The patient received maintenance therapy with 5 amino-salicylate suppository for 18 months. A few months later, after a period during which he was asymptomatic without treatment, he reported the presence of blood accompanying the stool for 15 days, without abdominal pain. What data do you seek, during the interrogation, in favor of a hemorrhoidal pathology at the origin of bleeding? (one or more expected answers)

Presence of pain per and post defecatory

Presence of spontaneous anal discharge containing traces of blood


Context: A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol

A colonoscopy is therefore performed and shows cicatricial proctitis and congestive hemorrhoids without procidence in the lumen of the anal canal. What support do you envisage? (one or more expected answers)

Short course of nonsteroidal anti-inflammatory drugs

Surgical consultation to consider hemorrhoidectomy


The symptomatology improved after a few days of treatment with lubricating suppositories and mucilage-based laxatives. During the follow-up, you carry out an assessment that objective: Hemoglobin: 14 g / dL / VGM: 85 fL / Leukocytes: 8.5 G / L / Polynuclear neutrophils: 5.3 G / L / Lymphocytes: 2.8 g / L / CRP: 6 mg / L / Ferritinemia: 80 μg / L (N: 50 -200 μg / L) / AST: 52 IU (N<35). What do you suspect?


You suspect primary sclerosing cholangitis. What diagnostic tests do you perform as a first-line treatment? (one or more expected answers)


Bili-MRI and ultrasound show a succession of dilatations and strictures of the bile duct, which suggests primitive sclerosing cholangitis. The patient is lost to follow-up and consults the emergency room 5 years later for jaundice associated with chills. Its vital parameters are: PA 130/80 mmHg, FC92/min, temperature 38.7°C.  There is no marbling. The biological assessment shows:Leukocytes 14 G/LPolynuclear neutrophils 11.3 G/LLymphocytes 2.6 G/LCRP: 98 mg/LASAT: 356 IU (N<35)


Hepatobiliary ultrasound shows dilation of the intra- and extra-hepatic bile ducts upstream of stenosis of the main bile duct. What support do you offer? (one or more expected answers)


In this patient, which antibiotics are essential in the first line? (one or more expected answers)


You choose antibiotic therapy with cefotaxime and intravenous metronidazole. Which of the bacteria potentially involved in this infection is naturally resistant to the selected antibiotic therapy? (only one answer expected)


In addition to antibiotic therapy, with a view to stenting, the patient benefits from endoscopic retrograde cholangiopancreatography. The latter shows biliary stenosis with dilation of the bile ducts upstream. What are the following structures? (one or more expected answers)

4 corresponds to an intrahepatic bile duct


Context: You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.

As part of its follow-up, you request a blood count that shows: red blood cells 3.1 T/L, hemoglobin 105 g/L, MCV 105 fl, MCHC 32 g/dl, leukocytes 4.8 G/L, neutrophils 2.8 G/L, eosinophilic polynuclear 0.2 G/L, lymphocytes 1.4 G/L, monocytes 0.4 G/L, platelets 152 G/L.


The assessment you had done shows reticulocytes at 2.5%. Which exams do you think are relevant? (one or more possible answers)


The assessment carried out shows a normal TSH, the creatinine clearance evaluated on serum creatinine is normal and dosages of vitamins B9 and B12 within normal limits. You write her a letter for a hematologist, whom she does not decide to consult until 6 months later. The NFS made on the day of the consultation shows: red blood cells 2.1 T/L, hemoglobin 79 g/L, MCV 110 fl, MCDC 34.3 g/dl, reticulocytes 33 G/L, leukocytes 3.9 G/L, neutrophils 1.7 G/L, eosinophils 0.2 G/L, lymphocytes 1.4 G/L, monocytes 0.6 G/L, platelets 112 G/L. On reading the blood smear, lecytologist notes signs of dysgranulopoiesis but no blast. What are the reasons for diagnosing myelodysplasia? (one or more possible answers)


Which exams do you think are indicated at this stage? (one or more possible answers)


The myelogram shows a rich marrow with granular line 40%, of which 8% blasts, erythroblastic line 45%, lymphocytes 10%, monocytes 5%. Megakaryocytes are numerous. There are signs of dyserythropoiesis, dysgranulopoiesis, and dysmegakaryopoiesis. What diagnoses do you mention? (one or more correct answers)


It is therefore a refractory anemia with excess blasts type 1.At first, you decide to transfuse the patient. She was never transfused and did not become pregnant. What needs to be done? (one or more possible answers)

the determination of the ABO Rhesus group must be carried out on two different samples

compatibility must be determined twice on the same sample

a search for irregular agglutinins is justified

the determination of the ABO group is sufficient for globular concentrates

the patient must receive irradiated red blood cells


You propose to your patient to participate in a clinical trial testing a hypomethylating agent, an investigational drug that does not have the MA. About the patient's consent, what propositions are true? (one or more possible answers)

consent to participate in the trial may be given orally

consent must be signed by the patient and physician

consent must be signed without constraint and preceded by informed information

the information given to the patient before the possible signing of the consent can be given to him without the presence of a third party

Free and informed consent commits the patient to participate in the trial until its completion


The hypomethylating investigational medicinal product has already been tested in phase I and its dose and pharmacokinetics have been determined. The trial you are proposing to your patient is a phase II trial. Which propositions are true? (one or more possible answers)

a phase II trial may include randomization

a phase II trial evaluates the effectiveness of a drug

a phase II trial must conventionally, if successful, be followed by a phase III trial to obtain a marketing authorization

phase II trials can test drug combinations

patients in phase II trials are generally advanced/refractory


The patient agrees to the clinical trial. It is warned of the risk of worsening cytopenias induced by the proposed treatment. What types of infections does severe neutropenia expose the patient to? (one or more possible answers)


During this treatment exposing to a risk of thrombocytopenia, what semiological elements would suggest a risk of serious bleeding? (one or more possible answers)


She receives 6 monthly cures quite well tolerated but she remains cytopenic. She is rehospitalized one week before her 7th cure for alteration of the general condition with dyspnea of recent installation. The CBC shows hemoglobin at 65 g/L, leukocytes at 98 G/L with 80% myeloid blasts and platelets at 15 G/L. The patient was admitted to the emergency department and transfused overnight. The next morning, she is very dyspneic. What are the two most likely diagnostic hypotheses to explain this dyspnea?

pulmonary edema post-transfusion lesional


The diagnosis finally retained is that of pulmonary edema of overload and dyspnea regresses rapidly under diuretic treatment. The patient is transferred to haematology for the management of her transformation into acute leukaemia. A hemostasis assessment shows: TP 30%, TCA patient/control ratio 1.8, fibrinogen 0.7 g / l. D-dimer is at 9000 ng/ml.How do you interpret this hemostasis assessment in this context? (one or more possible answers)


The diagnosis of DICD is mentioned, so the patient leaves the clinical trial. A cytoreductive treatment is started to try to reduce blast proliferation. The patient becomes oliguric and serum creatinine doubles in 24 hours. Which diagnosis do you think is most likely?


A tumor lysis syndrome is evoked, what biological argument(s) would be in favor of this diagnosis? (one or more possible answers)


Context: A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.

Express in pack-years the smoking consumption of this man (only one answer expected)


With the elements you have, what hypothesis(s) diagnosis (s) do you retain?


What element(s) would be important to define the antibiotic therapeutic strategy?


During a new interrogation, the patient reports dyspnea of effort for a few months. Which of the following antibiotics are indicated at this stage?


His condition improved after 7 days of amoxicillin. What do you foresee in the course of this episode?


The patient is not seen again at the end of the episode. Six months after this first visit, he became unwell at home and was referred by his entourage to the emergency department. On clinical examination, the pulse is at 110 bpm, the temperature at 38.5 ° C, the blood pressure at 120/70mmHg, the respiratory rate at 32 cycles / min with a saturation in ambient air of 91% initially. You mention pneumonia. Which clinical sign(s) would be in favor of this hypothesis?


You have heard a focus of apical crackling upright. What is your assessment? (one or more correct answers)


The chest X-ray is as follows: What is your interpretation?


What biological assessment do you prescribe?

Cytobacteriological examination of sputum


The laboratory assessment shows a biological inflammatory syndrome (CRP at 275 mg / L) with hyperleukocytosis. Biological kidney function is normal. Arterial lagazometrics is as follows: pH 7.48, PaO2 66 mmHg, PaCO 2 34 mmHg, HCO 3- 27 mmol / L.Regarding the cytobacteriological examination of sputum, which parameter(s) will encourage you to consider this examination as quality and reliable?

Number of polynuclear units less than 25 per field

Number of bacterial colonies at 10 3 per m L

Number of epithelial cells less than 10 per field


Under 1 L/min of nasal oxygen, saturation rises to 94% and respiratory rate drops to 22/min. What is your attitude towards this patient? (one or more correct answers)

Hospitalization in the medical department


A chest CT scan has been requested by your colleague on duty who also introduces treatment with amoxicillin-clavulanic acid. What is your interpretation of the image?


Two blood cultures are gram-positive diplococcus. Which antibiotic therapy(s) do you think are the most suitable at present?


Your patient's condition improves after 7 days of amoxicillin. As he goes home, he tells you that he worked for 30 years in insulation until his retirement, and handled a lot of asbestos. What pathology(s) can be related to this exposure to asbestos?


