It is assumed to be vastly underestimated

4 to 8.5% of cancers are of occupational origin

The majority of occupational cancers compensated in France are linked to previous exposure to asbestos

Secondary prevention is to be prioritized


Mesothelioma is the most represented cancer

Occupational exposures to carcinogens are more common in women

All occupational cancers are recognized as such

Exposure to wood dust should be accompanied by an ENT examination and naso-fibroscopy regularly

Prevention and follow-up stops at retirement

Post-occupational supervision must be provided by the doctor chosen by the insured person


Which of these proposals are proto-oncogenes?


Which of these proposals are anti-oncogenes?


R0 means that the quality of resection is not determined

R0 status refers to a resection with healthy margins

Surgery is a marginal therapy compared to chemotherapy

Surgery is still the first-line management in most non-metastatic cancers (breast, lung, liver, colon, skin, etc.)

Oncology is a medical specialty. The surgery is done by the surgeon of the organ concerned

R2 status refers to resections in which margins are macroscopically invaded.


p means that it is an anatomopathological observation

Thanks to ultrasound, as the name suggests.

Almost all types of cancer have a TNM grade

TNM cannot, without definition, be measured after neoadjuvant chemotherapy


The cTNM classification is clinical or radiological

The pTNM classification is anatomo-pathological.

The most reliable classification is the usTNM

This is pTNM. Histological evidence is often the most accurate

M0: no distant metastasis. M1: distant metastasis(s)


Which of these proposals corresponds to a WHO 2 stage?

A person bedridden less than half of his time

A person who is autonomous but cannot work

A person who is permanently bedridden or in a chair

This is stage 4. It is then totally dependent

It is capable of activity comparable to that before the disease


Before age 80, upper gastrointestinal bleeding is more common in men

Lower bleeding accounts for 40% of gastrointestinal bleeding

Lower bleeding accounts for 20% of gastrointestinal bleeding

Lower gastrointestinal bleeding is more common in women

The most common cause of upper gastrointestinal bleeding is peptic ulcer disease.

Lower gastrointestinal bleeding is of hail origin in more than 80% of cases

Lower gastrointestinal hemorrhages are most often of colo-rectal or origin


The risk of ulcerative complications is multiplied by 3 to 4 in patients on NSAIDs and that of fatal ulcer complications by a factor of 7 to 8

Gastrointestinal bleeding-related deaths increase in patients treated with NSAIDs

Some risk factors further increase the risk of bleeding complications with NSAIDs such as age > to 65 years, excessive alcohol consumption

Compared to non-selective NSAIDs, anti-COX-2 drugs reduce the risk of serious gastrointestinal events (bleeding, perforations, strictures) by 50%.

The risk of digestive toxicity of aspirin is dose-independent

The risk of digestive toxicity of aspirin increases with dose


Aspirin has high-dose antiplatelet effects

Aspirin has low-dose antiplatelet effects

There would be in patients treated with serotonergics a blockade of the reuptake of serotonin by platelets inducing a disorder of primary hemostasis

Helicobacter pylori infection is an independent risk factor for ulcerative upper gastrointestinal bleeding

Mortality from upper gastrointestinal bleeding is 1-3%

Mortality from upper gastrointestinal bleeding is 3-10%

Haemorrhage-related mortality is constantly increasing


In front of a hematemesis and a melena the origin of the bleeding is usually upstream of the right colonic angle

Rectorrhage is usually a sign of lower gastrointestinal bleeding

In front of a hemorrhagic shock without externalization of blood it is necessary to evoke in principle a digestive hemorrhage, especially of the upper digestive tract

The amount of externalized bloody fluid is a reliable outcome

To assess the immediate severity of bleeding, the amount of externalised bloody fluid is a poor outcome. Pay attention to signs of shock.

Hemodynamic impact assessment is the best way to assess the immediate severity of bleeding


They are considered by definition high when the lesion is located upstream of the Treitz angle (duodenum-jejunum junction), and low downstream of this zone.

The incidence of high HD is estimated at 100 to 150/100,000 per year

The incidence remains high despite therapeutic progress on HD-generating pathologies, due to the aging of the population and the greater use of NSAIDs & anti-thrombotics

Mallory-Weiss syndrome is a tear of the mucosa in the cardia following iterative vomiting

Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or tobacco.

Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or alcohol


Hemobilia is a common cause associating high HD, biliary pain and jaundice

Hemophilia is a rare cause combining high HD, biliary pain and jaundice

The risk of HD occurring in patients with cirrhosis is the same regardless of the severity of the cirrhosis

The risk of HD in patients with cirrhosis increases with severity of cirrhosis

The intensity of clinical signs depends on how quickly the bleeding builds

In subjects with cirrhosis, the pulse should be interpreted according to the intake of beta-blockers, the presence of a withdrawal syndrome in case of alcoholism, and the existence of a possible associated infection

The active nature of the hemorrhage is assessed by the evolution of hemodynamic parameters under filling, and possibly by repeated gastric lavages.


Initial hematocrit is an excellent reflection of blood loss

Initial hematocrit is not a good reflection of blood loss, until physiological hemodilution or vascular filling has occurred.

Upper GI endoscopy is the key examination

Endoscopy should be performed best in the first 24 hours after the onset of bleeding because the early examination improves diagnostic performance

The time to perform a gastro-duodenal endoscopy is 6 hours in case of associated cirrhosis

This period is 12 hours in case of associated cirrhosis

The endoscopy procedure is possibly preceded by an injection of gentamycin 250 mg IV route in the 30 minutes preceding the examination.

Possibly preceded by an injection of erythromycin 250 mg IV route (unless contraindicated, QT prolongation on ECG) within 30 minutes prior to examination


Endoscopy is performed as soon as possible when high active HD is suspected

It affirms the cause of bleeding in 90% of cases, assesses the risk of bleeding recurrence, and allows possible hemostatic treatment

Sometimes the CT scan is indicated in case of severe HD (abundant externalization and hemodynamic impact) and: – high HD presumption but FOGD not available immediately, – or suspicion of aorto-duodenal fistula

Mortality from PH-related hemorrhages is about 20%, while mortality from ulcerative bleeding is about 5%.

Hemorrhagic recurrence is an independent severity factor


Prognostic factors for high HD in general are related to the abundance of bleeding, its active nature and the terrain

For ulcerative hemorrhages, the endoscopic appearance of the ulcer is assessed by Forrest's classification

Adherent clots (IIb) are at intermediate risk of recurrence

Ulcers with pigmented spots (Ic) or clean bottom (III) are at low risk of bleeding

Ulcers with pigmented spots (IIc) or clean bottom (III) are at low risk of bleeding

Three quarters of HDs stop spontaneously


Early postprandial chest pain points to gastroesophageal reflux disease or peptic ulcer disease

Gastroesophageal reflux disease or angina. A peptic ulcer is rather associated with a late postprandial doulor

Chest pain yielding to trinitrine in less than 3 minutes may suggest pericarditis

By lowering the parietal tension and friction

In the case of pericarditis, pain is triggered by anteflexion

A normal intercritical ECG eliminates the diagnosis of acute coronary syndrome

Caution: a normal intercritical ECG does not eliminate the diagnosis, and a left branch block should be considered as an equivalent of SCA with ST segment elevation. Ischemia in the territory of the circumflex artery can be electrically mute!

A paradoxical pulse, i.e. decreased on inspiration, is a sign of hemodynamic gravity


ST elevation associated with PQ undershift suggests left ventricle aneurysm

In pulmonary pain associated with dyspnea, an elevation of a pulmonary cupola on chest X-ray suggests a pulmonary embolism

Cardiomegaly symmetrical on chest X-ray suggests left heart failure

A pericardial effusion. Cardiomegaly of left heart failure is asymmetric

A negative troponin assay should be systematically repeated

Only in case of chest pain that started less than 6 hours ago


Chest pain with dyspnea and normal chest x-ray must necessarily evoke the diagnosis of aortic dissection

On blood gas, a hypoxemia hypocapnia combination characterizes a shunt effect

Pulmonary embolism must then be systematically evoked

Arterial gas is systematically indicated in front of chest pain

Only in case of arterial oxygen saturation <95%, brady^nea or tachypnea

A T1 T4 negative T wave on ECG characterizes ischemia of the right ventricle

Sign seen among others in the massive EP, reflecting a suffering of the right heart

Because of the pulmonary infarction they cause. Proximal PE is rather associated with inaugural shock


Dissection of the descending aorta is associated with a risk of tamponade and shock

This concerns the dissection of the ascending aorta

The first risk factor for aortic dissection is high blood pressure

Faced with a suspicion of acute pericarditis, echocardiography and troponin testing should be performed

In case of chest pain, pericarditis is a diagnosis of elimination

Benign cause: serious causes must first be eliminated

Cardiomegaly with a "carafe" appearance on X-ray raises fears of aortic dissection


The DAILY/STANFORD classification is the reference classification for aortic dissection

Infectious pneumonia is constantly accompanied by chest pain

Only in case of parietal contact (the pleura is innervated, but not the pulmonary parenchyma)

Some severe pulmonary arterial hypertension gives anginal pain

By ischemic suffering of the right ventricle

Chest pain may be due to vesicular lithiasis

Tietze syndrome is a form of tracheobronchitis associated with chest pain

Parietal pain of the chondrocostal or sternoclavicular joint


Chest pain caused by pericarditis is not influenced by breathing

Extremely common (1/4 of chest pain in the emergency room), they remain however a diagnosis of elimination

Absence of effusion on transthoracic echocardiography excludes diagnosis of pericarditis

Esophageal spasm may be associated with anginal pain yielding to nitrates

A pneumothorax is to be evoked in case of chest pain with signs of severity

Pneumothorax suffocating. Other etiologies to be mentioned in priority in case of signs of severity: ACS, massive PE, tamponade, aortic dissection


Which of the following are blood tests to be performed urgently (after drug management)? (one or more expected answers)


After an injection of IM adrenaline, symptoms persist. How often should the adrenaline injection be repeated?


What is the preferred route to introduce adrenaline?


What type of reaction causes anaphylaxis, according to the classification of Gell and Coombs?


What is a grade II severity according to the Ring and Messmer classification?

True, with mucocutaneous signs, arterial hypotension and unusual tachycardia, bronchial hyperresponsiveness (cough, ventilatory difficulty)

Severe life-threatening multi-organ disease

Cardiocirculatory inefficiency and respiratory arrest


What is a grade IV severity according to the Ring and Messmer classification?

