Regarding the Anatomy of the Obstetric Pelvic Duct: Normal Childbirth

The pelvic girdle consists of 3 bony pieces

A Maternal pelvis 1 Bone pelvis The pelvic girdle is a symmetrical osteoarticular ring consisting of 4 bony parts and 4 joints: • the 4 bony pieces are: − the 2 coxal bones, − the sacrum, − the coccyx

The 4 joints of the pelvis are very mobile

The pelvic girdle has the shape of a funnel with a large lower base the large abdominal cavity with the pelvis through the lower strait (DI)

The pelvic girdle has the shape of a funnel with a large upper base that communicates the large abdominal cavity with the pelvis through the upper strait (SD)

The lower orifice consists of all the middle and lower straits

The upper strait is also called the Demelin "engagement cylinder"


Regarding the Anatomy of the Pelvis in Women: Normal childbirth

The promontory overlooks the pubic symphysis 8-9.5 cm

Note that the axis of the DS is oblique backwards and upwards

It should be noted that the axis of the DS is oblique backwards and downwards: it aims at the sacrococcygeal line spacing.

The axis of the DS targets sacrococcygeal space

The circular section of the pelvic excavation is 18cm anteroposterior

Its circular section is of constant diameter at the level of all planes (about 12 cm)

The middle strait (MD) is an oblique plane passing through the two sciatic spines.


Regarding the Concerning the generalities about normal childbirth: normal childbirth

The lower strait (ID) is the lower opening of the pelvic canal

The posterior surface of the lower strait corresponds to the 2 ischia and the tip of the coccyx

The soft pelvis corresponds to Douglas's uterus, bladder and cul-de-sac

2 Soft pelvis It consists of: • the vagina • the pelvi-perineal diaphragm: musculotendinous hammock which includes: − a deep plane: fibers of the levator of the anus, ischiococcygeal muscles and large sacrosciatic ligament, − a superficial plane: muscles of the superficial perineum

The curled up fetus is amalgamated with a cube with 4 poles

1 Fetal head The fetal head has an ovoid shape with the small end corresponding to the chin and the large end to the occiput (Figure 30

The anterior fontannelle is called bregma


Regarding the Concerning the pregnant uterus: normal childbirth

The posterior fontanelle is called bregma

The pregnant uterus consists of 3 parts: the body, the lower segment and the cervix

The uterine body, in late pregnancy, has the shape of an ovoid with a large upper end

The axis of the body of the uterus in late pregnancy is always craniocaudal

Its axis depends on the tone of the anterior abdominal wall

In the frontal plane, the uterus is often tilted to the right side


Concerning the basics of normal childbirth

At the level of the inner circular layer, the fibers retract to erase the lumen of the vessels in order to reduce the hemorrhage of normal delivery (live ligatures)

At the level of the plexiform layer, the retraction of the fibers erases the lumen of the vessels, which has the effect of reducing the hemorrhage of normal delivery: this is the phenomenon of living ligatures

Uterine contraction is the driving force of childbirth

The mechanical study of uterine contraction requires expensive and rare electrophysiology equipment

1 Means of study The mechanical study of UC is commonly used in obstetrics thanks to monitors that allow simultaneous recordings of fetal heart rate and uterine contractions: • external tomography allows

External tocography makes it possible to note the duration of uterine contractions thanks to an intravenous sensor

Internal tocography provides basic tone and intrauterine pressure


These questions may seem tedious, but these measures are worth knowing according to the College

Sternodorsal diameter or bi-acromial diameter after settlement


This diameter is not reduced by compaction. It is 8 cm

Sorry for these questions, but these measures are to be known according to the college :/

This is the sterno-dorsal distance as well as the bi-acromial distance after settlement


Sorry for these questions, but these measures are to be known according to the college :/. 8 cm is the bi-iliac diameter


Bi-trochanterian diameter. Sorry for these questions, but these measures are to be known according to the college :/

This distance can be reduced by settlement


Which of the following proposals is/are a risk factor for postpartum haemorrhage?

Very fast or too prolonged work is a ToR


Regarding plasters, which proposals are true?

There are two types of plasters: circular and gutter

Pain = problem = systematic removal of the cast for complete clinical examination

Conventionally, the cast contains the fractured limb and the underlying joint only

Conventionally, the fingers of the hand are left free


What are the delays in radiographic control of plaster?

The deadlines mentioned by the college of orthopedics are: J2, J8, J21 and J45


What are the two main etiologies of paresthesias under plaster?


Which of the following are frequently found in DRESS syndrome?


Regarding pain in a patient suffering from a psychiatric pathology:

The tools used to measure pain are specific to psychiatry

There is no specific tool in psychiatry to measure pain

Dental pain is often directly related to psychiatric pathology

No direct link, but an indirect link: psychiatric pathology -> poor hygiene -> no dental care -> dental pain


The placebo effect has no place in therapy

The placebo effect is accompanied by the release of endogenous opioids

There is an addictive risk if taken care of morphine


Anxious manifestations make you forget the pain

It concerns 10% of the general population on the time of life

Everyone went through periods of acute pain


It is defined for a duration greater than 1 week

No, but often depressive symptoms. In addition, the psychiatric reference framework explains that about 50% of bipolar patients have a pain syndrome, mainly neck pain, back pain and arthralgia.

The flagship treatment is long-term paracetamol

Not at all (beware of the risk of addiction): it is a multidisciplinary care based on medicamental and non-drug therapies that must be put in place


The average age of reporting a bladder tumour is around 60 years

Bladder tumours affect both men and women

Deaths caused by bladder tumors account for 3% of cancer deaths

The main risk factor is alcohol consumption

It can be recognized as an occupational disease


Which of these proposals are factors that promote squamous cell carcinomas?

Be careful, it promotes urothelial carcinoma (see the Medline, part "trap to avoid", on page 424)

Not cited as a risk factor for bladder tumours

Especially in endemic areas in the Middle East and especially in Egypt

Be careful, they promote urothelial carcinoma (see the Medline, part "trap to avoid", page 424)


Regarding the diagnosis of bladder tumors:

Hematuria is often terminal or even total

In case of hematuria, clots can be found

Unlike hematuria of nephrological origin


It will perform a cytological examination infondi via cystoscopy, after verification by the ECBU

Urinary cytology has excellent negative predictive value (NPV)

Cytology has excellent positive predictive value


Follow-up includes regular endoscopic check-ups

In 90% of cases, bladder tumours present immediately as a bladder tumour that infiltrates the IMTV muscle.

Survival of patients with MITV is greater than 90% at 5 years

The main risks of a NMITV are recidivism in the form of one or more MINTVs

The urothelium covers the entire urinary tract


The normal testicle is formed by seminiferous tubules, contained in lobules

Seminiferous tubules contain four types of cells

Germ cells and Sertoli cells are the two most important cell types

Sperm are produced in the seminiferous tubules

The Leydig cells that produce sperm are present in the stroma


Which of the following propositions are true?

Non-germline tumours include gonadal stromal tumours

The Doppler ultrasound makes it possible to define the lymph node and metastatic status of the patient on which the TNM stage of the disease will depend

Staging of metastatic forms according to the IGCCCG classification

Diagnosis is based on ultrasound which makes it possible to highlight hyperechoic areas

More generally, the presence of grade 3 microcalcifications in a patient with gonadal dysgenesis syndrome warrants periodic clinical and ultrasound monitoring.


Which of the following are the side effects of cisplatin?

This is the case of etoposide (inhibitor of topoisomerase type II)

Especially anthracyclines, docetaxel, 5FU and capecitabine


Which of the following are non-germline tumors?

Non-seminoma germ cell tumours, AFP synthesis

Non-seminoma germ cell tumours, hCG synthesis


Which of the following propositions are true about the extension balance?

The PET-CT has no place in the initial assessment.

Scrotal MRI should be performed to better characterize the mass

False: scrotal MRI does not provide a decisive element to the local assessment.