An objective control CT scan of bilateral non-calcified pleural plaques that had not been seen on the previous CT scan. Pleural plaques in a context of exposure to asbestos are the subject of an occupational disease table with a treatment period of 40 years. Can the patient claim recognition as an occupational disease?

Yes because of the principle of presumption of origin

Yes because it does not exceed the support time


Context: A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166/80 mmHg in the right arm and 162/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol / L, K 3.6 mmol / L, serum creatinine 70 µmol / L, total cholesterol 1.76 g / L, triglycerides 1.3 g / L, HDL-C 0.55 g / L, LDL-C 0.95 g / L.

What is (are) the semeiological data(s) to be specified at the interrogation that would direct you towards the diagnosis of arteriopathy obliterans of the lower limbs?

the occurrence of this pain when walking

The characteristics of this pain type of electric shocks s

the disappearance of pain at elevation of the lower limbs

the later onset of pain when walking on hills than when walking on flat ground

the onset of pain for a constant walking distance on flat ground


In this patient, the pain occurs when walking, only in the lower right limb, for a fixed distance on flat ground that he estimates at 350 meters with a cramp type sitting at the calf. You notice the presence of a right iliac murmur and a murmur in the lower 1/3 of the left thigh. Femoral pulses are perceived on both the right and the left. The left popliteal pulse is very easily found it appears ample, the right popliteal pulse is not perceived. In distality you perceive only the left posterior tibial pulse and the left pedinous pulse. On these data you evoke the presence of an obliterating arterial disease of the lower limbs. Which arterial lesion(s) do you suspect based on these clinical data?


The clinical examination data led you to suspect the existence of right iliac stenosis, right femoral obliteration, left femoral stenosis and left popliteal aneurysm. What are the first two tests you need to order to confirm your diagnosis of peripheral arterial disease and to locate the arterial lesions you suspected?

a measurement of ankle systolic pressure indexes

arterial Doppler ultrasound of the lower limbs


The measurement of ankle pressure indexes confirmed the diagnosis of peripheral arterial disease obliterating the lower limbs (humeral systolic pressure at 166mmHg in the right arm and 162 mmHg in the left arm with systolic pressure in the right ankle at 114 mmHg: IPS at 0.69 on the right and systolic pressure in the left ankle at 132 mmHg:  IPS at 0.80 on the left). The Doppler ultrasound of the aorta and lower limbs shows: a normal aorta (antero-posterior diameter at 22 mm), a stenosis at 50% of the right external iliac artery, an obliteration of the right femoral artery with reinjection of the popliteal artery. The left femoral artery has a non-significant stenosis and the other arterial axes on the left are the site of diffuse atheromatous overload but without significant obstructive lesion. The left popliteal artery is not aneurysmal. The examination does not retain significant lesion of the leg arteries on the right or left. There is obliterating arterial disease of the lower extremities. What is the element that allows you to say that it is at the stage of exercise ischemia?

the value of the patient's estimated walking distance below the threshold of 500 meters

symptomatic character to intermittent claudication type

ankle systolic pressure greater than 50 mmHg

the value of the ankle pressure indexes less than 0.90


In this symptomatic patient at the claudication stage, additional examinations objectified ankle systolic pressures greater than 50 mmHg and SNPIs <0.90 confirming the diagnosis of peripheral arterial disease of the lower limbs at the stage of exercise ischemia. There is no aneurysmal lesion, there is 50% right iliac stenosis and right femoral obliteration. The assessment of vascular risk factors in this former smoker did not find diabetes. What therapeutic strategies are possible at this stage? (one or more expected answers)


The patient begins gait rehabilitation. He now receives atorvastatin, acetyl-salicylic acid, indapamide, fluoxetine and lercanidipine. He returned for consultation 3 months later. He performed a self-measurement cycle, the averaged values are 139/64 mmHgThe blood pressure is measured at 160/80 mmHg at the beginning of the consultation and then at 146/60 mmHg symmetrically 15 minutes later. At this stage, what type(s) of high blood pressure can be suspected in this patient?


A biological assessment carried out before this visit shows: Na 130 mmol / L, K 3.4 mmol / L, serum creatinine 75 μmol / L. LDL cholesterol is 0.90 g / L.Among the treatments taken by the patient, which drug (s) can (can) explain the abnormalities of the ionogram?


Regarding the management of high blood pressure, what change(s) do you make to this patient's prescription?


You replace indapamide with an ACE inhibitor. In addition, what other measure(s) do you propose to this patient?

the prescription of potassium supplementation

the decrease in beverages to 0.75 liters per day


What is the most suitable test to evaluate the effectiveness of antihypertensive treatment in this patient? (only one exact answer)

24-hour electrocardiographic recording (Holter)


What is (are) the expected benefit(s) of your care?


The patient is currently being treated with ACE inhibitor and calcium channel blocker for antihypertensive purposes. Self-measurement shows an average blood pressure of 158/72 mmHg.What are you looking for at the origin of this therapeutic ineffectiveness in this patient? (one or more correct answers)

fibromuscular dysplasia of the renal arteries

improper use of the blood pressure self-measuring device


Poor blood pressure control was linked to medication non-adherence. The patient received therapeutic education. During the first check-up visit to his general practitioner, the blood pressure self-measurement values are in the objectives. Biological abnormalities are normalized. You renew his treatment. What follow-up do you propose to this patient? (one or more correct answers)

a monthly consultation with the general practitioner

Blood pressure monitoring by self-measurement


Context: A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.

Here is the dermatological aspect of the patient. What semiological characteristics do you find on the 2 photos? (one or more correct answers)


From your semiological analysis and the history of this patient, which dermatological diagnosis seems to you to be the most likely? (only one response expected)


You remember the diagnosis of psoriasis. How do you assess the intensity, severity and impact of it? (one or more correct answers)

Genetic analysis for determination of susceptibility genes

dermatology life quality index (DLQI) score


You suspect the association with psoriatic arthritis. What semiological and anamnestic elements would be in favor of this association? (one or more correct answers)


The PASI score is 22 (severe form) and the DLQI shows a profound alteration in the quality of life of this patient. At this stage, psoriatic arthritis is not confirmed. Blood ionogram, kidney function and liver function are normal. What are the treatment options available as a first-line treatment? (one or more correct answers)

Local treatment with betamethasone and calcipotriol


The patient living in a rural area far from a phototherapy center, he asks you for an effective treatment because he is very affected by the extension of his dermatosis which confines him to his home. Which treatment do you prefer for this patient? (only one answer expected)


The patient's hypertension makes you prefer methotrexate to ciclosporin. You start treatment with 17.5 mg methotrexate weekly. You see the patient again after 3 months, the PASI score (Psoriasis Area and Severity Index) is 15, the heel pain is less intense but the patient still has hip pain for which he regularly takes NSAIDs. You are considering the use of biotherapy. What elements are part of your pre-therapeutic assessment? (one or more correct answers)


What three biotherapies are you considering for this patient?


You have chosen to introduce an anti-IL17 biotherapy.What other elements should be considered in the management of psoriasis? (one or more correct answers)


You see the patient again 1 year later, he followed your advice, lost 5 kgs. Psoriasis was greatly improved by an anti IL-17. As the prescription has not been renewed, the patient has not received any treatment for 4 months. He complains of persistent pain in his right foot (see photo). What diagnosis do you envisage for the involvement of the right big toe? (only one answer expected)


What test do you request in first line to confirm the diagnosis of onycho-pachydermo-periostitis? (only one answer expected)


The X-ray of the feet confirms your hypothesis. In association with the resumption of anti-IL-17, you have infiltrated cortisonic derivatives and prescribed non-steroidal anti-inflammatory drugs on demand. During a biological assessment to monitor the treatment, you find a high ferritinemia greater than 600 ng/ml (N: 30-300). What is the most likely cause? (only one answer expected)


You consider that the metabolic syndrome that this patient presents is the most likely cause of this hyperferritinemia. What therapeutic measure(s) do you propose in the context of this patient?

Replacement of glibenclamide with metformin

Limiting daily dietary intake of iron to less than 5 mg/d


Context: A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.

For this patient, what information available makes you suspect sleep apnea syndrome? (one or more correct answers)


You perform a nocturnal polygraph that targets a hypopnea apnea index of 55/h and confirms severe obstructive sleep apnea syndrome. What treatments do you offer as a first-line treatment? (one or more correct answers)


As part of his profession as a bus driver, what measures do you recommend? (one or more correct answers)

A work stoppage at the beginning of the care

A wakefulness maintenance test after 1 month of well-conducted treatment

Information about his sleep apnea from his employer


Despite the appropriate and effective management of sleep apnea syndrome for several months, your patient's wife sees no improvement in their sex life. What clinical elements would point to the existence of hypogonadism in this patient? (one or more correct answers)


Testicular palpation reveals small testicles, he has gynecomastia and states that he does not have a morning erection. You strongly suspect acquired male hypogonadism. Which biological examination, for diagnostic purposes, is the most relevant at this stage? (only one answer expected)


You prescribe a total testosterone assay performed one morning on an empty stomach whose result is: 1.2 ng / mL (N: 4-10). What are the two tests that you must imperatively prescribe to advance in your diagnostic process?