True, requiring cardiopulmonary resuscitation maneuvers


Which cells degranulate massively during anaphylaxis?

False, anaphylaxis is a reaction of innate immunity


What is a grade I severity according to the Ring and Messmer classification?

True, erythema, urticaria, with or without angioneurotic edema


Irritable bowel syndrome (IBS), a preferable designation to functional colopathy, is one of the first reasons for consultation in gastroenterology

IBS is defined by the coexistence of chronic abdominal pain and fluctuating transit disorders (constipation, diarrhea, alternation of both).

This condition does not engage the prognosis but considerably alters the quality of life of patients and has a strong medico-economic impact

The prevalence of IBS in the general population ranges from 40 to 50% in all countries of the world

The prevalence of IBS in the general population ranges from 10 to 15% in all countries of the world

There is a female predominance, 70% of consultants are women


There is visceral hypersensitivity in at least 60% of patients

Regular exposure to stressful events are factors associated with greater severity of symptoms

Abdominal pain is the main symptom of IBS and the main reason for consultation

An colscopy should be performed in front of a family history of cancer or colorectal adenomas

An age > 40 years (in the absence of a complete colonoscopy since the onset of symptoms) is an indication for colonoscopy

Age > 50 years (in the absence of a complete colonoscopy since onset of symptoms)


Resistance to symptomatic treatment or recent change in symptoms are incdications for colonoscopy

The presence of warning signs such as overt digestive bleeding or weight loss are indications for colonoscopy

Abdominal bloating is the second main reason for consultation

Bloating may be aggravated transiently by the emission of gas and/or stool

It can be improved transiently by the emission of gases and/or stool


Normal bilirubinemia is less than 20 μmol/L

Jaundice occurs when bilirubinemia exceeds 60 μmol/L

Jaundice occurs when bilirubinemia exceeds 40 μmol/L

A light jaundice, or beginner, is visible next to the ocular sclera, the lightest place of the integuments

In healthy subjects, bilirubin circulates in plasma in 2 forms

In healthy subjects, plasma total bilirubin is almost exclusively represented by unconjugated bilirubin


The main causes of conjugated bilirubin jaundice are hyperhemolysis and dyserythropoiesis

These are causes of unconjugated bilirubin jaundice (also the case of decreased activity of bilirubin glucuronide transferase)

Urine is normal in colour in case of unconjugated bilirubin jaundice (free)

Gilbert's syndrome is a totally benign and very common condition linked to partial glycuronyl transferase deficiency.

Crigler-Najjar syndrome is an exceptional, often very serious condition due to an absence or collapse of glucuronyl transferase activity.

Crigler-Najjar syndrome is inherited genetically in an autosomal dominant manner

It is transmitted genetically in an autosomal recessive manner


Cholestasis is the most common mechanism of conjugated bilirubin jaundice

Cholestasis is defined by decreased bile secretion

Cholestasis is mainly manifested by a concomitant increase in serum alkaline phosphatase and γ-GT

Isolated elevation of γ-GT or alkaline phosphatases does not indicate cholestasis

Small bile duct involvement must be diffuse to result in jaundice


The CIF was adopted by the European Union in 2002 and enshrined in French law.

ICF allows for a holistic approach to all aspects of a disease

The ICF applies only to children and the elderly


Depending on the person's life project, a compensation plan is developed that translates into a disability compensation benefit (PCH)

The ICF model distinguishes between two levels of disease expression: functional and social.

4 levels: lesional, clinical, functional and social

Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss


Activity refers to the execution of a task in everyday life

Personal factors include age, gender and physical condition

Impairment refers to the inability to perform an action

Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss

In practice, the most common impairments that cause functional limitations are neurological and musculoskeletal impairments.

A limitation of joint amplitudes can be quantified in degrees using a goniometer


What is the prevalence of overweight in France?

The prevalence of overweight (BMI between 25 and 30) is about 35% in France


Which of these proposals are complications of adult obesity?

With hypopnea index greater than or equal to 5 (severe if greater than or equal to 30)

In this particular case, it is rather a protective factor.


Among these proposals, which indicate the carrying out of additional examinations in an overweight minor?

The presence of a family history of diabetes

The presence of a family history of dyslipidemia


Which of these proposals are the causes of secondary obesity?

Primary adrenal insufficiency. It results in hypotension and hyperpigmentation and can be complicated by acute adrenal insufficiency with cardiovascular collapse.

A genetic disease of the development of the olfactory system characterized by the association of hypogonadotrophic hypogonadism due to gonadotropin-releasing hormone deficiency (GnRH) and anosmia or hyposmia.


Which of the following are complications of obesity?

Restrictive ventilatory disorder rather!


Obesity is defined as a BMI > 25kg/m squared

BMI > 25 -> Overweight
BMI > 30 -> Obesity

First-line treatment is dominated by anorectic molecules

False, they are not indicated in the medical care (attention!). Lifestyle change and hygiene-dietary rules are the first-line measures.

Treatment can be surgical in case of grade 3 obesity

True especially with a bypass or a sleeve-gastrectomy!

Treatment may be surgical in cases of grade 2 obesity under certain conditions

Android obesity is more at cardiovascular risk than gynoid obesity


Regarding the clinical diagnosis of myasthenia gravis:

The diagnosis of myasthenia gravis must be evoked in front of fluctuating sensory-motor signs from the age of 40

The diagnosis of myasthenia gravis should be evoked in front of exclusively muscular signs and symptoms

Only the muscles directly put into action during the effort are at the origin of the symptoms

The symptoms may be related to muscles directly activated during the effort or to remote muscles not directly involved in the effort.

The only symptom is muscle weakness of the limbs


Regarding the positive diagnosis of myasthenia gravis:

Unilateral ptosis should suspect myasthenia gravis of the eye and palpebral muscles

Damage to the eye muscles cannot result in diplopia

Diplopia possible, most often intermittent

Damage to the bulbar innervation muscles induces, among other things, swallowing, phonation and chewing disorders

Myasthenia gravis affects only the proximal muscles

The involvement predominates on the proximal muscles, but can more rarely affect the distal musculature also

The Barré event is normally held 2 min 30


Regarding pathologies associated with myasthenia gravis:

The diagnostic sensitivity of the ENMG is 98%

When myasthenia gravis is diagnosed, a CT scan or chest MRI should be prescribed to explore the thymic compartment for thymic hyperplasia or thymoma.

Thymic hyperplasia is found in 90% of myasthenia gravis cases

Thymomas can be mild or malignant and need to be operated on

Thymic hyperplasia corresponds to a macroscopically normal thymus but microscopically characterized by a proliferation of germinal follicles with a clear center


Which of the following are symptoms or signs of early generalized myasthenia gravis?

Cranial nerves are respected in myasthenia gravis

True, it is a sign of severity (like dyspnea and dysphonia)

No amyotrophy because it is a non-total damage to the neuromuscular junction. Amyotrophy is observed in motor deficits by damage to the second motor neuron. Be careful ⚠, in myasthenia gravis in the late stage, when they are severe and chronic, selective muscular atrophy can be seen.

True, this is the Dropped-Head Syndrome 😌. It is also seen in amyotrophic lateral sclerosis.


Which of the following propositions are true for the first-line management of generalized myasthenia gravis?

Treatment with pyridostigmine-type anticholinesterase

A background treatment with corticosteroid therapy

Third line (after pyridostigmine and thymectomy)

A remission of the list of contraindicated drugs

Benzodiazepine have a muscle relaxant effect that contraindicate them in myasthenia gravis


Which of the following proposals about electroneuromyogram (ENMG) are true?

True. This is the case for all examinations whose sensitivity is less than 100%

It can objectify a decrement after repetitive stimulation at 3 Hz

True, otherwise we come across a differential diagnosis (demyelinating pathology such as polyradiculoneuropathies)

It is most often associated with motor evoked potentials

Sensitivity increases in clinically healthy territories


It is a pathology that affects the neuromuscular junction


Myasthenia gravis is linked to a pre-synaptic block of the neuromuscular junction

Myasthenia gravis is related to a postsynaptic block of the neuromuscular junction

True since this concerns acetylcholine receptors

Myasthenia gravis usually begins after an infection

This is the case of Guillain-Barré syndrome (acute inflammatory polyradiculoneuritis)

Myasthenia gravis is an autoimmune disease


Which of the following are myasthenia gravis abnormalities that can be seen in a chest CT scan?

Not seen on chest CT scan + is not associated with myasthenia gravis


Which of the following are additional tests for myasthenia gravis?

True. They have a sensitivity of about 80%, and are very specific.

True, we are looking for a decrement to repetitive stimulation at 3 Hz

True, looking for thymoma or thymic hyperplasia


In what proportion of myasthenia gravis is associated thymic hyperplasia found?


Which of the following proposals are in favor of a cholinergic crisis?

Rather, a miosis is found in parasympathetic hyperactivation

Rather, they are found in myasthenic seizures.


What is the minimum percentage decrease in the amplitude of the muscle evoked potential necessary to evoke a decrement at the ENMG?

True. A decrement at the ENMG is significant if it is greater than or equal to 10%


Which of the following are signs or symptoms of myasthenia gravis?


In what proportion of myasthenia gravis is an associated thymoma?


Which of these patients have an HbA1c goal of 7% or less?

Seniors whose life expectancy is considered satisfactory

Newly diagnosed T2DM with life expectancy >15 years and no history


Which of these patients have an HbA1c goal of 6.5% or less?

With fasting blood glucose levels< 0.95 g / L and 2h post prandial < 1.20 g / L

Target <= 8% (patient categories with advanced cardiovascular complications)


Which of these patients have an HbA1c goal of 8% or less?

Objective< 9% and/or pre-prandial capillary blood glucose between 1 and 2 g/L

Patients with microvascular complications

Myocardial infarction with heart failure

Group of patients with a history of advanced macrovascular complications

Moderate CKD: target <= 7%. Severe or terminal CKD: target <= 8%


What are the goals of a type 2 diabetic patient during pregnancy?

Postprandial blood glucose levels <= 1.25 g/L

Postprandial blood glucose levels at two hours < 1.20 g/L

There is no goal or monitoring of nighttime blood glucose


NPH insulins are intermediate-acting insulins

Insulins are contraindicated during pregnancy

Metformin is the only antidiabetic drug to lose weight

Insulin doses are less than 1 U/kg most often

Insulins are preferred to metformin in case of pregnancy or breastfeeding


Which of the following are possible causes of polyuro-polydipsic syndrome?

