSPI is mandatory for any general anesthesia or regional loco, even if the patient was conscious

According to decree, any surgical procedure with the use of an anesthetic product requires postoperative monitoring (AG and ALR included)

In general, morphine is THE drug used to put the patient to sleep during general anesthesia.

It is the hypnotic that puts the patient to sleep in general (propofol IV / inhaled halogenated ...)


A patient must undergo a scheduled endoscopy in 48 hours, but he goes on a trip in 24 hours, what are the true answers.

Not within the deadline for the anesth consultation, postponement of the mandatory endoscopy

He can have his pre-anesthetic consultation now and have the endoscopy right after.

Scheduled surgery. It would have been true in a hurry.

He may have a pre-anesthetic visit before having his endoscopy right after

If he had had his anesthesia consultation 24 hours ago, he can do the endoscopy in 24 hours (48 hours after consultation) and directly jump on his plane just after the endoscopy

Use of anesthetic products, so mandatory passage to SSPI

If he had been able to have his endoscopy, the patient would have had a pre-anesthetic visit a few hours before the endoscopy.

Visit pre anesth qq hours before the act, to check that there have been no new events.


What is the minimum conditioning in a patient who will undergo general anesthesia?

False. It is a pulsed oxygen saturation (SpO2)

A measurement of the concentration of O2, CO2, NO and anesthetic gas of the inhaled and exhaled gases

False. The fraction in NO is not measured

Conditioning in anesthesia is called multiparametric monitoring


Which of these trips are considered to be very risky?

Young adults on an unorganized trip to India for 4 weeks

Hitchhiking travellers in Eastern Europe

3 types of travellers most at risk: young adults travelling unorganized to India or Sub-Saharan Africa for a stay of several weeks, immunocompromised people and people who have emigrated to France and stayed in their country of origin when it is a source of endemic


Among these proposals, which are the first and second causes of medical repatriation or death during a stay in a tropical zone?


Travel to Australia requires yellow fever vaccine

The endemic areas of yellow fever are intertropical Africa, South America and the Amazon region. In this case, the vaccine is recommended

Vector protection measures are advised in malaria prevention

Food hygiene helps limit the risk of turista and faecal diseases

Traveller education during consultation is essential


Abstention/monitoring is indicated in case of:

Moderate SBAU with return on quality of life

Moderate SBAUs with no clear impact on quality of life

Minimal SBAUs without impaired quality of life


α-blockers are effective after 6 months of treatment

This is the case for 5-alpha reductase inhibitors. A-blockers are effective in 48 hours

After TURP or AVH, the prostate adenoma should be sent to anatomical pathology in search of prostate cancer

The main side effect of surgical management is the spread of cancer

The main side effect is retrograde ejaculation

Prostate cancer screening by TR and annual PSA is recommended in patients aged 30 to 50 years in the general population

Screening for prostate cancer by TR and an annual PSA is recommended in patients aged 50 to 75 years or from 45 years in case of risk factors (Afro-Caribbean origin, family history)

Benign prostatic hyperplasia (BPH) is a subvesical obstacle to urine flow


BPH is hyperplasia of the glands in the marginal zone of the prostate

It corresponds to hyperplasia of the glands of the periurethral prostate (transition zone of the prostate)

The symptomatology may be stable or worsen more or less rapidly

There is a clear parallelism between the volume of BPH and the severity of SBAUs

There is no parallelism between the volume of BPH and the severity of SBAUs

BPH is hyperplasia of the transition zone of the prostate surrounding the subbladder urethra


The evolution of a prostate adenoma does not systematically lead to the appearance of complications

BPH cannot be latent, it is always symptomatic, especially from the age of 70

BPH may be latent and responsible only for functional discomfort

BPH never escalates into prostate cancer

Prostate cancer is developed from the transition zone of the prostate

Prostate cancer, developed from the peripheral area of the prostate, is therefore often sought when diagnosed with BPH.


For the following definitions, check the correct answer(s):

Autonomy and dependence are two opposite terms

Autonomy is the person's ability to move

Autonomy refers to the person's ability to make a free choice.

Addiction is defined by the need for human help

The assessment of dependence in the elderly must be systematic during its management

The assessment of dependence in the elderly is part of the personalized health project


A person is said to be "old" after the age of 50 or 55

A person is said to be "old" after the age of 70 or 75

Sarcopenic obesity is defined by BMI ≥ 30 and sarcopenia

An undernourished obese is defined by a BMI ≥ 30 and a criterion of undernutrition

Obese undernourished BMI ≥ 30 and a criterion of undernutrition

Decreased muscle performance signs probable sarcopenia

Severe sarcopenia (see Table 11.1, page 155, College of Nutrition, 3rd edition)

Entry into an institution is one of the criteria of fragility


Which of these proposals make it possible to define undernutrition?

Weight loss greater than or equal to 15% in 3 months

Weight loss greater than or equal to 5% in 1 month or 10% in 6 months

Weight loss greater than or equal to 15% in 6 months


Which of these proposals make it possible to define severe undernutrition?

Weight loss greater than or equal to 10% in 1 month or 15% in 6 months


BMI increases with age, reaching about 26–27 on average between the ages of 70 and 80

There are changes in body composition during aging: fat mass increases, muscle mass decreases.

Muscle mass decreases by about 40% between the ages of 20 and 80

The prevalence of obesity increases with age with a peak of 20–23% at age 55–65 years, then gradually decreases.


Among these proposals, which are pathologies of which obesity could be a protective factor?

Decreased risk of fracture (mechanical protective role of adipose tissue in case of trauma, stimulating pressure of weight on bone structure and hormonal effect related to the transformation of adrenal androgens into estrogens by adipose tissue)


vascular tumors are most often capillary

The term 'angioma' is a generic term for vascular tumours such as hemangiomas and vascular malformations such as CAVs.

The main vascular tumor is angiocarcinoma of the elderly

The prevalence of infant hemangiomas is 0.01%

Most common childhood tumours, with a prevalence of 10%

Hemangioma is a malignant tumor and a diagnostic emergency

Benign skin proliferations of vascular endothelial cells, non-congenital, more common in girls, premature infants and low birth weight infants


The origin of infant hemangiomas is unknown

The endothelium is proliferating in malformations

Biopsy is usually unnecessary in typical uncomplicated hemangioma

The hemangioma is non-blowing on auscultation


Hemangiomas are the most common tumours in children, with a prevalence of 10%

Deep hemangiomas are arterial and present with bright red swelling

Deep hemangiomas are more elastic in consistency than superficial forms

Subcutaneous hemangiomas are always clinically diagnosed only

The clinic is sometimes non-specific: imaging may be necessary

Doppler ultrasound shows a richly vascularized tumor


Hemangiomas regress completely and the majority require no treatment

The variation in the evolution of hemangiomas is important depending on the individual

Their natural history is stereotyped and is an important part of the diagnosis

The growth phase begins between the 3rd and 6th month of life

A beginning in the first days/weeks of life

The increase in size is quite rapid during the first 5 to 6 months


The life-threatening prognosis of severe trauma is still at stake

By definition, a severely traumatized person is a trauma patient whose violence or mechanism of trauma may result in life-threatening injuries.