Here are the results of this assessment: LH 3.3 IU/L ( N: 2.1 - 6.3); prolactin 54 μg/L (N < 20). At this stage, what is the most relevant imaging test? (only one answer expected)

MRI of the hypothalamic-pituitary region


You request an MRI of the hypothalamic-pituitary region, a section of which is shown below. Which of the following are true? (one or more correct answers)


Among the elements at your disposal, which can guide you towards the diagnosis of acromegaly in this patient? (one or more correct answers)


You recover the IGF1 test that you requested as part of the pituitary assessment. It returns moderately increased for the age of the patient. In order to establish your diagnosis of acromegaly, you perform oral induced hyperglycemia (OPGH) with 75 grams of glucose whose results are as follows:

Changes in GH testing during OPGH are sufficient to confirm the diagnosis of acromegaly

Concomitant testing of IGF1 and GH is necessary to diagnose acromegaly

Diagnosis of acromegaly is based on concomitant blood glucose and GH testing during OPGH

Concomitant insulin and GH testing is necessary to diagnose acromegaly

The concomitant discovery of diabetes mellitus prevents the interpretation of the GH assay


You have been diagnosed with acromegaly and diabetes mellitus. He was cared for and considered cured of his acromegaly. His diabetes persists. Among the following biological results, what would be the two elements expected in the context of type 2 diabetes of recent discovery?

Triglycerides at 2.40 g/L (N: 0.6 - 1.6)

AST at 85 IU/L (N < 35) and ALT at 35 IU/L (N < 40)


Metformin was introduced about one year after diagnosis. HbA1c is now at 7.3%, with late morning blood glucose levels at 2.30 g/L. His current BMI is 28.5 kg/m 2.Which of the following treatment options do you think is the most relevant?

Adding a rapid-acting insulin injection before breakfast

This question was a single answer, as indicated in the statement

Adding a slow insulin injection at bedtime


His treatment was intensified by the addition of sitagliptin. Which of the following elements from his medical history constitute an issue in order to validate or not his fitness to drive buses?


He complains of edema of the lower limbs which he attributes to amlodipine. He wants to stop this treatment. What therapeutic classes can be indicated for him in first line? (one or more correct answers)


Context: A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8/10. Physical examination objective generalized abdominal contracture.

What measures do you take in the emergency room, when the patient is admitted? (one or more correct answers)


Regarding the abdominal contracture of this patient, what are the exact proposals? (one or more correct answers)

It may be related to significant desydratation

it is voluntary, in reaction to abdominal palpation


What diagnoses do you mention at this stage? (one or more correct answers)


What biological tests do you prescribe urgently? (one or more correct answers)

blood type and search for irregular agglutinins


What additional examination do you request to establish your etiological diagnosis? (only one answer expected)

X-ray of the abdomen without preparation


Here are some scannographic sections:What are the exact proposals? (one or more correct answers)

it is an abdominopelvic scan in axial section (transverse)

the number 2 corresponds to an effusion in Douglas' cul de sac

The number 3 corresponds to an appendicular stercolith

The right kidney is visible in one of these pictures


About this scannographic section:What are the exact proposals? (one or more correct answers)

the number 4 corresponds to the left kidney

The number 5 corresponds to a fluid effusion


About digestive vascular anatomy, what are the exact answers? (one or more correct answers)

the celiac trunk gives rise to the left gastric artery, the common hepatic artery and the splenic artery

the Riolan arch is an anastomosis between the upper and lower mesenteric territory

The appendix is vascularized by an arterial branch from the superior mesenteric artery

the right colon is vascularized by the inferior mesenteric artery

The inferior mesenteric vein drains into the inferior vena cava


You are diagnosed with acute generalized peritonitis of appendicular origin. What are the main principles of management of this pathology? (one or more correct answers)

The surgery may be postponed for a few hours under the guise of antibiotic therapy

At this stage, intravenous broad-spectrum antibiotic therapy should be prescribed.

A peritoneal toilet with saline will be systematically performed

An appendectomy and resection of the cecum more or less extensive to the ascending colon must be performed

The appendix is systematically sent to the Anatomical Pathology Laboratory


The patient receives an emergency appendectomy with peritoneal toilet. She has a postoperative antibiotic therapy for 5 days paramoxicillin-clavulanic acid, adapted to the identification of a multisensitive Escherichia coli isolated in samples taken intraoperatively. The postoperative follow-up is simple. Discharge is allowed on the 6th postoperative day. The patient is urgently readmitted 48 hours later for hyperthermia at 38.5 ° C associated with abdominal pain. The digital rectal examination objective a painful pelvic mass. What is the most likely diagnosis? (only one answer expected)


The patient quickly benefits from an abdominopelvic CT scan confirming the diagnosis of abscesses at the pelvic level, measured at 6 cm. (one or more correct answers)

there is no need to hospitalize the patient

drainage is required to drain the abscess

a bacteriological sample of the contents of the abscess must be taken

Percutaneous radio-guided drainage is possible

Antibiotic therapy with amoxicillin-clavulanic acid should be resumed


The patient is hospitalized. The abscess is drained under CT control. Antibiotic therapy is adapted to bacteriological samples taken during drainage. There is no need to reoperate the patient. Six months later, she consults for the appearance of an umbilical swelling, appeared at the level of an incision scar. What signs point to uncomplicated eventration? (one or more correct answers)


The patient asks you about this eventration, what can you tell her? (one or more correct answers)

The risk of strangulation increases with the size of the collar

An intervention can be scheduled to close the parietal defect

ventration may increase in size over time

An intervention prevents the risk of strangulation


The patient prefers not to consider intervention. Five years later, she was referred to the emergency room for a sudden abdominal pain syndrome, associated with vomiting and stopping gas. On clinical examination, the abdomen is weathered, sensitive as a whole. The umbilical ventration has increased in volume, it is reducible. What is the most likely diagnosis? (only one answer expected)

Recurrent peritonitis on appendicular stump release


The patient is operated urgently for a flange occlusion. It is not necessary to do digestive resection and the postoperative follow-up is simple. What information can you give to the patient post-operatively? (one or more correct answers)

A new occlusion is no longer to be feared because the flange has been severed

Eventration can still occur on the scars of this procedure

Low molecular weight heparin at a prophylactic dose is indicated postoperatively

Rapid resumption of oral feeding is possible with a residue-free diet during the 20 post-operative days

The resumption of transit is favored by the rapid resumption of physical activity


Context: You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.

With the elements of pulmonary auscultation that you have, what are the two most likely diagnostic hypotheses?

chronic obstructive pulmonary disease (COPD)


In the context of this chronic dyspnea, which additional examination(s) do you request in first line?

Chest CT angiography with pulmonary arterial time


CBC is normal. The chest x-ray requested is below.   As part of the assessment of this chronic dyspnea, you perform the following examination:

There is a disorder in the diffusion of carbon monoxide

there is reversibility of FEV1 after taking beta2 mimetics

The exam, to be interpretable, requires smoking cessation for at least two days.


You associate, in a second step, a plethysmography to the volume flow loop previously realized. What is (are) the additional information(s) provided by this review?

It makes it possible to measure non-mobilizable lung volumes

total lung capacity is significantly increased

the residual volume is significantly increased

You can say that there is no restrictive syndrome


In addition, to complete the EFRs, a carbon monoxide diffusion test (DLCO) was performed. It is 55% theoretical. Based on all the elements you now have available, what diagnosis(s) do you remember?


This patient therefore suffers from COPD. What therapeutic strategy(s) can you implement at this stage as background treatment?

home nebulizations of short-acting beta2 mimetics

inhaled treatment with a long-acting bronchodilator

inhaled therapy with a combination of two inhaled long-acting bronchodilators

inhaled therapy with a fixed combination of inhaled corticosteroid and long-acting beta2 mimetic

oral corticosteroids of 1 mg/kg for 15 days before new EFRs


Another essential step in its management is to consider quitting smoking as soon as possible. The patient seems motivated and asks you about nicotine substitutes. Regarding these nicotine substitutes, which is (are) the right answer(s)?

None of these nicotine substitutes are covered by health insurance

A cardiological assessment must be carried out prior to prescription

they have few side effects at recommended doses

their dosage must be adapted to the consumption of cigarettes

Only the cutaneous form by patch is effective


The patient also described during questioning daytime asthenia responsible for a lack of enthusiasm and drowsiness that she considered normal. You mention the possibility of sleep apnea syndrome. The patient does not know if she is snoring. What signs do you look for besides daytime sleepiness to get arguments in favor of diagnosing sleep apnea syndrome? Give the answer(s) right.


You decide to make a ventilatory polygraph recording of which you have attached an extract of its nocturnal trace. What is (are) the exact answer(s)?

