Vegetation is identified by transthoracic echocardiography (ETT) or transesophageal ultrasound (TEO) especially in case of valve prosthesis

The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETT

The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETO and on the aortic ring rather than mitral

Gastric fibroscopy or colonoscopy in case of germ of digestive origin are performed in search of the front door

The clinical manifestations of endocarditis are very varied, not very specific and can affect several organs

Diagnostic classification of infectious endocarditis based on Jones criteria


Infective endocarditis (IE) is a rare but serious infection

Staphylococci (mainly Staphylococcus aureus) and streptococci are responsible for 50% of cases of infectious endocarditis

The rapid initiation of antibiotic therapy is crucial even before blood culture is performed

The identification of the causative infectious agent is crucial for diagnosis and treatment: 3 aero-anaerobic blood cultures should be collected before any antibiotic therapy in case of suspicion of AE

When AE is suspected, an echocardiogram should be performed as soon as possible and repeated if the first is negative.

Renal (glomerulonephritis) and digestive complications are the most frequent and serious complications

Cerabral and cardiac complications are the most frequent and serious complications


Management of patients with AE without signs of severity can now be ambulatory

The management is hospitable and must involve an experienced multidisciplinary team

Indications for antibiotic prophylaxis of infective endocarditis are restricted to invasive dental procedures

Infective endocarditis (IE) is an infection of one or more heart valves, native or prosthetic, most often by bacteria, more rarely by a fungus

Right heart valves are affected more often (90% of cases) than left heart valves

The valves of the infectious left heart are more often affected (90% of cases) than the valves of the right heart (mainly tricuspid valve in case of drug addiction)

Bacterial grafting at the endocardium level results in the development of infectious lesions associating vegetations and progressive lesions consisting of fibrin clusters.


It affects men more than women and is more common before age 70.

Predisposing factors are intravenous drug addiction, prosthetic heart valves, degenerative valve sclerosis.

Oral streptococci have supplanted staphylococci and are in first place in the distribution of infectious agents responsible for AEs

The most frequent streptococci are oral streptococci, of oral origin, and Streptococcus gallolyticus

In 40-50% of cases, blood cultures remain negative and the causative agent may not be identified


Regarding the basics of urinary incontinence:

The diagnosis of urinary incontinence is clinical

Urinary incontinence is defined as a subjective feeling of urinary loss

Urinary incontinence is defined as an involuntary loss of urine, objectively demonstrable, constituting a social and/or hygiene problem.

For women, it is a major public health problem

Urinary incontinence in men is due to prostate pathology in 95% of cases


It is defined as "involuntary loss of urine through the urethra"

Overactive bladder urinary incontinence is due to sphincter insufficiency

Sphincter insufficiency = UI of cerco-cystoptosis/hypermobility origin. It is a type of UI in itself

It is more common in women, especially postmenopausal women, with a history of obstetric trauma

There are two types of mechanisms explaining SUI: cervicocystoptosis/urethral hypermobility (HMU) and sphincter insufficiency (SI)

There is no etiology specific to the SUI

Many possible etiologies: trauma, trophic disorders, urological disorders, neurological disorders, etc.


SUI is an involuntary loss preceded by an urgent and uninhibited need from the outset

This is the case with overactive bladder UI

Bladder hyperactivity UI is an involuntary loss of urine without feeling of craving

Intense sports activity protects against UI

Drug treatments must be identified because some aggravate the voiding status and in particular anticholinergics and opioids (decrease in bladder contraction)


Addiction is often the result of inappropriate prescriptions

Among psychotropic drugs, benzodiazepines and related have a very marked addictive potential

About 2% of women in France have been prescribed benzodiazepines or related benzodiazepines

Harmful use results in medical complications or prolonged social repercussions

Dependence is defined by an inability to stop use because the desire to stop is not present

Dependence is defined by an inability to stop benzodiazepine use, either because of signs of withdrawal or because of excessive cravings.


Regarding the effect of benzodiazepines:

In case of dependence, there is a risk of withdrawal syndrome at the sudden cessation of consumption

In therapy, benzodiazepines are used exclusively for sedative purposes

In therapeutics, benzodiazepines are used for anxiolytic, sedative and hypnotic purposes, but also muscle relaxant and anticonvulsant

Benzodiazepines and related drugs are among the most prescribed psychotropic treatments in France and Europe

3 benzodiazepines or related benzodiazepines are currently marketed in France


Regarding the consequence of benzodiazepine addiction:

They are orogenic and require a check-up (EAL and blood glucose)

60% of benzodiazepine or related users are women

Half of the subjects treated with this type of molecule are treated for a period of more than two years

In case of significant disturbances of alertness, benzodiazepine poisoning is a vital emergency

It is very clearly established an increase in the risk of dementia type Alzheimer's disease in case of prolonged use of benzodiazepines

French authors have recently found an increased risk of Alzheimer's dementia in case of prolonged use of benzodiazepines, but these results are still debated internationally.


Article analysis is a standardised method of analysing a study in order to assess its quality and to be able to define the level of evidence.

Assessing the conflicts of interest of the CPP is done by the AGREE grid (second version)

The AGREE grid is used to develop a method for creating CPRs

Advances in medical knowledge require an effort of synthesis

The only method to develop recommendations is the PRC

There are several methods, 2 will be presented: Consensus Conference (CC) Recommendations for Clinical Practice"


Consensus conference begins with the presentation of expert reports synthesizing knowledge at a public conference

The second step in a consensus conference is the drafting of recommendations by a multidisciplinary jury in a public manner.

Then the drafting of recommendations by a multidisciplinary jury behind closed doors 3.2.2. The 1. The promoter actors

The promoter of consensus conferences are either university hospitals or pharmaceutical companies

It is in practice either a scholar, an organization of health professionals, insurance organization of a health health organization, a public association, a patient society, an industrialist. .. Its role: the initiative

The promoter does not have the opportunity to choose the theme of the reflection

The promoter provides the financial means


The organizing committee is composed of members from the promoter

Persons nominated by the sponsor (usually 5 to 10 members), but independent of the sponsor

A leader (the President of the organizing committee) is designated to organize and coordinate the meetings

The jury of a consensus conference is composed of 5 researchers and doctors

8 to 16 members, multiprofessional methodologists, researchers, other ethical, economic: physicians, and multidisciplinary representatives or legislative professionals, health, representatives of the general public

The jury is coordinated by a president, appointed by the organizing committee (sometimes in consultation with the promoter)

Jury members must have no financial or professional interest (no conflict of interest)


The bibliographic group provides an objective analysis of the literature, literature analysis without interpretation of the results

The experts are chosen by the organizing committee

Experts must have particular expertise on the theme of the conference (recent works and publications)

The composition of the expert panel must be representative of the diversity of opinions on the subject

The expert group must present its results orally to the jury

Provide a text gathering the information (from their experience and literature) to answer"


Regarding recommendations for clinical practice

The CPM is an analysis of the extensive literature by a working group that drafts the recommendations

The subject to be dealt with must be sufficiently broad

Literature data must be diverse and dispersed

We make a PRC when there is a lot of controversy on the subject

Proponent takes the lead in developing recommendations


Concerning links and conflicts of interest

The concept of a link of interests covers the interests or activities, past or present, patrimonial, professional or family, of the expert in relation to the object of the expert opinion entrusted to him.

A conflict of interest arises from a situation in which the links of interest of an expert are by their nature or to call into question his impartiality or independence.

The declaration of links of interest is optional if one has nothing to reproach oneself with.

The declaration of links of interests concerns direct and indirect links

The declaration of links of interest concerns only physicians

It must be carried out by any expert called upon to draw up expertise in the field of health and health safety"


Concerning links of interest and their impacts

The declaration of links of interest engages the responsibility of the order of physicians which must ensure that it is updated

It engages the responsibility of the declarant, who must ensure that it is sincere, up-to-date (continuous updating) and exhaustive

The anteriority of the links to be declared is 15 years

The anteriority of the links to be declared is 5 years

The longer a collaboration lasts, the stronger the impact of the link of interest will be.

Too strong links of interest can lead to erroneous expert conclusions

The stronger a healthcare professional's interests, the more patients trust him/her.


LDL-cholesterol is the most powerful cardiovascular lipid risk factor

Pure hypercholesterolemia affects 10% of 35-64 year olds.

30% ! All dyslipidemias combined, 51% of this population is concerned

The LDLc level is calculated with the Friedewald formula only if the triglyceride level is greater than 4g/L

An EAL is routinely requested for an overweight individual (BMI >25)

If a screening EAL is abnormal, it should be repeated

It is then associated with a measurement of fasting blood glucose


Tuberous xanthomas are a clinical sign of hypertriglyceridemia

During an EAL, in the creaming test, a cloudy subnatant indicates an abnormality in the chylomicronemia level

An anomaly in the VLDL level. A creamy supernatant indicates an abnormality in the rate of chylomicronemia.

In the Frederickson classification, dyslipidemia of phenotype IIA is pure hypercholesterolemia

<b>Chronic</b> renal failure is a cause of secondary hypercholesterolemia

Loop diuretics are an iatrogenic cause of mixed dyslipidemia


Primary monogeneic hypercholesterolemia by mutation of the LDL-cholesterol receptor is inherited autosomal dominant

The involvement can be heterozygous (50% functional receptors) or homozygous (0% functional, severe++)

Familial combined hyperlipidemia affects 1 to 2% of the general population in France

And 10-11% of patients who had a myocardial infarction before 60 years

According to the HAS 2017, the LDL-cholesterol objective to be achieved in case of moderate cardiovascular risk is a level below 1.3

Attention, the thresholds recommended by the ESC are different

In a patient with a SCORE calculated at 7% who has not reached his LDL-cholesterol goal, lipid-lowering drug therapy is indicated from the outset

Here, the cardiovascular risk is high (5-10%): drug treatment from the outset

The combination statin + fibrate is recommended from the outset in case of mixed dyslipidemia

The combination statin + fibrate is classically at risk and strongly discouraged


Initiation of lipid-lowering drug therapy is not recommended for primary prevention in patients over 80 years of age

Statins induce a decrease in triglyceride levels

Statins are contraindicated in pregnancy

This concerns statins, ezetimibe and fibrates. Cholestyramine induces digestive disorders.