The first 15 minutes in the hospital are spent performing standard X-rays and a biological work-up

The first fifteen minutes of hospital care are devoted to clinical assessment and conditioning

The first 30 minutes in the hospital are devoted to the radiographic assessment including the CT scan

TDM does not enter the process of the first 30 minutes

Whole body computed tomography with contrast injection should be performed in all severe trauma patients whose haemodynamic status has been stabilized

Pre-hospital management includes an assessment of the haemodynamic, infectious, urinary and orthopaedic impact of lesions

What interests us urgently is the hemodynamic, ventilatory and neurological repercussions


Regarding the management of polytrauma patients:

Hemodynamic failure is managed by the treatment of hemorrhagic shock

Surgical management prioritizes bleeding lesions

Treatment of ventilatory failure involves orotracheal intubation

Treatment of neurological failure involves orotracheal intubation


What are the roles of the witness of an accident?

avoid the "super-accident", protect yourself, remove the injured person(s) from the traumatic agent

call 15 (Samu-SMUR), 18 (Firefighters), look for help around you.

compression of active bleeding, lateral safety position (PLS), basic cardiopulmonary resuscitation (CPR)

The 3 essential roles of the first link in the chain of survival are: Protect, Alert, Rescue


Which of the following propositions concerning pre-eclampsia are true?

Pre-eclampsia is defined by the combination of blood pressure ≥140/90 mmHg and proteinuria ≥ 300 mg/24h occurring at any time during pregnancy

Pre-eclampsia is said to be early when it occurs before 34 SA

In the majority of cases, pre-eclampsia disappears before the end of the 6th postpartum week

Pre-eclampsia affects less than 1% of pregnancies

A woman who has already had pre-eclampsia will have a decreased risk of pre-eclampsia for a later pregnancy.


Which of the following proposals for the treatment of pre-eclampsia are true?

The only effective treatment is delivery of the placenta.

It is recommended to use calcium sulfate during the appearance of severe neurosensory signs and during eclampsia.

IV nicardipine is the attack treatment for pre-eclampsia with a SBP of 190 mmHg.

True, for a SBP > 180 mmHg or a > 140mmHg MPA, the attack treatment is Nicardipine IV bolus of 0.5 to 1 mg, then infusion of 4-7 mg over 30 min. Evaluation of the efficacy and safety of the treatment after 30 min.

Blood pressure objectives are a PAD between 80 and 105 mmHg.

Perindopril is part of the antihypertensive therapeutic arsenal in pre-eclampsia

False. All ACE inhibitors and angiotensin II receptor antagonists (sartans or ARA II) are contraindicated in the 2nd and 3rd trimesters of pregnancy!! Perindopril is an ACE inhibitor, and therefore contraindicated! They are contraindicated because they can induce acute renal failure in the fetus, resulting in oligo-amnios.


Any accident at the workplace is considered a TA, it also concerns the home-to-work journey or accidents in common areas (toilets, cafeteria)

The TA only concerns the company's employees

It also concerns stagaire pupils, people under contract, temporary workers, etc.

This is particularly relevant for differentiation with PD

The maternality of the accidental event refers to the material that caused the accident

These are the precise conditions, localizable in time and space, in which TA occurs.

Accidents occurring during strikes are TAs

There is suspension of the employment contract, so it is not a TA


The insured must provide proof of this in the TAs

There is a presumption of accountability

The insured must provide proof in the PM

Via the classification tables for example which will determine the minimum exposure times

In the TA, imputability is established by the occupational physician

The CPAM medical officer is responsible for determining accountability

Relapses and late complications of TAs are covered by the presumption of initial imputability

The presumption of imputability applies only to initial injuries and direct complications

No one can dispute a TA and its accountability

Within the time limits, the employer and the CPAM may contest the imputability of a TA


Progressive and insidious unlike TAs which are sudden

The only way to recognize PM is the array system

There is an ancillary system with the Regional Committee for the Recognition of Occupational Diseases which will in particular recognize as PM pathologies in workers who do not meet the criteria set out in the tables

It is the victim who must notify the employer

Unlike the AT, it is not the employer but the employee who must send the declaration of PM to the CPAM within 15 days of the finding of the disease.


Esophageal cancers are the most common digestive cancers

This is the 4th digestive cancer after colorectal, pancreatic and stomach cancer

Esophageal cancers are most often excellent prognosis

Esophageal cancers more common in the northwest


What is the risk of malignant transformation of an endobrachyoesophagus (EBO) during life?


Which of the following are true about Plummer-Vinson syndrome?

It is also called "Kelly-Paterson syndrome"

True. It is a risk factor for squamous cell cancer of the esophagus


Which of the following are true about endobrachyoesophagus?

Monitoring is done, in the absence of dysplasia, every year

Every 2, 3 or 5 years depending on the length of metaplasia

Monitoring involves only a clinical examination

Suspected low-grade dysplasia involves fibroscopic control after 6 months of PPI

Low-grade dysplasia involves fibroscopic control after 2-3 months of double-dose PPI

It is an important risk factor for adenocarcinoma of the esophagus


Which of the following are risk factors for squamous cell cancer of the esophagus?

Caustic esophagitis after several decades of evolution


What is the 5-year survival of esophageal tumors?


About 10% of ovarian cancers occur in a context of genetic predisposition

About 5-10% of women will have an ovarian tumor in their lifetime, and it is most often a benign ovarian cyst.

The ovary is a complex organ that is home to many different cell types

Mature dermoid cysts or teratomas derive from a highly differentiated cell

Mature dermoid or teratoma cysts derive from a multipotent cell that can be the source of different tissues present within the cyst


Which of the following are formal contraindications in case of suspicion of ovarian cancer?

True, except in very special cases (end of life), it is necessary to explore urgently because the prognosis is very poor


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

Lynch syndrome: mainly colon, endometrium, small intestine and excretory urinary tract


Which of the following proposals are part of the assessment of the extension of adenocarcinoma of the cecum?

Not in the first intention. Can be done in case of an increase in CEB

True. An elevation of the CEA suggests a metastasis that will be sought by PET-CT

However, a liver MRI injected with gadolinium can be performed with a chest CT scan without injection, if an injected TDP-TAP is contraindicated (renal failure for example)


Which of the following are true for preoperative measures in a patient with adenocarcinoma of the cecum?

True because all surgical procedures are at risk of malnutrition. In case of oncological digestive surgery, a supply of micronutrients to begin 7 days before the intervention, is recommended to limit infectious complications and postoperative mortality.

Unnecessary in the case of laparotomy or laparoscopy.