Bone scintigraphy is performed at the point of clinical call

The CT-TAP is the reference exam for the extension assessment

Brain imaging should be performed in case of extranodal metastatic disease


Which of the following should be put in place before taking cisplatin?


Which of the following proposals must be made before the treatment is implemented?

Presentation of the file in Multidisciplinary Consultation Meeting (RCP)

Proposal of a gamete collection to CECOS

Diagnostic announcement according to the recommended modalities


Which of the following are germ cell tumours?


Which of the following serum tumor markers are relevant in germ cell tumors of the testicle?


At what stage is the invasion of the spermatic cord established?

Tumor limited to the testicle and epididymis WITHOUT vascular invasion

Tumor limited to the testicle and epididymis WITH vascular invasion OR with invasion of the tunica vaginal

No T5. The maximum is T4 (invasion of the scrotum)


Which of the following are risk factors for germline testicular tumors?


Regarding venous thrombosis and pulmonary embolism

Pulmonary embolism (PE) is most often a complication of deep vein thrombosis (DVT)

PE causes 5,000 to 10,000 deaths per year in France

PE results in an initial dead space and then a shunt effect by redistribution of blood flow and secondary bronchoconstriction

As a reminder: shunt effect = unventilated infused, and dead space = ventilated not infused

PE results in a picture of hypercapnic hypoxemia with ventilatory alkalosis

Hypocapnic hypoxemia (by hyperventilation, normocapnia in COPD), with ventilatory alkalosis

The hemodynamic consequences of PE (increased cardiac work by increased afterload) appear for obstruction >50-60% of pulmonary circulation

For obstruction >30%. If the obstruction is >50-60%, cardiogenic shock (drop in cardiac output and hypotension) = acute pulmonary heart is feared


About venous thromboembolic disease (VTE)

For the diagnosis of DVT, D-Dimer should be age-appropriate

Age adjustment only in the case of PE and if elderly patient

D-Dimer have a PPV (positive predictive value) of 99% for PE and proximal DVT

A VPN (negative predictive value) of 99%: in case of negativity and low clinical probability, the diagnosis is excluded

In a patient suffering from cancer and faced with a suspicion of PE, a CT angiography will be requested immediately regardless of the clinical probability

DDimers have no value in the case of cancer (false positive)

On ECG, an S1Q3 associated with a right axial deviation and a right branch block is specific to pulmonary embolism.

Signs of suffering of the right heart, they can evoke PE but are not specific

In case of high clinical probability, a negative CT angiography does not exclude pulmonary embolism

This is an indication for ventilation/perfusion scan or arteriography


In case of superficial venous thrombosis, Doppler ultrasound of the lower limbs is essential

In case of distal DVT or spontaneous superficial venous thrombosis, 6 weeks of anticoagulant therapy is recommended

In PE, a cardiac ultrasound may show direct signs, such as a non-enlarged hypokinetic dilated right ventricle

This is an indirect sign (acute pulmonary heart)

In PE, pulmonary angiography is particularly recommended in case of thrombi in the right atrium

Severe PE is defined as a SBP <90 mmHg or a decrease in SBP of 20mmHg for more than 10 minutes

STEP <90mmHg or drop of 40mmHg for more than 15 minutes


In PE, the early onset of basithoracic pleural pain accompanied by a dry cough should suggest pulmonary infarction

In case of surgery <3 months and prescription of LMWH, an NFS is recommended in the pretherapeutic workup, then 2 times a week for 1 month, then 1 time per week

Indications for NFS monitoring in LMWH: chir/trauma <3 months, UFH/LMWH <6 months, significant comorbidity at risk

The PESI score assesses the risk of developing a chronic pulmonary heart

In PE in an 81-year-old patient with cancer and SBP at 85 mmHg, right ventricle ultrasound dysfunction and elevated BNP biomarkers: PE is of intermediate severity

In severe PE, LMWH should be initiated as soon as possible in the absence of severe renal impairment

LMWH is contraindicated in severe PE. UFH is indicated in combination with fibrinolysis


Which of these proposals fall within the scope of calculating the Geneva score?

65 years, as often in cardiology (it is at this age that it is considered a cardiovascular risk factor)

Neither alcohol, tobacco nor diabetes are recognized risk factors for DVT (Deep Vein Thrombosis) or PE (Pulmonary Embolism)


From what Geneva score do we do without D-Dimer and do we do a CT injected directly?

A Geneva score greater than or equal to 11 requires the performance of a chest CT angiography


From what Wells score do we do without D-Dimer and do we do a Doppler ultrasound of the lower limbs directly?

A Wells score greater than or equal to 3 is strong. It requires the realization of a venous Doppler ultrasound of the lower limbs


D-dimer are specific products of fibrin degradation formed under plasmin action

The management of Deep Vein Thrombosis (DVT) is done in cardiovascular service only

Well-tolerated DVTs can be managed on an outpatient basis

A PESI score greater than or equal to 1 is intermediate

A BP (Systolic Blood Pressure) less than 90 mmHg classifies a PE as high risk

The objective, in case of an intermediate PESI score, will be to dissolve the clot

Management with DOAC (direct oral anticoagulants) aims to prevent the appearance of new clots. DOACs, like VKAs or antiaggregants, are not thrombolytics.


Which of these proposals can elevate D-Dimers?


The determination of D-dimer has an excellent negative predictive value in ambulatory patients for whom the clinical probability of diagnosis of DVT/PE is not high.

The so-called "antiphospholipid" antibodies are specific for complexes associating anionic phospholipids and proteins which may be β2-glycoprotein I

APS (Anti-Phospholipid Syndrome) is linked to ANCA vasculitis

Many antibodies
antiphospholipids may be present transiently and are non-thrombogenic


Which of these factors and proteins are involved in mutations that can cause VTE?

4 proteins and factors to know: Protein C, Protein S, Factor III and Factor V


Which of the following identifies the most common germ in urinary tract infections?


Which of the following are mandatory examinations in case of suspicion of severe acute pyelonephritis?

Useless if you do not think you have to transfuse (this is the general case)

We prefer the uroscanner from the outset

True, before administration of antibiotic therapy (C3G IV + Aminoside IV)


Which of the following are the probabilistic first-line treatments for severe acute pyelonephritis?

True, it is the aminoglycoside that is preferred


Which of the following propositions concerning simple acute cystitis are true?

The diagnosis of simple acute cystitis does not require the realization of a urine strip in the young woman

ECBU is not necessary in young women without comorbidities

First-line treatment is Fosfomycin-tromitamol as a single dose

Macroscopic hematuria is a sign of severity

False
It is not a sign of the severity of the infection


What is the significant threshold of bacteriuria in humans (with notable exceptions)?

True. 10^3 in all cases EXCEPT atypical Enterobacteriaceae (other than E. coli, Enterobacteriaceae, etc.) in women (in this case, the threshold is 10^4)

This threshold is allowed for atypical enterobacteriaceae in women


What is the threshold of significant bacteriuria in women for E. coli?

True. 10^3 all the time, except in the case of atypical enterobacteriaceae (other than E. coli, enterobacteriaceae, etc.) in women (threshold of 10^4)


Renal aging is the consequence of intrinsic genetic and extrinsic mechanisms, related to environmental factors and comorbidities

Renal aging concerns only endocrine functions

It concerns all the functions of the kidneys: elimination of waste and toxins, homeostasis, endocrine functions

Renal ageing is accompanied by 'physiological' proteinuria

Renal aging is not accompanied by proteinuria or significant hematuria

The finding of proteinuria is always pathological, regardless of age

There are transient and physiological proteinuria (orthostatic, effort ...)

Age-related structural and functional renal changes do not have significant consequences in normal situations

But they limit the capacity for self-regulation, thus increasing the risk of occurrence of an IRA


Regarding the renal physiology of the elderly:

The determination of serum creatinine gives a poor reflection of renal function in the elderly and overestimates the severity of renal failure

It most often leads to underestimation of the severity of renal failure

The GFR value should be estimated by the CKD-PPE formulas rather than by the MDRD formula which is not very precise after 75 years.