Treatment with fibrates is indicated in 1°intention in a patient with a triglyceride level of 3 g / L

Fibrates are indicated only after failure of hygienic measures, or in case of isolated severe hypertriglyceridemia


Gemfibrozil + Simvastatin is not recommended

It is absolutely contraindicated!! And the combination of a statin with any other fibrate is not recommended

A monitoring EAL is indicated 4 weeks after initiation of lipid-lowering therapy to assess effects

12-24 weeks in case of low/moderate cardiovascular risk, 8-12 weeks if high/very high

When the LDL-c objective is reached, a control EAL is scheduled every 3 years (except comorbidities)

CPK testing is recommended before statin initiation, 8 weeks after any dose change, and then 1 time per year

This concerns the control of liver function. CPK testing is only recommended in case of muscle pain or risk factor for muscle damage

In case of increase in CPK < 5 times normal on statins with moderate myalgia, treatment can be continued

CPKs are rechecked at one week. In case of severe myalgia, statins are discontinued


Their prevalence varies greatly from one pathology to another, but taken together, they would affect about 1% of the population of industrialized countries.

Given the extreme diversity of the repertoire of these antigen receptors, the appearance of lymphocytes recognizing antigens of the self is statistically inevitable.

Pathological autoimmunity is the result of a breakdown in immunological tolerance

The presence of isolated autoimmune biology (e.g. isolated positivity from anti-nuclear antibody testing) poses the inevitable diagnosis of autoimmune disease

The presence of isolated autoimmune biology (e.g. isolated positivity from an anti-nuclear antibody test) without clinical or other biological manifestations is not sufficient to define an autoimmune disease as such.

The term "overlap syndrome" refers to patients who meet the criteria for classification of several autoimmune diseases at once.


Autoimmune dysthyroidism is very common in the general population, while primary ANCA vasculitis is very rare.

According to the European definition, a pathology is said to be "rare" when its prevalence is less than 50/100,000 (i.e. affects less than 1 in 2,000 people)

Autoimmune diseases are multifactorial pathologies, which result from the complex interaction between a genetic terrain at risk and environmental factors favoring

The existence of a genetic predisposition to autoimmune diseases is attested

In the majority of cases, autoimmune diseases are monogenic

In the majority of cases, autoimmune diseases are called "polygenic", because the genetic terrain favoring these diseases is determined by the polymorphisms of many genes each conferring only a low to moderate excess risk of developing the disease


Anti-nuclear antibodies are encountered in about 10% of healthy subjects

aPLs are common during systemic lupus (30-80%) but can be present in many connective tissue diseases such as RA and systemic scleroderma

The Rheumatoid Factor was classically sought after by Elisa

By the Waaler-Rose reaction and the latex test

Anti-CCP are positive in 30% of RA that are negative for RF

The joint positivity of RF and anti-CCP confers a very good positive predictive value for the diagnosis of RA, but with a sensitivity not exceeding 40-50%


Which of the following are possible complications of Sjögren's syndrome?

No, however, we can sometimes observe a tubulointerstitial syndrome by lymphocyte infiltration (significant diapedesis)


Which of the following are causes of dry syndrome?

Not directly. But some psychotropic treatments can cause dry syndrome.


What types of ACAN are found in Sjögren's syndrome?

Rather in the case of lupus (useful in follow-up)

Rather in favor of native anti-DNA (lupus)


Which of the following are additional tests useful in the diagnosis of Sjögren's syndrome?

Schirmer's test to objectify xerophthalmia

Useless in this case (useful in rheumatoid arthritis)


Which of the following proposals can cause polyclonal hypergammaglobulinemia greater than 20 G/l?


Which of the following proposals are possibly associated with Sjögren's syndrome?


Children with Autism Spectrum Disorder (ASD) have deficits in communication only

Children with Autism Spectrum Disorder (ASD) have deficits in 3 clinical domains: (1) Verbal and nonverbal communication abnormalities (2) abnormal reciprocal social interactions and (3) Restricted and repetitive behaviours, interests and activities

The prevalence of ASD is 0.01% in the general population

ASD prevalence is 1% and sex ratio is 4:1 in favour of boys

Diagnosis of ASD is done clinically in a single consultation

The diagnostic evaluation is based on the patient's current symptomatology as well as his developmental trajectory over time. It is a dynamic diagnosis

Management of patients with ASD really begins at puberty

Management of patients with ASD should be early, intensive, multidisciplinary and adapted to the clinical profile of each child


ASD is the presence of persistent deficits in ideation and social behaviour

This syndrome corresponds to the presence of persistent deficits in 3 clinical domains: * abnormalities in verbal and non-verbal communication * abnormality of reciprocal social interactions * restricted and repetitive nature of behaviors, interests and activities

The prevalence of ASD in the general population is 1%

The sex ratio of ASD is 4 boys to one girl

Childhood affected by ASD seeks to attract the attention of others

It does not seek to draw the attention of others to an object or situation


One of the symptoms of the autistic child is that he does not respond when called even insistently.

The child only participates in games that do not require interaction with adults

No reciprocal social games, with adults or children

The child has an aversion to all objects and does not tolerate physical contact with them

Repetitive use of objects: the child tends to line up his toys or other objects, spin the wheel of a small car, etc.

Verbal stereotypies are a sign that can point to autism


Autism severity levels are assessed based on impact on parents, social interactions, and school adjustment

These levels of severity are determined from the intensity of autistic symptoms and their functional impact.

40% of patients with ASD have an intellectual disability

15% of children with ASD have attention deficit hyperactivity disorder (ADHD)

20% of patients with ASD have impaired acquisition of motor coordination

The presence of genetic disease (such as Rett syndrome) eliminates the diagnosis of ASD

Many genetic (such as Rett syndrome or fragile X syndrome) and metabolic diseases are associated with ASD.


Which of the following proposals are structures dedicated to the management of ASD at home?

Medical and psychological centres. It is not home care, but close to home.

Psycho-pedagogical medical centres. Not at home.

Centre for Early Medico-Social Action. Not at home.

Medical-educational institutes. Not at home. These are structures whose mission is to take care of patients with intellectual disabilities, and whose missions are education, care, and general education.


The main goitrogenic factor is iodine deficiency

Even relative iodine deficiency is a risk factor

The recommended iodine intake in a pregnant woman is higher than in the general population

Normal population: 100-150μg in adults, In pregnant women: 200-250μg

A family predisposition is often found. Several susceptibility genes have been identified but it is a multigenic condition that does not warrant screening.

This is the TSH test. If it is abnormal, free T4 is dosed to quantify the extent of hormonal dysfunction.

A goiter and increased TSH makes suspect a disease of Graves.

TSH is lowered in Graves' disease. This biological context makes us suspect rather an autoimmune thyoiriditis of Hashimoto, which leads us to perform an assay of anti-thyroperoxidase antibodies (anti-TPO), then, in case of negativity, anti-thyroglobulin antibodies (anti-Tg).


A thyroid nodule is a localized enlargement of the thyroid gland

The majority of nodules are malignant and require surgical management

About 10% of thyroid nodules are hyperfunctional

They are therefore at risk of hyperthyroidism

Transition to malignancy of a benign nodule is exceedingly rare

As for the goiter, the sex ratio is 3-4F/1H


It is not necessary to explore nodules less than 1 cm in diameter except in special circumstances.

The first-line biological assessment is the TSH assay

Ultrasound uses very low frequency probes

Low frequency probes allow deep penetration. The thyroid being superficial, very high frequency probes are used, which also have the advantage of making images of better definition.

An isolated low TSH strongly points to a functional adenoma

Hyperfunctional nodules that cause hyperthyroidism are treated with surgery


The overall prognosis is good, with a 10-year survival greater than 90%

Differentiated papillary carcinomas are the most common vesicular carcinomas

In 85% of cases. Differentiated vesicular carcinomas constitute 5% of cases while the rest is represented by poorly differentiated and oncocytic carcinomas, and anaplastic carcinomas

Surgery is the first-line treatment for virtually all thyroid cancers.

Papillary or vesicular differentiated thyroid cancers never recur

Papillary or vesicular differentiated thyroid cancers can recur in the long term, requiring prolonged monitoring

Cervical recurrences are treated with hormone therapy

Surgery remains the best treatment for local recurrences, supplemented by radioactive iodine when these recurrences fix.


Benign adenoma is accompanied by euthyroidism

Papillary carcinoma may be accompanied by euthyroidism

A benign goiter is accompanied by euthyroidism

An over-functional nodule is accompanied by hyperthyroidism


Iodine-139 is a very rare isotope not used at all in medicine. Iodine-131 is used.

The treatment is done over one week in day hospital (outpatient)

Hospitalization in radio-protected rooms

It is a complementary treatment to surgical management


Regarding malignant nodules and cancers:

A male sex directs to a malignant nodule

Papillary cancers have a pretty good prognosis

Papillary carcinomas constitute 85% of differentiated carcinomas, they have an excellent prognosis (95% survival at 10 years), it is the only form observed in young people and follow-up is carried out using thyroglobulin

Vesicular carcinomas can be encapsulated or invasive

Anti-Tg for follow-up, anti-TPO are indicated in particular for the etiological assessment of hypothyroidism


Up to age 40, the annual incidence of distal radius fractures is higher in women

Up to age 40, the annual incidence of distal radius fractures is higher in men

There is no link between the quality of anatomical reduction and functional outcome

There is a parallelism between the quality of the anatomical reduction and the functional result

Fractures of the distal end of the radius are fractures mainly involving the proximal epiphysis

Fractures of the distal end of the radius are fractures mainly involving the metaphysis but can also concern the distal epiphysis

The distal epiphysis is articular with the head of the ulna and the first row of the carpus

It is necessary to oppose extra-articular fractures which are the prerogative of the elderly subject and which most often follow a low-energy trauma, complex joint fractures affecting more readily the young subject and resulting from a high-energy trauma


Health safety is the protection of health against the risks induced by the metabolism of infectious agents

It is the protection against the risks induced by the functioning of the company

A health crisis is an unforeseen and complex situation

A health crisis is always of proven seriousness

Not always proven. It may only be potential

A health crisis requires immediate action

The means of managing health crises is exceptional


Cosmetovigilance only concerns consmetic products sold in pharmacies

Manufacturers report any adverse reaction to the ANSM directly

The Biomedicine Agency is the authority that deals with biovigilance

Reactovigilance concerns radiation risks

Materiovigilance is organized around 4 levels of procedure

Minor, major, critical incidents and the overall assessment


Disorders of motility or sensitivity of a limb are very rare

Limb motility or sensitivity disorders are common reasons for consultation, sometimes in emergency situations

This type of disorder must be referred directly to hospital neurologists in view of the potential seriousness