True, hyper-filtration due to high pressure


Regarding the paediatric peculiarities of diabetes, which proposals are true?

An acanthosis nigricans is a peculiarity of T1D

An acanthosis nigricans and a polycystic ovary syndrome should suspect insulin resistance and in particular T2DM (rare ++ in T1D)

Vaginal yeast infections should suggest T2DM

HbA1c ≥ 8.5% is a diagnostic criterion for T2DM

False, the diagnosis of T2DM is made on venous blood glucose

The presence of autoantibodies does not rule out the presence of T2DM

The presence of autoantibodies eliminates the presence of T2DM and points to T1D

Drug therapies that have marketing authorisation for T2DM in children are sulphonylureas and insulin.

Drug therapies that have MAiD in the treatment of T2DM in children are metformin and insulin


The finding of a blood glucose > 2.5 g / L must make a urine strip in search of ketone bodies.

Among the complications of ketoacidosis, cerebral edema has a mortality of 25%.

Regarding the management of cerebral edema complicating ketoacidosis, it is essential to confirm its presence by a brain scan before starting treatments.

If clinical suspicion:
1. 30% decrease infusion rate
2. Mannitol injection 20%
3. Elevation of the patient's head
4. Brain scan in a stable child on mannitol

Neuroglucopenic syndrome occurs quickly for blood glucose levels < 0.7 g / L in diabetics.

Blood glucose < 0.7 g/L: Neurovegetative SD ++
< 0.54 g/L: Neuroglucopenic Sd ++

In a diabetic child who is unconscious during hypoglycemia, it is recommended as a first line to inject him with Glucagon.

Glucagon 0.5 mg if < 25Kg / 1 mg if > 25 Kg


Which of the following proposals can be used to diagnose diabetes?

2 fasting blood glucose levels > 1.26 g/L

Fasting blood glucose > 2 g/L at any time of the day

False, association with symptoms of hyperglycemia is necessary

Blood glucose > 2 g/L at 2 hours from OGGH 75g

HbA1c is not used in France for the diagnosis of TD

Fasting blood glucose > 2 g/L at any time of day associated with polyuria

True, associated with one or more symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, ...)


Which of the following are true about type 1 diabetes?

Alpha-pancreatic cells are destroyed by autoantibodies

These are the Beta-pancreatic cells that secrete insulin!

True, although it is more common to diagnose it in young people


Which of the following proposals designate drugs that can cause hypoglycemia?

This is thanks to the discovery of a PU of Réa de Montpellier who realized that his patients had unexplained manifestations under Sulfonamides (then used as ATB).
By measuring their blood sugar he realized this unsuspected therapeutic action.


Regarding the basics of nephrological (or renal) hematuria:

Urological hematuria corresponds to an anatomical lesion

Communication of a urinary tract (between the calyx and the prostatic urethra) and one or more blood vessels

Nephrological hematuria is most often due to tubular disease

It is most often a disease of the glomerulus

Alport syndrome is a congenital anomaly in the composition of the basement membrane

Red blood cells have a diameter of 70 mm

We are several orders of magnitude lower; the diameter of red blood cells is 7 μM

Macroscopic hematuria of glomerular origin does not find clots or voiding burns


Hematuria can be the consequence of a urological condition

The main etiology of urological hematuria is taking anticoagulant therapy

The main etiologies of these hematuria are urinary tract infections and neoplasias. We also find renal lithiasis.

Nephrological hematuria is most often glomerular

Microscopic hematuries can be objectivized by confocal or two-photon microscope only

Diagnosis of hematuria is based on quantitative cytological examination of urine


Hematuria is defined as the presence of more than 50 red blood cells per mL

That's more than 10,000 red blood cells per mL. It is quite physiological to have some red blood cells that cross the barrier of the glomerulus.

Quantitative cytological examination of urine eliminates false hematuria

See item in the last (8th) edition of the college p.111

A red coloration of urine is the pathognomonic sign of hematuria

There are many other causes of red urine: hemoglobinuria, myoglobinuria, porphyria, metronidazole, rifampicin, beets, ...

Initial macroscopic hematuria is often cervico-prostatic

Nephrological hematuria finds associated lower back pain most often

No lower back pain, no clots, no fever, no burning urination


One of the main causes of mascroscopic hematuria of glomerular origin is IgA deposition nephropathy

Associated with significant alteration of GFR, glomerular mascrocopic hematuria indicates an imperative and urgent renal biopsy

And this because of the need to quickly treat the causes of extracapillary proliferative glomerulonephritis

The most common etiologies of microscopic hematuria due to glomerular nephropathics are trauma and cysts.

These are diseases of the basement membranes (Sd d'Alport for example) and Berger's disease

Renal ultrasound with bladder time is indicated in case of microscopic hematuria after 50 years

The presence of haematic cylinders and/or deformed red blood cells points to a glomerular cause


Which of the following propositions point to a nephrological origin of hematuria?


The nodal tissue that constitutes NS and NAV is contrasted with the "Purkinje" tissue that makes up the bundle of His, the branches and the Purkinje network.

Sinus dysfunction and BAV can be symptomatic unlike branch blocks which are never symptomatic if isolated

NS is under close dependence on the autonomic nervous system

NS is vascularized by a branch of the left coronary artery or circumflex artery

NS is vascularized by a branch of the right coronary artery or circumflex artery

Sinuslae dysfunction or DS may follow a bradycardial medication


In case of DS, an escape rhythm may hatch in the atrium or NAV (emergency rhythm)

The bundle of His is the only communication between atrium and ventricles and travels through the membranous septum

The AV Node is also under close dependence on the autonomic nervous system

NAV is most often vascularized by a branch of the left coronary artery that arises from the cross of the furrows (artery of the NAV)

NAV is most often vascularized by a branch of the right coronary artery that arises from the cross of the furrows (artery of the NAV)


In the case of a full nodal BAV, an escape rhythm may hatch in the His beam at a frequency between 35 and 50 bpm

In case of BAV in the beam of His or infrahissian, the escape rate is unstable and slower (15 to 30 bpm), which makes the gravity of this localization

The bundle of His is divided into right and left branches which are subdivided into thin and thick anterior hemi-branches or hemi-branches.

The branches are very highly sensitive to the effects of the autonomic nervous system

The branches are not very sensitive to the effects of the autonomic nervous system

In the branch block, there is a slowdown or interruption of conduction in a branch


A BAV can be totally asymptomatic, this is of course the case of the BAV of the first degree and most blocks of the second degree)

Nodal blocks are often responsible for first-degree BAVs or Möbitz I type second-degree BAVs

Blocks in the bundle of His or infra-hissians occur beforehand on branch blocks or BAVs of the second degree of type Möbitz I

Blocks in the His or infra-hissian bundle occur beforehand on branch blocks or second-degree BAVs of the Möbitz II type.

At BAV III, the exhaust is wide (40%) or thin (60%)

Block is sometimes promoted by beta-blockers or reperfusion;  in the latter case, the BAV contraindicates beta-blockers


In BAVs, the width of the QRS often gives the seat of the block

The 24-hour ECG (Holter) is very helpful and non-traumatic

A branch block is always asymptomatic if isolated

A branch block is often of fortuitous discovery

The isolated left branch block can be benign and considered a variant of normal, whether complete or incomplete.

The isolated right branch block can be benign and considered a variant of normal, whether complete or incomplete


Right branch block is almost always seen in most congenital heart defects affecting the right ventricle

The left branch block is never considered benign.

A left branch block is observed in 10% of cases of anterior infacrtus, with uni-, biou trifascicular block type, either pre-existing or acquired during infarction

A prolonged sinus arrest or complete BSA are the cause of asystole or simple bradycardia thanks to an escape for example atrial

A progressive elongation of the PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval signs a second degree BAV mobitz 2

BAV of the second degree type Möbitz I or Luciani-Wenckebach: – progressive prolongation of PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval; – often associated with a 2:1 BAV; – as a rule, nodal seat and most often QRS duration < 120 ms (fine QRS)


Vascular nephropathies include heterogeneous diseases characterized by damage to the renal vessels.

Nephroangiosclerosis involves the small vessels of the kidney

High blood pressure is very rarely associated with these diseases

It is often very present. It can be either the cause or the consequence

Vascular nephropathies can be classified according to their rate of evolution

These diseases can be classified according to the arterial territory affected.


Which of these nephropathies are rapidly progressive or acute?


Thrombotic microangiopathy syndrome belongs to the group of chronic or slow-growing NVs

It belongs to the group of acute or rapidly progressive NV

Moschowitz syndrome preferentially affects children

Mostly affects adults. Cerebral damage is at the forefront.

Hemolytic uremic syndrome preferentially affects children

Hemolytic uremic syndrome is, most often, due to toxins produced by enterobacteriaceae that destroy the endothelium

HUS is the leading cause of acute renal failure in children aged 1 to 3 years


Regarding hemolytic uremic syndrome (HUS) in children:

Post-diarrheal HUS is a reportable disease in all cases

Only when the patient is under 15 years of age

The infectious agent most often involved is Shillega

HUS starts slowly and gradually with low back pain

The onset is brutal with diarrhea, fever, acute renal failure and anuria

Renal biopsy is indicated in emergency in front of a supiscion of HUS

Treatment is purely symptomatic most often


Malignant nephroangiosclerosis is the renal consequence of malignant hypertension by ischemic lesions

HTA generates a significant natriuresis called "pressure"

Paradoxical hypovolemia puts the renin angiotensin (RAS) system to rest

Blood renin and asdosterone are very low

They are increased because of hypovolemia


Regarding nephoangiosclerosis due to malignant hypertension:

Malignant hypertension is clinically defined

Proteinuria and renal failure are observed

Secondary hyperaldosteronism causes hyperkalemia

PBR is indicated in diagnostic emergency

It is contraindicated as long as hypertension is not controlled

Treatment of malignant hypertension is a medical emergency


The positive diagnosis of an occlusive syndrome is based on a combination of the following functional and clinical signs:


Bowel obstruction is one of the most common reasons for emergency hospitalization in surgical settings

The most specific sign is the cessation of transit and in particular gases

Stool transit can be temporarily preserved

Vomiting may be late in case of high and progressive obstacle

Vomiting may be late in case of low and progressive obstruction

Meteorism may be minimal in case of low occlusion

Meteorism may be minimal in case of high occlusion


Flanged occlusion is the most common cause of colon occlusion

It is the most common cause of small bowel occlusion

Volvulus of the pelvic colon occurs most often in postpartum women

Volvulus of the sigmoid most often in the elderly ( > 70 years)

It is possible to perform a diagnostic endoscopy.