This trace shows obstructive sleep apnea

This examination also includes an electroencephalogram

Oxygen saturation varies during this recording

This plot shows that the thoraco-abdominal movements are in phase opposition during the phases of cessation of nasal flow


After complete analysis of this recording, you were able to calculate a hypopnea apnea index greater than 60/h. Give the right answer.

the patient is not obese, so you do not remember the diagnosis of obstructive sleep apnea syndrome

you are considering the installation of a continuous positive airway pressure device

you are considering hygiene measures alone for three months before a new inspection

you are considering a diuretic test before a new control at one month

you prescribe low doses of benzodiazepines


She had recently benefited from a chest CT scan that she shows you. This confirms the predominant emphysema lesions at the top. This scanner also makes it possible to discover a nodule measured at 6 mm in its largest axis at the level of the lower left lobe (arrow). What are the criteria in favor of the benign nature of this nodule? Give the right answer(s)

the absence of calcification in its center


Regarding the management of this nodule, what will you propose? (one or more correct answers)

an interferon release test even in the absence of tuberculosis contagion


A follow-up by control scanner was carried out. This monitoring is reassuring without any evolution of the nodule. Two years after initial management, the patient uses her continuous positive airway pressure (CPAP) machine very regularly and has benefited greatly symptomatically. His dyspnea is improved by taking a long-acting beta2-mimetic. She still pursues a smoking of the order of 5 cigarettes / day. She has no other comorbidities and is not taking any other treatment. Its EFRs are stable. You lose sight of it. She comes back to see you in consultation four years later because for about 3 days she has a worsening of her respiratory symptoms with an increase in dyspnea and the appearance of dirty sputum while she had no sputum before. Pulmonary auscultation findbilateral ronchi. The respiratory rate is 12/min at rest. Air saturation is 96% at rest, there are no signs of respiratory distress. You prescribe appropriate antibiotic therapy. What other treatment(s) is (are) justified in the management of this COPD exacerbation?

home oxygen therapy to be re-evaluated in one month

oral corticosteroid therapy of 1 mg/kg per day for 15 days


It improves and returns to its basic state thanks to your treatment. In the following year she experienced at least two more similar episodes of COPD exacerbation. Her dyspnea is stage I of MRCD. To adapt his background treatment, what do you prescribe? Give the right answer(s)

inhaled therapy with a combination of two inhaled long-acting bronchodilators

inhaled therapy with a fixed combination of an inhaled corticosteroid and a long-acting beta2

inhaled therapy with a combination of two long-acting bronchodilators and an inhaled corticosteroid

oral corticosteroid therapy of 0.5 mg/kg for one month before new EFRs


You want the patient to undertake pulmonary rehabilitation. You have also prescribed inhaled treatment with a combination of an inhaled corticosteroid and a long-acting beta2-mimetic. What side effects are common with this type of inhaled treatment? Give the right answer(s)


The patient continued to smoke for another two years and eventually stopped. She is 75 years old. Unfortunately very gradually his respiratory condition worsened and dyspnea only progressed. She is now dyspneic for moderate efforts of daily life. She had not wanted to do pulmonary rehabilitation. She has not had a new exacerbation for at least a year. You produce arterial blood gases at rest: pH 7.40; PaO 2 54 mmHg; PaCO2 42 mmHg; bicarbonates 26 mmol / l.Blood gases made three weeks apart under the same conditions are identical. She always puts on her CPAP well. You have achieved a nocturnal saturation that shows a regular pattern but a low saturation of the order of 89% all night. What can you conclude from the data you have available? Give the correct answer(s).

It's too late to consider pulmonary rehabilitation

It will be necessary to make a blood gas while she sleeps

It will be necessary to replace CPAP with nocturnal oxygen therapy

The patient is on an indication for ambulation oxygen therapy only

The patient is undergoing long-term oxygen therapy


The patient is undergoing long-term oxygen therapy. This will be implemented alone during the day and associated with CPAP at night. Give the correct answer(s) regarding long-term oxygen therapy.

Its main purpose is to avoid the occurrence of right heart failure

it will impose the institutionalization of the patient given her age

it will be necessary to ensure, during its implementation, that PaCO 2 remains stable


Context: Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg / day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.

What can you conclude from these clinical elements? (one or more possible answers)

The clinical picture suggests polyarthritis

The interrogation of his wife can provide elements of etiological orientation

the clinical picture is compatible with a depressive syndrome

An associated weight loss should be sought


The weight in consultation is 68 kg. He announces a usual weight of 70 kg, relatively stable in recent years, and he has not recently changed his eating habits. It is 1.75 m tall. The body mass index (BMI) is 22.2 kg/m2. Which proposal(s) is (are) the exact proposal(s)?

his weight loss corresponds to the definition of voluntary weight loss

his BMI corresponds to a phenotypic criterion of undernutrition

the presence of tachycardia would constitute an element of orientation

the existence of associated diarrhoea is a discriminating element of interrogation


There is no mood sadness, or anything else in favor of a depressive syndrome. However, there has been a decrease in libido for several months. What question(s) should you ask to look for hypogonadism?


Mr. R. has erectile dysfunction, depilation, predominant in the lower limbs, as well as a diffuse brown coloration, especially of the face, neck, back of the hands, forearms, and oral mucosa. What biological abnormality(s) can be associated with the abnormal skin coloration observed in this patient?

low 8-hour cortisol level with high 8-hour plasma ACTH assay

increased 24-hour cortisoluria with low plasma ACTH assay

elevated transferrin saturation coefficient (TSC) with increased ferritin

Tricytopenia with increased erythropoietin


The examination reveals a firm hepatomegaly at 2 finger crossings. The spleen is not palpable. You do not notice jaundice or stellar angioma. There is no abdominal collateral venous circulation. Abdominal percussion does not show dullness declivated. There is no palpable lymphadenopathy. Mr. R. consumes 3 glasses of red wine at the evening meal. What interpretation(s) can you make of this clinical picture? (one or more possible answers)

absence of signs of portal hypertension excludes hepatic cirrhosis

absence of signs of hepatocellular insufficiency excludes hepatic cirrhosis

It is necessary to look for hepatojugular reflux

the patient's BMI points to metabolic syndrome

The patient's daily consumption of pure alcohol is 15 grams per day


The analyses show: ALT 105 IU/L (normal: 8-35), AST 55 IU/L (normal: 6-25), gamma-glutamyl-transpeptidase 60 IU/L (normal < 40), alkaline phosphatase 173 IU/L (normal: 35-105), TP 65%. The blood count is normal. A liver ultrasound shows hepatomegaly with hypertrophy of the left lobe and hepatic dysmorphism with heterogeneous parenchyma and irregularity of the hepatic contours (bumpy appearance). Absence of portal flow reversal or splenomegaly. Which exam(s) are you requesting?

Anti-cytoplasmic antibodies of neutrophils

anti-smooth muscle antibodies (anti-LKM1)


In this patient, who most likely has cirrhosis, the biological assessment reveals: transferrin saturation coefficient 80%, ferritin 2450 μg / L, search for anti-HCV antibodies negative, HBs antigen: negative, anti-HBs antibodies: positive with rate at 100 IU / L, anti-HBc antibody: negative. Against this background, you also prescribe serum protein electrophoresis. What is your interpretation of this electrophoresis? (one or more correct answers)


Which condition(s) or situation(s) could be responsible for the results of the martial assessment observed in this patient?


You mention genetic hemochromatosis. Genetic analysis reveals a homozygous C282Y mutation in the HFE gene. Regarding the joint pain of which he complains, what elements would lead to an osteo-articular attack of his hemochromatosis? (one or more possible answers)

osteophytosis in hook of the heads of the metacarpals


What examination(s) do you ask Mr. R to assess the possible impact of his hemochromatosis?


The results of the examinations are as follows:- trans-thoracic cardiac ultrasound: left ventricular ejection fraction 65%, normal filling pressures, undilated heart chambers, absence of valvular heart disease;- testosteronemia (total): 0.5 ng / mL (normal: 2.5 - 10); - vitamin D 10 ng / mL, serum calcium 2.2 mmol / L, phosphoremia 1.1 mmol / L;- bone densitometry: T-score at -2 at the lumbar spine, T-score at -1.8 at the femoral neck.- as a reminder,  the biological assessment has previously highlighted: transferrin saturation coefficient 80%, ferritin 2450 μg/L, negative anti-HCV antibody test, HBs antigen: negative, anti-HBs antibodies: positive with 100 IU/L level, anti-HBc antibodies: negative. What measure(s) should be put in place?


Vitamin D supplementation is implemented, and you inform Mr. R of the importance of stopping alcohol consumption during pathology. You also start a depletive treatment with bloodletting. Regarding the methods, objectives and elements of bloodletting monitoring that you are going to set up at Mr. R, which is (are) accurate?

Initially monthly rhythm in the attack phase

suspension of bleeding if the blood haemoglobin test falls below 11 g/dL

Initiation of bloodletting in a hospital setting


Mr. R. asks you about the mechanisms behind his disease and iron metabolism. Which proposal(s) is(are) accurate?

Iron absorption occurs mainly in the ileum

Hepcidin is increased during genetic hemochromatosis

Hepcidin inhibits the absorption of iron by the enterocyte

Hepcidin inhibits the release of iron by macrophages


What genetic counseling will you offer Mr. R about his relatives? (one or more possible answers)

his 3 children must have a search for HFE mutation within the year

C282Y heterozygosity is associated with a minor form with moderate iron overload

his children have a one in 2 risk of being homozygous if his wife is heterozygous

Genetic testing in relatives is covered by health insurance

the attending physician should contact the patient's siblings for CST, ferritin and HFE genetic testing


What follow-up exam(s) do you propose to Mr. R?

Cardiac MRI with annual iron overload measurement


Context: A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.

What is most suggestive of the central origin of facial paralysis?

Asymmetry of the mouth with sagging of the labial commissure

Facial asymmetry more marked during voluntary movements than during automatic movements

Deviation of the tongue to the left during protraction

Sign of Souque's eyelashes during forced occlusion of the eyes


What element(s) of favorable prognosis do you retain in this patient?

The moderate nature of proprioceptive sensory disorders


Given the clinical elements, which of the professionals mentioned below will you solicit?