Every physician must know how to guide his diagnosis: by distinguishing between a deficit due to impairment of motor or sensitivity pathways and a disorder of non-neurological origin

There are four major neurological motor syndromes

Syndromic diagnosis makes it possible to establish the topographic diagnosis of the attack

Involvement of the first motor neuron is responsible for pyramidal syndrome


Regarding the central and peripheral origins:

In pyramidal syndrome, the lesion may be in the cerebral hemisphere, brain stem or spinal cord

Lumbar spinal cord involvement is peripheral involvement

Central involvement is characterized by the presence of an extrapyramidal syndrome

The central involvement is characterized by the presence of a pyramidal syndrome: the motor deficit predominates on the extensor muscles of the upper limbs (radial, interosseous) and the shortening muscles of the lower limbs (psoas, anterior hamstring)

A spastic deficit is always of peripheral origin

Remember A spastic deficit is always of central origin

A flaccid deficit is always of peripheral origin


Regarding the neurological semiology of motor deficits:

The RCP is in flexion in pyramidal syndrome

It is the only syndrome where it is in extension = Babinski's sign

Hemiplegia reflects damage to the central nervous system above the cervical cord (included)

Alternate motor syndrome is the combination of hemiparesis or hemiplegia and contralateral involvement of a motor cranial nerve (III, VII, XII)

Tetraplegia reflects damage to the thoracic or lumbar spinal cord

It reflects damage to the upper cervical spinal cord or brain stem

Paraplegia reflects damage to the motor cortex

It reflects low, thoracic or terminal cone cervical involvement, the spinal cord ending at the L1-L2 level


When the lesion is small and/or spares sensory structures, the motor deficit can be isolated

Peripheral neurogenic syndrome is characterized by impairment of voluntary and reflex motor skills

Spontaneous fasciculations may be observed upon inspection in peripheral neurogenic syndrome

There is no amyotrophy in perpipheric neurogenic syndrome

Abolition of osteotendinous reflexes and Amyotrophy of affected muscles when motor deficit is prolonged

There are three main types of diffuse neuropathies depending on the mode of installation


Acute polyradiculoneuritis has unilateral involvement

Acute polyradiculoneuritis has symmetrical involvement

Acute polyradiculoneuritis is exclusively proximal

Multiple mononeuropathies are multiple truncal disorders

Focal neuropathies are related to the involvement of a root, plexus or trunk responding to a precise systematization


Concerning motor and sensory impairments:

Myogenic syndrome is characterized by a motor deficit of varied topography

Myogenic syndrome affects the distal muscles

In case of complete transverse involvement of the spinal cord, in addition to motor deficit (tetra or paraplegia), there is a sensory level with a lesional and sublesional syndrome

Hemi-marrow syndrome (Brown-Séquard syndrome) has a very high localizing value

Plexic involvement corresponds to the involvement of a single dermatome

The sensory territory corresponds to the involvement of several dermatomes


Sialitis is an inflammation of the salivary glands

Sialitis can have an infectious component


Difficult to formally diagnose a tumor, except by histological examination

An isolated non-inflammatory swelling evokes a tumor in first line

Tumours of the main salivary glands sometimes appear for several years

Differential diagnoses are numerous and must be eliminated

They are relatively rare (mastoiditis, transverse apopysis of the atlas, etc.)

The most common parotid tumors are pleomorphic adenomas


Treatment of pleomorphic adenoma is surgical

Post-surgery monitoring of pleomorphic adenoma is unnecessary

Prolonged because it exsites a small risk of cancerization

Malignant tumors account for 50% of tumors

In children, almost 50% of parotid tumors are malignant


Treatment is started as soon as the hromonal assays have validated the diagnosis.

Treatment is urgent even without diagnostic certainty. Hormonal assays can be carried out secondarily.

Hemoconcentration is found in primary adrenal insufficiency

Hyponatremia is specific for primary adrenal insufficiency

No, but hyperkalemia yes, due to aldosterone deficiency

Metabolic acidode is found in blood gases


Regarding the symptoms of acute adrenal insufficiency:

Extracellular dehydration is often marked

These include a skin fold and hypotension up to collapse

Hypernatremia can lead to confusion and seizures

It is hyponatremia and hypoglycemia that have these effects.

The presence of fever eliminates the diagnosis of adrenal insufficiency

Fever may be present, it may be part of an infection that has precipitated decompensation

Associated urinary disorders confirm the picture


Regarding the diagnosis of acute adrenal insufficiency:

It is biological (determination of cortisol and ATCH). In children, renin is additionally dosed.

Known chronic adrenal insufficiency renders hormone testing unnecessary

Hormonal dosages are of no interest if adrenal insufficiency is known

Cortisolemia collapsed in acute adrenal insufficiency

ACTH collapsed in primary adrenal insufficiency

It is greatly increased in primary adrenal insufficiency

Complete adrenal enzyme block (21-hydroxylase) is an etiology of acute adrenal insufficiency


Regarding the management of acute adrenal insufficiency:

The patient is transferred to emergency or intensive care

At the patient's home, 100mg of hydrocortisone is injected

In IV or IM. failing that, in SC. A patient with known adrenal insufficiency should have at least two packs of Hydrocortisone 100 mg with him and know how to make an SC injection of hydrocortisone in case of Emergency.

In hospitals, dehydration is compensated by filling with 0.9% NaCl

Hydroelectrolyte disorders are compensated by the administration of potassium and bicarbonates

No potassium supplementation, because hyperkalemia (+++)

Maintenance therapy is 100 mg per 24 hours as an IV infusion


Regarding adrenal insufficiency, which propositions are true?

Melanoderma is specific for secondary adrenal insufficiency.

Melanoderma (due to excess ACTH) is specific for primary adrenal insufficiency, it is a clinical element that can help guide the diagnosis

In children, the treatment of adrenal insufficiency can not correct the signs of hyperandrogenism in the long term, in case of deficiency of 21 hydroxylase

The absence of signs of long-term hyperandrogenism is one of the objectives of treatment in case of 21 hydroxylase deficiency

In the biological follow-up of the treatment of chronic adrenal insufficiency in children, it is recommended to measure cortisol and plasma ACTH

In the case of acute adrenal insufficiency in a newborn or infant, persistent cholestatic jaundice may be found.

Hypoglycemia, hypotonia, convulsions, low blood pressure and persistent cholestatic jaundice

Acute adrenal insufficiency can be triggered in older children by abruptly discontinuation of long-term, high-dose inhaled corticosteroid therapy.

Abrupt cessation of corticosteroid treatment p.o., inhaled (high-dose and prolonged Fluticosone) or topically applied (large area)


Which of the following are etiologies of false syphilitic serology?


Which of the following are true about Chlamydia trachomatis?

It is the leading cause of bacterial STIs in Europe

The incidence is more common between 15 and 34 years of age in women

The gram is negative, like many bacillus (except Clostidioides, Listeria and Tropheryma)

Carriage is never asymptomatic in humans


Which of the following is the first-line treatment for N. gonorrhoeae?

True, indeed, it is Ceftriaxone in IM monodose of 500 mg


CAPG is defined as progressive optic neuropathy

It is the widely predominant clinical form of all glaucoma in Western countries.

CAPG mainly affects the population over 40 years of age

It is the second leading cause of blindness in Western countries (after AMD) and the leading cause of irreversible blindness worldwide.

CAPG has several risk factors such as age or ethnicity


Ocular hypertonia is not a known risk factor

ocular hypertonia: increased intraocular pressure (IOP) beyond two standard deviations is a risk factor

Ocular hypertonia is a known cause of CAPG

Direct family history confers a 3-fold higher risk of developing CAPM for offspring

No genes predisposing to CAPG were found

Genes have been identified but their research has no clinical application at the moment


Melanoderma patients have a 3-fold higher risk of developing CAPM

Myopia regardless of its intensity multiplies by three the risk of developing a CAPM

Cardiovascular and metabolic diseases are not proven risk factors

Other risk factors such as diabetes, cardiovascular diseases are described but much less well supported than those retained above

The pathophysiology of CAPM is part of neurodegenerative diseases

There are about 1 million ganglion cells in each eye


After 40 years, the simple fact of aging leads to the loss of about 8000 ganglion cells per year

CAPG is the sudden and fleeting loss of retinal cells whose impact is spread over time

CAPM is actually the accelerated loss of these optical fibers compared to age-related physiological loss.

An open angle is observed in gonioscopy (visibility of the pigmented trabeculum of more than 180 °)

Visual acuity drops steadily and aggravates myopia already often present

Visual acuity is not affected, except in the late stages of the disease or in case of other associated eye pathology (cataract, age-related macular degeneration)

It accounts for about 70% of CAPM cases in Western populations.


It is characterized by progressive optic neuropathy with structural and/or functional abnormalities

Increased papillary excavation accompanies loss of the neuroretinal ring

An asymmetry of this ratio greater than 0.2 between the two eyes is suspicious of glaucoma

OCT can calculate areas and volumes at a resolution of about 5 microns

It is useful for the positive diagnosis and differential diagnosis of CAPM as well as for the evaluation of the follow-up and effectiveness of the treatments put in place.


Central visual acuity is affected very late

The key examination is the visual field performed today with automated static perimetry (PSA)

The PSA takes about 30 minutes per eye and is performed by an orthoptist

This exam, which today takes about 5 minutes per eye, requires good cooperation and understanding of the test.

The alteration of the visual field is mainly marked by the appearance of scotomas

The usual form of CAPM occurs untreated with IOP greater than 21 mmHg


Normal pressure CAPM accounts for approximately 70% of CAPM cases in Asian populations

Alterations in structure and function are substantially the same as high-pressure CAPM

Unlike the classic form of CAPG, normal IOP CAPM occurs untreated with IOP less than or equal to 21 mmHg

CAPG is a risk factor for retinal vein occlusions

Ocular hypertonia is defined as IOP greater than 15 mmHg

Ocular hypertonia It is defined as IOP greater than 21 mmHg, an open angle in gonioscopy and the absence of optic neuropathy


Diffuse interstitial lung disease (PID) brings together many entities whose common point is to give diffuse infiltrative opacities on the chest X-ray

Acute IRS is dominated by infectious and hemodynamic causes

Bronchoalveolar lavage is the key examination during acute febrile PID

Cardiology is essential during acute febrile IRS

Cardiology is essential during acute non-febrile IRS

Sub-acute or chronic PID are dominated by sarcoidosis, idiopathic pulmonary fibrosis and pulmonary fibrosis associated with connective tissue


Clinical presentation and EFRs of IRS are indiscriminate

Chest CT is the cornerstone of the etiological orientation of sub-acute or chronic IRS

PIDs have in common to chest imaging DIFFUSE, non-systematized, bilateral and symmetrical parenchymal opacities

The diagnostic approach and management are fundamentally different, depending on whether you are dealing with acute PID or sub-acute or chronic PID (PID-SC)

The LBA is very effective for the diagnosis of infections and allows diagnostic guidance in other cases


The analysis of the predominant lesions, their topography and associated lesions makes it possible to define radiological profiles (patterns) which each have an etiological orientation value.