Contraindicated: risk of perforation. Endoscopy only indicated for placement of colonic or duodenal prosthesis or treatment of a sigmoid volvulus.

The CT scan is the reference morphological examination

In case of high occlusion the hydroaeric levels are multiple, central and wider than high

Signs present qd standing. Lying down: presence of conniving valves (spring aspects). Look for abdominal scars, palpate hernial orifices and perform a digital rectal examination.


The occlusive syndrome, defined by an interruption of normal intestinal transit with a cessation of materials and gases, is a diagnostic and therapeutic emergency

Small bowel occlusions are observed at any age, colonic occlusions are more frequent beyond 50 years

The volvulus corresponds to a twisting of a digestive loop on a vascular axis

Most often, the patient is seen in the emergency room for abdominal pain syndrome

Shutting down of materials and gases can be replaced by false diarrhea (downstream segment emptying)


imaging is systematically indicated when occlusion is suspected

The abdominal CT scan is the reference exam

Moderate renal impairment secondary to dehydration is not a contraindication to injection

The sensitivity and specificity of the CT scan is greater than 95% to make a positive diagnosis of an occlusion

In case of occlusion of the small intestine, the CT scan shows a dilation of more than 5 cm of the small loop and more than 9 cm in case of colonic occlusion

In case of occlusion of the small intestine, the CT scan shows a dilation of more than 2.5 cm of the small loop and more than 6 cm in case of colonic occlusion


A caecal distention of more than 9 cm should raise fears of a perforation

The place of ultrasound is very limited. In occlusive syndrome, it can nevertheless be useful in children (intussusception)

Absence of peristalsis and hypoechoic parietal thickening are signs of intestinal distress

In case of occlusion of the small intestine the clinical signs are in the foreground with: – a sharp pain of sudden onset, – abundant vomiting, – and a rapid alteration of the general condition

The shutdown of materials and gases is not very clear in case of hail obstruction


Which of the following is a first-line recommended examination(s) for the diagnosis of an occlusive syndrome?

A snapshot of the abdomen without preparation of face and profile

True, this is the only indicated examination recommended in first line


Regarding the veins of the lower limbs and varicose veins

The veins of both superficial and deep networks of the lower limbs are provided with valves

The superficial femoral vein is a deep proximal vein

Venous insufficiency is defined by obstruction of the venous system, with or without valve dysfunction

It's the opposite: Valvular dysfunction, with or without obstruction of the venous system

A varicose vein is defined by a permanent venous dilation of more than 3mm in orthostatism


Varicose veins affect 30 to 60% of the population of industrialized countries

Chronic venous insufficiency affects both men and women

Primary venous insufficiency is promoted by post-thrombotic syndrome

By definition, post-thrombotic syndrome is the cause of secondary venous insufficiency

Cockett syndrome refers to the compression of the left common iliac vein by a pelvic tumor, which can result in iliofemoral thrombosis.

Compression of the left common iliac vein by the right common iliac artery

Obesity and constipation promote chronic venous insufficiency


Telangiectasia is defined by a diameter <1 mm

And a reticular vein by a diameter between 1 and 3 mm

Symptoms are aggravated by contact with the cold, when walking, or when elevating the legs

These symptoms are calmed by contact with the cold, when walking, or when raising the legs.

The clinical examination of varicose veins is performed in the supine position

The clinical examination of varicose veins is performed in a standing position, at best on a platform with altered unipodal support, in order to highlight ambulatory venous hyperpressure

Venous ulcer is the most common cause of leg ulcer

Typically, the venous ulcer is perimalleolar, round or oval in shape, little algic


Corona phlebectatica is a therapeutic emergency

This is a very early cutaneous clinical sign of venous insufficiency. Not to be confused with phlegmatia cerulea (ischemic DVT, therapeutic emergency)

Hemorrhagic ruptures of varicose veins are common

Stasis dermohypodermatitis has an initial course by inflammatory flare-ups

Eczema secondary to venous stasis predominates in the upper 1/3 of the leg

Atrophic dermatitis concerns advanced old venous insufficiency, and fears the occurrence of a venous ulcer


In case of septic venous thrombosis, class 2 venous compression is indicated

In this case, venous compression is contraindicated

Compressive bands should be preferred in case of venous ulcer

Compression should be worn within two months of an episode of deep vein leg thrombosis

Compression must be worn within two years, usually by Class II compression socks

In case of chronic venous insufficiency, and especially in the ulcer stage, venous restraint must be worn daily and for life

In cases of peripheral arterial disease (PAD), compression is contraindicated if the systolic pressure index (SPI) is less than 0.09

Compression is contraindicated if the systolic pressure index (SPI) is less than 0.5. It should be reduced to a maximum of 30 mmHg for patients with an SNI between 0.5 and 0.9


Among these proposals, which are situations of lack of inputs?

This is an increase in losses by malabsorption, according to the College of Nutrition (2019 edition, page 134)

Post-stroke sequella swallowing disorders

Increased protein losses via skin tissue


Which of these proposals are situations of increased losses?

May cause an obstacle of the upper digestive tract, and therefore a limitation of the intake

May have as an adverse effect anorexia and therefore a decrease in intake


Lean mass is mainly represented by skeletal muscle

Lean body mass is the body's main protein store

The lean butse is the compartment most affected by nutrition

Fat mass disappears in case of malnutrition

The metabolism is protein in case of prolonged youth

Higher prevalence at the extreme ages of life (infants and the elderly) but also exists between the two


A BMI below 18.5 indicates undernutrition

Unintentional weight loss of more than 5% in 6 months is a sign of undernutrition

An involuntary weight loss greater than or equal to 15% in 6 months is a sign of severe undernutrition

Without inflammatory syndrome, a serum albumin less than 50 g / L suggests severe malnutrition

The thresholds are 30 g/L for undernutrition and 20 g/L for severe undernutrition


Which of these proposals are social risks?

Includes social and medical benefits related to maternity

It is a crime. It is its consequences on employment or health that are social risks.


Social protection refers to all collective pension schemes that enable individuals or households to cope financially with the consequences of social risks.

Social risks are situations that can lead to a decrease in resources or an increase in expenses within a household

In France, there is only one social protection body (unlike Germany or the USA)

There is not just one social protection body but several: mutual societies, private insurance, social security, etc.

Social Security was founded in 1981 on the occasion of the election of Francois Mitterand

On 4 and 19 October 1945, two ordinances instituted "an organization of Social Security intended to guarantee workers and their families against risks of any kind likely to reduce or eliminate their earning capacity".

Social security is the main source of social protection.


Social security consists of two main schemes: general and SNCF.

It consists of four main schemes: the general scheme the agricultural scheme the social scheme the special schemes for self-employed persons and civil servants (non-agricultural self-employed persons) 2.2. HISTORY-MAIN REFORMS

Creation in 1945 (ordinances of 4 and 19 October) according to 3 principles: Equal access to care Quality of care Solidarity

The 1967 ordinance saw the creation of the 3 autonomous branches: sickness, old age, family

80% of French people are covered by the general scheme

The CNAMTS manages the risk of maternity only

Manages sickness, maternity, disability, death and, as part of a separate management, occupational accidents


Regarding the organization of social security:

The sickness branch is managed by the CNAMTS only

There are 166 CRAMs (1 for about 2 departments)

The old-age branch is managed by the CNAV and CARSAT

The family branch is managed by CAF and CNAF

The recovery branch is managed by the URSSAF

The URSSAF is responsible for collecting contributions and social contributions but it is the ACOSS that manages and coordinates the URSSAF"


The agricultural scheme is managed by the MSA

The agricultural scheme is a special scheme

3 types of special regimes: the civil service, public establishments and enterprises and 'others'

The RSI is the regime of computer scientists

This is the regime for the self-employed

The current trend is towards an increase in special diets

The public service plan is managed by the IHR

The RSI is the regime for the self-employed"


Concerning the different social protection schemes

The agricultural scheme covers material risks linked to the weather

It covers farmers and agricultural employees

The agricultural scheme is administered by the Ministry of Agriculture

It is managed by the Mutualité Sociale Agricole (MSA)

The MSA collects the contributions itself

The MSA operates as a "one-stop shop": all benefits (sickness, family, old age) are covered by the MSA

The IHR covers graphic designers and computer scientists

It covers craftsmen, traders, industrialists and liberal professions"


Regarding the sources of financing of the social security system:

There are 3: social contributions, taxes and public contributions

VAT contributes directly to the financing of social security

The taxes and taxes allocated to the financing of social security are: compulsory levies, general taxes, the CSG, the CRDS and taxes on alcohol, tobacco and medicines.

Social contributions are paid directly to the Ministry of Health

Social contributions (employer and employee) are paid to the URSSAF

Its scope of levies is wider than that of the CSG

The CSG only concerns employees on permanent contracts

It concerns all the incomes of people living in France (including pensioners for example)"


Concerning the different schemes and the financing of social protection

The IHR operates as a one-stop shop for collecting contributions and paying benefits.

The Social Security Financing Act has been in place since 1945

The LFSS aims to control social and health spending

The National Health Insurance Expenditure Target (ONDAM) is approved by Parliament each year

In 2015, the expenditure of the various basic social security schemes was more than €500 billion.


Which of these costs are covered by the sickness branch of social security?


Concerning the reimbursement of social protection

The social security deficit is of the order of 10 million euros per year

The deficit of the general scheme, for all risks, was 6.8 billion euros in 2015: This is the famous "hole" of the social security

The amount of the reimbursement is made on the basis of conventional or regulatory tariffs

The assumption of certain expenses is subject to the agreement of the medical officer of the CPAM

The co-payment is the amount covered by the mutual insurance company

Rest at the expense of the insured after reimbursement by !' Health insurance on the "compulsory" part

Co-payment applies to all reimbursable medical expenses


Which of the following is a type 2 reaction (according to Gell and Coombs)?