You have asked a physiotherapist, an occupational therapist and a speech therapist for the patient's rehabilitation program. After the speech-language pathologist has carried out an initial assessment, what elements will he have to work on to improve the patient's health? (one or more correct answers)

On the improvement of language disorders


His rehabilitation is going normally and you are planning a therapeutic weekend. Given the age and fragility of the patient, you are considering a nursing visit morning and evening. His wife asks you about the necessary elements for this therapeutic outing. She is also worried because the arrangements for her Sunday are not made. What information can you provide? (one or more exact propositions)

Nursing care is covered by the health insurance fund

It will have to send the medical transport vouchers issued for the weekend to the departmental home for disabled people

If necessary, she can call her doctor or an emergency department during the weekend.

An occupational therapist will be able to best define with her the arrangements of her home

To make adjustments to her home, she will have to call on the departmental home for people with disabilities.


Seven weeks after admission, the patient falls. He has left hip pain. The hospital student reports the data of his clinical examination to you. What proposals are compatible with a fracture of the upper end of the left femur? (one or more exact propositions)

A vicious attitude in irreducible internal rotation


You ask for X-rays as follows:What is your diagnosis?


The radiologist sends you his report with a diagnosis of coxarthrosis associated with a basicervical fracture. What proposals can treat both fracture and coxarthrosis? (one or more exact propositions)


The patient received a total left hip replacement. Postoperatively, he presented with a hematoma of the thigh that required the cessation of anticoagulation and the transfusion of 2 red blood cells. He is transferred to the neurological follow-up care unit with his blood type card. On arrival a biological assessment shows: albumin 35 g / L (34-50); Calcium 1.90 mmol/L (2.08-2.65); serum folate 7.9 nmol/L (normal if greater than 12); vitamin B12 371 pmol/L (156-672); Ultrasensitive TSH 0.460 mIU/L (0.400-4.00). In view of these elements and for the purpose of prevention, which of the following treatments are you prescribing immediately?


The patient is treated with calcium 1 g per day and vitamin D3 100,000 IU every 15 days for 3 months. Ten days after surgery a parapixaban treatment is resumed. Five days later, he has a very marked increase in the hematoma of the left thigh associated with a feeling of fatigue and a great mucocutaneous pallor. His blood pressure is at 100/50mmHg his heart rate at 74 beats per minute. Its temperature is 37.2°C.What additional examinations do you prescribe urgently? (one or more exact propositions)


Faced with the situation you evoke acute bleeding and ask the nurse to urgently order 3 red blood cells. The search for irregular agglutinins is negative. Which proposal(s) apply to your patient?

you ask the patient for permission to consider a transfusion

you write a prescription for long-term illness (ALD) for 3 red blood cells

In this context of multiple transfusion you ask for compatible pellets

you check the patient's bedside Rhesus D compatibility with the Beth-Vincent test

You ask for irradiated red blood cells in front of this context of fragility


When administering the third red blood cell, the nurse calls you because the patient shivers, and his temperature is at 39.2°C.What proposals apply to your patient? (one or more exact propositions)

You will need to make a haemovigilance declaration

You address the blood bag that passed at the time of the febrile episode to the laboratory according to the local procedure


The bleeding episode is controlled and there were no other post-transfusion complications. The patient can resume walking after 3 weeks and is considering returning home. Which of the following suggestions concerning the information you should include on the physiotherapy prescription apply to your patient? (one or more exact propositions)

If the prescription is at home it must include the number of sessions

If the prescription is in the physiotherapist's office, it must include the mention "physiotherapy treatments (or sessions)"

If you want to insist on the recovery of hip joint amplitudes, you must precisely define on the prescription the number of sessions spent on this goal

If you want physiotherapy at home you must explicitly stipulate this on the prescription

If you want rehabilitation of the lower right limb and left hemiplegia you can register it on the same prescription


You are considering home help. Which of the following proposals do you consider for your patient? (one or more exact proposals)

Application for a personalized autonomy allowance

Applying for a special education allowance


Context: You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.

Controls report an initial loss of consciousness estimated at 2 minutes. The patient has a motor response adapted to simple commands, opens his eyes to demand, reveals his identity and is correctly located in time and space. The case is a 38-year-old man with no known medical history. How much do you estimate his score in Glasgow? (only one answer expected)


You estimate the Glasgow score at 14.Which of the following proposition(s) is true for this patient?

There is an indication of cranioencephalic CT

The score is modified by the existence of an initial loss of consciousness

The score must be reassessed upon arrival at the hospital

There is an indication for airway protection by intubation

The score could be altered by taking psychotropic drugs


The patient mainly complains of pain in the right lower limb and right upper limb. In the right upper limb there is a deformity of the arm. The patient has functional impotence. You suspect a fracture of the humerus and seek to rule out paralysis of the radial nerve. To do this, what do you test specifically? (one or more correct answers)

Altered sensitivity of the medial edge of the hand

A deficit of active extension of the thumb

A deficit of active abduction/adduction of long fingers


At the level of the right knee, there is a large anterior wound, and a free bone fragment of the femoral condyle is externalized. Distal pulses are well perceived. Which of the following actions do you think is appropriate and to be implemented on the spot as a first intention?

Wound cleansing with an alcoholic antiseptic solution

Placing and tightening a tourniquet at the root of the thigh


The patient is unable to lift his leg by holding the knee in extension. A photograph of the wound is shown below. Which of the following applies?

A rupture of the extender apparatus is suspected

The mobilization of the knee in flexion puts tension on the skin banks

Management of this wound requires extensive surgical debridement


Haemodynamic stability of the patient was achieved with the infusion of 750 ml of crystalloid during transport. Which of the following anamnestic and clinical elements is (are) in favor of performing a whole body scan?

The estimated speed at the time of the accident was 75 km/h

The patient has a Glasgow score calculated at 14

There is a joint wound of the right knee

An evolution requiring the introduction of vasopressive amines


X-rays of the right knee front and profile as well as frontal reconstructions of the CT scan are attached. Which of the following is (are) correct?

There is a fracture involving the tip of the patella

There is a supracondylar fracture of the distal femur

There is a fracture of the lateral femoral condyle

There is a fracture of the proximal metaphysis of the tibia


The whole body scanner finds no lesions other than those of the limbs. Injuries to the right knee and arm were managed in the operating room. At the knee, it was indeed a fracture of the lateral condyle, which was reinserted and osteosynthesized, and a fracture of the tip of the patella which was equivalent to an avulsion of the patellar ligament at the tip of the patella. Due to the articular nature of the lateral ducondyle fracture, you postpone the resumption of support during the 3rd postoperative month. To promote skin healing, you limit flexion to 90° during the first month after surgery. Post-operatively, you inform the patient of the progressive risks. What are the exact proposition(s) regarding the risk of postoperative stiffness?

The limitation of the prescribed flexion is intended to promote the healing of the intra- and extra-articular elements

The intra-articular nature of the lesion increases the risk of stiffness

In the absence of complex regional pain syndrome type 1, there should be no loss of long-term mobility

The existence of a significant limitation of the flexion amplitude to 6 weeks after surgery may lead to discussion of mobilization under anesthesia

The persistence of stiffness beyond 3 months can be recovered by surgery


For his rehabilitation, he is cared for in a follow-up care and rehabilitation department in a day hospital and wonders about the long-term goals of this treatment. Which of the following information(s) is (are) accurate and that you can give him?

The knee will have to bend at least 110° for it to descend the stairs normally

A strengthening of the thigh muscles is necessary to ensure good stability in the phase of support to walking

The work of endurance to the effort will facilitate its resumption of activity

An evaluation of his workstation by the departmental home for disabled people will have to be organized

A regular assessment of participation restrictions will be made by a physical medicine and rehabilitation doctor throughout his recovery.


Which of the following proposals is (are) the professional(s) who you think should be solicited for the rehabilitation of this patient?


During the consultation he asks you about his professional future because he is worried. His accident is an accident at work (commuting accident). He has still not received daily allowance. Which of the following is (are) the exact answer(s)?

Knee pain may persist despite good consolidation

You confirm that his daily allowances will not be paid until he is released from hospital.

If he retains sequelae, he may request an evaluation which may give rise to compensation by the health insurance fund.

The adaptation of one's workstation may be carried out by the health insurance fund.

If necessary, the departmental home for disabled people may award him a certificate of disabled worker status.


After two months, he was allowed to gradually resume support on the lower right limb. During follow-up, the patient complains of the gradual appearance of pain in the upper left limb, with an impression of numbness of the fingers. The phenomena are increased at the end of the day when he leans on his English cane. Which of the following elements of the clinical examination is (are) in favor of carpal tunnel syndrome?

Percussion next to the flexion fold of the wrist triggers pain

Painful phenomena increase when bending the elbow

Pain predominates in the last two fingers

There is amyotrophy of the hypothenar eminence


The situation does not improve despite the gradual abandonment of the English cane on the left with persistent pain and paresthesias in the left hand. You suspect a comprehension of the ulnar nerve. What test do you prescribe to determine its location and impact? (only one answer expected)

Comparative electroneuromyogram of the two upper limbs


The electromyogram confirmed compression of the ulnar nerve but the symptoms gradually improved with the disappearance of paresthesia. The evolution of pain and strength was favorable to the lower right limb after 4 months of rehabilitation but he remains embarrassed for the descent of the stairs because the flexion of the knee reaches only 100 °. However, you are concerned because it retains pain in the upper right limb. Yet you notice a very good evolution both in the strength and amplitudes of the shoulder and elbow which have returned to normal. You gave him a prescription for physiotherapy sessions without specifying the number. Among the following proposals, which is (are) the one (s) you can make for his outpatient follow-up?