The GFR value should be estimated by the CKD-PPE or MDRD formulas rather than by the Cockcroft formula, which is imprecise after age 75 and should no longer be used.

A plasma creatinine value > 135 μmol/L may indicate severe chronic renal failure (stage IV) in the elderly

The decrease in GFR is continuous and of the order of 10 ml / min and per year from adulthood

Aging is accompanied from adulthood, without threshold effect, by a decrease in the glomerular filtration rate of the order of 0.7ml / min / year

Water-electrolyte disorders are common in the elderly because the adaptive capacities of the kidney are quickly exceeded


Osmolar intakes tend to decrease with age

Body composition changes, with a lower percentage of fat mass and an increase in water volume

Lower percentage of total water and a higher percentage of body fat

Hyponatremia increases the risk of falls

The incidence of acute renal failure increases exponentially with age

Rapidly progressive glomerulonephritis syndrome is an urgent indication for renal biopsy


Age does not increase the rate of progression of chronic kidney disease

Renal failure alters the pharmacokinetics of all drugs

Not all but a lot, and you have to be careful!

Contraindications to dialysis management should be discussed on a case-by-case basis

The occurrence of certain pathologies may lead to consider the cessation of extrarenal purification

Kidney transplantation cannot be performed after age 75

Must be prosposed if necessary up to 85 years according to the HAS


What is the threshold of red blood cells per mm3 for which we speak of microscopic hematuria?

The threshold is 10 GR/mm3 or 10 to the power of 4 red blood cells per mL


Regarding renal aging, which proposal(s) is/are accurate?

Albuminuria is physiological as long as it remains moderate

Microscopic hematuria is physiological after 80 years

The GFR decrease, from the age of 40, is 10 points per year

The decrease in GFR from the age of 40 is 10 points per decade, or 1 point per year about

The decrease in GFR observed with age is about 0.7 per year

The best formula for estimating GFR is the Cockcroft-Gault in the elderly


What are the exact suggestions regarding kidney size?

The size of the kidneys remains the same from the age of 20

The size of the kidneys decreases with age, at the expense of the cortex, which remain regular (no notches, no cysts, etc.)

The kidneys increase in size with age physiologically

There is a decrease in the size of the kidneys at the expense of the parenchyma

The decrease in kidney size is at the expense of the cortex

The cortex remains regular in physiological situation


Regarding renal aging, which proposals are accurate?

The CKD-Épi formula is preferred to the Cockcroft-Gault formula to estimate the GFR

It decreases due to the decrease in muscle mass, which can mask kidney failure.

Creatinineuria decreases due to the decrease in GFR with age

It is increased by the decrease in GFR, it is decreased by the loss of muscle mass

The feeling of thirst is decreased with age

The dilution capacity of urine is increased with age, which increases the risk of dehydration

The dilution capacity of urine is decreased in the elderly


GFR decreases by about 0.7 ml/min/1m73² per year

GFR decreases by about 10 ml/min/1m73² per decade from age 40

The renin angiotensin aldosterone system is potentiated by aging

The decrease in the size of the kidneys occurs in the cortex

Chronic kidney disease progresses faster and faster with age

The MRC continues its course without being impacted by age


Treatment of fibroids is mainly medicated

The essential complementary examination is pelvic ultrasound

Tumor markers are to be measured in second line possibly


The 3 most common pelvic swellings are uterine fibroid, ovarian cyst and pregnancy

Always think about pregnancy in a woman during genital activity

The bHCG test is unnecessary in women taking contraception

Uterine fibroids are most often mucous when palpable

The uterine fibroid, when palpable, is most often subserous (types 5,6,7 according to the FIGO classification) or interstitial (types 3,4)

1-2% of women over the age of 35 have uterine fibroids

It is the most common tumor of the uterus: 20 to 30% of women over 35 years of age have it

Fibroids are extremely painful most often


Menorrhagia is the main telltale sign of uterine fibroids

Rules are increased in duration and abundance

In menorrhagia indicative of fibroids, menstruation is increased in abundance but not in duration

The Huntigton score specifies the number of diaper changes per day

The number of exchanges per day = Higham score

Sometimes endometrial hyperplasia is associated with fibroids

Dysmenorrhea is a sign eliminating the diagnosis of fibroid

It may be related to a fibroid of the cervix or isthmus interfering with the evacuation of menstrual flow.


A submucosal fibroid is very rarely hemorrhagic

A submucosal fibroid is often responsible for significant bleeding (especially if an IUD is present), which can lead to hyposideremic microcytic anemia

Subserous fibroids rarely cause bleeding

This is also the case with interstitial fibroids.

Hyperplasia and nerve compression of a fibroid is the main cause of pain in fibroids

Complications are multiple during pregnancy, often minor and low impact once pregnancy has set in.

Adenomyosis is a very common cause of pelvic tumours

They are rarely the cause of a pelvic tumor because the uterus is rarely palpable (does not exceed one x2 in size)


Endometrial cancer is a common cause of palpable pelvic tumours

This is actually a very rare cause, which is then often an endocavitary tumor with cervical stenosis and intrauterine retention.

Functional ovarian cysts are the most common of a woman's pelvic swellings during genital activity

Follicular cysts or lutein cysts (of the corpus luteum) whose regression is most often spontaneous

70% of ovarian tumours are malignant or borderline

20% of ovarian tumours are malignant or borderline, and the risk of cancer increases with age


The symptomatology of ovarian cysts is very specific: swelling, cyclical pain and menometrorrhagia

There is no specific symptomatology of ovarian cysts

Ovarian cyst is symptomatic in 10% of cases

In more than 50% of cases, the ovarian cyst is latent, and is discovered by incidentaloma

Sometimes the ovarian cyst is discovered during a complication

Acute pelvic pain from a cyst complication is mild and cyclical

It is a thunderclap in a serene sky not yielding and amplifying

Abdominal-pelvic pain begins abruptly from one second to the next and does not give way, getting worse.


Regarding complications of ovarian cysts

In case of torsion, surgery is urgently needed to untwist the ovary or appendix and remove the cyst

Hysterectomy is preferred in young women to ensure 100% survival

It is necessary to be conservative in young women, even in case of late gesture and even if the appearance of the ovary is worrying

Intracystic hemorrhage often occurs in organ cysts

A tusk is found in one of the two iliac fossa in case of intracystic hemorrhage

The cul de sac homolateral to pain is filled

Peritoneal effusion associated with intracystic hemorrhage is rare and indicates the severity and urgency of management

It is common to observe an associated peritoneal effusion


Regarding the consultation in a woman with a very painful pelvic swelling:

Vaginal touch guides the diagnosis and is often very contributory

It is the essential examination because it helps to guide the diagnosis but it is often not very contributory because of the pain (see statement)

A uterus globally enlarged in volume most often corresponds to one or more interstitial fibroids

The clinical examination is emptied bladder

So as not to have a bladder globe that would trap us

Laterouterine masses in young women are always dependent on the uterus

Not at all, they can be independent if they interest the ovary for example

Transparietal and transvaginal pelvic ultrasound is the additional examination to be requested first


Solid swellings most often correspond to ovarian cancers

Solid swellings most often correspond to uterine fibroids and ultrasound specifies their size, number and location

Cancer masses are rarely large enough to give pelvic masses

In case of a supposedly benign cyst, a cystectomy or appendectomy is performed depending on the age

Therapeutic abstention is promoted in case of asymptomatic fibroid less than 25 cm


What is the FIGO classification of an intramural uterine fibroid in contact with the endometrium?

Intramural interstitial fibroid (no contact with the endometrium)

Intracavitary pedunculated submucosal fibroma


What is the FIGO classification of a pedunculated subserous uterine fibroid?

Intramural interstitial in contact with the endometrium


Which of the following propositions are true in pregnant women?