The diagnostic approach uses histology very frequently

Histology is used in less than 10% of IRS

The complexity of the reasoning in the face of IRS justifies that the vast majority of cases are the subject of a multidisciplinary discussion

1 Idiopathic pulmonary fibrosis (IPF) The most common IRS of unknown cause after sarcoidosis

Hypersensitivity pneumonitis rare in smokers


Regarding the main generalities on osteoarthritis:

It mainly affects the spine, knees, hips and hands

It is a disease of all joint tissues affecting primarily articular cartilage, but also the synovial membrane and subchondral bone

When it becomes symptomatic, it causes mechanical pain and functional disability

It affects about 1% of the French population

Excess cardiovascular mortality is observed in gonarthrosic patients


Chondrocytes are in charge of the production and degradation of the extracellular matrix of cartilage

The extracellular matrix is composed of more than 10% water

This matrix is composed of more than 80% water and a network of collagen and proteoglycans, strongly hydrophilic

The interactions between bone and cartilage are very important and allow the passage of nutrients and different mediators

The inner surface of the joint capsule is lined with the synovial membrane responsible for the production of synovial fluid

Cancellous bone provides nutrients for articular cartilage

It is the synovial membrane that takes care of it


The pain is due to inflammation of the cartilage

Pain is a poorly understood phenomenon in osteoarthritis and complex since cartilage is not innervated. It is rather a suffering of the subchondral bone that is responsible for the pain

Coxarthrosis refers to gonalgia due to osteoarthritis

Functional limitation is the most common reason for consultation

The most specific localization of coxarthrosis pain is in the groin crease

Mechanical knee pain is very specific to gonarthrosis

Careful! The pain of coxarthrosis can be said to be "projected" in front of the knee, which can be misleading


Which of the following proposals could correspond to an installed coxarthrosis?

Is rather seen in the after-effects of stroke (stiffness of the knee, hypertonia of the quadriceps / triceps sural which gives an attitude of the foot in varus)

Rather seen in Charcot-Marie-Tooth or in peripheral neurological disorders, where there is a defect in dorsiflexion of the foot


Concerning cognitive disorders in the elderly

The most common cause of dementia is Alzheimer's disease

Demeance includes deterioration in cognition

In the predemential phase of Alzheimer's disease the most common clinical sign is forgetfulness


The histological stigmas of Alzheimer's disease are


The minimum balance sheet of a demence shall include


Carriage of homozygosity for apolipoprotein E ε4 allele is a risk factor for Alzheimer's disease

abnormal accumulation of β-amyloid proteins (Aβ-42) in extracellular clusters characterizes Alzheimer's disease

Low level of education protects against Alzheimer's disease

Analysis of cerebrospinal fluid found during Alzheimer's disease finds a massive decrease in AB42 and an increase in TAU-p

The diagnosis of certainty of Alzheimer's disease is based on neuropathology (post mortem)


Which of the following proposals are mandatory and systematic in the first instance?

Biology: NFS, CRP, TSH, ionogram, Blood glucose, Calcemia

Not recommended. The recommended serologies according to the context are: HIV, Syphilis, B9 and B12

Brain MRI with sections passing through the axis of the hippocampuses

False, on the other hand this is the case of typical Parkinson's disease


Which of the following proposals can be found in Alzheimer's disease?

Visuopraxic disorder with errors when copying the MMSE figure

Delayed recall disruption during the 5-word test, normalized by indication

There is no problem of restitution or access to information in Alzheimer's disease

Delayed recall disruption during the 5-word test, little improved by cueing

Difficulty with motor sequences during the BREF (Fast Battery of Frontal Efficiency)

As its name suggests, it would be found in frontal syndromes


A neurological deficit is the loss of function related to a temporary dysfunction (transient deficit) or lesional (permanent deficit) of a region of the nervous system

A recent neurological deficit (less than 1 month) is a common reason for emergency room and neurology visits

A recent neurological deficit most often indicates an attack of the central nervous system but can also be caused by an attack of the peripheral nervous system, the neuromuscular or muscular junction

A recent neurological deficit is a sign of entry into a chronic disease and is therefore never urgent.

A recent neurological deficit may be a sign of a serious neurological problem requiring specific and urgent treatment, but may also be a mode of entry into a chronic neurological disease.

Any recent neurological deficit of sudden onset should lead to suspicion of a stroke


In the case of central nervous system involvement, the lesion is located on the roots, plexuses, nerve trunks, neuromuscular junction or muscles

Damage to the peripheral nervous system is evoked in front of the involvement of a hemibody (motor or sensory)

Damage to the central nervous system is evoked in the face of such an attack

The homonymous lateral hemianopsia is a sign of involvement of the frontal cortex

Homonymous lateral hemianopsia is a sign of retrochiasmatic involvement

The sign of Babinski is an interesting sign the spinal cord

Babinski's sign = pyramid sign = central involvement

Damage to the peripheral nervous system is evoked in front of fasciculations


Concerning etiologies and differential diagnoses:

Involvement of the neuromuscular or muscular junction is evoked in front of pure motor impairment

The clinical analysis must make it possible to define the syndrome

There is no non-neurological differential diagnosis of recent neurological deficit

Metabolic, psychiatry, orthopedics, etc.

A cuff rupture can mimic a recent neurological deficit

Speech disorders always have a neurological origin

For speech, balance and vision disorders, the cause may be non-neurological, of local origin: ENT


A deficit can have a psychogenic origin, it is then a conversion disorder

It is then a somatomorphic disorder: motor or sensory territory a little "aberrant", non-anatomical, with discordance of the clinical examination, changing complaints, "beautiful indifference"... Somatoform disorders can be part of different contexts: hysterical (conversion), simulation, depressive syndrome...

The mode of installation of the deficit is a major element of diagnostic orientation

The study of the anamnesis must be particularly careful

Age The older the patient, the more frequent the vascular causes

Complementary neurological examinations are guided by topographic diagnosis


What is the corrected QT threshold to suspect long QT syndrome?


EBV is an important risk factor for cavum cancer

Unilateral earache can sometimes be the only symptom of VADS cancer

HPV is a very important risk factor for oropharyngeal tumors

HPV-induced oropharyngeal tumors are favored by sex

The most common histological type of sinus tumours is undifferentiated carcinoma

This is the case of the cavum. For the nasal cavity and sinuses, we mainly find adenocarcinomas


Cervical radiation therapy can induce hypothyroidism

MRI is mainly indicated in the assessment of extension of tumors under the hyoid bone

Above the hyoid bone (oral cavity, cavum, sinuses, nasal cavity, oropharynx): MRI. Below: Scan

The CT scan is mainly indicated in the assessment of extension of tumors above the hyoid bone

Above the hyoid bone: MRI. Below (larynx, hypopharynx): CT scan

The localization of VADS tumors is often bilateral

Often almost exclusively unilateral. The accompanying symptoms are therefore also unilateral.


Which of these specialties are absolutely necessary for the holding of a CPR?

Three specialties: surgery, oncology, and radiology


The cavum is the new name for the oropharynx

The cavum is the new name for the nasopharynx (or nasopharynx)

It is specifically promoted by HPV infection

Examination of the ear can find unilateral seromucosal otitis


Which of the following is the most common histological type of ethmoid tumor?

Common in tumors of the oral cavity, oropharynx, larynx and hypopharynx

True, common in nasal cavity and sinus tumors

It is not a histological type but a stage T

Adenocarcinoma is the most common hystrophological type of ethmoid tumors.


Regarding the epidemiology of VADS tumors, which proposals are true?

The peak frequency is between 60 and 70 years.

The peak frequency is between 60 and 70 years (except HPV-related oropharyngeal cancers)

They are often associated with a low socio-economic level.

They are most often located at the level of the cavum.

False, cavum in < 1% of cases. Most often in the larynx (35%).

There is currently a decrease in the incidence of these tumours in humans.

There is currently a decrease in the incidence in humans of these tumors due to the decrease in alcohol and tobacco intoxication.


Regarding the cancer risk factors of VADS, which proposals are accurate?

Not CMV but EBV for cavum cancer and HPV for oropharynx.

Exposure to wood dust (possible recognition as an occupational disease)


Ethmoid cancers are frequently associated with EBV.

False, these are nasopharyngeal cancers.

Cavum cancers are usually squamous cell carcinoma.

False, they are most often UCNT type (undifferenciated carcinoma of nasopharyngeal type)

Alcohol and tobacco are the most common risk factors for head and neck cancers.

Adenocarcinoma of the ethmoid is considered an occupational disease.

Ethmoid adenocarcinoma is considered an occupational disease (occupational exposure to wood dust)

VADS cancers are the 5th most common cancer in France.


What is the annual incidence of childhood cancer in France?


What is the approximate cure rate for childhood and adolescent tumors?


Have very slow and pauci-symptomatic growth

They are indeed pauci-symptomatic, but their growth is very fast (in general, much more than adult tumors)

Except in some leukemias, there is a general condition fairly well preserved

Result in disparate and non-specific clinical signs


Which of the following are elements of Claude Bernard Horner syndrome?

False, this does not fit into the definition of CBH

It is a myosis of the affected eye that falls within the definition of CBH

The CBH includes: ptosis, myosis and enophtalmos, all on the same side


Which of the following are true about Lactate Dehydrogenase?

It is often used as a marker of tissue damage

It catalyzes the conversion of pyruvate to lactate

LDH are enzymes found in a wide variety of organisms, both plant and animal.

It is abundant in red blood cells and can therefore be used to guide hemolysis


Lameness corresponds to an asymmetrical approach

Additional examinations will be requested based on the data collected by the clinic

The age of the child is the determining factor that points towards one pathology rather than another.