Physiotherapy may also be accompanied by balneotherapy despite the absence of specific mention on the prescription

The conditions of management of occupational therapy are no different from physiotherapy-balneotherapy

The physiotherapist will be able to adapt the number of sessions by himself without this posing any problem of coverage by the social security

It is not necessary to see the surgeon again before 18 months given the severity of the fractures

Physiotherapy can be performed at home despite the absence of specific mention on the prescription


Since the patient fails to carry a load on the right side at 6 months postoperatively, you decided to refer him back to the surgeon. Here is the radiographic aspect on front and profile images. Which proposal(s) is (are) true?

The chances of spontaneous consolidation at this stage are minimal in the absence of intervention

This is the normal course of a fracture after osteosynthesis.

The osteosynthesis material in place is a centromedullary nail


Context: A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.

What do you think is the most important thing to collect during questioning? (only one answer expected)

a family history of systemic inflammatory disease


What is (are) the element(s) that orient you towards an inflammatory nature of pain?

progressive worsening of pain during the day


Joint pain is inflammatory. What are the three most likely diagnoses in this patient to explain all the symptoms?


Your clinical examination objective the abnormalities visualized in the following photograph. What do you suspect (one or more possible answers)?


You prescribe a biological assessment. Which of the following proposals do you think is relevant at this stage?

anti-citrullinated peptide (ACPA) antibodies


The immunological assessment shows: negative anti-citrullinated peptide antibodies (ACPA), anti-nuclear antibodies positive at 1/80 without specificity, a rheumatoid factor positive. CRP is 60 mg/L.Given all the clinical and paraclinical information available at this stage, what is the most likely diagnosis?


Faced with this distal, bilateral and symmetrical polyarthritis, the presence of rheumatoid nodules and the positivity of rheumatoid factor, you have made the diagnosis of rheumatoid arthritis and started a background treatment with methotrexate. The patient has progressive dyspnea stage 2 on the modified Medical Research Council (mMRC) scale that has been on for six months now. The objective auscultation of the dry crackling of the two bases. The rest of the chest examination is normal. The heart rate is regular without any particular breath. What do you suspect first (only one answer expected)?


Faced with this suspicion of diffuse interstitial lung disease, what are the two most relevant complementary examinations?


You complete your approach by performing a chest CT scan, a section of which is attached. What basic lesion(s) do you observe on this scanner?

condensation erasing vascular structures


You perform pulmonary function tests:What is (are) the exact answer(s)?


You are diagnosed with diffuse interstitial lung disease related to rheumatoid arthritis. Two years later, on the blood test, isolated neutropenia was found at 789/mm3. The patient is asthenic. He has no fever. On examination, you find splenomegaly. Which diagnosis do you think is most likely?


You are diagnosed with Felty's syndrome. The patient is now being treated with immunosuppressants. He contacts you again after 3 months of treatment due to a worsening of dyspnea for two days with dyspnea at the slightest effort. The respiratory rate is 35 cycles per minute, hemodynamics are stable. Saturation is 95% under 6 liters of oxygen per minute. Pulmonary auscultation finds bilateral crackling at the bases. Vocal vibrations are unchanged and chest percussion is normal. What are the three diagnoses that you first mention in the face of this brutal decompensation?


Given the severity of the patient, you hospitalize him. The temperature is 38.6°C.  An X-ray of the chest in bed is performed while sitting. What do you see? (one or more correct answers)


Severity criteria dictate that you transfer your patient to critical care. What sample(s) do you take to make the microbiological diagnosis of this infectious pneumonitis?

cytobacteriological examination of sputum


While waiting for microbiological results, which probabilistic antibiotic therapy do you prescribe? (one or more correct answers)


The microbiological balance is negative. Nevertheless, the patient's course is favorable after 7 days of treatment with cefotaxime and spiramycin. The patient returns home but is unable to leave easily due to fatigue. It retains bronchial congestion. You decide to continue chest physiotherapy. What elements must be included on the prescription? (one or more correct answers)

the mention << seven days a week>> if you consider weekend care necessary


Context: You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130/75 mmHg, heart rate at 90/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.

Faced with this complicated fall from a head trauma, what elements justify the realization of an emergency brain scan? (one or more correct answers)


Which proposals are correct regarding the brain scan? (one or more correct answers)


Among the tests requested, the INR is 2.1. What therapeutic measures are you putting in place regarding anticoagulant treatment? (one or more possible answers)

Prescription of concentrate of prothrombin complexes

Prescription of a low molecular weight heparin at a prophylactic dose


You stop coumadin, inject vitamin K and concentrate of prothrombin complexes intravenously. What monitoring measures do you put in place? (one or more correct answers)


The controlled INR at 30 minutes is 1.1. As part of the exploration of the patient's chest pain, you perform an ECG and chest X-ray. What etiological diagnosis do you retain for this chest pain? (only one exact answer)


Biologically, you note a natremia at 128 mmol / L. What additional elements can be used to explore this result? (one or more correct answers)


Protein and blood sugar are normal. The appearance of the serum is normal. You conclude hypoosmotic hyponatremia.   Kidney function is normal. The urinary ionogram reveals: natriuresis 60 mmol / L; kaliuresis 30 mmol/L; urinary urea 250 mmol/L.What are the two etiologies you mention at this stage?

Syndrome of inappropriate DHA secretion related to serotonin reuptake inhibitor therapy

Syndrome of inappropriate DHA secretion related to chronic subdural hematoma

Water retention related to calcium channel blocker treatment

Syndrome of inappropriate DHA secretion related to pleural effusion


What therapeutic measures do you take with regard to this hyponatremia? (one or more correct answers)

Discontinuation of serotonin reuptake inhibitor therapy


You suspect syncope. Returning to the interrogation, the patient's daughter tells you that this is the second episode of sudden discomfort in a month, but her mother was not injured last time. What abnormalities do you notice on the ECG (same trace as question 5)? (one or more possible answers)


What diagnosis do you mention in priority in this patient regarding the etiology of her syncopes?

Atrioventricular block of the paroxysmal 3rd degree


Since her admission, the patient has spoken incoherently. The neurological condition is different from the usual state according to her daughter. What elements will you look for in favor of a delirium syndrome? (one or more correct answers)


You are diagnosing confusion. What factors do you mention to explain the appearance of delirium syndrome? (one or more correct answers)


What therapeutic measure(s) are you putting in place regarding this delirium syndrome?

Continued treatment with benzodiazepine at the same dosage

Increased benzodiazepine treatment to cover nycthémère

Daily reminders on temporo-spatial orientation


The patient presents with significant false routes to saliva and during the water test. His daughter tells you that her mother had no difficulty swallowing her meals before this fall. What complications can occur because of these swallowing disorders? (one or more correct answers)


What measures do you put in place to avoid complications related to swallowing disorders? (one or more correct answers)


Context: A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.

What semiological elements are present in this patient? (one or more correct answers)

A fatigability suggestive of diabetic neuropathy

peripheral neurological clinical syndrome


This patient has signs and symptoms consistent with diabetic neuropathy. Which ones are compatible with this diagnosis? (one or more correct answers)

Very lively and diffused patellar tendon reflexes

Normal tendon reflexes in the upper limbs

Unilateral sensory deficit up to the umbilicus


To confirm the lesional location that best explains the clinical picture, which additional examination is most relevant? (only one answer expected)


You have requested a spinal cord MRI :P the following proposals, which ones are correct? (one or more correct answers)

An intramedullary hypersignal is observed next to thoracic vertebrae

The intramedullary signal suggests an inflammatory lesion

There is a mass effect on the spinal cord


In the light of the inflammatory involvement of the dorsal marrow in relation to the 5th thoracic vertebra, what additional examinations could confirm the etiology of this central neurological disease? (one or more correct answers)


A brain MRI is performed. It is an MRI in axial section weighted in T2 at the subtentorial level and axial FLAIR at the supratentorial level. Which of the following are true? (one or more correct answers)

Abnormal images are visualized in hyposignal

Hypersignals suggest multiple metastatic lesions

At least one subcortical lesion is visualized

At least one periventricular lesion is visualized

The largest lesion, in subtentorial, affects a cerebellar peduncle


A study of cerebrospinal fluid was performed. The main results are as follows:P roteinorachia: 0.68 g / LCellules: 0 red blood cells; 6 mononuclear cellsGlycorachia: 0.90 g / LIndex IgG: 0.92Oligoclonal appearance with at least 9 supernumerary bands of IgG.Regarding this analysis of cerebrospinal fluid, what are the exact answers? (one or more correct answers)

There is an intrathecal synthesis of IgG

There are arguments in favor of bacterial meningitis

Elevated glycorachia is compatible with the context of diabetes

Cellularity is compatible with a diagnosis of multiple sclerosis


What diagnoses do you retain to explain all the clinical, radiological and biological data in this file? (one or more correct answers)


In addition to a picture of polyneuropathy, this patient has multiple sclerosis (MS). You tell him this diagnosis. He asks you questions about MS. Which of the following are true? (one or more correct answers)

The primary progressive form is more common in the beginning of the disease

The presence of cognitive disorders, during illness, is common

The association of MS and type I diabetes is linked to chance

The risk of MS in siblings is increased compared to the general population


During his medical follow-up, the patient reports a few months later to be constipated. He sometimes needs to empty his bladder in two or three steps. His libido is diminished. Which of the following are true? (one or more correct answers)

The patient has symptoms of overactive bladder

The post-voiding residue must be measured

The decrease in libido is directly related to his spinal cord damage


In general, regarding neuroperineal disorders, which proposals are accurate? (one or more correct answers)

Overactive bladder is mainly manifested by voiding emergencies

First-line drug therapy for overactive bladder relies on alpha-blockers

In case of post-voiding residues, intermittent self-sounding should be preferred.