Fosfomycin (Monuril) is used as a single dose

Urinary colonizations should be treated probabilistic

Treatment of acute pyelonephritis is always hospitable

It can be ambulatory (good clinical tolerance, first AS)

Acute pyelonephritis requires ultrasound of the urinary tract


Urinary colonizations should be screened by BU

Urinary colonizations should be screened monthly from the sixth month

Urinary colonizations put you at high risk of pyelonephritis

Ultrasound of the urinary tract is systematic in case of urinary colonizations


Which of the following proposals correspond to a probabilistic antibiotic therapy for cystitis in pregnant 🤰 women?

Not indicated in urinary tract infection

True, in single dose, it is the first-line treatment

True, this is not the first-line treatment however (rather 3rd-4th line)


Which of the following proposals corresponds to the bacteriuria threshold requiring antibiotic management in pregnant women?


Which of the following is the probabilistic first-line treatment of acute pyelonephritis without signs of severity in pregnant 🤰 women?

It is the first-line treatment for simple acute cystitis

Not part of probabilistic treatments for urinary tract infections

True. Indeed, the treatment is based on C3G IV (same as for acute pyelonephritis at risk of complication outside pregnancy)


Cystitis in pregnant women corresponds to simple cystitis

Cystitis in pregnant women corresponds to cystitis at risk of complications

Cystitis gravidarum is cystitis at risk of complications

Cystitis in pregnant women corresponds to complicated cystitis

Cystitis in pregnant women is assimilated to pyelonephritis without gravity

Cystitis in pregnant women is equated with severe pyelonephritis


Antipsychotic treatments are indicated in the treatment of psychotic disorders, by definition

Some antipsychotic treatments are indicated in bipolar disorder

Antipsychotic treatments are antagonists of D1 receptors

The combination of several antipsychotics is most often advised to increase the effects

Monotherapy is preferred in the general context

Adherence is a major issue in the drug treatment of psychiatric disorders

This is why a blood test is interesting to check


Regarding antipsychotics and antidepressants

Conventional antipsychotic treatments are not subject to a specific pre-therapeutic assessment

NFS-P, Ionogram, Uremia, Creatinine, Hepatic Function, bHCG, ECG and Metabolic Assessment

Neuroleptic malignant syndrome concerns antipsychotics

Serotonin syndrome concerns antipsychotics

Antidepressants are contraindicated in anxiety disorders

Antidepressants increase intrasynaptic monoamine concentrations


Which of these proposals designates an adverse effect of antipsychotics?

This is possible and it is related to the blockage of the a1 and H1 receptors. Example CPR clozapine, drowsiness is a very common disorder.


Metabolic syndrome, hence EAL (Lipid Abnormality Explorations) in pre-therapeutic


They facilitate gaba-ergic transmission. GABA, unlike glutamate, is an action potential inhibitor

They have an orogenic effect that can cause metabolic syndrome

They are strongly discouraged in case of respiratory failure

They are contraindicated in respiratory failure, since their muscle relaxant effect can be very dangerous

They have an anti-epileptic action. Clonazepam is also the first-line treatment for status epilepticus. So they increase the epileptogenic threshold


They are indicated in case of myasthenia gravis

They are contraindicated in this case, since they have a muscle relaxant effect

It is formal and we have an obligation to inform the patient.

Their prescription must be limited to 12 weeks in case of prescription for insomnia

4 weeks in this case, knowing that it is a very limited indication


Which of the following proposals is/are a non-selective MAOI(s)?


Which of the following is/are tricyclic antidepressants?


Which of the following is/are serotonin reuptake inhibitor(s) (SSRIs)?


Which of the following proposition(s) is true about antidepressants?

The mechanism of action of SSRIs is the inhibition of serotonin reuptake

Talking about treatment failure usually requires at least 6 months


Which of the following are included in anticholinergic syndrome?

True, by inhibiting the parasympathetic system

True, as opposed to the bradycardizing effects of acetylcholine

False, rather constipation by antispasmodic action at the level of smooth muscle fibers


Which of the following are possible side effects of selective serotonin reuptake inhibitors?

True, by inappropriate secretion of DHA (especially in the elderly)

False, no anticholinergic effect of SSRIs


Which of the following proposals are part of the lithium pre-therapeutic assessment? 💉

True, because risk of tubulointerstitial nephropathy

True, because risk of kidney side effects

True, because risk of conduction and repolarization disorders


Akinesia is the only symptom of the Parkinsonian triad that must be systematically present for diagnosis.

May be present in concomitance but does not fall within the strict framework of Parkinson's disease (triad bradykinesia / plastic rigidity / resting tremors)


Key elements of the diagnosis are: the absence of signs other than parkinsonism and the positive and prolonged response from levodopa

There may be other signs, but no red flags

The existence of parkinsonism indicates a cholinergical deficit

The existence of parkinsonism indicates a dopaminergic deficiency

The diagnosis of Parkinson's disease is clinical and does not warrant further examination in case of typical presentation

Only additional examinations will be done if there are red flags or if there is a diagnostic doubt

It is important to exclude Wilson's disease in a young patient (before 40 years) with parkinsonism

Prevalence and incidence increase gradually with age up to age 80


It is the second leading cause of motor disability in the elderly

The manifestation of signs of the parkinsonian triad is bilateral or symmetrical

The manifestation of the signs of the parkinsonian triad is asymmetrical

Asymmetry persists throughout the disease

Parkinson's disease tremors are present at rest and disappear with movement

This is the case classically. Keep in mind that tremor can have a postural component

Bradykinesia is the slowing down of the execution of a movement and the decrement of the speed


Among these proposals, which are diagnostic arguments?

The progressive appearance of bradycardia

There are dysautonomic prodromes, but these are not the main diagnostic arguments in the foreground.

The normality of neurological examination, apart from parkinsonism


Are causes of symmetric extrapyramidal syndrome:

It is an asymmetric extrapyramidal syndrome.


This is an enunciating sign of Parkinson's disease, and may be present years before the onset of the Parkinsonian triad

Tremor is asymmetric in Parkinson's disease


Why prescribe a dopaminergic agonist rather than L-DOPA early in a patient under 70 years of age?

Achieve physiological dopaminergic stimulation

Their action is not to stimulate dopamine neurons but to 'replace' them.

True, they work by directly activating receptors downstream of neurons in the substantia nigra.


Among the following proposals, which are elements that should cast doubt on the diagnosis of Parkinson's disease in the face of parkinsonism syndrome?

True, it indicates a pyramidal syndrome, which is contrary to Parkinson's disease (which is an involvement of the extrapyramidal pathways)

True. No cranial nerve damage classically


Which of the following proposals do you prescribe for a 62-year-old patient with Parkinson's disease?

Selective norepinephrine reuptake inhibitor (ISRNA)

True, preferred in a subject under 70 years old

True, to be preferred in a subject under 70 years, especially in case of Restless Legs Syndrome associated


Which of the following are atypical degenerative parkinsonian syndromes?

True, with dysautonomia and pyramid signs

True, with cognitive impairment (hallucination and decreased alertness)


Which of the following proposals can precede the motor disorders of Parkinson's disease by several years?

True, low dopamine decreases motor inhibition during REM sleep. Patients describe animated dreams

True, is found in many neurodegenerative diseases


Which of the following is/are recognized risk factors for Parkinson's disease?

True, this is the only risk factor cited in the college


Which of the following are true about Wilson's disease?

The most common mode of disclosure in children is liver damage

It is often in young adults (before 35 years)

Genetic testing can be done without informed consent

Never genetic testing without free and informed consent

The accumulation of free copper is responsible for organic damage


Which of the following are side effects of dopamine agonists?


Which of the following are synucleinopathies (neurodegenerative diseases characterized by the abnormal accumulation of synuclein protein aggregates)?

True, the aggregate forms intracytoplasmic Lewy bodies in neurons of the nigrostriatal pathway (and especially in the substantia nigra, in the midbrain).

Instead, hyperphosphorylated Tau proteins are found in axons and extracellular Ab-42 peptides

True, there is an asymmetric parkinsonism syndrome and dysautonomia. We can find a pyramidal syndrome (with plastic rigidity and positive Babinski). There is no significant impairment of higher functions

True, there is an asymmetric parkinsonism with significant impairment of cognitive functions

There is an increased 24-hour cupruria associated with a decrease in serum cupremia and ceruleoplasminemia. Clinically, Kayser-Fleischer annals are observed at water level (copper deposit).