Hypersensitivity due to IgM and IgG mediated cytotoxicity

Hypersensitivity mediated by immune complexes


Which of the following is a type 3 reaction (according to Gell and Coombs)?

These lymphocytes do not mediate any hypersensitivity reaction


Which of the following is a type 4 reaction (according to Gell and Coombs)?


Atopy is a genetically determined ability to produce IgE against certain allergens

Sensitization is a positive reaction to a known allergen

The definition of allergy is clinical. This is a manifestation of exposure to a sensitized allergen

The preferred treatment is the eviction of the allergen

Binet's classification makes it possible to differentiate the different mechanisms of immunological hypersensitivity

This is the classification of Gell and Coombs. Binet's classification is a prognostic score for CLL (Chronic Lymphocytic Leukemia)


Which of the following is a type 1 reaction (according to Gell and Coombs)?

Hypersensitivity due to IgE-mediated cytotoxicity


Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.

Support and closeness to family, a loved one, a spouse and social relationships are risk factors

Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.

The search for protective factors allows the identification of members of the patient's entourage who can be caregivers


The most common mode of suicide is hanging

The incidence of suicide increases with age, and men over 85 are the most affected

The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants

Women most often resort to drug autointoxication

Suicide is the act of deliberately killing oneself


Support and closeness of family, relative, spouse and social relationships are risk factors

Clinical experience shows that asking the question usually has the effect of relieving the suicidal person, by offering to talk openly about suicide and to clearly express his suicidal ideations.


Suicide is the leading cause of death for young adults (25-35 years)

Suicide is the leading cause of death among adolescents (15-24 years)

There are about 10,000 suicides a year in France

There is about 1 suicide every 4 minutes

1 suicide every 40 minutes, 1 TS every 4 minutes

There is about 1 suicide attempt every 4 minutes


Hospitalization is systematic in case of suicidal ideation

Hospitalization 🏥 occurs when UDR is elevated, if TS is proven, or when there is no viable alternative.

It happens and they mostly concern adult men

Symptomatic treatments (hypnotics, sedatives, anxiolytics) are contraindicated in adolescents


3.9% of the population had suicidal ideation (SDI) in the year.

There are 10,000 suicide attempts (HCPs) per year in France

10,000 suicides per year in France, 100,000 TS

Rigel's pre-suicidal syndrome corresponds to a state of deep calm before suicide

Suicidal ideation is impossible before 10 years 👦

Quite infrequent, but can appear as early as 5 years. The preferred means are hanging or defenestration.

In adolescents, there are mainly IMVs (80% of cases)


The risk of hepatitis B transmission is zero with effective vaccination

The declaration of accident at work must be made within 72 hours


What are the first steps to take in case of EAS?

Report the occupational disease within 48 hours

Antiseptic rinsing should last 30 seconds

First, clean with soap and water. Then rinse with an antiseptic for several minutes. It is important that all patient cells that can be removed are removed.

We go to the occupational medicine that will take care of us

Occupational medicine has a preventive and not curative role

Washing should be done with water and mild soap


There are only 3 important risks: the needle is deep, the needle is hollow, and the needle is intramuscular (arterial or venous)

The needle is intravascular (arterial or venous)

Mucocutaneous exposure with a contact time > 15 minutes


Regarding the ESA. Which of the following are true?

The declaration of accident at work is mandatory within 24 hours

The declaration of work accident is mandatory within 48 hours

An initial medical certificate describing the injury and expressly stating that it is an accident with risk of HIV seroconversion is mandatory


The declaration of a compulsory work accident must be made in:


Regarding the cleaning of the wound following an accident of exposure to blood, which proposal(s) are true?

Absolutely not! This can create a capillary breach and promote infection by passing into the systemic circulation.

We are looking for an effect of cleansing and elimination of organic matter brought by the accident

Antisepsis: Bleach with 2.5% active chlorine diluted 1/5 or 1/10, Dakin solution, or failing that alcohol at 70 ° or polyvidone iodine, with a maximum contact of 5 minutes

It takes a contac of more than 5 minutes! The rest of the statement is true.


After an accident of exposure to blood with a high risk of HIV infection, the duration of TPE is:


The seroconversion rate is estimated to be 1% after insertive anal intercourse

The seroconversion rate is estimated to be 1% after susceptible anal intercourse

The seroconversion rate is estimated to be 1% after insertive vaginal intercourse

The seroconversion rate is estimated to be 0.1% after insertive vaginal intercourse

The seroconversion rate is estimated at 0.3% after an AES

The risk of HIV transmission through non-traumatic vaginal sex is zero when the infected partner is on antiretroviral therapy, an HIV load that has not been detectable for more than 6 months


LAD (age-related androgen deficiency) is an age-associated biochemical syndrome,

LAD is inconsistent although it is common (10–20% of men after age 50, and up to 50% after age 70)

The depth of LAD varies from one subject to another, and its onset is very gradual.

Decreasing nocturnal or morning erections is an essential call sign

During LAD, erectile dysfunction is functional in origin


The erection is generally longer to obtain despite ever greater stimuli

Detumescence is faster and the refractory phase lengthens

A decrease in libido should be sought during questioning, as well as a reduction in the frequency of sexual intercourse

The quality of orgasm remains the same but its occurrence is slower

An alteration in the quality of orgasm is sometimes associated with these disorders

Semen volume is increased most of the time

Rather, there is a reduction in volume and low sperm expulsion


The decrease in muscle mass corresponds to sarcopenia and can be severe (up to 40%) accompanied by muscle weakness

Skin atrophy eliminates the diagnosis of LAD

It is recommended to try to perform a bioavailable testosterone assay

TRUE: Sex Hormone Binding Globulin (SHBG) and albumin must also be measured with total testosteronemia to estimate the bioavailable concentration

Total testosterone dosage cannot be used as a rough value for bioavailable testosterone

When this assay is not possible, the determination of total testosterone should be used as an approximate value of bioavailable testosterone.

Testosterone dosage should be carried out in the evening at midnight

The dosage should be carried out between 8 a.m. and 10 a.m.


A new dosage of bioavailable testosterone 2 to 4 weeks after the first is recommended

Advanced age (over 75 years) contraindicates treatments for LAAD

The patient should be treated if there are one or more deficiencies in the androgen-dependent systems and a lower than normal testosterone level. Age is not a contraindication at all.

There is no pre-therapeutic assessment specific to the treatment

If. It includes prostate evaluation (IPSS score, digital rectal examination and total PSA assay), endocrine laboratory work (hematocrit, lipid profile, liver test, blood glucose) and bone densitometry in case of deep LAD or clinical call points

Treatment is based on the administration of natural testosterone to the patient until a plasma concentration is obtained as close as possible to physiological secretion.

The only possible route of administration of testosterone is IM

Transdermal or intramuscular according to the College of Urology (5th edition, page 239)


General information on the characterized depressive episode:

Depressive disorder is associated with a major suicidal risk

A depressive episode characterized is defined in particular by a break with the previous state

Symptoms must be present every day for 6 consecutive days

present almost every day for at least 2 consecutive weeks

The significant increase or decrease in weight or appetite is a symptom of a characterized depressive episode


What symptoms are associated with the rupture of the previous state to define the characterized depressive episode?

Indecision or alteration of concentration


Regarding the management of the characterized depressive state:

The only complication is the risk of suicide

Complications are mainly represented by the risk of suicide, socio-professional disintegration, depressive recurrences and psychiatric and non-psychiatric comorbidities

Drug treatments have no place in the management

For moderate to severe forms, drug treatment is always necessary: antidepressant (1st line SSRI) for at least 6 months

ECT is indicated in the most severe forms of depressive episode

Management is often combined with supportive psychotherapy

Characterized depressive disorder is a common psychiatric disorder associated with a high risk of suicide


Regarding the epidemiology of the characterized depressive episode:

The characterized depressive episode is an isolated psychiatric disorder most often

The characterized depressive episode fits into different nosographic entities (characterized depressive disorder, bipolar disorder) or can be comorbid of another psychiatric disorder (anxiety disorders, addictive disorders) or a non-psychiatric disorder

The term "depression" corresponds in the current DSM-5 classification to the characterized depressive episode (formerly "major depressive episode")

WHO records more than 100 million cases of characterized depressive episodes worldwide each year.

30-50% of suicide attempts in France are secondary to a characterized depressive episode

The first characterized depressive episode occurs in adolescence most often

The first characterized depressive episode can occur at any age


Regarding the presentation of the characterized depressive episode:

The first EDC occurs more frequently in young adults

It is more common in women from adolescence with a sex ratio of 1/2 (1 man to 2 women)

A depressive syndrome can be evoked in case of pathological sadness of mood and a drop in energy

It is one of the rare psychiatric pathologies whose interindividual variability of symptoms is almost zero.

It is characterized by a constellation of symptoms and signs, which varies from one subject to another.

Psychomotor slowdown or agitation may alternate or be associated


What symptoms are not compatible with a first EDC?

Possible neuro-vegetative sign. Congruent of anxiety

Must evoke a neurological differential diagnosis

Must have extrapyramidal syndrome sought


Negativism translates into active resistance exclusively

Anhedonia is an intense feeling of sadness

Anhedonia is the inability to feel emotions

Bradypsychia is the inability to express one's thoughts with fluidity

Bradypsychia is the slowness of reflection

Amoemia is the absence of the usual facial expression

Mutism is the voluntary loss of language


SSRIs are to be reserved for chronic, resistant and disabling forms.

The 'obsessive' part corresponds to the act of avoidance

Obsessive = thought. Compulsive = act in reaction to thought.

The most recurring themes are the 'washer', the 'magician' and the 'recuperator'

It is a rare disorder, found in 3% of adolescents

OCD is considered common and is found in both adolescents and adults.

SSRIs should be prescribed at a minimum dose

Doses are high or maximum for at least 12 weeks, and up to 2 years


It is a possible characteristic of EDC (such as psychotic, mixed, anxious, catatonic, etc.) that defines a maximum EDC, with major suicidal risk, deep sadness, etc.

Cotard's syndrome is a delusional syndrome during a melancholic EDC

A catatonic EDC may regain echolalia or echopraxia

An EDC may be associated with a schizophrenic disorder


In which pathologies is CBT psychotherapy indicated?

Treatment of EDC = SSRIs + Supportive Psychotherapy

Not in first line given the short duration


Regarding treatments for anxiety, which proposals are true?