In view of the emergency that is not vital, we start by questioning the patient

Episodes of fever strongly point to an infectious phenomenon


Regarding interrogation and clinical examination:

The precise origin of the lameness is difficult to trace in small children

The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the physiological hip

The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the pathological hip

A skin lesion points to endocrine pathology

The tibial diaphysis is palpated with particular attention to detect a possible fracture of the acetabulum


In hip diseases, adduction and external rotation are impossible

In hip disease, abduction and internal rotation are limited

The neurological examination looks for an equine walk, tests muscle tone, muscle strength, osteotendinous reflections

Refusal to sit is sometimes the only objective sign

The disease area is more easily identifiable in small children than in adolescents

Hip pathologies are often responsible for projected heel pain


Biological examination is systematic in search of an inflammatory syndrome

The best test to identify a joint effusion is the x-ray at the hip

It is the ultrasound that best visualizes a joint effusion at the hip or ankle

Ultrasound can objectify an effusion of soft parts

Comparative images are only justified in case of doubt about an image of osteolysis, or edema of the soft parts

MRI is indicated as a first-line test when the suspicion of ligament rupture is moderate to strong


An infectious assessment is essential in case of suspicion of osteoarticular infection

The puncture for bacteriological research is urgent in case of doubt about osteoarticular infection

Lameness in a febrile context is suspected of tendon rupture in the first place

Ë Lameness in a febrile context is due to an osteoarticular infection until proven otherwise

Bacteriological samples must be taken under general anesthesia, as a matter of urgency


An osteochondritis of the hip is febrile and concerns the child between 8 and 10 years

Non-febrile and between 3 and 8 years old

Infantile cerebral hemiplegia can occur at any age in childhood

Congenital hip dislocation is very common before 3 years of age

Transient acute synovitis is very febrile at peak


Lameness in a febrile context is due to an osteoarticular infection until proven otherwise

Initial antibiotic therapy is urgent, intravenous and adapted to the susceptibility test


Zoonoses are infectious diseases transmitted to humans, either directly by an animal or indirectly via vectors.

In metropolitan France, the most frequent zoonoses are Lyme borreliosis, pasteurellosis, toxoplasmosis and cat's scratch disease.

Brucellosis has been controlled and is currently almost non-existent in France

See item in the latest edition of the college

Slow incubation is characteristic of pasteurellosis

It is the speed of incubation is characteristic of pasteurellosis

In 10% of cases of pasteurellosis, an ophthalmic form combining conjunctivitis and pretrageal lymphadenopathy is described, mainly in children


The cat flea is the vector of cat scratch disease

In humans, from the inoculation lesion, the bacterium will multiply in a relay ganglion

Lymphadenopathy is a sign of an inflammatory reaction with caseous granuloma

This lymphadenopathy is the site of an inflammatory reaction with epithelioid granuloma without caseous necrosis

This disease is more common in children and young adults, with an incubation of 2-3 days on average.

In half of the cases, there is a primary papular erythematous lesion located in the lymphatic drainage territory of the skin lesion


Man is mainly stung during walks in fortê

From the inoculation point, the bacterium migrates and multiplies in the dermis (erythema migrans)

In a second step, it can spread through the blood and reach the central and peripheral nervous system, meninges and large joints.

A large proportion of infections are inapparent, leaving the only trace of their occurrence being the detection of specific antibodies

The vast majority of diagnoses are made in the tertiary phase of the disease

The vast majority of diagnoses are made in the primary phase of the disease


Humans are contaminated either by the digestive tract (consumption of raw milk) or by inhalation (inhalation of aerosols from elements contaminated by the bacteria: straw, manure, etc.)

Ticks can eventually transmit the bacteria

It is an exclusive disease of the Mediterranean basin and the Caribbean, more common in rural areas

It is a cosmopolitan disease, more common in rural areas

About 95% of infections will remain asymptomatic

About 60% of infections will remain asymptomatic

It is the fever Q eagle that is by far the most common clinical form of the disease


Which of the following are directly transmitted 🐩➡👩 pathologies?


Which of the following are vector-borne pathologies?


Which of the following are possible heart effects of Lyme disease?


Which of the following propositions are true regarding rabies 🐕 🦺?

True. Lyssaviruses are a genus of viruses in the family Rhabdoviridae, order Mononegavirales, which includes rabies virus and related viruses. In 2017, this genus has at least 14 members, the first known serotype of which is the rabies virus or RABV for RABies Virus, responsible for human rabies.

Wound management involves washing with soap, antiseptic and trimming

Vaccination should be carried out urgently if the patient is no longer immunized 🚨


Which of the following are signs or symptoms of congenital toxoplasmosis in a newborn?

Rather prematurity so a low birth weight


Which of the following are true about the Zika virus?


A zoonosis is a disease that can be transmitted from animals to humans

Brucellosis is transmitted by only one vector

Erythema migrans is found in Lyme disease


Which of the following are encapsulated bacteria?

The 3 to remember are: Haemophilus, Neisseria, Streptococcus


Constipation is a symptom that corresponds to a dissatisfaction of the patient during defecation

The chronic nature of constipation is defined by a duration of symptom evolution greater than 6 weeks

According to international criteria (Rome criteria), the chronic nature of constipation is defined as a duration of symptom evolution greater than 6 months

In drug addicts and especially morphine addicts, constipation is almost constant

Hyperactivity corresponds to an increase in segmental contractions in the sigmoid region, which slow down the progression of materials


The elements that point to distal constipation are:

This is the case for transit constipation

Sensation of a gene at the passage of stool or incomplete evacuation


Daily fibre intake should be greater than 5 g/d

Recent constipation or worsening of chronic constipation should investigate an organic cause

Osmotic laxatives are the first-line treatment for any constipation

In case of transit conservation, rectal laxatives are often necessary

This is the case for distal constipation

Certain medications can cause constipation such as anti-depressants and opiates


What is the antidote to paracetamol poisoning?


What is the antidote to benzodiazepine poisoning?


Which of the following are systematic additional examinations in case of suspicion of acute intoxication?


Which of the following proposals are providers of serotonin syndrome?

Antidepressants that inhibit serotonin reuptake


Which of the following proposals are providers of sympathomimetic syndrome?


Which of the following are the providers of anticholinergic syndrome?


Poisoning is the leading cause of hospital admission for adults under 30 years of age

True, this is exactly what is written in the college of anesthesia-resuscitation (2018 edition, page 365)

CO2 poisoning accounts for 4,000 to 8,000 victims each year in France

False, it is at the CO (note that it is written 4000 in the college of resuscitation, and 8000 in the college of emergencies)

The incidence of poisoning is drastically decreasing

The most frequent etiology is represented by voluntary intoxication with psychotropic drugs.

True, exactly the sentence of the Emergency Medline


Hypereosinophilia is defined as an absolute number of eosinophilic polynuclear > 5 G/L, confirmed on a second sample

Hypereosinophilia is defined by an absolute number of eosinophilic polynuclear > 0.5 G / L, confirmed on a second sample

The main causes of eosinophilia are, in order of frequency: allergic, infectious (parasitic), more rarely neoplastic (hematological malignancy, cancer) or related to a systemic disease

Major eosinophilia, whatever the cause, can have harmful consequences on the functioning of different organs and in particular the heart

TRUE. Activated NEPs release mediators (ationic proteins, toxic oxygen metabolites), toxic to certain organs, including the heart

A careful interrogation must seek in particular the possibility of giardosis

Among parasitosis, only helminthoses cause eosinophilia

It is most often a helminthosis, but other parasites may be involved


Hypereosinophil is found in some hemopathies

Mainly Hodgkin's disease, T-cell lymphomas, especially cutaneous, or myeloproliferative syndromes

The interrogation will have to look in particular for elements towards a parasitic attack such as the consumption of undercooked meat or a stay in a tropical zone

In case of eosinophilia with signs of severity, the patient must be put under emergency outpatient treatment

The patient must be hospitalized urgently with a specialized opinion

The introduction of new medicinal products and the taking of medicinal products must be sought at the interrogation

The imputability of a drug in the development of EO is difficult to prove, proof is sometimes provided only with the slow and gradual disappearance of HE after eviction of the drug

Hypereosinophilia> 1 G/L for >3 months are signs of severity

Hypereosinophilia> 1.5 G/L for >6 months


The first-line assessment of an asymptomatic patient who has stayed in the tropics will be completed by

The IgE assay is not in 1st intention but after the antiparasitic treatment of test of a chronic HE according to the college of hematology

Parasitological examination of stool to be repeated three times

Serology schistosomiasis, fillariosis, stronglyoidosis


The 5 spondyloarthritis are: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory enterocolopathies and undifferentiated SpA

The overall prevalence of all spondyloarthritis is 0.35% in France

The majority of cases begin in young adults (before thirty-five or forty years of age)

Entheses are the bone insertions of organs on bones

Rather tendons, ligaments, capsules and fascia on the bones


Sacroiliitis is a pain of the buttock of mechanical schedule

If. It can radiate below the gluteal fold and be confused with truncated sciatica

Neurological signs associated with this pyalgia can be found

No neurogenic or root character in pure sacroillitis

We manage to trigger these pains by shearing maneuvers of the sacroiliacs


Psoriatic arthritis may be accompanied by arthritis of the distal interphalengals

The characteristic involvement of spondyloarthritis is the distal fracture of the femur

Only the entheses of the lower limbs and back are affected

The most frequent and characteristic condition is heel pain


Regarding the associated signs and symptoms:

Dactylitis is pathognomonic of spondyloarthritis

SpA has purely rheumatological manifestations

In psoriatic arthritis: dermal involvement. In SpA associated with enterocolopathy: digestive involvement. etc

Acute anterior uveitis is, most often, non-granulomatous

Acute anterior uveitis can be either unilateral or bilateral

Acute anterior uveitis is never inaugural

Its prevalence is 20% and it can quite be inaugural


Psoriasis precedes the onset of psoriatic arthritis by 10 years in most cases

Ankylosing spondylitis is the most typical and severe form of SpA

Peripheral syndrome is clinically predominant

Pelvirachidal involvement is at the forefront

The ossification of entheses is not always painful

The extrarheumatic sign in the foreground is acute anterior uveitis


Fiessinger-Leroy-Reiter syndrome is the most complete form of reactive arthritis and is defined by the urethritis-conjunctivitis-arthritis triad

Undifferentiated SpA are SpA that meet the criteria of the ESSG for example

Peripheral enthesitis is the most common clinical sign

Undifferentiated SpA is most often benign


At the clinical examination of a 75-year-old patient at the UAA you find a BP at 106/67 mm Hg in the supine position and 85/45 mm Hg in the standing position and a skin fold. NFS = Hb: 16 g/dL, pq: 250 G/L, leuko: 9.6 G/L. Natraemia: 115 mmol/L. Kaliemia: 3.5 mmol/L. Protidemia 90 g/L. What is the state of hydration?