Which of the following are signs or symptoms of parkinsonism in parkinsonism?

Spastic rigidity is part of pyramidal syndrome. Parkinson's syndrome is an extra-pyramidal syndrome in which plastic rigidity is found.

True: slow walking, micrography, hypomimia, etc.


Which of the following proposals regarding the implantation of a stimulator are true?

The main objective is to reduce fluctuations related to drug treatments

Deep brain stimulation consists of the implantation of electrodes in basal ganglia by radiological route

The nucleus concerned is the caudate nucleus most often

The electrodes allow high-frequency stimulation that has an inhibitory effect on the affected nucleus

Electrodes stimulate endogenous dopamine production

They stimulate the subthalamic nucleus which is a powerful inhibitor and therefore helps to alleviate the signs of dopaminergic over-stimulation due to drugs


The typical onset of bipolar disorder is between the ages of 40 and 50.

Typical onset of bipolar disorder: 15-25 years

The manic episode is a medical-surgical emergency

Medical emergency. No surgical management on this pathology.

Manic syndrome has a psychoaffective, psychomotor and phsyiological disturbances component

Diet and sexuality are often disturbed in this disorder

The gold standard treatment for manic episode is lithium


The only effective thymoregulator in suicide prevention is xeroquel

It's lithium. Xeroquel is a quetiapine (second generation antipsychotic)

The recommended dosage of Depakote is 750 mg/day

Aripiprazole is a first-generation antipsychotic

Lithium is a treatment for the depressive episode characterized in the context of bipolar illness

Amotrigine is a preventive treatment for depressive episodes in bipolar disease


Quetiapine is a first-generation antipsychotic

Bipolar disorder is a severe, chronic and common psychiatric disorder

This disease was discovered by Freud in the 1890s.

This disease has been described since ancient times and is characterized by pathological changes in mood and energy that can be increased (mania) or decreased (depression)

Bipolar disorder is pure genetic in origin but the exact loci are not known

Bipolar disorder is multifactorial in origin, mixing genetic and environmental risk factors

It is considered that 1 to 4% of the general population has typical forms of bipolar disorder.


Which of these proposals correspond to the development of the cephalic end?

up to S2. (For information, S = week of development in utero)


The earlier a developmental abnormality is, the more severe it is

Phacomastoses are progressive tissue dysplasias that occur during histogenesis

Cellular abnormalities in primary blastema

Dystosis deformities reside mainly in the orbit and ear

They can sit in the orbit, nose, maxilla or mandibular (but not the ear)

The clinical expression of suturary involvement will be immediate in the face

Late because it is a discontinuous, multifactorial and long-term growth entity

The clinical expression of suturary involvement will be rapidly progressive in the cranial vault

It will be immediate and dependent on the brain


The cephalic tip of the fetus begins to round at S24

The nasofrontal bud will evolve into mandibular buds

It will give the frontal bud and the internal and external nasal buds

Cysts and fistulas result from a disorder of the coalescence of one or more facial buds and ectodermal inclusions at the junction of these structures

Treatment of cysts and fistulas is purely surgical


They result from a lack of attachment of one or more facial buds

They have a social and psychological impact exclusively

They also impact orofacial function and facial morpjology

The stomodeum is permanently obstructed by the pharyngeal membrane

Very rare malformation (cleft between the upper maxillary bud and the outer nasal bud)

The macrostomy is a cleft between the upper and lower maxillary buds


Cleft lip and palate are the most common facial clefts

It is multidisciplinary: genetic counseling, psychological care, speech therapy, orthodontic follow-up, surgery, etc.

It can be part of a polymalformative syndrome

It most often results from an accident during organogenesis between S5 and S7


Medical confidentiality has been one of the pillars of medical practice since 1980

Introduction Since Hippocrates, medical secrecy has been one of the pillars of the practice of medicine: "Admitted inside the houses, my eyes will not see what is happening there, my tongue will silence the secrets that will be entrusted to me..." Because there is no care without confidences, confidences without trust, trust without secrecy

Physician-client privilege has a dual interest: private and public.

The doctor must guarantee secrecy to the person who confides in him

The history of secrecy surrounding the medical act testifies to a complex, sometimes conflictual, triangular relationship between physicians, society and patients

Society or state can never access medical information

Indeed, in certain circumstances, the law requires or authorizes the disclosure of certain information for a private and/or public purpose, for example in the context of judicial requisitions."


The obligation to secrecy is now included in articles 226-13 and 226-14 of the 1994 Criminal Code.

In the penal code, we find the notion of medical confidentiality, reserved for health professionals

The Penal Code Compared to the old Code, the Penal Code of March 1994 no longer refers to doctors. It concerns any person holding confidential information.

Revealing secret information can be punished by a fine but not by prison

Article 226-13: "The disclosure of information of a secret nature by a person who is the custodian thereof, either by state, or by profession, or because of a function or a temporary mission, is punishable by one year's imprisonment and a fine of 15,000 euros.

The Act of 8 March 2003 establishes a breach in medical confidentiality by allowing doctors to hand over a file to a judicial police officer, on simple requisition, without violating the principle of secrecy.

Under the 2003 Act, a judicial police officer may compel a doctor to hand over a patient's medical file.

When the medical file is requisitioned during a criminal case, for example, the seizure must be made in the presence of a doctor who ensures the proper maintenance of medical confidentiality as well as the seizure of the file according to good practices.


Which of these proposed laws refer to medical confidentiality?

The Code of Ethics of the Ordre des médecins

It is not a piece of legislation, but several elements have been extracted and inserted into the various codes by the legislator.

This is the law on the financing of social security."


Professional secrecy, instituted in the interest of patients, is binding on every doctor under the conditions established by law.

Doctor's assistants are not subject to medical confidentiality if they are not doctors

The physician must ensure that the persons who assist him in his practice are informed of their obligations with respect to professional secrecy and comply with them

The physician must protect against any indiscretion the medical documents concerning the persons he has cared for or examined, regardless of the content and medium of these documents.

When using his experience or documents for scientific publication or teaching purposes, physicians must ensure that identification of persons is not possible.

Publishing a research paper with the name of an explicitly cited patient is illegal

Failing this, their agreement must be obtained.


Concerning the case-law on professional secrecy

It is binding on all health professionals as well as all professionals involved in the health system.

Medical confidentiality prohibits the doctor from giving the cause of death of a patient to his family

Secrecy shall not prevent information concerning a deceased person from being delivered to his successors, insofar as it is necessary for them to know the causes of death, to defend the memory of the deceased, or to assert their rights, unless otherwise expressed by the person before his death.

Case law tends to eliminate the notion of medical confidentiality

Jurisprudence, both judicial and administrative, has reinforced these provisions by proclaiming that medical confidentiality is of a general and absolute nature, as early as the nineteenth century.

The doctor is not subject to medical confidentiality if the patient does not request it

the patient cannot release the doctor from his obligation of secrecy

Talking with co-interns about a patient at the staff restaurant is not in contradiction with medical confidentiality

Secrecy is required with regard to other doctors if they do not contribute to an act of care


Regarding the solicitor-client privilege application(s)

A doctor working for an insurer is subject to medical secrecy that he shares with his colleagues hospital doctors

They may not examine the medical file, or question the attending physician of a patient, without the express agreement of the latter.

The doctor must communicate the medical file to the insurance companies for reimbursement

It is up to the patient to communicate his personal data to insurance doctors (the law of 4 March 2002 now gives him direct access to his file). Nevertheless, he can be helped by the doctor to fill out certain administrative forms. He remains the holder of all data concerning him.

The medical officer of the social security is not bound by medical confidentiality

The exchange of information between the attending physician and the medical officer, who is himself bound to secrecy, is also recognized in the name of the principle of "shared secrecy" (medico-social consultation).