Hypnotics are contraindicated in adolescents

Oxazepam is the shortest-lived benzodiazepine

OSA is a relative contraindication to benzodiazepine

Absolute contraindication: severe respiratory failure, OSA, myasthenia gravis, hepatic impairment


What symptoms lead to post-traumatic stress disorder?

Rather to classify in the symptoms of anxiety. The 3 symptoms of repetition syndrome are flashbacks, revivals and nightmares.


Which of these proposals are found in post-traumatic stress disorder?

This is neuro-vegetative hyperactivation syndrome

Heteroaggressiveness is a consequence of PTSD


Which of these proposals are predictive factors for EDC's recurrence?

A very low intensity of the first episode

A very high intensity of the first episode increases the risk of relapse

The sicker you are, the more likely you are to redo an EDC


Which of the following proposals fall within the scope of diagnosing the characterized depressive episode?

Clinically significant suffering or impaired functioning

The absence of non-psychiatric medical causes and the absence of toxic causes


Which of the following are true about amoebose?

The intestinal form is accompanied by fever

No, this is the case with the hepatic form

Treatment of the intestinal form is based on Metronidazole and Tiliquinol

True. Tiliquinol is a contact antiamibian


Which of the following are true about oxyurosis?

False, unlike cysticercosis (by tapeworm)

The interrogation mainly finds a pruritus of the back


Which of the following propositions are true concerning Giardiosis?

The protozoan involved is Giardia duodenalis

It is based on parasitological stool examination (PSE) and PCR

True. There are loose stools without fever


Which of the following propositions are true about ascariases?

Worms are visible only under a confocal 🔬 microscope

A bioclinical Löffler syndrome can be observed

True. Löffler syndrome or Loeffler syndrome, is characterized by the presence of parahilar or subclavicular pulmonary infiltrates, labile, most often related to mechanical and allergic phenomena secondary to the presence of parasite larvae in the pulmonary alveoli. These radiological images are associated with blood eosinophilia.

Treatment is based on Albendazole PO (or Flubendazole PO)


Concerning the monitoring of vascular prosthesis wearers

Mechanical heart valves require definitive anticoagulant treatment with vitamin K (risk of thrombosis of the prosthetic valve) and therefore expose to the risks of this treatment

Mechanical valves have excellent durability

Biological valves are most often animal valves (especially pigs)

The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month

The durability of biological prostheses is poor


There is a major risk of infective endocarditis (IE) regardless of the type of prosthesis, mechanical or biological,

Thromboembolic complications are the most common complications of prosthetic valves

Thromeboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond

The risk is lower for mitral prostheses than for aortic prostheses


Concerning the monitoring of vascular porthesis carrier

Hospitalization for emergency reoperation is required for valve change in case of acute denture thrombosis

In case of prosthesis dysfunction of lesser gravity, the patient will have to be reoperated in a deliasis of one month

In case of less serious prosthesis dysfunction, anticoagulant treatment should be rebalanced with transient transition to heparin if necessary

The differential diagnosis of prosthetic thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis

The diagnosis of disinsertion of a porthesis is made by the ETT and especially by the ETO:

Postoperative mediastinitis is one of the leading causes of early mortality from valve surgery


Concerning the survival of vascular prosthesis wearers

Mechanical heart valves require definitive anticoagulant treatment, by vitamin K or LMWH and therefore exposing to the risks of this treatment

No MA for LMWH in this indication. However, they remain an "acceptable alternative" in practice.

Mechanical valves have excellent durability and should, in principle, last the patient's entire life.

This is the principle of mechanical valves versus biological valves.

Biological valves are, most often, animal valves (pigs in particular)

For biological valves, bovine pericardium or porcine aortic valve can also be used.

The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month.

The durability of biological prostheses of the order of 55 years

10-20 years of lifespan (varies according to sources)


Thromboembolic complications are among the most common complications of prosthetic valves

Thromboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond

The risk is higher: for mitral prostheses (which operate at low pressures) than for aortic prostheses; for antique prostheses than for double-finned prostheses; in case of atrial fibrillation (AF), or left ventricular dysfunction


In case of less serious prosthesis dysfunction, the patient should be reoperated within one month

The differential diagnosis of prosthesis thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis

The diagnosis of disinsertion of a prosthesis is made by the ETT and especially by the ETO


All anticoagulants are authorized in bioprostheses from 3 months post-op as part of a non-valvular indication (e.g. AF)

For mechanical valves and bioprostheses, cardiac Doppler ultrasound monitoring is done every 1 to 2 years

For mechanical valves: every 1 to 2 years / For bioprostheses: at M3, 1 year, 5 years and then every year if there is no sign of degradation or infection.

It is unnecessary to prescribe an antiplatelet agent in the case of a post-op thromboembolic complication under effective INR.

Antiplatelet indications: if TAVI (lifetime), if stent placement or thromboembolic complications under effective INR.

There is no self-measurement of the INR to date.

CoaguCheck (same principle as the blood glucose monitoring device): 50% of patients use it

The fibrous Pannis is an atrial connective tissue covering the aortic prosthesis and performing extravalvular stenosis.

Atrial connective tissue if mitral valve, ventricular connective tissue if aortic valve.


Among these proposals, which are symptoms that can be found in case of Horton's disease?

It can be found in osteoarthritis or shrinking lumbar canal syndrome

CBH = ptosis, myosis, enophthalmos. It is found in case of involvement of the sympathetic pupillary territory homolateral to the symptoms and has nothing to do with GCAs.


Acute anterior ischemic optic neuropathy

Non-ischemic NORB = nerve damage = sign of MS

It is transient blindness. Patients describe a falling veil. It's painless

Occlusion of the branches of the retinal artery

There are no migraines, but temporo-occipital headaches


What organs can be affected by Horton's disease when isolated?

This is not described in the College of Internal Medicine


It is carried out in strict condition of asepty in the operating room

Is done, conventionally, in the service (with satisfactory conditions of asepsis of course)

A simple local anesthesia is sufficient, as during sutures in the emergency room.

It is done before any corticosteroid therapy

Biopsy should not delay starting treatment, especially if eye signs occur

In some cases, ultrasound may be preferred.

Ultrasound gives interesting results, but there is greater inter-operator variability


Peripheral lesions are generally not accessible in bronchial endoscopy

Bronchial endoscopy = paramedian lesions

Diagnosis of peripheral lesions is based on CT

Diagnosis of peripheral lesions is based on transparietal needle puncture

The diagnostic discussion is based on the location of the lesion in one of the 2 mediastinal compartments

CT scan is the key examination for anterior and middle mediastinum masses

Ultrasound is the reference examination for the diagnosis of masses of the posterior mediastinum

This is MRI for masses of the posterior mediastinum


Which of the following proposals favor the benignity of a micronodule?

Only biology makes it possible to have a diagnosis of certainty.

Malignancy criteria: high size, irregular contours, spiculate, attractants


Sleep Apnea Syndrome (SAS) is a real public health problem

OSA mainly results in the presence of nocturnal hypersomnia and nocturnal snoring in a patient who is frequently overweight but

OSA mainly results in the presence of daytime hypersomnia and nocturnal snoring in a patient who is frequently but not systematically overweight.

The diagnosis of certainty is based on polygraphy during sleep

Continuous positive airway pressure (CPAP) treatment with the nasal mask is the most effective treatment for OSA


The effectiveness of CPAP treatment is conditioned by initial therapeutic education as well as by the quality of its adherence and patient follow-up _ _

Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of the ventilatory control during sleep and which is observed in particular in advanced respiratory insufficiency

Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of ventilatory control during sleep and which is observed in particular in advanced heart failure

OSA and SACS have a very different nocturnal oximetry profile

OSA and SACS have a similar nocturnal oximetry profile

Pure alveolar hypoventilation manifests itself in oximetry by deep and sustained desaturations, most often contemporary with REM sleep periods

A central appnea is the cessation of the naso-oral airflow for at least 10 seconds with no ventilatory efforts during apnea


Mixed apnea begins as a central apnea and ends with breathing efforts

The severity of OSA is based on AHI or apnnea index is hypopnea

We talk about severe OSA for an AHI ≥ 60

Severe OSA is called for AHI ≥ 30 The importance of daytime sleepiness should also be considered in assessing severity.

Obesity, especially abdominal obesity, is a major risk factor for OSA

There is no parallelism between the prevalence of obsity and the severity of OSA

The prevalence of OSA increases with the severity of obesity (60-80% of morbidly obese patients have OSA)


The prescription of hypnotic is recommended as a first-line treatment in the treatment of chronic insomnia in adults

Hypnotic prescription is not recommended as a first-line treatment for chronic insomnia in adults

The prescription of hypnotic should only be done for a short time in the context of transient acute insomnia

The presence of restless legs syndrome should systematically be sought in front of a complaint of chronic insomnia with difficulty falling asleep in adults

Obstructive sleep apnea syndrome should always be evoked in the face of a complaint of excessive daytime sleepiness and snoring

Severe drowsiness in young subjects should suggest central hypersomnia


Normal sleep occurs at night, it lasts on average 7 to 8 hours, with large interindividual variations

It is suspected that these inter-individual variations are largely genetic.

The reference test for the study of sleep is the EEG during sleep

The reference examination for the study of sleep is polysomnography

The alternation of sleep cycles can be visualized by means of the hypnogram

The complaint of insomnia is extremely common in the general population: 30% of adults have experienced transient insomnia during their lifetime, and 10% chronic insomnia

Prevalence is higher in males and increases with age

Prevalence is higher in women and increases with age


Insomnia is a subjective complaint that is not defined by the objective duration of sleep

Insomnia must be responsible for a negative daytime impact on the subject's activities

It is associated with functional symptoms

Actimetry is a tool that makes it possible to assess sleep-wake rhythms under standardized conditions

This tool makes it possible to appreciate sleep-wake rhythms in ecological conditions

The drug approach is the first-line treatment for chronic insomnia

The non-drug approach is the first-line treatment for chronic insomnia


Insomnia disorder must be distinguished from the insomnia 'symptom', which is then one of the clinical manifestations of another etiology.

Symptoms such as dyspnea, pollakiuria, gastroesophageal reflux, or pain can cause sleep disorders

Restless Legs Syndrome (RLS) is most often associated with a complaint of sudden awakenings in the early morning

Restless Legs Syndrome (RLS) is most often associated with a complaint of insomnia falling asleep and maintaining

The diagnosis of restless legs syndrome is clinical and defined by the presence of unpleasant sensations in the legs responsible for an irrepressible need to mobilize them.