Which of the following propositions are true regarding the monitoring of Lynch syndrome-prone patients who have previously had resected colonic adenocarcinoma?

True, for Lynch syndrome (endometrial cancer)


Which of the following are true about Lynch syndrome?

There are more polyps in the lining of the colon than in Familial Adenomatous Polyposis (FAP)

The risk of developing CRC during life is about 70% in humans

The risk of developing CRC during life is about 70% in women

In the majority of cases, cancer develops in the sigmoid

The positive relative risk is only for colon tumours

Also cancer of the urinary tract, small intestine, endometrium. Also from the ovary, stomach, bile ducts, pancreas and brain


In case of stage T3 N+ stage T3 N+ lieberkühnian adenocarcinoma surgically resected, what postoperative treatment(s) do you prescribe?

True, this is the only adjuvant therapy in stage 3 colonic adenocarcinoma (i.e., which are N+). 5-FU and oxaliplatin are preferred


Which of the following are true in cases of adenocarcinoma of the cecum with negative extension assessment?


True, for Hereditary Non Polyposis Colorectal Cancer

It is responsible for 25% of colorectal cancers

4% of CRC, it is the most common form of hereditary cancers

The abnormality is expressed on the genes of the mismatch repair proteins

True, MMR (MisMatch Repair) genes. Mainly MLH1 and MSH2

Replication errors are mostly found on chromosome 6 and 18

They are found at the level of micro-satellite sequences (DNA sequences formed by a repetition of patterns), which themselves are found in all chromosomes


Among these proposals, which favor the occurrence of renal colic?

Heat, on the other hand, is a contributing factor

It can, however, cause kidney failure, in very rare cases


Urolithiasis affects 50% of the population in France

Between 5 and 10%. It is a common disease

It recurs in 50% of cases if preventive treatment is not put in place

Calcium lithiasis is the most common. It represents 80% of urolithiasis

Infectious stones account for 5% of urolithiasis


What are the elements of gravity to look for?

It is then a question of acute obstructive renal failure

It is one of the three risk areas: pregnancy, kidney transplantation and kidney failure.

Doesn't matter. It is a normal sign associated with


Which of the following are true about melanoma?

True, the incidence of melanoma doubles almost every 10 years 😱

True, mortality increases less than incidence, which can be attributed to earlier 😊 diagnosis.

The clear phenotype ⚪ is not a risk factor

The main prognostic index is the Breslow index

The main prognostic index is the Clark index


Which of the following propositions are true about the halo nevus?

The Ota nevus is a birth nevus 👼 with a distribution in unilateral rule, superimposed on the territories of the two upper branches of the trigeminal. The other name for the halo nevus is the Sutton nevus

There is a development of an achromic halo (white)

The halo observed is due to cytotoxic inflammatory infiltrate

It occurs mostly around the second decade and on the trunk. A later onset or irregular appearance of the halo should lead to fear of melanoma. (cf College of Dermatology, 7th edition, page 305). It is the Ota nevus or Mongolian blue spot that occurs from birth 👼


Which skin carcinoma should suggest a budding, ulcerated and crusty lesion in an elderly person who has worked outdoors all his life?

True. These are the 3 characteristics that make you think of a squamous cell tumor

Raised skin nodule. We think about it especially in front of a short and intense sun ☀ exposure

It is not cutaneous carcinoma. Melanoma is developed from melanocytes


Bowen's disease is invasive squamous cell carcinoma

Squamous cell carcinoma is squamous cell carcinoma in situ

Epidermoid and squamous cell are synonymous 😊

Basal cell carcinoma does not have a precancerous lesion

The evolution of invasive squamous cell carcinoma is first done in the lymph nodes

True. Stereotyped evolution: lung blood ➡ ➡ nodes ➡ then other organs

Hematogenous metastatic course is more common for cutaneous squamous cell carcinomas than for mucosal squamous cell carcinomas

It is more common for mucosal squamous cell carcinomas


The discovery of a heart murmur is a very common possibility in children

A third noise or B3 is common at the apex in children (50% of cases), it is physiological

There is a correlation between the intensity of a breath and the severity of the underlying disease

It should be noted that there is often no correlation between the intensity of a breath and the severity of the underlying disease.

Exertional dyspnea is the most common symptom


Chest pain is exceptionally of cardiac origin in children, unlike in adults

Abnormalities of physical examination, such as hypertension and absence of femoral pulse, immediately point to aortic coarctation

The heart rate is all the faster the older the child is

The heart rate is all the faster the younger the child is

The QRS axis is straighter than in adults, the PR delay is shorter

The echocardiogram-Doppler is the key diagnostic test


In newborns (from birth to the end of the 2nd month), a very early breath is less pathological than when it is heard after a few days

In newborns (from birth to the end of the 2nd month) 1 Isolated breath in a newborn A very early murmur is more pathological than when it is heard after a few days

It is necessary to perform a cardiac ultrasound before leaving the maternity in case of breath heard on Day 1 or Day 2

Transposition of the great vessels is the most common cause of neonatal cyanosis

Transposition of the large vessels represents the very type of neonatal cardiology emergency

Regarding the transposition of the large vessels, anatomical correction surgery must be performed in the first 15 days of life


Early surgery is imperative for infants with large shunts, especially IVC

Anorganic or innocent breaths are very common in children

In case of innocent breathing, no therapy, or supervision, or restriction of activity, is justified, and these children can lead a strictly normal life.

In case of innocent breath it is useful to see the child periodically in consultation

It is useless and even harmful to see the child periodically in consultation

Asymptomatic systolic murmurs discovered in infancy most often correspond to anorganic murmurs, or "innocent" or "functional" murmurs.


What are the two physiological shunts in the fetal circulation?

False. The round foramen is a round foramen is a foramen of the middle stage of the base of the skull.


Which of the following are cyanogenic heart diseases?

True, the leading cause of cyanogenic heart disease in children according to the College of Pediatrics


What heart defects form a left-right shunt?

False. It causes an obstacle of the right heart.

False. It causes poor connections in the heart.


Which of the following are non-cyanogenic heart diseases?


What is the prevalence of congenital heart disease in live births?


The Pearl Index (PI) is the number of pregnancies that occurred in 100 women exposed to the method studied for 1 year

The higher the Pearl Index (PI), the more effective the contraceptive method concerned

It's the other way around. The lower it is, the more effective the contraceptive method.

The patch is a progestin-only contraception

The ring is an estrogen-progestin contraception

Macro-progestogens have no MA for contraception

Their prescription is off-label. No study has calculated a Pearl index.


Which of the following proposals are part of the follow-up assessment in a woman on an estrogen-progestogen contraceptive?


After unprotected sex, how soon should levonorgestrel be taken?