In criminal matters, the Code of Criminal Procedure allows judges to use coercive means to access medical information and the truth.

The scope of professional secrecy stops at written information. Information seen and heard is not subject to this secrecy.

Secret information Case law has long been ruling on the extent of professional secrecy, and this consistently, specifying that secrecy concerns all information entrusted, but also everything that may have been seen, heard, understood, or even interpreted during medical practice.


Which of this information is covered by medical confidentiality?


Nasopharyngitis is almost exclusively viral

Nasopharyngitis is the most common mode of expression of influenza in children

There is often viral sinus involvement in nasopharyngitis, which heals spontaneously

Acute bacterial sinusitis is a rare complication of nasopharyngitis

The presence of sinusitis in immunocompromised patients should suggest a fungal origin (aspergillosis, mucormycosis), especially in case of bone lysis on CT


Most acute bacterial sinusitis complicates a viral infection of the upper airways

In case of doubt as to the viral or bacterial origin of acute maxillary sinusitis, clinical reassessment after 2 or 3 days of symptomatic treatment is advised

Imaging has no indication except in cases of unilateral maxillary sinusitis


Ethmoidal sinusitis is mainly observed in adults

In case of bacterial infection with frontal, ethmoidal or sphenoidal localization, there is a risk of serious damage to the central nervous system by proximity diffusion

Chronic sinusitis is defined by the persistence of symptoms of nasal obstruction, pain and rhinorrhea for more than 2 weeks

In infants, a picture of gastroenteritis with diarrhea and abdominal pain may be in the foreground

The intensity and impact of symptoms are very variable depending on the individuals and episodes.


In which case(s) is the sinus scanner systematic for management?

False. Sinus CT is indicated only if there is a diagnostic doubt, if there is doubt about complications, if there is resistance to first-line antibiotic treatment, or if it is chronic maxillary sinusitis

None. The diagnosis of sinusitis is clinical and only a CT scan is done if there is a diagnostic doubt.


Which of the following are systematic indications for sinus CT?

Dental panoramic or dentascan, to search for a dental focus


Maxillary sinuses are formed from 3-4 years

This is why we see frontal sinusitis only in adolescents/adults

Sphenoid sinuses form around 5-10 years of age

False, between 10 and 15 years old. These are the frontal sinuses that form between 5 and 10 years.

Ethmoidal cells are formed from the first months of life

Maxillary sinuses are formed from the first months of life

From 3 years old. We can therefore not see maxillary sinusitis before 3 years


Which of the following are signs of simple nasopharyngitis?


Regarding the development of sinuses in children. Which of the following are true?

Maxillary sinuses are present from birth

Sphenoid sinuses are present from the age of 5 to 10 years

False. Sphenoid sinuses are present from the age of 10 to 15 years.

Ethmoidal cells are present from the age of 3 to 4 years.

False. Ethmoidal cells are present from the age of 1 month.

The frontal sinus is present from the age of 5 to 10 years


Which of the following are sinusitis locations requiring Amoxicillin-Clavulanic Acid?


What type(s) of sinusitis(s) can an infant have?

False. The maxillary sinus is developed from the age of 3-4 years. It is impossible to have maxillary sinusitis before the age of 3.

False. The frontal sinus is present from the age of 5 to 10 years.

False. The sphenoid sinus is present from the age of 10 to 15 years.

True. Ethmoidal cells appear as early as 1 month of age.

None, sinusitis is not possible before the age of 3 years

False. Since ethmoid cells exist, it is possible to have ethmoid sinusitis.


What sinus involvement(s) requires the realization of a CT scan?


Regarding the bacteria responsible for sinusitis. Which of the following are true?

Ethmoiditis is often caused by Moraxella catarrhalis

False. Moraxella catarrhalis is not a germ that often causes ethmoiditis. On the other hand, it is a germ that can cause maxillary, frontal or sphenoid sinusitis.

Haemophilis influenzae is a gram-negative cocci

Haemophilis influenzae is a gram-negative bacillus

During acute maxillary sinusitis with dental entrance door, anaerobic germs and Aspergillus can be found.

True. Aspergillus is mentioned in the Pilly.

If bone lysis is found on CT scan in the immunocompromised, it is necessary to evoke a fungal infection (Aspergillus and mucormycosis)

Streptococcus pyogenes is a gram+ chain cocci on direct examination that often causes maxillary sinusitis

It is a gram + cocci on direct examination, but it is not a germ that is often involved in maxillary sinusitis. It is a common germ for ethmoidites.


Which of these proposals are natural radioactive sources?


The absorbed dose is expressed in Sieverts

The effective dose is expressed in Sievert

The equivalent dose is expressed in Sievert

The equivalent dose is expressed in Gray


The space between the two leaflets of the pleura is completely virtual

There is a pleural fluid of 5 to 20 mL, physiological, which allows the slippage ✌ of both leaflets into the lungs

Any unproven exudate should undergo a pleural biopsy

Complicated parapneumonic effusions are evacuated as soon as possible

Any febrile pleural effusion should be punctured urgently

Any pleural effusion should be punctured

Not if its cause is known, if a
heart failure is suspected or if effusion is minimal


Which of the following are characteristics of transudates?


What is the triglyceride level that defines the diagnosis of chylothorax?


Among the following propositions, what is the LDH threshold to define an exudate?


Which of the following are the causes of bilateral transudates?

True, loss of protein and decrease in oncotic pressure

Unless it is bilateral, there would be a unilateral transudate


Which of the following are the clinical diagnostic criteria(s) of ACR that would allow you to retain the diagnosis of Lupus?

It is a biological criterion, not a clinical one. In addition, leukopenia is mentioned in the ACR criteria.


Which of the following are the clinical or biological diagnostic criteria(s) of the ACR that would allow you to retain the diagnosis of Lupus?

We can find a false syphilitic serology (VDRL+ and TPHA-)


Which of the following criteria are the biological diagnostic criteria(s) that would allow you to retain the diagnosis of Lupus?

The presence of anti-Sm antibodies is rare (~20%) but very specific


What treatment(s) background and crisis do you propose to treat active class IV lupus nephropathy, without joint involvement?

Does not fit into the treatment of lupus. Normally, kidney damage does not hurt


Which of the following are true about lupus?

Joint damage is usually migratory and fleeting

Joint damage exceptionally affects small joints

Jaccoud's hand appearance is a complication of lupus


Which of the following proposals are part of the biological assessment useful for the positive diagnosis of systemic lupus erythematosus?


Which of the following proposals are contraindicated during pregnancy 🤰?

Unlike cyclophosphamide, methotrexate or mycophenolate mofetil, azathioprine can be used


Class 2 glomerulonephritis is intracapillary proliferation

There are 5 classes of lupus glomerulonephritis

There are 6 (1: minimal lesions, 2: mesangial proliferation, 3: focal proliferation with <50% of affected glomeruli, 4: diffuse proliferation with >50% of affected glomeruli, 5: extramembranous proliferation, 6: sclerotic)

Renal involvement affects about 5% of patients

Class 5 glomerulonephritis is an extramembranous involvement


Native anti-DNA antibodies can be detected by PCR

Only DNA can be detected by PCR (and RNA for RT-PCR)

Native anti-DNA antibodies can be detected in ELISA

Lack of native anti-DNA antibodies eliminates diagnosis of lupus

Native anti-DNA antibodies are essential for diagnosis

The level of native anti-DNA antibodies reflects disease activity


Which of the following proposals is part of the first-line background treatment for systemic lupus erythematosus?


He was a Lord. The Beveridgian system comes from the UK while the Bismarckian system comes from Germany (Chancellor Bismark)

The system is financed by employers' contributions

3 principles (the 3 U's): universality, uniqueness and uniformity

This is the system in place in Ireland and Finland.

England, Sweden, Finland, Denmark and Ireland"


It was founded by Chancellor Bismarck at the end of the 19th century.

Decentralised management by employees and employers

It is implemented in Germany and Austria

Also in Belgium, the Netherlands, Switzerland and Luxembourg

It was originally intended to protect industrial workers.