Skin fold, hypototension, hyperprotidemia


Formula for calculating plasma osmolarity:


Analyze this GDS: pH = 7.20 pCO2 = 45 mmHg pO2 = 75 mmHg HCO3 = 17 mmol/L.

Ventilatory acidosis with metabolic compensation because bicarbonates are elevated

Metabolic acidosis with ventlatory compensation because capnia is elevated

Mixed, ventilatory and metabolic acidosis

We speak of acidosis when the pH is < 7.38

In case of simple metabolic acidosis, the expected PaO2 is = 1.5 x HCO3+ 8 ( +/2 )


Which of the following are etiologies of inappropriate hypothalamic secretion of DHA?

Cause of paraneoplastic syndrome (ectopic tumor secretion of ADH, or ADH-like substance)


Posm = [Na+ x 2] + Blood glucose (mmol/L) + Kaliemia

The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea

Posm = [Na+ x 2] + Blood glucose (mmol/L) + Chloremia

Posm = [Na+ x 2] + Blood glucose (mmol/L) + Uric acid


It is indeed a cause of DHA secretion, but the secretion is ectopic (paraneoplastic syndrome) and not pituitary

It potentiates the effect of DHA (such as chlorpropamide or clofibrate) but does not cause more secretion


Which of the following are causes of isotonic hyponatremia?

Isotonic hyponatremia called "pseudohyponatremia", are those that are associated with severe hyperlipidemia or hyperprotidemia and do not darken with any intracellular hydration disorder.


Which of the following proposals can aggravate severe hypokalemia?

This is the right care. It must not exceed 20 mmol / h and under rhythmic supervision

Not recommended in case of severity, but does not aggravate it


Which of the following are clinical signs of intracellular dehydration?


Which of the following may be ECG abnormalities secondary to hypokalemia?


Bicuspidism is the most common etiology between 35 and 65 years of age

Bicuspidism is a "progressive" malformation that eventually leads to aortic narrowing in adulthood.

The bicuspid valve is often associated with an aneurysm of the ascending aorta

Post-rheumatic acquired aortic stricture is a very common etiology in France

Post-rheumatic RA has become rare in developed countries

The prevalence of degenerative aortic valve narrowing decreases with age

Prevalence increases with age and, in fact, is by far the most common cause of aortic valve narrowing


The main etiology of RA is degenerative in the majority of cases after 65-70 years

In the presence of an obstacle to ventricular ejection, there is the appearance of left intraventricular hyperpressure with ventriculo-aortic systolic pressure gradient: PVG > PAorta

The pressure gradient VG-aorta is lower the tighter the aortic narrowing

The tighter the AR, the greater the pressure gradient

When the VG-aorta pressure gradient reaches 4 mmHg, the AR is considered tight

it is when the VG-aorta pressure gradient reaches 40 mmHg that the RA is considered tight

Patients with AR maintain normal systolic performance for a long time


Initially, overall LV systolic performance is most often normal in a patient with AR.

Systolic performance of the ventricle can normalize as soon as the aortic obstacle is removed

The onset of symptoms in the presence of tight AR is preceded by a long asymptomatic period that can last several years

Cough, anginal pain and edema are the three main symptoms of aortic narrowing

The three main symptoms are: stress angina, stress syncope and exertional dyspnea.

When symptoms appear, the prognosis may be life-threatening


We find at auscultation a mesosystolic murmur, intense, soft, grating, maximum in the 2nd left intercostal space, radiating into the left armpit

The murmur is mesosystolic, ejectional, intense, rough, raspy at the maximum at the right intercostal 2nd space, radiating into the vessels of the neck

In advanced cases, there is a widening of the peak shock that is deflected at the top and left

The deviation of the tip shock is at the bottom and left signifying the dilation of the left ventricle

There is potential atrial fibrillation, usually poorly tolerated

Symptomatic tight AR is never complicated by sudden death

This is why the vital prognosis can be engaged according to hemodynamic tolerance

Sometimes it shows cardiomegaly is pulmonary overload


The size of the aorta is important to evaluate, especially in case of biscupidia in the preoperative assessment to know if an associated gesture on the aorta may be necessary

Catheterization is performed systematically

Catheterization is not usually performed

Angina can be seen in AR in the absence of any direct coronary involvement

The place of the coroCT scan as a replacement for preoperative coronary angiography is established

The scanner reliably assesses the size of the aorta


Replacement with mechanical prosthesis requires lifelong anticoagulant treatment

A biological prosthesis, indicated in the patient is young, avoids anticoagulant treatment

The biological prosthesis avoids anticoagulant treatment well but is indicated in patients over 65 years of age because there is a risk of degeneration within 10–15 years

The indication of percutaneous aortic valve cannot be carried without the approval of an experienced medical-surgical team and only after a multidisciplinary discussion in dedicated staff in trained teams

Any symptomatic tight aortic stricture should be operated on in view of the existing life-threatening risk and virtually without age limit, subject to a general condition preserved

In case of asymptomatic tight RA according to the interrogation, a surgical valve replacement is systematically proposed

In case of asymptomatic tight AR according to the interrogation, a stress test is proposed to check that the patient is really asymptomatic and thus detect false asymtomatics that are related to surgery: if blood pressure does not rise during the stress test or decreases with effort, the operative indication can be discussed


Mitral insufficiency is a leak in the mitral valve resulting in blood backflow from the left ventricle to the left atrium during diastole

The backflow of blood from the left ventricle to the left atrium is during systole

In type III MI according to the Carpentier classification: at least one valve protrudes beyond the plane of the ring during ventricular systole

type II: at least one valve protrudes beyond the ring plane during ventricular systole

Rheumatic etiology has become rare in developed countries

The combination of stenosis and mitral insufficiency is referred to as mitral disease.

Dystrophic mitral insufficiency is a very common etiology


The onset of dyspnea is slow and progressive

On examination, there is a deflection and lowering of the peak shock if there is a dilation of the LV

Auscultation contains a systolic murmur of maximum regurgitation at the tip

ECG remains normal for a long time in moderate MI


On radiography, cardiomegaly by dilation of the VD is found even in moderate MI

RT is often normal in MIs. In severe and advanced MI, cardiomegaly may be observed by LV hypertrophy

ETT is the key test for positive diagnosis and etiological diagnosis

The mitral leakage is confirmed by a holosystolic Doppler signal behind the mitral floor recorded in pulsed, continuous and color Doppler

The mechanism must be specified by echocardiography (according to the Carpentier classification)

ETT is a fundamental examination for the diagnosis of MI on endocarditis, highlighting sometimes very fine vegetations

ETO is a fundamental examination for the diagnosis of MI on endocarditis, highlighting vegetations sometimes very fine and impossible to see in ETT


Coronary angiography is systematic as part of the preoperative assessment when a surgical indication is retained in case of cardiovascular FDR

The gradation of MI is based on the calculation of the regurgitating fraction

Right catheterization allows the measurement of cardiac output by thermodilution and the measurement of straight pressures (capillary and pulmonary pressures)

The main interest of the test is to unmask symptoms and understand them in patients who say they are asymptomatic.

The stress test with VO2 measurement makes it possible to better assess the patient's exercise capacity


A low maximum O2 consumption < 15 mL/kg/min indicates poor tolerance of MI

Stress echocardiography makes it possible to assess the leakage during exercise, its possible increase, its impact (increase in PAPs> 60 mmHg)

In general, gradually formed MIs are well tolerated for a long time, and signs of heart failure appear late.

On the contrary, MI of sudden onset (rupture of ropes, endocarditis, MI on infarction) are generally poorly tolerated and quickly evolve towards the appearance of a picture of edema of the lung

Complications of MI include infective endocarditis


The appearance of atrial fibrillation or atrial flutter can lead to cardiac decompensation

Heart failure is late onset in chronic MI but can occur rapidly in acute MI. It can be favored by a rhythm disorder

Always look for signs of other associated pathologies (e.g. stigmata of Marfan's disease)

If mitral leakage is significant and responsible for functional symptomatology, it is urgent to consider surgery

In case of acute MI, treatment for OAP or shock should be initiated, and emergency surgery should be discussed.


Regarding Aortic Narrowing, which propositions are true?

Monckeberg's disease is synonymous with calcified aortic narrowing (CAR)

Aortic narrowing leads to an increase in afterload and thus induces a decrease in the ventriculo-aortic gradient.

Aortic narrowing leads to an increase in afterload and thus induces an increase* in the ventriculo-aortic gradient.

Aortic narrowing is well tolerated for a long time, until an advanced stage with the appearance of stress symptoms such as exertional angina, exertional dyspnea and intermittent claudication of the lower limbs.

The clinical triad of tight aortic stricture is: stress angina, stress syncope, exertional dyspnoea

Criteria for tight aortic narrowing on cardiac Doppler ultrasound include: a mean gradient > 40 mmHg and an aortic surface area > 1 cm2 (0.6 cm2/m2 body surface area)

Aortic surface <* 1 cm2 (0.6 cm2/m2 body surface area)

It is possible to find on the ECG: left ventricular hypertrophy, left atrial hypertrophy, conduction disorder (BAV 1 and left branch block), as well as a rhythm disorder (atrial fibrillation).


About cholelithiasis and its complications

The frequency of vesicular lithiasis in Western countries is about 20%

The frequency increases with age to reach 60% after 80 years

•Almost 90% of subjects with a gallbladder never have any symptoms

A gallstone complicates this in 20% of cases, this complication is the migration of the stone into the cystic duct or the main bile duct

• It can therefore be estimated that 2 to 4% of French people are likely to develop at least one complication requiring an exploration of the bile duct


Concerning vesicular lithiasis and its complications

Despite its frequency, screening for vesicular lithiasis is not indicated

The incidental discovery of an asymptomatic gallstone does not lead, in most cases, to any treatment

The most typical symptom is hepatic colic

Hepatic colic is due to the sudden tension of the bile ducts, by permanent blockage of a stone, either in the cystic duct or in the main bile duct

It is due to the sudden tension of the bile ducts, by transient blockage of a stone, either in the cystic duct or in the bile duct

Typically, hepatic colic is a sudden pain often intense, permanent, sitting in the epigastrium (2/3 of cases) or the right hypochondrium


Treatment of cholecystitis is cholecystectomy without delay

Clinical manifestations can be of varying severity, and are: colic, cholitis, cholecystitis

Cholangio-MRI and endoscopic ultrasound are the most sensitive tests to detect a stone of the main bile duct

Acute cholitis lithiasis results in the successive appearance of 3 signs


Video game addiction is a neurodevelopmental disorder

Video game addiction does not fall within this framework

These disorders have a prevalence of about 10% in the general population in France

These disorders are more common in girls than boys

It's the opposite: they are more common in boys


The management of these patients is done by the psychiatrist only

Multidisciplinary care is very important

The origin of these disorders is essentially genetic

It is multifactorial and unknown. The genetic part is surely non-zero.