This is true for EllaOne®, Ulipristal Acetate

Norlevo® is an emergency contraception consisting of a 2nd generation progestin (levonorgestrel 1.5 mg)


What is the concentration of ethinyl estradiol (EE) of a so-called "normodosed" contraception (in micrograms)?

True: the pill is called "normo-dosed" if it contains 50 μg of EE


What emergency contraception is administered 4 days after sexual intercourse?


Which of the following are absolute contraindications (ICs) of estrogen-progestogen contraceptives (OCCs)?

Not an absolute CI if it is family, personal only. Family = relative (we will not CI a COP to a patient because her older sister had phlebitis at 65 years after 8 hours of plane returning from Reunion ^^)

The absolute ICs of COP are: ischemic heart disease, complicated valvular heart disease, ischemic stroke ATCD, migraine with aura, porphyrias / connective tissue (lupus are hormone-dependent),
Personal ATCD or venous (DVT or PE) or arterial TED accident
major surgery with prolonged immobilization, hereditary or acquired predisposition to thrombosis (AV), tobacco > 15 cigarettes / day if > 35 years, severe unbalanced hypertension or FdR CV, confirmed or suspected pregnancy, breastfeeding < 6S postpartum, severe dyslipidemia, active viral hepatitis, severe or recent liver disease (including cirrhosis), benign hepatic tumor, malignant or suspected breast tumor, uterus, meningioma, pituitary tumor (on a case-by-case basis) and non-genital hemorrhages Diagnosed.


Which of the following have a Pearl Index (PI) of less than 1?

True, one of the contraceptives with the lowest Pearl index

True. IP = 0.6 for classics. IP = 0.2 for impregnated IUDs


How soon should ulipristal be taken after unprotected sex?

It is a progesterone receptor antagonist


Among the following proposals, which are part of the biological assessment to be prescribed essential before starting estrogen-progestin contraception in a woman without personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal?

True. In a person with no personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal, the laboratory assessment can be performed 3 to 6 months after prescription.


Which of the following are true about emergency contraception? (one or more exact propositions)

Free only for minors. Reimbursed at 65% for adults, if medical prescription.

It can be issued to minors free of charge, anonymously and without a doctor's prescription, regardless of the medication used.

Contrairement à ce que l'on peut trouver dans certaines sources, l'ulipristal est bien disponible sans ordonnance d'après cette fiche de la HAS (mise à jour en 2019) : https://webzine.has-sante.fr/upload/docs/application/pdf/2015-07/contraception_urgence_officine_maj_juillet2015.pdf Si elle n'est plus valide, n'hésitez pas à nous prévenir en signalant la QI :)

Or in a CeGIDD, in a family planning or education center, with the school nurse or academic medicine

Two ICs: Allergy to one of the components and pregnancy. In addition, it is not recommended in cases of severe hepatic impairment and severe asthma insufficiently controlled by oral glucocorticoid. After taking UPA, breastfeeding not recommended for one week (during this period, express and discard breast milk in order to maintain lactation stimulation). (according to HAS)


Which of the following are true for intrauterine devices (IUDs)?

True, L-5134 of the CSP: "The insertion of intrauterine contraceptives can only be performed by a doctor or midwife."

Wilson's disease is a contraindication to the copper IUD

It is refunded. It is proposed as a first-line treatment for multiparous women with stable sex lives


The Pearl Index of the progesterone IUD is less than 0.5

The Pearl number of the copper IUD is less than 0.5

A history of ectopic pregnancy is a contraindication (CI)

Taking chronic NSAIDs is a contraindication (CI)


Which of the following are true about progestin-only contraception?

They have the same contraindications (CI) as estrogen-progestogens

The cycle disorders they can cause are sometimes poorly tolerated

Their tolerance to forgetfulness is 12 hours

3 hours for progestin-based contraceptives

Personal history of ectopic pregnancy (GEU) is part of the contraindications (CI)


Which of the following proposals concerning estrogen-progestogen is (are) correct?

They are also called combined oral contraceptives or combination pills and are composed of a synthetic or natural estrogen and a progestin

Ethinyl-estradiol is a synthetic estrogen

The dosage of synthetic estrogen ranges from 15 to 50 μg

Estrogens and progestins may contain a natural estrogen, estradiol

The dose of estradiol in estrogen-progestogens is conventionally 1.5 mg


Which of the following is (are) correct?

The first generation progestinfs are levonorgestrel and norgstrel

1st generation = norethisterone and lynestrenol

The third generation progestogens are gestodene and norgestimate

Chlormadinone acetate is a toxic element contraindicated in humans

Chlormadinone acetate is not toxic at all and is used in combination pills

Nomegestrol acetate is in combination with levonorgestrel most often

It is a progestin in combination with estradiol most often in estrogen-progestin pills

Cyproterone acetate is a progestin used in combination pills


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

The first generation progestins were obtained from the testosterone molecule

Second-generation progestogens are gonans

Third-generation progestogens have a very high affinity for the progesterone receptor and a lower affinity for the androgen receptor

3rd generation progestogens have very minor antigonadotropic activity

Their antigonadotropic activity is very high and has reduced the dose of ethinylloestradiol used

The androgenic effect of 3rd generation progestins is major

They have a lesser androgenic effect, on the contrary


Among these proposals, which fall into the triad of symptoms of retroplacental hematoma:

Abdominal pain in stabbing, uterine contracture, metrorrhagia


Regarding acute abdominal pain in pregnant women:

Abdominopelvic pain without metrorrhagia in the 1st trimester may be a telltale sign of an ectopic pregnancy

The severity argument suggests a retroplacental hematoma in the 2nd and 3rd trimesters

Retroplacental hematoma is to be evoked systematically in the 2nd half of pregnancy

Retroplacental hematoma is life-threatening for the fetus

The HELLP Syndrome is to be evoked in case of epigatric pain or right hypochondrium


HELLP syndrome is life-threatening for mother and fetus

Salpingitis is a common and relatively benign algic etiology in pregnant women

Salpingitis and endometritis DO NOT exist in pregnant women!

Diagnostic criteria for UTI are extremely different in pregnant women compared to non-pregnant women

Urinary pathologies have no impact on pregnancy

Careful! Urinary pathologies can trigger a threat of premature delivery


Pregnancy drastically reduces the frequency of urinary tract infections

Caution: Pregnancy increases the frequency of urinary tract infections

Uro-scanner is contraindicated in pregnant women

Renal colic: The uro-scanner is possible if the ultrasound is not contributory

A pyelocalicial dilation of 100 mm is physiological and frequent in pregnant women, especially on the left

Be careful, a physiological moderate pyelocalicial dilation (< 20 mm) is common in pregnant women, especially on the right because of the physiological dextrorotation of the uterus

Injected abdominal CT scan is strictly contraindicated during pregnancy

Ultrasound is not always very effective because of pregnancy and injected abdominal CT is possible at any age of pregnancy (benefit/risk ratio)"


Digestive pathologies can trigger a threat of premature delivery

Uterine palpation is looking for uterine contracture or deformity of the uterus

Cardiotocographic recording is done from 25 SA

Retroplacental hematoma is ultrasound diagnosis

Retroplacental hematoma is exceptionally seen in ultrasound, the diagnosis is clinical

The BU always shows the presence of blood in case of metrorrhagia


Regarding acute abdominopelvic pain in pregnant women:

Ultrasound of the cervix is indicated only in case of imminent threat of delivery

Renal and abdominal ultrasounds are made difficult by pregnancy

In the absence of an identified etiology, the patient is redirected to her general practitioner with a close consultation.