Electromyogram of the lower limbs reveals numerous abnormalities in restless legs syndrome

An electromyogram of the lower limbs is not indicated to explore an RLS, if performed it reveals no abnormality


Treatment of insomniac disorder relies on CBT

The prescription of hypnotic is not recommended as a first-line treatment in the treatment of chronic insomnia in adults.

The prescription of hypnotic is contraindicated in case of insomnia in adults

It should only be done for a short time in the context of transient acute insomnia.

OSA only affects adolescents over the age of 16


The homeostatic, accumulative process increases throughout wakefulness and decreases during sleep.

The biological clock is located in the basal ganglia

It is located in the suprachiasmatic nuclei

The biological clock modulates states of alertness but also other parameters including hormonal secretions, internal temperature, cell division cycles and mood.

The ultradian rhythm of alertness is faster than the circadian rhythm


Which of these proposals are included in sleep polysomnography?

There is a monitor of cardiorespiratory parameters but not as advanced as an ECG


There are two main types of sleep: slow wave sleep and deep sleep.

Slow wave sleep, on the other hand, ranges from light to deep.

Slow wave sleep is characterized by increased EEG activity

On the contrary, in slow-wave sleep, EEG activity gradually decreases

REM sleep is characterized by an EEG state close to wakefulness

Slow-wave sleep accounts for more than 50% of total sleep

REM sleep is accompanied by rapid eye movements


The alternation of sleep cycles can be visualized by means of the hypnogram.

3 stages of slow wave sleep: light, moderate, deep.

30% of the general population complains of chronic insomnia.

The sleep agenda is conventionally done over 3 nights

Polysomnography is not recommended when exploring primary insomnia.


Slow-wave sleep is subdivided into three stages, of increasing depth, defined on ECG criteria.

Slow wave sleep is subdivided into three stages, of increasing depth, defined on EEG criteria

The amount of slow delta waves during sleep reflects the depth of sleep and is regulated in a homeostatic way

Circadian sleep pressure is highest between 1 a.m. and 5 a.m.

Serotonin is the main hormone regulating chronobiological rhythms

Melatonin is the main hormone regulating chronobiological rhythms

Insomnia is dissatisfaction with the quantity or quality of sleep with daytime repercussions


Insomnia can be secondary to a psychiatric pathology

Psychophysiological insomnia is the most common primary chronic insomnia

Treatment of insomnia in children and adolescents should be etiological

In children and infants, the therapeutic approach is often behavioral and educational in first line

Drug treatments are often overprescribed and should be avoided


The main differential diagnosis is circadian rhythm phase delay which can be confused with insomnia of sleep initiation or falling asleep.

Regardless of the nosological framework used, the diagnosis and evaluation of insomnia is essentially based on the questioning of the patient

Sleep aggenda is an essential tool for the assessment of insomnia and its management

The sleep diary often highlights discrepancies between the patient's overall appreciation of his sleep disorders and their reality.

Actimetric recording makes it possible to establish the activity-rest rhythm over several weeks


Polysomnography in the laboratory is still necessary for diagnosis

Laboratory polysomnography Not necessary for diagnosis but indicated punctually to eliminate a specific etiology including

It also exerts a hypnogenic effect but should not be considered a hypnotic substance

Immediate-release melatonin can be used to improve sleep-onset insomnia at night

Extended-release melatonin (Circadin®) may be used to improve sleep-maintaining insomnia (intrasleep wakefulness)

Hypnotics are indicated in the treatment of transient or occasional insomnia for a limited time


Persistent complex bereavement is the persistence, for more than 12 months (or 6 months for children), of severe and disabling psychiatric symptoms.

Psychiatric disorders occurring during bereavement have a specific management

When a psychiatric disorder is identified as a result of bereavement, in particular a characterized depressive episode, it should be managed in the same way as if it had occurred in another context.

Grief corresponds to the reactions that the body develops as a result of the announcement of the death of a person we have already met

Definition Grief refers to the reactions: * emotional, * cognitive, * behavioral, * and sociocultural, to the loss by death of a loved one to whom one was significantly attached (such as a parent, a spouse, a friend)

It is classic to distinguish 3 phases in the grieving process


Grief is a stressor that exposes to biological, psychological and social changes

Bereavement is a risk factor for the occurrence of decompensations of existing pathologies

Psychological reactions usually disappear within a few hours

Grief in children and adolescents may manifest as a moderate initial reaction, and then they experience the full effects later

The impact of grief is purely psychiatric in children

The child may also manifest polymorphic symptoms of cognitive appearance (regression in acquisitions for example) or non-psychiatric (enuresis for example)


The elderly are no longer at risk of pathological bereavement from the age of 60

The elderly are particularly at risk of a marked depressive episode and the risk of suicide is all the higher as one ages, especially in men

Despite the pain of grief, most people adapt to the loss and cravings of the deceased and continue to live satisfactorily.

Normal grief lasts on average 1 to 2 week(s)

Normal grief lasts on average 2 to 3 months, but will depend on the bond of attachment that united the bereaved to the deceased, the age of the deceased, and the circumstances of the death

Persistent complex grief occurs when a subject has experienced the death of a loved one and has clinically significant symptoms after more than one year.

The characteristic symptoms of persistent complex grief are those of nostalgia related to the state of withdrawal of the deceased and invasive ruminations


Subcutaneous vaccination is done in the deltoid region

Flu vaccination can be done without a doctor's prescription

Attenuated vaccines are most often effective at a single dose, whereas inactivated vaccines must be administered multiple times.

Measles, mumps and rubella vaccine is an inactivated vaccine

Contraindications of vaccination should be systematically sought


Live vaccines are generally contraindicated in cases of congenital or acquired immunosuppression.

Serious complications of vaccination are exceptional

The hepatitis B vaccine is a mandatory vaccine

Mandatory since the law of 1 January 2018

The measles, mumps and rubella vaccine is a mandatory attenuated vaccine before 2 years of age

Since January 2018, vaccination against tuberculosis is mandatory and helps prevent severe forms of the disease


Pneumocooccal vaccination is recommended for all children before 2 years of age

Flu vaccination is recommended from November to March (to be done as soon as possible)

Vacciantion against pneumococcus is strongly recommended in spelonectomized subjects

The flu vaccine is an attenuated live vaccine


The vaccines provide protection against a large number of serious diseases for non-existent or benign side effects

Vaccination not only prevents the vaccinated person from the disease, but also prevents the circulation of the disease in the population, provided that vaccination coverage is sufficient.

Live vaccines usually do not need a booster; they are contraindicated in immunocompromised patients

Tenuated vaccines require several administrations close together during primary vaccination

Polysaccharide vaccines (pneumococcus, meningococcus, Haemophilus influenzae, Salmonella typhi) are more effective in their so-called "conjugate" form, which should be preferred


Serotherapy is an active humoral immunoprophylaxis

Serotherapy is passive humoral immunoprophylaxis

Vaccine provides immediate but transient protection

Pneumococcal vaccines and most meningococcal vaccines have several antigenic valences of the pathogen, allowing vaccination against several serogroups

Attenuated vaccines produce rapid protection is durable


Concerning vaccination and catching up on vaccinations

Only conjugate vaccines can eliminate carriage (pharyngeal for example for pneumococcus)

The subcutaneous route is generally more effective than the intramuscular route

The intramuscular route is generally more effective than the subcutaneous route

In an adult or child of unknown vaccination status, a complete age-sensitive regimen is delayed at the outset.

For diphtheria and tetanus, we can use the anti-tetanus antibody assay after a 1st injection: if the titer is high, the subject has already been vaccinated and we can schedule a booster at the ages provided for in the schedule

All vaccines are given SC or IM (in the deltoid), except BCG (intradermal)


Which of the following are recommended vaccines for splenectomized patients?


At 3 months, which vaccines have been injected?


Which of the following proposals are contraindicated in immunocompromised patients (CD4 < 200)?

True, live attenuated IC vaccine if CD4 < 200

True, always CI in HIV patients with CD4 < 200


At what ages is it recommended to inject the pertussis vaccine?


Which of the following are mandatory vaccines in the second month of life?

True. 2 months, 4 months, 11 months (booster) and 6 years (booster)


Regarding abortion and the morning-after pill:

The Veil law is definitively renewed from 1979

The doctor must obtain the authorization of one of the two parents which is mandatory

The doctor must endeavour to obtain the authorization of one of the parents or the legal representative, or verify that this has been done during the social consultation. But this authorization is not mandatory. However, the minor must be accompanied by an adult.

In the absence of parental consent, an abortion may be performed solely by an adult accompanied by an adult.

If the person is a foreigner, the abortion can only be performed if he or she has been living in France for more than 3 months.

For foreign women: abortion is no longer subject to any condition of duration and regularity of stay in France

The law requires pharmacists to dispense the morning-after pill free of charge to minors


The reception centre must ensure a correct reception with respect for confidentiality

Abortion care facilities operate seasonally

Structures must ensure fast deadlines with weekly operation all year round

An abortion can only be performed in an establishment with a surgical technical platform

Up to 12 weeks, they can be carried out in a simple sound establishment with a gynecology-obstetrics department

Abortions must be taken care of in a structure with a surgical technical platform when they are between 12 and 14 SA

Reception centers are required, by the HAS, to have at least one ultrasound machine with a vaginal probe


Anyone requesting an abortion must get a consultation appointment within 30 days of their call

The earlier abortion occurs during pregnancy, the lower the risk of complications

Access to abortion must therefore be simple and fast in all circumstances

Abortions require 24-hour hospitalization for monitoring and psychological support

Except in exceptional cases, abortions must be performed on an outpatient basis or in a day hospital (stay of less than 12 hours). This in a concern for confidentiality in particular

A psychosocial interview is systematically offered for adults


The psychosocial interview is mandatory for adults

Psychosocial retention is compulsory for minors

We must try to understand the reasons for the failure of current contraception or its absence

Gestational age is deduced from the interrogation or ultrasound

The subsequent contraceptive method must be prescribed from the visit preceding the abortion

It is discussed and discussed, but it is by no means mandatory (neither to prescribe it, nor that the patient accepts it)


The cooling-off period is 7 days and must be respected in all circumstances

There is no longer a mandatory reflection period of 7 days (or 48 hours) between the two consultations.