Neurodevelopmental disorders are often associated with other psychiatric disorders

These disorders are common in the general population (~10%) and more common in boys than girls.

Neurodevelopmental disorders are defined in particular by their functional impact


Regarding the impact of parents and child development:

There is very little inter-individual variability in child development

Inter-individual variability is important

Developmental age is measured directly by automatic standardized tools

Tests measure skills. Developmental age is based on statistics: 95% of children have acquired these skills at this age

Early parent-child interactions have little impact on child development, which is essentially controlled by genetics.

They have an important role in the development of the child

It is very pathological for a child aged 6 months to show anxious manifestations in moments of separation from his parents

Quite physiological in most cases. The College of Psychiatry indicates that it is physiological until the age of 1 year

Separation anxiety is an anxiety disorder that appears in situations of separation from parents at a young age


Psychologists have no role to play in these pathologies

Psychologists can intervene in the raliization of assessment, for psychotherapy and learning

The functional impact corresponds to the difficulties in carrying out actions in one or more given areas

A deficit in the development of a domain is said to be "specific" when it is not explained by another disorder

Children with hearing loss frequently have oral language delay

There are several levels of severity of intellectual disability


It is also called staphylococcal scarlet fever

This is the case of streptococci. Staphylococci secrete enterotoxins, also called TSST1

Also: infants, young children or immunocompromised adults

Exanthemas begin at the level of the large folds


Infectious mononucleosis is caused by HCV

Epidemic megalerythema has a fracture-type rheumatological component

Kawasaki syndrome cannot give morbiliform exanthema

The incubation of measles is about a month


Its indications are very numerous and go far beyond the framework of hematological pathologies

This is the most prescribed exam in France

It is made from a blood sample taken by venipuncture and collected in a tube containing a dry anticoagulant type EDTA

It aims to provide quantitative information on blood cells but also qualitative information

Accurate identification of cells and their possible abnormalities requires a good quality blood smear


Normal values vary by age, gender and ethnicity

Thrombocytopenia <200 G/L should always be checked on the blood smear examination

We speak of thrombocytopenia if < 150 G / L (serious if <50 G / L)

The lower limit of hemoglobin (anemia) is as follows: Newborn: 14 g/L ● Adult male: 13 g/L ● Adult female: 12 g/L

The limits are: Newborn: 140 g/L Adult male: 130 g/L Adult female: 120 g/L Pregnant woman (from the second trimester of pregnancy): 105 g/L

MCV can be calculated as the ratio of hematocrit to red blood cell count.

The normal value is 80 to 100 fl in adults


MCV < 80 fl signs microcytosis in adults

CCMH is the Average Corpuscular Hemoglobin Concentration

CCMH normal values range from 32 to 46 g/dL

The leukocyte formula, expressed in %, has no interest taken in isolation

Preference should be given to absolute values concerning the leukocyte formula


Normal TGMH values are 27 to 32 pg per cell

Any thrombocytopenia without bleeding signs should be investigated for false thrombocytopenia with EDTA by platelet agglutination

A hemoglobin level < 60 g / L or poorly tolerated requires urgent management by a specialist

Anemia is defined as a decrease in CCMH concomitant with clinical signs

Anemia is defined as a decrease in hemoglobin at the hemogram, after eliminating false anemia by hemodilution

Microcytic anemias (MCV < 80 fl) reflect a disorder of hemoglobin synthesis

The most common cause is iron deficiency


The most common microcytic anemias are hyposideremic anemias due to iron deficiency.

Macrocytic anemias (MCV > 100 fl) first evoke 3 major etiologies: Ethylism, vitamin B12 deficiency, myelodysplastic syndrome

Regenerative anemia with reticulocytes < 150 G/L reflects periperic involvement

Viral infections do not usually result in neutrophil polynucleosis apart from superinfection

Myelemia is the passage into the blood of immature forms of the granular line of the spinal cord


Blood erythroblastosis (erythroblastemia) corresponds to the passage into the blood of erythroblasts

Erythromyelemia is the combination of myelemia and blood erythroblastosis

The two main etiologies of eosinophilia are parasitic and allergic etiologies

True hyperlymphocytosis is defined as an increase in the absolute number of blood lymphocytes


Which of the following are causes of false anemia?


Which of the following are healthcare professionals?


Which of the following are enzyme inhibitors?


Which of the following are enzyme inducers?


How long does it take to affirm a couple's infertility?

A couple is considered infertile in the absence of pregnancy after 1 year of unprotected sex


How many couples in France consult for pregnancy?

In France, one in seven couples (14%) consult for children


The term sterility can only be used if the situation of infertility is definitive

A bilaterally castrated person is sterile

A postmenopausal woman is said to be infertile

A postmenopausal woman is said to be sterile, the term infertility is reserved for couples

The fecundability of the woman per cycle is about 75% per exposure cycle.

At best, fecundability is 25% per cycle.

Fertility is a term defined in the context of a couple.


Regarding the epidemiology of the origin of infertility:

1/3 female, 1/3 male and 1/3 of shared origin

It is of male origin in about 33% of cases


The frequency of reporting needs to be addressed

In particular, whether they are regular or episodic

Gynecological history will need to be clarified

Pelvic pain in women may suggest endometriosis

It is not important to look for a possible history of abortion, especially in the presence of the husband

This is not at all useless since there can be consequences. On the other hand, it will obviously be necessary to discuss it alone with the patient, at first.

Libido disorders cannot impact fertility

Libido disorders can decrease the frequency of sexual intercourse


Regarding first-line hormonal exploration in women:

In case of irregularity of the cycle, the dose is mainly LH

The first attempt is to clarify the origin of the irregularity

In case of irregularity of the cycle, the FSG is mainly dosed

Estradiol (E4), LH, FSH and prolactin are dosed

Indeed we dose LH, FSH and Prolactin. It is not estradiol E4 but estradiol E2!

The objective in case of regular cycle and to determine their ovulatory character (or not)

If the cycles are regular, we try to clarify their character
ovulatory by plasma progesterone assay, on Day 22-Day 23 of the cycle

Not systematic but depending on the clinic


It is a very informative examination in humans

It should be done after 1 week of abstinence

Below we talk about hypospermia and above we talk about hyperspermia

Mobility of less than 30% defines asthenospermia

Necrospermia is defined by a rate <58% of living forms


COPD is a common disease, causing morbidity, mortality and high health costs

COPD is defined by the presence of chronic respiratory symptoms and permanent bronchial restriction

It is defined as the presence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging lower respiratory infections) and permanent bronchial obstruction: there is an obstructive ventilatory disorder (defined by a FEV1/FVC ratio<0.70) that persists after taking bronchodilators

Occupational exposures may also be involved

The main symptom is dyspnea but it is late often underestimated


The main differential diagnoses are asthma and bronchial dilatations

Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement in the absence of any medication

Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement after bronchodilator

pulmonary rehabilitation is an integral part of treatment

COPD is a chronic respiratory disease defined by the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging) and reversible obstruction

Frequent chronic respiratory disease, defined as the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnoea, repeated or dragging) and permanent and progressive airway obstruction = obstructive ventilatory disorder (OVD) not completely reversible

Obstructive ventilatory disorder (OSVD) is defined as a FEV1/FVC ratio < 0.7 (or < 70%)


Chronic bronchitis is a daily or near-daily productive cough lasting at least 3 months a year and for at least two consecutive years

− Asthma should be evoked when there is a very significant reversibility of bronchial obstruction (increase in FEV1 of more than 400 ml),

− The "frequent exacerbator" phenotype is an element in assessing the severity of COPD

The severity of exacerbations: 1 exacerbation / year requiring hospitalization is an element of poor prognosis


COPD is a major health problem affecting 5-10% of the population over 45 years old

Worldwide, COPD is on the rise and is expected to be the 3rd or 4th leading cause of death by 2030

Exposure to occupational air contaminants is implicated as a risk factor for COPD

Alpha-1 antitrypsin deficiency is the only identified genetic risk factor for COPD


The severity of TVO assessed by VEMS post BD makes this simple measure an important prognostic factor

Parameters such as dyspnoea intensity and undernutrition are also strongly predictive of COPD-related mortality.

Spirometry allows the diagnosis of certainty, helps in differential diagnosis with asthma, evaluates severity, participates in therapeutic choices

Obstructive TV rises after BD administration

This TVO persists after BD administration. He gets up in case of asthma:)

The severity of bronchial obstruction varies depending on the value of post-BD FEV1


reversibility is studied by performing a 1st spirometry before the administration of fast-acting BD and a 2nd spirometry 10 minutes after

The measurement of carbon monoxide transfer capacity (which reflects the available gas exchange surface) makes it possible to evaluate alveolar destruction

Any value of DLCO (or OBT) < 50% of the predicted value is considered pathological

Any value of DLCO (or OBT) < 70% of the predicted value is considered pathological

Chest X-ray has no interest in the positive diagnosis of COPD

Chest X-ray may suggest associated heart disease


Regarding the generalities of facial dermatoses:

Acne is a chronic inflammatory dermatosis of the pilosebaceous follicle

Sebum secretion is triggered and maintained mainly by dihydrotestosterone

Circulating androgens are often increased in acne

Circulating androgens are present at normal levels and acne results only from a particular sensitivity of androgen receptors present on sebocytes and keratinocytes (peripheral hyperandrogenism)

The formation of comedo is due to hyperproliferation of keratinocytes of the pilosebaceous follicle

The anaerobic flora of the sebaceous follicles is dominated by a gram-positive bacterium Propionibacterium acnes


Acne is not an infectious disease but an inflammatory disease of the pilosebaceous follicle

Seborrhea is an abnormally thin aspect of the skin

Acne mainly affects areas low in sebaceous glands such as the face and back

Affects areas rich in sebaceous glands: central part of the face (nose, forehead, chin, cheeks) and upper thoracic region (neck, back and anterior surface of the chest)

Ironed comedones are small papules of 2 to 3 mm of normal skin color


Closed comedones correspond to "blackheads"

Open comedones correspond to the accumulation of oxidized keratinocytes within the dilated orifice of the infudibular duct

Open comedones are on the order of a centimeter

These are infracentimetric lesions, between 1 and 3 mm

The natural course of open comedones is inflammation in any case

can spontaneously expel or become inflamed

Inflammatory papules progress to resorption or pustule formation


Pustules are usually derived from papules

The contents of pustules are inflammatory by accumulation of lymphocytes

Nodules larger than 10mm reaching the dermis

The nodules are of the order of a centimeter and reach the dermis


Regarding the different clinical forms of acne:

Juvenile combination acne is the most common form of acne

Juvenile mixed acne occurs in late adolescence

Exogenous acne has a predominance of open comedones

Acne in adult women appears after about 25 years

Adult female acne concerns women who did not have acne during adolescence only

Most of the time, juvenile acne extending into adulthood


Which of the following is true for acute inflammatory polyradiculoneuritis?