The 4 major etiological families are obstetrical, urinary, gynecological and digestive

Urinary causes are only very rarely due to pain of this type


Which of the following are signs or symptoms of uterine rupture?

It is especially to be evoked in a nulliparous woman

Especially in case of uterine scars (history of caesarean section in particular)

Exceptional outside of work, it is especially during work that we evoke a uterine rupture


Which of the following proposals is(are) possible cause(s) of acute abdominal pain in pregnant women?

True, especially in the first trimester, to evoke systematically

True especially in the context of hypertension or preeclampsia

True, especially in cases of sudden pain, red blood metrorrhagia and uterine deformity


Primary headaches are far more common than secondary headaches

They often evolve by paroxysmal crises and less often in a continuous and daily mode

The diagnosis of a primary headache is clinical, based on questioning in particular

Additional examinations show an inflammatory syndrome in 60% of cases

Complementary examinations are by definition normal

Primary headaches are mild and do not require management

Although benign, primary headaches and essential facial neuralgia have a significant impact on quality of life


There is no specific treatment for migraine

The management of migraine is based on non-specific treatments (paracetamol, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]) and specific treatments (triptans)

Subarachnoid hemorrhage is a secondary headache etiology

Facial and cranial neuralgia are responsible for electrical discharges in the territory of a sensory nerve

The main causes of headaches occurring less than 15 days a month are intracranial hypertension and meningitis

Headaches < 15 days a month: the main causes are migraine and episodic tension headache

Chronic daily headache (CCQ) is the leading cause of headache occurring more than 15 days per month for at least 3 months


"Short-term" chronic daily headaches (QCDs) are seizures lasting less than 30 minutes a day

"Short-term" CCQ: seizures lasting less than 4 hours a day

The main causes of QCC are cluster headache and trigeminal neuralgia

Chronic migraine or, more rarely, chronic tension headache, both with or without medication abuse

With a prevalence of 75%, migraine is one of the most common neurological conditions

With a prevalence of 15%, migraine is one of the most common neurological conditions

Migraine without aura is a more common cause of CCQ than migraine with aura

Some patients have only one variety of migraine attacks and others have both (with and without aura)


Which of the following propositions are true about reversible cerebral vasoconstriction syndrome?

It can be triggered by the Valsalva maneuver

It can be complicated by cerebral ischemia

It can be complicated by cerebral hemorrhage


Sexual violence is any sexual assault committed with violence, coercion, threat or surprise

Rape is any act of sexual penetration of any kind, committed by violence, coercion, threat or surprise.

The competent court to try marital rape is the administrative court

Penalty: jurisdiction: crime: Assize Court 15 years imprisonment 20 years if aggravating circumstances (rape by spouse or common-law partner ...)

Limitation period: 10 years if adult victim 20 years if rape committed when the victim was a minor In France:

In France, there were 980 rapes in 2014 (about 3 per day)


16% of women and 5% of men report having been raped or attempted rape in their lifetime

Sexual assault is a non-penetrative act committed by violence, coercion, threat or susception.

The jurisdiction that judges sexual assaults is the criminal court

The penalty for sexual assault is a fine of up to 100,000 euros (but no prison sentence)

Penalty: offenses: (minimum) 5 years in prison € 75,000 fine these penalties vary the prison sentence depending on 7 to 1 0 years, and the fine to € 100,000 of "aggravating situations": increase of possible"


Concerning sexual violence and harassment

There were 26,700 sexual assaults in 2014

Sexual harassment is the infliction of non-consensual touching (without penetration) of a person.

Definition: Imposing connotations or intimidating on a person who repeatedly engage in sexual comments or behaviours that violate their dignity or create a hostile situation

Sexual harassment is a crime punishable by law

The competent court to deal with sexual harassment cases is the Assize Court only

Jurisdiction: Jurisdiction of High Court If sexual harassment at work: (private sector) Administrative Court (public sector)

Penalties can be up to 2 years in prison and a fine of €30,000 (without aggravating circumstances)


During the somatic examination of a rape victim, we look for:

It will have to be carefully described in the medical record

Never breast palpation spontaneously, unless clearly urgent and informed agreement of the patient"


Dealing with sexual assault/rape is an emergency

If the rape victim is a minor, contact the legal guardians and the public prosecutor.

If the person is of age, the information of the Public Prosecutor is done only with the agreement of the patient

Psychological examination of rape victim looks for suicidal risk and acute stress

Samples are taken with sterile gloves in duplicate for DNA (spermatozoa)


What are the biological elements to be systematically sought, within a reasonable time, in the event of rape?

Local sampling for chlamydia and gonococci but never blood serology"


Rape is defined as any act of sexual penetration carried out against the will of the person by surprise, threat, violence or coercion.

Lack of consent results exclusively from physical violence

Lack of consent may result from physical or moral violence

Victims of sexual abuse have experienced criminal violence that must be handled in the most professional manner

Epidemiology: 16% of women report having experienced forced or attempted forced sex in their lifetime

Oral penetration is sexual violence but not rape

Oral penetration is called rape because it involves a sexual organ and an orifice.


Concerning the care of victims of sexual violence

Taking samples to identify the perpetrator is crucial

The doctor must write an initial medical certificate

Rapes dating back more than 5 days require emergency care with samples and declaration to the prosecutor

It is the recent aggression of less than 72 hours that requires urgent care, in particular because it allows samples to be taken.

Medical consultation with genito-anal examination should be carried out with maximum competence

After explaining the objectives of the medical examination, it must be carried out in a welcoming, well-lit room


The interrogation of rape victims makes it possible to specify:

Difficult question to ask, like many others, but necessary

The relationship is a question that does not arise

The victim's behaviour after the assault is unnecessary

If she has lost consciousness, changed her clothes or made a toilet, the medical management changes


The Maddreay score calculates the probability of contracting viral hepatitis

Maddrey's score defines the severity of alcoholic hepatitis

There is never a severe form of HEV infection

The hepatitis B virus has a diameter of 2 microns

Viruses are smaller than cells (so about ten ometers). HBV is 47 ometers in diameter

Mutated pre-C HCV viruses cause more severe chronic hepatitis than non-mutated viruses

Hepatitis is said to be chronic when it lasts more than 3 months


There may be, but very rarely, fulminant hepatitis


A positive HBs antigen can be found in case of:

Immunoprotective vaccination against HEV


Regarding the transmission of hepatitis viruses:

HAV is not transmitted from mother to child during pregnancy

This is the case for all viruses are HEV

HCV is not affected by fecal-oral transmission

Blood transmission is possible for all hepatitis viruses

HEV cannot be transmitted during sexual intercourse


Which of the following designates active hepatitis B?