Each country has a system of santoe that has been built according to its political choices and traditions.

Health spending in England was 1.9% of GDP in 2014

The health system is named National Health Service (NHS)

The financing of the system in England is provided by taxes


Healthcare in England is extremely expensive for users

Health care is almost free for all residents (co-payment for medicines)

Doctors are paid based on the medications they prescribe

Doctors are paid by the NHS according to the number of patients registered and certain procedures they perform.

Doctors do not have complete freedom of installation

The GP is the mandatory gateway to specialists, hospitalizations, etc.

The English model, however, has the disadvantage of rationing care quantitatively.


In Germany, health spending was 21.1% of GDP in 2014

Health expenditure = 11.1% of GDP in 2014

Public and private funds are in competition with each other and autonomous in their management

The Länder are responsible for hospital planning

Patients are free to choose their insurance fund

There is a regulation of medical demography


The federal state covers major risks (the elderly, the severely disabled, people in need)

Health spending is very high: 17.1% of GDP in 2014 2.2. HEALTH INSURANCE VIA EMPLOYER sickness

Health insurance is most often job-related


About 25% of the population is covered by compulsory health insurance

MEDICAID is for the elderly and the disabled

MEDICAID: For the poorest. Financed by federal states (inequalities according to regions)

2 to 8% of Americans do not have health insurance in the US

Without health insurance, individuals must pay the full cost of health care


Historically, the health system in France is under the Bismarckian system.

One of the objectives of health policies is to promote health in all living environments

The organization of logical health pathways is one of the objectives of health policies


Which of these proposals are actors in the health system?

It is the producer of health services and goods

Have nothing. Even health journalists are not actors in the healthcare system (role of commentators and not actors)


Which of the following proposals are part of the pre-therapeutic assessment before the introduction of an anti-TNF alpha?

True (tuberculosis: indeed, the main immune pathway that allows the control of Koch's bacillus is based on TNF-alpha)

False, on the other hand we do: EPP-NFS, HBV-HCV-HIV, ECBU ± sinus-panoramic


Which of the following propositions regarding herpes virus infections are true?

Very common, 90% of adults are HIV-positive

No, only atypical pictures or in some patients who need to document the infection

Diagnosis requires additional examinations

Several treatments are available, including Aciclovir, Valaciclovir...

There is currently no treatment available


Which of the following are treatments for atrophic AMD, if any?


Which of the following are mainly unilateral etiologies?


Which of the following proposals are favored in case of cryptorchidism?


Regarding the complications of diabetes, what are the true propositions?

False, the complications are caused precisely by the excess of glucose in the endothelial cells that saturate their glucose metabolism pathway. Entry into these cells is through transporters that are not dependent on insulin. Insulin acts on GLUT4 receptors that concern adipocytes and rhabdomyocytes.

Insulin resistance and then insulinopenia prevent the entry of glucose into the cells, which is the cause of complications of diabetes

Prevention of complications starts with good glycemic control

False, first by the general practitioner. The diabetologist's advice is recommended only in case of complications of diabetes

The management of the diabetic patient goes first through the diabetologist

True, however, it is necessary to look for them immediately in type 2 diabetics

Degenerative complications are rare when T1D is diagnosed

It is annual from diagnosis, regardless of age


Which of the following are needed for classic TDPS?

True, you cannot do SPDT for a minor (only SPDREs or PPOs are possible)


What is(are) the main toxicity(s) of vancomycin?

Vancomycin is ototoxic (like aminoglycosides)

True, to remember !! Another side effect to remember is the red man syndrome in case of injection too fast.


Which of the following propositions are true about hyperopia?

It concerns all persons over 70 years of age


Which of the following are signs of spondyloarthritis?


Which of the following propositions corresponds to a normal reading of the finest letters in the Parinaud scale?


What is the prevalence of allergy (to any substance) in children under 15 years of age?

True, and the prevalence of food allergy is 7%


Which of the following proposals for particular cardiopulmonary resuscitation situations are true?

In pregnant women (≥20 SA) the uterus should be reclinated to the left during cardiac massage to promote venous return

In pregnant women, the heels of the hands are applied higher than in non-pregnant women

In case of drowning, cardiopulmonary resuscitation should be started with 2 breaths

True, however, it is necessary to quickly identify rapidly curable etiologies at the origin of an ACR in a traumatic context (compressive pneumothorax, hemorrhagic shock, etc.).

RTAs of traumatic origin primarily follow the same recommendations as RTAs of "medical" origin

Abdominal compression is not indicated in case of drowning


Which of the following proposals are the rights of involuntary hospitalized patients?


In............ In cases, acute pancreatitis is life-threatening.

In 20–30% of cases, pancreatitis is severe (necrotizing) and life-threatening.


Which of the following are diseases associated with prematurity?


Which of the following are true about Stargardt disease?


True, unless hemodynamic instability, surgical samples are first taken

It is generally forbidden to introduce blind probabilistic antibiotic therapy in case of suspected infection on equipment

Diabetes and obesity are risk factors for prosthetic infection

Tobacco is a delayed bone consolidation factor

The average duration of bone consolidation of a talus fracture is about 6 weeks


Regarding contraception, which of these answers is/are true?

False, only progestin-only contraception acts on the tube, which explains the fact that ectopic pregnancies are one of the main adverse effects.

Estrogen-progestorative contraception acts on the endometrium, ovary, hormonal feedback to the pituitary gland and fallopian tube

True, the Pearl Index is an indicator of the number of accidental pregnancies under contraception, the higher it is, the less effective contraception is

So-called "natural" contraception (withdrawal, temperature measurement) have a high Pearl index

True, as well as personal or family history of venous thromboembolic disease, history of arterial disease, or cardiovascular risk factors

Among the contraindications of estrogen-progestin contraception, we find migraine with aura

False, taking emergency contraception is unique

Following emergency contraception, emergency contraception must be continued for 7 days


Which of the following propositions are true for oral rehydration solutions (ORS) in children?

ORS is the only essential treatment for dehydration in children.

ORS does not stop diarrhoea but can prevent and/or correct acute dehydration induced by diarrhoea and/or vomiting, as well as secondary ionic disorders.

The intake of ORS must be early, at the first symptoms.

ORS is contraindicated in cases of vomiting


No! The only one not reported among the 3 MMR vaccine.

Treatment combines ritonavir and antiplatelet agents


What is the blood glucose goal at 2h post-prandial in a pregnant woman with type 2 diabetes?

True. College of Gynecology (4th edition)

Threshold defining fasting type 2 diabetes (twice)


Which of the following are etiologies of intravitreal hemorrhage?

True, vein occlusion = blood cannot come out = aneurysm and edema = flammèche and spot hemorrhage, papillary edema, macular edema, cottony nodules, intravitreal hemorrhage

Artery occlusion = blood does not arrive = no bleeding

True, complicated or not retinal detachment.


Regarding the positive diagnosis of goiter. Which of the following propositions, which one or which are true?

False. > 16 mL in adolescents. > 18 mL in adult women and > 20 mL in adult men

The WHO definition of goiter is palpation of the surface of each lobe that exceeds that of the last phalanx of the thumb.

The WHO definition of goiter is palpation of the surface of each lobe that exceeds that of the last phalanx of the index finger.


Which of the following proposals cause enteroinvasive diarrhea?

Choleriform diarrhea (secretory mechanism) ➡ fluid diarrhea without fever


Which of the following are signs in favor of ulcerative-necrotizing enterocolitis?

True, which corresponds to air in the intestinal walls observed at ASP


Which of the following are notifiable diseases?

False. The updated list is available on https://www.santepubliquefrance.fr/maladies-a-declaration-obligatoire


What is the significant bacteriuria threshold to confirm urinary gestational colonization?

True, not to be confused with bacteriuria thresholds cf table p 143 of the pilly


Which of the following proposals are needed for emergency TDPS?

True, as with all procedures except SPDRE

An established disturbance of public order


In.......... of cases, acute pancreatitis is mild

In 70-80% of cases, pancreatitis is benign, edematous (it will heal in a few days)


Which of the following proposals is part of the couple's first-line infertility assessment?