The lesions affect the motor neurons of the precentral cortex

Root of nerves and their nerve trunks downstream


Cytomegalovirus infection may precede Guillain-Barré syndrome

Epstein-Barr virus infection often causes an axonal form of GBS

Campylobacter jejuni often causes an AMAN-like demyelinating form of GBS

The lesions affect in particular the roots of the nerves


Regarding Guillain-Barré syndromes (GBS):

They evolve in 8 phases more or less long (about 1 year in total)

3 phases: extension, plateau, recovery. The duration of each of these phases varies

The diagnosis is confirmed by MRI and biopsy

Acute axonal motor neuropathies are pure motor

Acute motor axonal neuropathies (AMAN) are at risk of intubation


Regarding the extension phase of Guillain-Barré syndrome:

True for the sensory form, but false for the motor form

The motor impairment is unilateral and not very severe most often

Relatively symmetrical, extensive and severe, it predominates proximal and then affects the extremities

Motor involvement begins in the extremities and then goes up

First proximal and then affects the extremities

1-5% of patients should be on assisted ventilation


Regarding the plateau phase of Guillain-Barré Syndrome:

One hundredth of patients require respiratory support

Tendon reflexia in deficit territories fades rapidly

It persists throughout the plateau phase

It can last up to several months in some cases. It's very variable


Which of the following propositions about Miller-Fischer syndrome are true?

There is a progressive fatigability throughout the day


Nausea is a painless disagrable subjective sensation originating from the upper digestive tract.

Differential BDiagnostics • Regurgitation: passive rise of gastric contents Regurgy

• Merycism or rumination: are involuntary rises in the mouth of recently ingested food that is then swallowed again after chewing

Upper GI endoscopy is necessary to confirm the diagnosis and, if necessary, to perform hemostasis; Rupture of the oesin case of Mallory-Weiss syndrome


Chronic vomiting is vomiting that lasts more than 7 days

Drug use may be accompanied by vomiting (cannabis), as well as withdrawal syndrome (heroin)

The evaluation of the metabolic impact of vomiting is systematic

Vomiting should be sought for pregnancy, adrenal insufficiency and intracranial hypertension

Vomiting related to chemotherapy can be treated with antihistamines

Chemotherapy-related vomiting can be treated on a case-by-case basis by:


Which of the following proposals is expected in case of pyloric stenosis?


Which of the following are ultrasound signs in favor of pyloric stenosis?

True. The signs are: "roundel" appearance, thickening of the muscle ≥ 4 mm, lengthening of the pyloric canal and gastric stasis (College of Pediatrics, 2021)


All sexual disorders are of the order of psychiatric pathology

They may be related to non-psychiatric pathologies or psychological disorders

Hypersexuality is considered addictive behavior

Sexual health is a state of physical, mental and social well-being in the field of sexuality

'Normal' sexuality requires a positive and respectful approach to sexuality and sexual relationships


The excitation phase is characterized in men by the establishment of erection

The sexual relationship is preceded by a phase of sexual desire consisting of sexual and erotic thoughts or imaginative fantasies.

The orgasm phase consists of several successive phases in men

In men, orgasm and ejaculation usually coincide

Vaginal or clitoral stimulation is the same

The vaginal or clitoral difference corresponds to different stimulation modalities, but is underpinned by the same anatomophysiological entity (glans or pillars of the clitoris)


Notions of deviance, normality of sexual performance, and behavioral role identity can vary across cultures and times.

The interview is a fundamental moment in the assessment of a sexual complaint

The interview must look for all history of psychiatric disorders

Nocturnal penile plethysmography and cavernography (venous leakage, Peyronie) are almost no longer used in common practice.

Sexual conduct disorders are classically distinguished into six pathophysiological categories

3: sexual dysfunction, paraphilic disorders, and hypersexuality


Sexual dysfunctions often correspond to one of the phases of sexual intercourse (desire, arousal, or orgasm)

Sexual pain is not a real sexual dysfunction

Sexual pain is part of sexual dysfunction

A fairly high proportion of men and women in the general population suffer from sexual dysfunction (5-35% depending on type and sex)

Comorbid psychiatric disorders have little impact on sexual dysfunction and should not be considered in etiological research

A comorbid psychiatric disorder is found in 30% of cases – depressive or anxiety disorder, addictive disorder, anorexia nervosa, etc.

Non-psychiatric differential diagnoses are to be systematically sought by a systematic clinical examination


Exhibitionism is the act of being excited to show one's body to one's partner(s)

It is sexual arousal caused by exposing one's body to strangers in public places.

Exhibitionism is the act of being sexually aroused by objects

Exhibitionism is being sexually aroused by showing one's body to strangers in public places.

Fetishism is being sexually aroused by humiliating others

Fetishism is sexual arousal caused by visual and/or physical contact with a specific object, body part or situation.

Pathological if it meets the 4 criteria of the DSM


Which of these proposals can promote sexual conduct disorder?

Any history of psychiatric disorder can promote sexual conduct disorder


In any case, it is not mentioned in the colleges

Rather, it is hyperprolactinemia, which may be responsible for secondary amenorrhea or erectile dysfunction.


What propositions are part of classic sexual behavior in both sexes?

Desire -> Arousal -> Plateau -> Orgasm -> Resolution -> Refractory period (in men only)

The orgasm phase, which always corresponds to ejaculation in men


What is the neurotransmitter most involved in the refractory period?

These are endorphins. Researchers believe that serotonin curbs arousal and desire

College does not report GABA role in sexuality


What is the neurotransmitter that curbs arousal and desire?

Researchers believe that serotonin curbs arousal and desire

Endorphins are involved in the refractory phase mainly


Which of these proposals can cause hypersexuality?

However, some dopamingergic agonists used in the treatment of Parkinson's disease can cause hypersexuality.

Frontal and temporal syndromes can cause hypersexuality. But not occipital syndrome.


In symptomatic radiculalgia, the pain is:

Awakening in the second part of the night


Which of these proposals refer to mechanical pain?

Or positional awakening in the first part of the night


Which muscles are affected by a C5 deficiency?

The biceps is innervated by C5 and C6, like the deltoide


The anterior surface of the arm is innervated by C6

Outer side of the forearm is innervated by C7

By C6, which innervates the front of the arm, the outer surface of the forearm and the thumb

The brachial plexus is notably composed of C7 and C8

The roots of the brachial plexus are mostly sensitive


C7 = the 3 medial fingers, especially the middle finger


The posterior side of the arm and forearm is innervated by C7

The three middle fingers (especially the middle finger) are innervated by C8

By C7, which also innervates the posterior surface of the arm and forearm (the root arrives from the back)

C8 innervates the lateral side of the arm and forearm

Medial side of the arm and forearm, as well as the 4th and 5th fingers

The Deltoid allows the abduction of the arm


The Brachial allows the flexion of the elbow

The Triceps brachial allows the extension of the hand

Elbow extension since it is a muscle of the arm (and not the forearm)

Interosseous muscles are innervated by C8

The Bicipital reflex is only dependent on C6


Regarding sensory territories and reflexes:

The Cubito-pronator reflex is dependent on C7

The front of the thigh is innervated by S1

Anterior surface of the thigh = L3. Posterior side of the thigh = S1

The medial side of the knee is innervated by L3


Regarding the sensory territories of the leg:

The anterior side of the knee is innervated by L4

The anteromedial side of the leg is innervated by L3

L3 stops at the medial surface of the knee after passing through the anterior surface of the thigh. It is L4 that innervates the anteromedial surface of the knee

The posterior side of the thigh is innervated by L2

The lateral side of the leg is innervated by S1

It's L5. S1 innervates the posterior side of the leg


Regarding the sensory territories of the leg and the patellar reflex:

The back of the foot and the big toe are innervated by L5

The posterior side of the thigh is innervated by L4

The posterior side of the leg is innervated by S1

The sole of the foot and the 5th toe are innervated by L4

The Patellar reflex is dependent on the root L3


Regarding the bases of risks related to the consumption of water or food:

Encapsulated commercial water bottles do not normally contain bacteria, viruses or parasites

Transmission of intestinal infections through food is impossible

Swimming is not a vector of transmission until you drink the water

During swimming (in swimming pools, fresh water or at sea), contact with dirty water is a vector of transmission

Human-to-human transmission can be reduced by simple hygiene measures

Food can be vectors of toxins responsible for digestive tables generally brief and benign


Certain foods are responsible for poisoning

Any TIAC must be declared to the departmental health authority

Only the physician must make the mandatory declaration of TIAC

This declaration is also mandatory for the person in charge of the premises where the patients are located.

Mandatory reporting is unnecessary from a health point of view, its only function being administrative

It is this that makes it possible to decide, if necessary, on an epidemiological inquiry

The main causes of TIAC reported in France are Escherichia Coli

These are, in order of frequency, salmonella (70% of TIAC), Clostridium perfringens and Staphylococcus aureus


Gout is intermittent inflammatory rheumatism, in countries with high GDP, the most prevalent

Chronic arthropathies are due to dysregulation of renal purification

This is due to intra-articular and bony tophus

The diagnosis of gout is made by the detection of strongly birefringent tapered microcrystals in the joint fluid

It is a polygenic disease with several predisposing genes

The usual terrain is the young vegan woman

The middle-aged man with too much calorie diet and too much animal protein


The symptomatological peak is reached in about 31 days

There is swelling and local redness, a sign of inflammation

The most frequent localization is the first metatarsophalangeal

The resolution of the crisis necessarily requires drug treatment associated with good hydration

Resolution is spontaneous but can be shortened by NSAIDs

Any patient who has uricemia greater than 60 mg/L is at risk of gout