HBsAg negative / Anti-HBs Ac negative / HBeAg negative / Anti-HBc Ac negative

HBsAg negative / Ac anti-HBs positive / HBeAg negative / Ac anti-HBc negative

HBsAg negative / Ac anti-HBs positive / HBeAg negative / Ac anti-HBc cloudy

HBsAg positive / Anti-HBs ac negative / HBeAg negative / Positive anti-HBc Ac

HBsag positive / anti-HBs ac negative / HBeAg positive / positive anti-HBc ac


It signs an increase in androgen or a decrease in estrogen

The opposite: an increase in estrogen and/or a decrease in androgens

Parapubertal gynecomastia must evoke a gonadotropic tumor

It is physiological and regresses spontaneously

The different etiologies are all endogenous

There are also many exogenous etiologies: alcohol, drug addiction, iatrogeny, etc.

An increase in hCG should be investigated for testicular choriocarcinoma


Which of these proposals can cause gynecomastia?

Inhibition of aromatization of androgens into estrogens

The genetic absence or decrease of estrogen receptors

Iatrogenic decrease in androgen receptor availability


What element(s) are included in the biological assessment of gynecomastia:

The assessment contains (according to the College of Endocrinology): hCG, estradiol, testoserone, LH, FSH, Prolactin, TSH, Liver enzyme, Ionogram and Creatitine


Adipomastia is a subcutaneous fat deposit next to the nipple

An increase in estrogen is a sign of Leydig cell tumor

An increase in estrogen may be a sign of a malignant adrenocortical carcinoma

A karyotype 47,XXY signs Klinefelter syndrome


The diagnosis of mononucleosis syndrome is clinical

The diagnosis of mononucleosis syndrome is made on the leukocyte formula of the blood count

The diagnosis is made on a blood count showing a proportion > 5% of mononuclear cells in the leukocyte population

Diagnosis is made on the blood count and the leukocyte formula: proportion > 50% of mononuclear cells in the leukocyte population; and proportion > 10% of activated lymphocytes (increased size, polymorphs, basophilic staining).

Mononucleosis syndrome shows intense activation of cellular immunity

T cells are activated by a virus, most often

The presence on physical examination of lymphadenopathy and/or angina should be sought on clinical examination.

TRUE. In EBV infection, fever and influenza-like syndrome are found with, on clinical examination, erythematous, erythematopultaceous or pseudomembranous angina, lymphadenopathy predominant in the cervical and posterior, splenomegaly and / or hepatomegaly (more rarely)

Other biological abnormalities can lead to a misdiagnosis of mononucleosis syndrome by the laboratory, especially in acute leukemia.

TRUE. Confusion between circulating blasts and activated T cells. In acute lymphoblastic leukemia, lymphocytes are immature and monomorphic.


An HIV infection is to be evoked systematically

TRUE. It's rarer than toxoplasmosis, CMV or EBV, but it's also much more serious.

Some drug hypersensitivity reactions (to sulfonamides, ß-lactams, certain anticonvulsants...) can result in a mononucleosis syndrome

A mononucleosis syndrome may accompany a DRESS syndrome (Drug Rash with hyperEosinophilia and Systemic Symptoms)

TRUE. Some drugs induce a viral reaction against certain viruses (present but asymptomatic), including EBV and CMV, causing severe toxiderma and containing a mononucleosic syndrome: this is the DRESS syndrome

The most common cause is primary infection with Epstein Barr virus.

TRUE. The Epstein Barr Virus (EBV) is the cause of infectious mononucleosis, or MNI. It is a DNA virus. The other two main causes are CMV infection (DNA virus too) and toxoplasmosis (intracellular parasitic zoonosis)

In the face of a mononucleosic syndrome, to look for primary EBV infection, a first-line serological search is carried out

First, a MNI-test is performed. This agglutination test is fast for diagnostic orientation, but not very sensitive.


Transmission occurs through contact with infected shedding

It is the leading cause of mononucleosis syndrome

This is the second cause. The first cause is NIM (infectious mononucleosis), caused by the EBV virus.

There is systematic screening for pregnancy

In pregnancy, seroconversion can be serious/fatal to the fetus


The virus has a tropism for B lymphocytes causing lymph node hyperplasia

The MNI-test has low specificity and high sensitivity

Low sensitivity. The College of Hematology does not mention its specificity


Regarding the ancillary causes of mononucleosis syndrome:

Rickettsiosis are parasites that can cause this syndrome

Hepatitis B and C viruses can cause this syndrome

SCA ST+ can be accompanied by this syndrome because of muscle soreness


Which of these virus proposals are not herpes viruses?


Which of these proposals are factors promoting primary post-infection reactivation?

For cutaneous tropism viruses such as HSV and VZV


Incubation of chickenpox is about 21 days

Scattered vesicles and pruritus with possible scratching lesions are then observed.


Herpes viruses are the second most common entity in infectious encephalitis

Herpes virus = first cause of infectious encephalitis

EBV is the most common cause of viral encephalitis.

HSV is responsible for about 33% of viral encephalitis

Primary HSV-1 infection is preferentially sexual

HSV-2 is more frequently responsible for encephality than HSV-1


Which area(s) is/are respected by chickenpox?

Only the extremities of the limbs are respected by chickenpox


In case of genital lesions due to HSV-2 concomitant with late pregnancy, caesarean section is recommended

Aciclovir is an inhibitor of HSV DNA polymerase

Aciclovir will be phosphated 3 times before use

The active metabolite is therefore aciclovir-triphosphate


Which pathology(s) is/are favored by HHV8?

The repository does not mention it in any case

Viral meningitis is clear fluid most often


Which elements of the blood count are greatly increased in case of infectious mononucleosis (EBV)?

These are the hyperbasophilic lymphocytes


How many viruses are there belonging to the group of Herpes Viruses?

VZV (varicella-zoster), CMV, EBV (mononucleosis), HSV1, HSV2, HHV6 (Castleman and Kaposi), HHV7, HHV8


Which of the following propositions about chickenpox are true?