Both multiple sclerosis and diabetes can impair erectile abilities


This patient has primary progressive MS. It has no background treatment. You see him again six months later. He tells you that he has been feeling particularly tired for a few months and that he is << stiff >>. You observe spasticity of the posterior laloge of the right leg. What support do you offer? (one or more correct answers)

You are initiating corticosteroid therapy with prednisolone

You contraindicate the resumption of physical activity

You are discussing an antispastic treatment (baclofene)

You gradually introduce pregabalin therapy


An electroneuromyogram is performed in this patient given the context of diabetes. The results are as follows: normal sensory and motor conduction velocities to all four limbs. The amplitude of the motor and sensory potentials is halved. The tracings in detection are in favor of neurogenic involvement. What syndromic diagnosis do you remember? (only one answer expected)


What medico-social measures should be put in place for this patient? (one or more correct answers)

MDPH file for applying for a mobility inclusion card


Context: A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.

The NFS finds: hemoglobin 10.5 g/dL, MCV 70 fL, reticulocytes 10 G/L. What is the most likely diagnosis?


What proposals can explain this non-regenerative microcytic anemia? (one or more correct answers)


By plotting the staturo-weight curve, you notice an absence of weight gain for 3 months, without stature break in this young girl previously having a growth curve on the median in weight and height. What are the plausible diagnostic hypotheses? (one or more correct answers)


During interrogation, the mother finds that her daughter eats little at home and sorts her food. What element(s) is (are) in favor of a restrictive eating disorder?


School absenteeism is important. The girl says that in addition to fatigue, she often has headaches. What element(s) are you looking for in the interrogation that will make you mention secondary headaches?


The headaches are bifrontal, lasting between 10 minutes and 2 hours, relieved with paracetamol that she has been taking about 2 times a month for more than a year. She is not bothered by noise or light. What can it be? One or more exact proposal(s)?


On clinical examination, you notice a small breast bud with enlargement of the areola, the absence of pubic hair, it is not settled. Regarding pubertal development in this patient, which is the exact proposal(s)?


In front of these persistent headaches, you have a brain MRI performed, the image of which is here. Which proposal(s) is the exact proposal(s)?

legend 1 corresponds to the stem of the pituitary gland

Legend 2 corresponds to the third ventricle

legend 3 corresponds to the corpus callosum

Legend 4 corresponds to the cerebellar vermis

Legend 5 corresponds to the sphenoid sinus


Brain MRI is normal. The ingesta evaluated by the dietician are lower than the average energy requirement. What is the average energy requirement of a 12-year-old girl? (only one answer expected)


In front of microcytic anemia and the absence of weight gain, you evoke celiac disease. Which proposal(s) is the exact proposal(s)?

you find the child too old to discuss this diagnosis

you prescribe an anti-transglutaminase IgA assay

you prescribe an anti-endomysium IgG test

you are doing a proof treatment excluding gluten


The dosage of anti-transglutaminase IgA is not in favor of the diagnosis of celiac disease, you now evoke Crohn's disease.Which element(s) would be the element(s) to look for in favor of this diagnostic hypothesis?


What would be the biological element(s) in favor of the diagnosis of Crohn's disease?


The diagnosis of Crohn's disease was ruled out in the absence of normal inflammatory syndrome, faecal calprotectin and albuminemia. You finally retain the diagnosis of isolated iron deficiency in front of a ferritinemia at 3 ng / mL.What element (s) do you seek at the interrogation to explain this disorder in this patient?

Replacement of meat products with pulses


She reports not consuming any meat products. Regarding martial supplementation, what is (are) the exact proposal(s)?

The initial prescription is preferably in injectable form

Treatment may result in black stool staining

It is best to divide the daily dose into 3 doses

A reticulocyte seizure usually occurs around day 10 of treatment

The duration of supplementation will be at least 3 months


Context: A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60/min, blood pressure 130/80 mmHg, respiratory rate 10/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol/L and capillary oxygen saturation is 92%.

Which diagnosis is most likely? (only one answer expected)


Which of the following is more suggestive of opioid poisoning?


A coma by opioid overdose is diagnosed. What elements are part of the immediate drug treatment? (one or more correct answers)


After a bolus of naloxone the patient wakes up, naloxone is kept in continuous infusion for a few hours. He reveals that he had bought 50 mg of methadone hydrochloride on the street where he has been living for 3 days, following his release from prison. He was incarcerated for a robbery. He doesn't understand what happened to him because, before entering prison two years ago, he had been taking 80 mg of methadone a day for several months. He was able to stop this treatment in prison, he says proudly: "It was not easy, especially with the pain." But he admits to having "plunged" as soon as he left not having been able to control his desire for products. The health care team finds it a little odd. Which of the following elements of the observation are diagnostic criteria for opioid dependence? (one or more correct answers)

Consumption continues despite negative consequences


To take stock of the social situation of this patient, what needs to be specified? (one or more correct answers)


The patient is homeless. What options can be considered to relocate him? (one or more correct answers)

Hospitalization in addictological follow-up care


A few weeks later, the patient is housed in a Residential and Social Reintegration Centre (CHRS). He consults in addictology because "decidedly, with heroin, it does not go anymore! ". He consumes 2 to 3 grams per day in sniffing or more rarely in injection. He went to see a doctor in town who advised him to withdraw or substitute treatment. Suspicious, he wants a second opinion on the resumption of methadone hydrochloride. Which of the following statements are true? (one or more correct answers)

It is too risky given the history of overdose

It should be avoided in favor of clonidine withdrawal

It is possible with psychosocial support

It is part of an overall risk reduction strategy


The patient now lives with a 23-year-old woman, with whom he has been shopping for three months. She occasionally uses heroin sniffing and does not think she needs treatment. She regularly visits a centre where she is given information on the risk of overdose. Which of the following are appropriate risk and harm reduction strategies in this context? (one or more correct answers)

The realization of serologies HIV, HVB, HVC


The patient has been stabilized for 2 years by treatment with 80 mg of methadone hydrochloride per day. It is his attending physician who reproduces. Last week, he was on vacation and the patient had to deal with a replacement. He was questioned about his drinking, particularly alcohol and tobacco. The patient admitted to regularly drinking two to three beers every night. In order to reduce his cravings for alcohol, the patient asks if he could benefit from treatment like one of his friends who has managed to be weaned. What are the two molecules that could have been prescribed to his friend to help him reduce alcohol consumption?


The patient recalls that his friend received nalmefene treatment; He therefore wishes to obtain some. The patient's general practitioner's substitute explains the incompatibility of nalmefene with methadone, and offers acamprosate treatment after weaning. At the next consultation, the patient explains to his doctor that he thinks the replacement "is in cahoots with the pharmaceutical industry". He noted certain clues that support his idea. "He would have done better to help me quit smoking," he told his doctor. He says he has smoked two packs a day for 10 years. He only supports cigarettes that he makes himself – "It's safer," he says – and also the electronic cigarette. Which of the following signs of tobacco addiction is most severe? (only one answer expected)

Continued consumption despite negative consequences

Smoking your first cigarette when you wake up


The patient is severely addicted to tobacco. He agrees to a treatment. Which treatments have a marketing authorization in this indication? (one or more correct answers)


Two years later, the patient presented to the emergency room of the hospital because he was not feeling well. He has now been living alone for several months. He has not resumed heroin and is still taking methadone hydrochloride treatment. His partner left him because she could no longer stand his << laziness >> and his lack of motivation to do the markets. She also blamed him for his lack of emotions. He is not well, according to him, since a doctor finally acceded to his request for nalmefene, which he did not support. He often repeats "evil is not fun" with a knowing tune and sometimes fabricates new words. He doesn't see anyone anymore. He has trouble washing. Which psychiatric syndrome dominates this clinical picture? (only one answer expected)

A syndrome of disorganization in the context of schizophrenia


The picture is mainly dominated by a negative syndrome suggestive of a schizophrenic disorder. What semiological elements are in favor of this syndrome? (one or more correct answers)


The patient claims that "he was very harmed." He doesn't know who but he has researched the internet and knows "now what really happened, and everything is connected". He pauses in his speech and does not finish his sentences, but does not wish to say more because one could hear him and take it at him. In front of this clinical picture evolving for more than 6 months and the entire history of the patient we can conclude to a diagnosis of schizophrenia. What elements in favor of this diagnosis are in the observation? (one or more correct answers)


The patient agrees to take treatment. Which of the following proposals apply to the antipsychotic treatment you are going to offer this patient? (one or more correct answers)

it must be based on a second-generation antipsychotic

It must be combined with an anticholinergic corrector

It must be prescribed in delayed injectable form

It must be prescribed after analysis of an electrocardiogram


A study was carried out by drawing lots from the electoral lists 5,000 subjects aged 40 to 60.  Whether or not these subjects had diabetes was investigated by taking their medical history, treatments taken and measuring their fasting blood glucose. Which of the following is correct about this study?

This study will estimate the prevalence of diabetes in this population

This study will estimate the case fatality associated with diabetes in this population


A 3-year-old child is brought to the emergency room by his parents for diarrhea for 2 days associated with a fever at 40 ° C.  You learn that he returned from Senegal 3 days before. Which additional examination(s) do you think are etiologically justified in view of the whole clinical picture?