All patients should have Rhesus groupage and RAI

If Rhesus is positive, a prophylactive injection of anti-D gamma globulins should be performed

If the Rhesus is negative, a prevention of Rhesus immunization by an injection of gamma globulins anti-D, should be carried out at the time of the act

The initial certificate of request for abortion must be given to the patient if the doctor agrees to perform the abortion


Regarding the second abortion consultation:

The second consultation is carried out 21 days after the initial consultation

7 days after the initial consultation, which corresponds to the cooling-off period

The patient must confirm the abortion request in writing during the second consultation

If the patient is a minor, she must present the certificate of social maintenance

The second consultation is when the abortion is performed

This is a confirmatory consultation. Abortion is performed at the third consultation

A surgical abortion can do without a pre-anhesthesic consultation since anhesthesia is local

Pre-anesthetic consultation necessary in case of surgical abortion. They are also not reserved for general anesthesia.


Post-abortion consultation is done between the 14th and 21st day after the act

It is impossible to perform an abortion under general anesthesia

In all cases where possible, women must be able to choose the technique, medical or surgical, as well as the mode of anesthesia, local or general.

Surgery involves dilation of the cervix and evacuation of uterine contents by aspiration

A medicated cervical preparation can help with cervical dilation in surgical technique

The medical technique is based on the combination of antiprogesterone and prostaglandins


Which of the following are complications of low molecular weight heparins?

True, at the injection site. Patients are therefore asked to vary the injection sites as much as possible.


Which of the following are drug causes of MAT?

Functional IR, glomerular involvement and allergic nephritis


Which of the following are drug causes of functional renal failure?

True, by inhibition of vasoconstriction of efferent arteriole

Renal organ failure due to direct tubular toxicity


Regarding general information on epidemiological investigations:

Epidemiology is a discipline that deals with health problems within a population

TRUE. This is the description given in the Public Health KB

An experiment is any investigation where the attribution of exposure is controlled by the proponent alone.

An experiment is any investigation where the attribution of exposure is controlled by the investigator.

In epidemiology, studies are most often experimental

They are rare in epidemiology because the exposure of subjects to a particular factor often cannot be controlled.

Experimental studies may or may not be randomized

Observational surveys are very rare in epidemiology

Observational surveys are often the only possible ones. Their interpretation is often more difficult, but they have the advantage of reflecting more faithfully the real situation of the subjects of a population."


Prevalence is a parameter from analytical epidemiology

Descriptive epidemiology, incidence and evolution

Incidence is a parameter from evaluative epidemiology

Descriptive epidemiology, prevalence and evolution

The cohort study is part of analytical epidemiology

There are 2 types of observational epidemiology: descriptive and analytical

3: descriptive, analytical and evaluative

There are 3 types of analytical studies: cohorts, case-controls and cross-sectional studies


Among these proposals, which ones designate markers of fragility of the elderly?

A marker of fragility only when it is involuntary

It's pathological when it's so pathological. But decreased grip strength (with normal testing) is a marker


The 1 concerns the decompensating factor

The 2 corresponds to the chronic disease

The 3 corresponds to physiological aging

The 2 corresponds to the decompensating factor


It is the Certified Advancement Program in Technical and Experience

This is the Continuous Improvement Program of Teamwork

It is proposed by the Ministry of Health

The primary challenge is to reduce EIAS to an acceptable level.


Debriefing is the short sharing of information before team action

Debriefing: Short information sharing after the team action.

Team accreditation has been launched by the ANSM

Physician accreditation involves an evaluative component and a cognitive component

Team accreditation is complemented by a collective work dimension

Team accreditation has been launched by the HAS


Regarding the formulation of the scientific question:

This is PICOT, for P = study population, I = the type of intervention, C = the comparison group, O = outcome (= outcome) and T = type of study

There must be an element of comparison/control

The population studied may be vague (for example: seniors)

The type of population must be extremely well detailed.

The design of the study is chosen according to the question


Regarding literature search and Clinical Research Methodology hypotheses

HO: alternative hypothesis (which we wish to reject)

H1: alternative hypothesis that we wish to demonstrate

Documentary research is a process of identifying relevant information

Literature search should aim for completeness

The formulation of the research question is an essential step


Which of these proposals are secondary sources of information?

Produces professional recommendations on the use of the drug

NICE is in England. It is indeed a secondary source (equivalent to HAS)

The AHRQ is in the USA. It is indeed a secondary source (equivalent to HAS)"


Which of these proposals are part of 'grey literature'?


Concerning the bibliographic search of Methodology in clinical research

The primary sources are the recommendations of the HAS (in France)

Primary sources are accessible reports Either in the form of a summary in electronic banks: study, data Or in full by the search of the periodical (paid access most often)

Accessibility to primary sources is extremely simple (internet search)

Accessibility to primary sources is problematic: cost of subscriptions, time needed for research, need for training, etc. 2.3.2. Secondary sources

Secondary sources convey information directly from research laboratories

Secondary sources convey information previously digested by an intermediary Syntheses, literature reviews, meta-analyses, professional recommendations The intermediaries are mainly:

The journal Prescrire is independent of the pharmaceutical industry

"Grey literature" refers to publications funded by the pharmaceutical industry

The search for "grey literature": literature not indexed in conventional channels of information dissemination (congresses, government documents, unpublished studies, other unconventional documents)"


OPHANET is a research server on diseases concerning orphans

Open access rare disease and orphan drug information server for professionals and the general public

ORPHANET is a non-scientifically validated portal set up by patients

Global Reference Portal on Rare Diseases

Comprehensive and effective keyword research is important to find relevant results

Reading the summaries of the publications allows you to make a first sort

The abundance of references requires a critical mind at all times


Regarding the different types of research

Routine care research is a type of non-interventional research

Intervention research because there are specific monitoring modalities

Biomedical research is a type of intervention research

Biomedical research focuses on health products only

May also include things other than health products

Biomedical research involves action on the person

Randomized controlled tests (RCTs) are interventional


Sample research is generally non-interventional

Data research is generally non-interventional

Biomedical research is carried out on human beings with a view to developing biological or medical knowledge

Biomedical research involves sick people only

Involves an action on the person (healthy or sick) who habitually takes care of modifies the RESEARCH

Routine care research is an assessment of current medical practices


The preclinical phase takes place in vitro (cells or cell cultures) and/or in vivo (animal)

Clinical trials are organized in 3 phases

Clinical trials are organized in 4 phases (see table) In total, 10 to 15 years are needed for the research and development of a new drug. PHASES OF THE CLINICAL TRIAL POPULATION OBJECTIVES l F#iB PHASE I PHASE IL Healthy volunteers ■ Safety (maximum tolerated dose) Small number in some (Patients ■ Toxicity cases, in ■ Pharmacokinetics oncology for example) Patients (effective dose) Small number ■ Pharmacodynamics ■ Efficacy PHASE Ill Patients Large comparative number ■ Efficacy ■ Toxicity Ratio ■ benefit/risk PHASE IV General population ■ Pharmacovigilance of new ■ Research After MA indications = study of the fate of the drug in the body: absorption, metabolism, pharmacokinetics distribution and elimination Pharmacodynamics Toxicity MA = Authorization = side effects of Marketing = effect of the drug on the body 0 (.9 LJ. J a: (.9 LJ. J a: CO 0 z a: LJ. J > in z 0 fC = 0 LJ. J @ 228 ITEM 18 1 THE METHODOLOGY OF EXPERIMENTAL AND CLINICAL RESEARCH 4.2. REGULATORY FRAMEWORK FOR THERAPEUTIC TRIALS The founding texts 4.2.1. The founding texts:

In total, it takes between 10 and 15 years to develop a new drug

Phase 2 involving patients with small numbers of patients

The objective of Phase 3 is to assess the benefit/risk balance


Cephalic duodenopancreatectomy (CPD) is the gold standard of care for tail pancreatic tumours

pancreatic head tumour = cephalic duodenopancreatectomy

Cephalic duodenopancreatectomy (CPD) is the standard of care for tumours of the body of the pancreas

Cephalic duodenopancreatectomy (CPD) is the standard of care for pancreatic head tumours

Left splenopancreatectomy is the standard of care for left pancreatic tumours

Left splenopancreatectomy is the standard of care for pancreatic head tumours

left pancreatic tumour = left splenopancreatectomy


Serous cystadenoma degenerates only exceptionally

Cystic tumors of the pancreas are most often of incidental discovery

Ultrasound is the exam of choice to study cystic tumors of the pancreas

Mucosal cystadenoma does not communicate with the main pancreatic duct


Which of the following are useful markers for the diagnosis and/or monitoring of neuroendocrine tumours?

This dosage should no longer be done (College of HGE, 4th edition)

True. It is a general marker of all neuroendocrine tumors. The college of HGE (4th edition) does not report other markers to be measured


Which of the following are true for endocrine pancreatic tumors?

Pancreatic neuroendocrine tumors are malignant in more than 60% of cases

Symptoms are related to hormonal secretion

Gastrinoma causes maladaptive organic hypoglycemia

This is the case with insulinoma. Gastrinoma causes recurrent OGD ulcers and diarrhea

Necrolytic erythema migrans may be a sign of glucagonoma

Spiral TAP CT +/- Abdo MRI (liver metastases) +/- endoscopic ultrasound (if little or not visible)


Which of the following are tumors that preferentially metastasize to the bones?


The appearance or increase of a heart murmur in a febrile context is very suggestive of the diagnosis

The diagnosis should also be evoked in front of a stroke, purpura or febrile low back pain.

The absence of breath makes it possible to exclude the diagnosis

However, the absence of breath does not exclude the diagnosis

Any febrile heart failure should suggest the diagnosis of endocarditis


The two pillars of AE diagnosis are blood cultures and echocardiography

Blood cultures isolate the responsible microorganism in 100% of cases

They make it possible to isolate the responsible microorganism in 90% of cases

They should be repeated for 2 or 3 days if the initial blood cultures are negative, especially in subjects who have received antibiotics.

The suspicion of AE is to be reported to the microbiology laboratory, because it sometimes takes a long culture time for microorganisms with difficult growth (HACEK group, Brucella, deficient streptococci, yeasts)

Echocardiography affirms the diagnosis in front of one of the characteristic lesions: vegetation, abscess, valve perforation or disinsertion of prosthesis