The causative agent is herpes virus type 3 or VZV (Shingles and Chickenpox virus)

It is contagious until D + 2 of the beginning of the eruption

Until the appearance of crusts in practice

Transmission is possible through direct contact


There are several types of risk factors: * social, * psychological, * biological

The age of the individual has little impact on his or her likelihood of developing a psychiatric disorder

Some risk factors are more specifically related to the age of the individual

Any situation of social and family isolation is a risk factor for psychiatric disorder

Any stressful social environment is a risk factor for psychiatric disorder

Primary prevention does not exist in psychiatry

There are three types of prevention: * primary prevention is the set of acts aimed at reducing the risk of new cases appearing (incidence)


Mental health is an integral part of health

Mental health is defined by the College of Physicians as "a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his community"

The MDG does not make a definition. The latter comes from the WHO and is accurate

Psychiatric disorders are most often genetic in origin

Analytical epidemiology assesses the frequency and impact of psychiatric disorders

This is the role of descriptive epidemiology, while analytical epidemiology is concerned with the correlation and causal relationships between several variables (e.g. alcohol consumption and incidence of schizophrenia).

In France, about 3 million people suffer from a psychiatric disorder

In France, almost one in five people suffer from at least one psychiatric disorder, or 12 million people


On the impact of psychiatric pathologies:

The prevalence of psychiatric disorders in general practice is about 25%

Psychiatry pathologies are the 3rd most common disease, after cancer and cardiovascular diseases

Psychiatric disorders are a major cause of disability

Psychiatric disorders have no impact on mortality

The resulting socio-economic repercussions make it a major public health issue


Analytical epidemiology identifies vulnerability, risk and prevention factors

A genetic factor is defined as a characteristic regarding DNA material and may be heritable

Genetic and environmental factors are distinct and mutually exclusive

Genetic and environmental factors can interact

A risk factor (genetic and/or environmental) increases the likelihood of developing a disease

There are also genetic and/or environmental protective factors that decrease the likelihood of disease occurring.


According to the WHO: "Prevention is the set of measures aimed at avoiding or reducing the number and severity of diseases, accidents and disabilities"

Primary prevention is directly aimed at reducing prevalence

Primary prevention is the set of acts aimed at reducing the risk of new cases (= incidence and not prevalence, which can only be reduced by cure or time)

Primary prevention aims globally to improve the quality of life and living conditions of individuals

Primary prevention of psychiatric disorders, says WHO, should also aim to strengthen social integration

The objective of secondary prevention is to reduce the prevalence of a disease in a population


This is a critical period for psychic development

Harassment at work explains almost all possible psychiatric pathologies of adolescents

False for two reasons: we talk about school bullying at this age (except in special cases), and bullying is not the main risk factor for neurodevelopmental disorders (even if it is a very strong risk factor)


Which pathologies are more common in women?


Which pathologies are more common in men?


What are the real proposals regarding primary prevention?

It decreases morbidity and mortality directly

It increases the general quality of life of individuals

It is secondary prevention that aims to reduce the prevalence

It is part of general public health actions


Mental health is the absence of mental disorders

A much more complex definition given by the WHO and which boils down to the sufficient degree of adaptation to the social group

Mental health is "a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his or her community."

Only biological and social factors impact mental health

3 factors: biological, psychological and social

Psychiatric disorders affect 1 in 2 French people

12% of the population. 25% of consultations in general practice

Psychiatric disorders are the 8th type of disease in terms of prevalence


The committee for the protection of persons makes it possible to involve citizens in ethical reflection.

It is the National Consultative Ethics Committee (CCNE) whose one of its objectives is to involve citizens in ethical reflection.

Medical ethics is the "set of rules and duties that govern medical practice and individual relationships vis-à-vis the practice concerning their patients and colleagues"

The ethical principles in the medical field are: Primum non nocere, beneficence, patient autonomy and justice/equity.

It serves as a reference for criminal courts

It serves as a reference for the judicial bodies of doctors, the Order but first and foremost as a guide to doctors in their daily practice, at the service of patients. 23 iKB PUBLIC HEALTH 2.CODE OF MEDICAL ETHICS 2.1. HISTORY The Hippocratic Oath: from the Code of Ethics

The Hippocratic Oath has nothing to do with the Code of Ethics

Always used to take an oath of the Code of Ethics: 1st version


He is completely free to refuse to take medication if he does not want to. He cannot, however, oblige a doctor to prescribe a specific medicinal product.

It is free to require the prescription of originators instead of generics

He can ask. The doctor can accept if necessary. But he is in no way entitled to oblige the doctor

His freedom is reinforced by the doctor's duty to inform


Medical ethics is the "set of duties imposed on professionals in the exercise of their profession"

Deontology brings together the elements of a discourse on duties

Medical ethics concerns the doctor who exercises a profession in the strict sense of the term, to which French laws have given for nearly two centuries a monopoly in the field of health

The patient has the fundamental freedom to choose his or her physician and to accept or refuse care

Medical acts cannot be tried by a court because it does not have the jurisdiction to do so.

May be tried at the criminal, civil, administrative or disciplinary level


Drugs used to treat nociceptive pain are classified into three tiers by WHO

Co-analgesic drugs are contraindicated when administering true analgesic

Specific drugs for neuropathic pain as well as so-called "coanalgesic" drugs can be combined with analgesics at WHO levels

Non-drug therapies are useless in times of crisis and should be reserved for cold periods

Non-drug therapies, alone or as part of multimodal analgesia in combination with drug therapies, can reduce the intensity of acute or chronic pain

The benefit/risk balance should be evaluated before the administration of analgesic therapies, except in case of 10/10 pain.

Pain relief is a fundamental right of every person


The source of the pain will need to be treated before the pain itself is treated

There is no ethical or scientific rationale for using placebos, even though 30-70% of patients seem sensitive to them to varying degrees.

Optimal treatment results from a proprietary medication approach that relieves pain

Optimal treatment results from the combination of several approaches, both drug and non-drug, ideally coordinated by a multidisciplinary team

Non-therapeutic approaches have several interests, so that of limiting iatrogeny

It would allow an improvement in analgesia as well as a reduction in side effects via a decrease in the doses of each drug

The source of the pain will need to be treated concomitantly with the pain itself


The WHO established a 3-tiered conceptual model in 1986 to guide pain management.