As part of the procedure before the Conciliation and Compensation Commission (CCI), following a medical accident, compensation from the National Office for Medical Accident Compensation (ONIAM) can be obtained if one or more conditions are met.  Which one(which)?

Prior application of the administrative responsibility of the hospital

Damage with a Violation of Physical or Mental Integrity (AIPP) greater than or equal to 25%

A cessation of professional activities greater than or equal to 6 months over a period of 12 months


A 3-year-old child with normal psychomotor development is usually able to:


When a mother has gestational diabetes, there is an increased risk of:

That the newborn is hypotrophic (small for gestational age)


A 10-month-old infant with normal psychomotor development should:

Worrying at the sight of an unfamiliar face


What is (are) the complication(s) associated with prematurity?


You are seeing a 12-year-old obese teenager. The body mass index curve shows a rebound in adiposity at age 3. There is an acceleration of the stature growth curve. On examination, you will see purple stretch marks on the flanks and thickened, rough skin on the neck. His parents report that he is constipated. Which additional exam(s) do you prescribe?


Premature if born at a gestational age less than 37 weeks of amenorrhea

Hypotrophic if its measurements are strictly less than at least two standard deviations from the reference curves

Post-mature if born at a gestational age greater than or equal to 42 weeks of amenorrhea

Newborn in the first three months of life

Very premature if born at a gestational age of less than 32 weeks of amenorrhea


All newborns should be routinely screened for:


At the maternity discharge examination, a healthy full-term child must have:

A popliteal angle less than or equal to 90°


A 55-year-old patient with breast cancer with bone metastases under pamidronate treatment consults you. She has had endooral bone exposure for several weeks, following the avulsion of a mobile tooth. She has no other medical history. You mention the diagnosis(s) of:


A 56-year-old patient, a tobacco user since the age of 16, consults you because of the appearance for 1 month and a half of lingual ulceration. The elements that guide you towards the diagnosis of squamous cell carcinoma are:

Indurated homolateral group II cervical lymphadenopathy


In a displaced right zygomatomaxillary fracture, you are looking for hypoesthesia in the following territory(s):


Helps to delimit the isthmus of the throat

May be hypertrophic and responsible for snoring

Is essential in the mechanisms of swallowing


Is characterized by local aggressiveness

Gives a multilocular lytic radiological image


With which diagnosis(s) is compatible the following assessment: serum calcium 2.80 mmol / L; phosphoremia 0.6 mmol/L (normal values 0.80 to 1.45); PTH 3 pmol/L (normal values 1.2 to 5.8)?


What examination(s) can you request for the diagnosis of corticotropic deficiency in a patient who has had corticosteroid therapy at a dose of 1 mg/kg/day of prednisone for 4 months?


Among the following proposals, which non-pharmacological therapeutic (s) can (s) be prescribed in the chronic phase of osteoarthritis (at a distance from a flare-up)?


A 76-year-old patient, living alone in a single-storey house, had surgery for a total hip replacement on the right. She has lost weight by 1 kg since the procedure. However, she keeps a good appetite, is not afraid of falling and walks with a cane on the left. She plans to have cataract surgery. She consults 3 months after the intervention for pain in the right hip. What is (are) the sign(s) you are looking for in favor of a prosthesis infection visible on a prosthetic hip X-ray?


Diabetic retinopathy, at the stage of "rare micro-aneurysms":

Contraindicates the rapid achievement of strict normoglycemia

Indicates laser photocoagulation in preparation for pregnancy

May be observed as soon as diabetes is diagnosed


Disappears after 2 hours of clinostatism

Is associated with high cardiovascular risk


Are a potential side effect of all anti-diabetics

On sulfonamide, are more common in cases of renal failure

On metformin, are more common in heart failure

Are responsible for the majority of cardiovascular events in diabetics


Concerns 15% of the adult French population

Is considered a low-grade inflammatory disease

Is accompanied by an increase in lean body mass

Is associated with decreased resting metabolism

With a well-followed diet, the expected weight loss is of the order of 15% at 2 years


What is (are) the pathology(s) associated with a "white" scintigraphy in the presence of an increased free T4?


On a systematic count carried out in a 63-year-old patient, you find: leukocytes 7.2 G / L; neutrophils 47%; lymphocytes 45%; monocytes 8%;  haemoglobin 14.4 g/dL; VGM 89 fL; CCMH 33 g/100 mL; platelets 755 G/L. You mention:


A 74-year-old woman has the following blood count: leukocytes 2.1 G/L; neutrophils 0.7 G/L; lymphocytes 1.4 G/L; hemoglobin 8.5 g/dLv VGM 104 fL; blisters 567 G/L. The myelogram returns to a marrow of normal richness with 3% blasts and signs of dysmegakaryopoiesis. Which diagnosis(s) evokes this table?


Metabolic adaptations observed during a hunger strike include:


A 28-year-old patient comes to your consultation for a gradual installation fatigue over several weeks. She is out of breath at the effort and is very embarrassed in her activity as a cleaning lady. The clinical examination finds only a mucocutaneous pallor. A first assessment finds: leukocytes 7.6 G / L, neutrophils 62%, eosinophilic polynuclear 2%;  lymphocytes 33%; monocytes 3%; haemoglobin 9.7 g/dL; VGM 76 fL; CCMH 31.2 g/dL;  platelets 633 G/L; reticulocytes 67 G/L. Which of the following results explains the abnormalities of the blood count?

Increased serum iron and normal transferrin

Hb A2 at 10.2% on hemoglobin electrophoresis


As part of the monitoring of synthetic antithyroid therapy, it is interesting to measure:


When monitoring differentiated papillary thyroid cancer with lymph node invasion, it is customary to use the following monitoring parameters:


The clinical symptomatology of Willebrand disease is dominated by:


Malignant humoral hypercalcemia: B. Is due to hypersecretion of

Is one of the causes of hypercalcemia of myeloma


Regarding primary amenorrhea, which is (are) the exact proposal(s)?

It is characterized by the absence of secondary sexual characteristics after 16 years in young girls

It is more common than secondary amenorrhea

It requires in its etiological assessment a dosage of gonadotropins

Associated with an absence of secondary sexual characteristics, it may be due to a syndrome


What is (are) the exact proposal(s) regarding menopause?

It is characterized by a stop of the rules

She is suspected in front of climacteric signs

His progestogen treatment will reinstate withdrawal hemorrhages

It must lead to the prescription of a bone densitometry


Regarding the semiology of sensitivity, what following statement(s) is (are) true?

Sensory extinction is seen in parietal lobe involvement (parietal syndrome)

Romberg's sign testifies to the involvement of small amylin nerve fibers

Involvement of the left ulnar nerve can cause hypoaesthesia of the first 3 fingers of the left hand

Involvement of a thalamus causes contralateral hypoaesthesia in all modes (thalamic syndrome)

Alternate sensory syndrome is a sign of brainstem involvement


What following statement(s) is (are) true regarding the semiology of the cerebellum?

The Stewart-Holmes maneuver highlights a delay in contraction of agonist muscles

Static cerebellar syndrome is linked to damage to the cerebellar hemispheres

Hypermetry of the right upper limb may be due to damage to the right cerebellar hemisphere

There is hypotonia in cerebellar syndrome

The voice may be paretic in case of cerebellar damage


A 55-year-old patient comes to consultation for vision disorders, he has had two traffic accidents because he did not see the priorities on the right. You will focus your clinical examination on the exploration of the visual field. Regarding this patient, what is (are) the exact proposal(s)?

He may have a right homonymous lateral hemianopsia

If his lesion is intracranial, it may be in left retrochiasmatic

If his lesion is intracranial, it may be at the level of the chiasma

If his lesion is intracranial, it may be at the right occipital level


Corresponds to involvement of a long pathway homolateral to the lesion and a contralateral cranial nerve

There is an alternate sensory syndrome in Wallenberg syndrome


The peripheral nerve(s) most often compressed in case of prolonged immobilization is (are):

The fibular nerve in the popliteal fossa

The sciatic nerve in the lower third of the thigh


The taking of meals by the patient himself

The lying position, on the right side during meals


Regarding Parsonage-Turner syndrome, quote the exact proposal(s):

Initial pains are centered on the shoulder

The motor deficit is present from the beginning

The motor deficit concerns the C8-T1 roots


What is (are) the typical clinical sign(s) to consider treatment without additional examination in case of vulvovaginal mycosis?


Regarding typical absence epilepsy, what is (are) the exact answer(s)?

The definition is clinical and electroencephalographic

Is characterized by generalized peak wave discharges at 6 Hz

EEG discharges are synchronous and symmetrical

May be associated with generalized tonic-clonic seizures


Which of the following proposals can (which) correspond to dysautonomic impairment?


Zollinger-Ellison syndrome is related to hypergastrinemia secondary to gastrinoma.  In which condition(s) should this diagnosis be evoked? nor

In case of recurrent duodenal ulcer or resistant to medical treatment

In case of duodenal ulcer associated with gastric or jejunal ulcers

In case of duodenal ulcer associated with diarrhea

In case of duodenal ulcer occurring without taking aspirin, nonsteroidal anti-inflammatory drug,


What is (are) the exact answer(s) regarding the practical modalities of performing the immunological test for occult bleeding in the stool?

It is necessary to follow a diet excluding foods rich in tryptophan three days before

It is the attending physician who gives the test to the patient