Therapeutic pain management always begins at level 1 and then increases in step until it reaches the desired effectiveness

Not at all. We go directly to the most suitable level

NSAIDs are contraindicated postoperatively if clearance < 50 ml/min

The choice of level is based on the assessment of the intensity of the pain

Moderate pain assessed between 3 and 7 requires a level 3 analgesic

Moderate pain is 4 to 6/10 and requires a level 2


Puberty in girls begins with the appearance of the breast bud

The absence of breast development at the age of 13 makes it possible to define a pubertal delay

Primary amenorrhea at the age of 15 can define delayed puberty

Puberty includes accelerated growth rate


The gonadotropic axis is functional for the first time during puberty

This gonadotropic axis is functional during intrauterine life and for a few weeks after birth

"Mini puberty" is seen during the few weeks postpartum in infants

During childhood, the gonadotropic axis is inhibited

Puberty is the consequence of the pulsatile secretion of GnRH by pituitary neurons

GnRH is secreted by hypothalamic neurons

The gonadal steroid is estradiol in girls


The age of onset of puberty depends on genetic factors only

Also environmental factors, especially nutrition and energy expenditure

Obese children have puberty later than children in the general population

Excessive physical exertion or lack of sleep induces delayed puberty

In girls, the first sign of puberty is enlarged breasts

In boys, the first sign of puberty is increased muscle volume


Regarding the clinical signs of puberty:

Pubarche is the appearance of pubic hair

The stage S2 or appearance of the breast bud corresponds to the telarche

Stage S2 occurs on average at the age of 16

The vulva changes from the horizontal to the vertical position

It changes from the vertical position to the horizontal position, the labia minora develop, the clitoral volume increases


The onset of menstruation is the first stage of puberty

First breast development and then changes in the vulva

In France, the average age of menarche is 16.9 years

An irregularity of the cycles during the first 2 years after menarche should lead to explore the pathology

In boys, Tanner's stadiums range from G1 to G3

The development of testicular size begins on average around the age of 11.5 years


Testicular volume greater than 4 mL or height greater than 2.5 cm is in favour of early puberty

Normal adult testicular volume is greater than 35 mL

The onset of puberty coincides with the appearance of capitatum

The onset of puberty coincides with the appearance of the sesamoid of the thumb, on the bone age X-ray performed on the left wrist in right-handed people and vice versa.

At puberty, there is an acceleration of the growth rate from 5 mm/year to 9 mm/year

The peak of growth occurs in the girl around the age of 12


Regarding pubertal growth and precocious puberty:

Total pubertal growth averages 25 cm in boys

Final height is reached on average at 21 years in boys

There is during puberty a major increase in lean mass compared to fat mass, in girls

When breast development occurs before the age of 8 in girls, it is called precocious puberty

Precocious puberty affects 15% of boys today

It is rather rare: 0.2% of girls and 0.05% of boys


Regarding precocious puberty and advanced puberty:

Precocious puberty is 10 times more common in boys than in girls

Converse: it is 10 times more common in girls than in boys

Puberty is said to be advanced when it occurs between 8 and 10 years of age in girls

Advanced puberty is as pathological as precocious puberty

Precocious puberty is of central or hypothalamic-pituitary origin

Precocious puberty can be a "true" puberty of central or hypothalamic-pituitary origin or a "pseudo puberty" of peripheral origin, either of gonadal or adrenal origin

Precocious puberty is idiopathic in 90% of cases in girls, it is pathological in 66% of cases in boys


Which of these proposals are possible etiologies of precocious puberty?

Associated with café au lait spots and fibrous bone dysplasia. Resulting from a mutation in the GNAS gene"


The main impact of precocious puberty in the long term is the permanent small size

Pubertal delay should be evoked in boys in the absence of an increase in testicular volume at the age of 14 years

Pubertal delay can be congenital or acquired

A family investigation is necessary in case of pubertal delay

Pubertal delay is always of central origin

Pubertal delay can be of central or peripheral origin


Among these proposals, which are times of the announcement device?

The 4 times of an announcement consultation are, in order: the medical time, the time of caregiver accompaniment, the time of support care and the time of articulation with the city medicine


Which of these proposals belongs to level 3 analgesics?


Which of these proposals is(are) supportive care?


Which of these proposals concerning medical information are true?

And we must ensure that the patient has understood and integrated it by asking him to reformulate

The information must be verified with relatives before being delivered to the patient

Medical confidentiality contravenes this proposal


It is contraindicated except in end-of-life care

It is usually established at a dose of 10 mg / day

There is no maximum dose common to all patients

The dose-efficacy-tolerability relationship varies greatly from one patient to another. It is therefore important to frequently evaluate efficacy and tolerability, and to adapt the dosage gradually according to the patient's needs. There is no maximum dose, as long as adverse effects can be controlled.

The only effect of morphine is analgesic


It facilitates the use of active euthanasia

Absolutely not. Active euthanasia is illegal in France

It makes it possible to stop all treatments

We do not stop medications that have a positive effect on patient comfort

They are set up exclusively at the patient's home

Possible also in the hospital, or with relatives for example

No more "than elsewhere", pain management is still essential

The main goal is to improve the patient's comfort of life through better control of symptoms.


Which of the following propositions are true about Lefort's classification?

Lefort III corresponds to an abnormal mobility of the upper dental arch compared to the base of the skull

Lefort III corresponds to an abnormal mobility of the dental arch superior compared to the eyebrow arch

Lefort II corresponds to an abnormal mobility of the upper dental arch compared to the cheekbones

The most common fracture is the Lefort I

The most serious fracture is the Lefort II


Which of the following are innervated by the mandibular V3 portion of the trigeminal nerve?


Pyogen skin infections are mainly due to Staphylococcus aureus and Streptococcus pyogenes (also called ß-hemolytic group C streptococcus)

Impetigo is a contagious infection of the epidermis due to S.aures or S. pyogènes

Local treatment is most often sufficient in impetigo

Folliculitis and boils are infections of the pilosebaceous follicle

General antibiotic therapy is indicated in boils of the face because of the risk of malignant staphylococcal disease


The skin abscess is most often linked to S. pyogènes

The skin abscess is most often linked to S. aureus

The treatment of abscesses is essentially based on antibiotic therapy

Erysipelas is a necrotizing dermohypodermatitis mainly due to S. Aureus

Erysipelas is a non-necrotizing dermo-hypodermatitis mainly due to Streptococcus pyogenes


Superficial mycoses are frequent and benign infections of the epidermis and appendages due to fungi

The diagnosis of mycoses is essentially microbiological

In France, community Staphylococcus aureus are sensitive to methicillin in > 95% of cases and the reference antibiotic is penicillin M (cloxacillin)

Streptococcus pyogenes is 100% sensitive to penicillin and the reference antibiotic is amoxicillin

In case of allergy to ß-lactam in staphylococcal or streptococcal infections, pristinamycin or clindamycin is used.


Which of the following propositions are true for osteitis of the foot in diabetic patients?


Which of the following propositions are true about impetigo?

S. aureus and S. pyogenes are the two most common germs found in impetigos

Diagnosis requires bacteriological sampling before starting antibiotic therapy

Treatment of simple impetigo is based on doxycycline

True, and water rinse them. Daily washing with soap and water of the lesions is a measure to advise in all cases


Ecthyma is a common pathology of precariousness

Complications of ecthyma include post-strep throat and rheumatic fever

Control of proteinuria 3 weeks after the infectious episode is necessary

Folliculitis is inflammatory papulopustulous in nature


The boil is a deep but non-necrotizing infection of the pilosebaceous follicle

Handling of boils by the patient should be avoided

For boils, oral systemic antibiotic therapy if necessary should be active on S. Aureus

Panari is an elementary lesion of the erythematous, edematous and painful nail fold

Incision and drainage in case of purulent collection of a panari are necessary