False. J21. Progesterone is used to analyze the presence of ovulation.

False. J3. It makes it possible to analyze the ovarian reserve. It is also not systematic in first line, unless indicated: woman > 35 years, ovulation disorders, indication of treatment with ART, history of ovarian aggression and family history of early ovarian failure

False. It is part of the second-line balance sheet and is not reimbursed by social security.

True. The examination analyzes the uterus and fallopian tubes


Which of the following are radiological signs of prosthesis infection?

Diffuse joint pinching with subchondral geodes


What biological sign generally reflects an obstacle in the ampulla of Vater?

"The elevation of total bilirubin (> 40 μmol / L) generally reflects the blockage of a stone in the ampulla of Vater" cf College of HGE


Which of the following is used to measure visual acuity up close?

Classification of the different phototypes. From 1 (clear) to 6 (tanned)

Classification of signs of severity of anaphylaxis


What type of kidney failure is most commonly observed?

It is functional in 75% of cases and organic in 25% of cases, it is a pejorative prognostic factor


The somatic examination must take place in:


What is the prevalence of food allergy in children in France?

True. In France, the prevalence of food allergy is estimated at between 5 and 7% in children.


Which of the following are signs or symptoms of primary HIV infection?

True, in 70% of cases according to the College of Dermatology (2017 edition)

Digestive signs: acute diarrhea, nausea/vomiting, abdominal pain (non-specific, not very sensitive)


Which of the viruses that cause viral hepatitis is chronic only in immunosuppression?

Chronicity possible even without immunosuppression, in 5 to 10% in adults (caution 90% in children)

Chronicity possible even without immunosuppression, in 75% in adults

Possible if co-infection or superinfection with HBV

True. The virus causes chronic hepatitis only in cases of immunosuppression.


Which of the following propositions are true about the hyperopia of the child?

The image of a point located at infinity is formed behind the retina

The child can compensate for the lack of refractive power of his eye by accommodation

Concave for myopia, convex for hyperopia

Corrective lenses are concave spherical lenses

Hyperopia and astigmatism, never myopia because there is no adaptation by accommodation

Accommodative asthenopia is only possible in case of myopia


The common toxicity of spindle poisons is peripheral neuropathy

True, it's not nice to see (better to put the varnish) 😫

Taxanes can cause onycholysis, which can be prevented by the use of solidifying nail polish

Vinca alkaloids can cause onycholysis, which can be prevented by the use of solidifying nail polish


Which of the following propositions regarding herpes virus infections are true?

Very common, 90% of adults are HIV-positive

No, only atypical pictures or in some patients who need to document the infection

Diagnosis requires additional examinations

Several treatments are available, including Aciclovir, Valaciclovir...

There is currently no treatment available


Which of the following are trophallergenic proteins contained in eggs?

True. Mnemonic means: the two proteins starting with 'ov' = egg 🐣


Which of the following are complications of ascites?


False, the fact that the testicle goes up to the abdomen relieves the patient. In favor of an orchitis. Against a twist

The positive Prehn sign is in favor of this diagnosis

The cremasterian reflex is abolished on the torsion side

False, 6 hours after the onset of pain (time before necrosis sets in)

Exploration must be done within 24 hours

False, Surgical emergency: ultrasound should not delay management (not very sensitive and not very specific)

Ultrasound is mandatory to make the diagnosis


False, unlike malignant tumors of infants, hemangiomas are elastic and not indurated

have in the majority of cases a phase of spontaneous involution in a few years

False, they are neither flapping or quivering on palpation, nor blowing on auscultation unlike arteriovenous malformations.

False, absent at birth, unlike vascular malformations and congenital hemangiomas (Differential diagnosis)


In which case should the dosage of peri-conceptional folic acid be increased?

True, these are the three indications where 5mg/Day of B9 is administered (instead of 0.4mg/D)


Which of the following propositions are true about Paroxysmal Pain Attacks (PDAs)?

True. This is the definition of Portenoy, 1990. Not to be confused with poorly controlled background pain, nor with painful bouts at the end of the dose

Paroxysmal Pain Attack is a transient exacerbation of pain in patients with a stable chronic pain background, well controlled by opioids.

Paroxysmal pain attacks (PDA) of cancer justify the use of fast-acting transmucosal morphine.

They are well supported for a morphine Per Os


This muscle is the only oculomotor muscle to be innervated by the fourth pair of cranial nerves (trochlear nerve)

The superior oblique muscle is innervated by the sixth pair of cranial nerves

The superior rectus muscle is innervated by the third pair of cranial nerves

The inferior oblique muscle is innervated by the third pair of cranial nerves

This muscle is the only oculomotor muscle to be innervated by the sixth pair of cranial nerves (abducens nerve)

The lateral rectus muscle is innervated by the third pair of cranial nerves


Which of these endocrine pathologies is complicated in 5 to 10% of cases by acute pancreatitis?


What is the blood glucose goal at 1h post-prandial in a pregnant woman with type 2 diabetes?


What is the hip replacement dislocation rate?


Which of the following are etiologies of exudative ascites?


True Secreted permanently by ciliary processes, mood
aqueous is discharged at the iridocorneal angle through the trabeculum into the canal
of Schlemm which joins the general circulation


Which of the following propositions, which one or which are true?

Bleomycin causes reversible pulmonary fibrosis

False. Dose-dependent when the total cumulative dose exceeds 280 mg

Bleomycin causes nondose-dependent pulmonary fibrosis

A DLCO/VA ratio < 67% contraindicates the use or continuation of bleomycin

True, according to Wikipedia; "Biosynthesis of bleomycin is completed by glycosylation of the aglycones."

Bleomycin is a chemotherapy that is derived from glycopeptides

Bleomycin is particularly used in metastatic non-germinal testicular cancer


What are the possible causes of hypokalemia?

True, cortisol has a strong affinity for aldosterone receptors


What is the goal of fasting blood glucose in a pregnant woman with type 2 diabetes?


Which of the following are treatments for early stage AMD?


Which of the following are possible genetic causes of hearing loss?

True, ligament hyperlaxity and bone fragility

True, no malformation of the ossicles / external ear canal


Which of the following proposals suggest hemolytic uremic syndrome (HUS) in children?


Which of the following identifies the most common perennial pneumallergen?

True. Dermatophagoids pteronyssinus and D. farinae


What is the recommended duration of contraception after each dose of chickenpox vaccine in a woman of childbearing potential?

Contraception is not required after the chickenpox vaccine.


False. This is iodine deficiency. Tobacco, on the other hand, is a factor promoting goiter because it contains thyocyanate which is goitrigen.

The first factor favoring goiter is tobacco

False. Despite the fact that it is goitrigen, it does not increase the risk of thyroid cancer.

Tobacco is a risk factor for thyroid cancer

Thyroid follicles have receptors for estrogen

True. Lithium acts as a synthetic antithyroid.

False. 100 to 150 μg/day for the majority of the population, but 200 to 250 μg/day for pregnant women.

Lithium requirements are 100 to 150 μg/day for the entire population


Abdominal pain of the child:
Which of the following are true?

False.
In practice it is a frequent reason ++ consultation in the emergency room (more precisely they come for crying).
Not much effective treatment unfortunately, it's a lot of parental reassurance explaining that it will pass.
In practice we often offer abdominal massages, and probiotics that have a certain effectiveness.

Treatment of infant colic is based on antispasmodics and laxatives.

False.
Paracetamol can be used from birth even in premature babies of 500g :).

It is contraindicated to use paracetamol to treat abdominal pain in a child under 1 month of age.

True
In practice this is very common. It remains a diagnosis of elimination so often we make the diagnosis by doing an ultrasound to eliminate appendicitis. It is often secondary to an ENT infection just like primary acute intussusception.

Mesenteric adenolympitis is a common cause of abdominal pain in children 2 to 12 years of age.

Primary acute intussusception usually occurs in a child 2 months to 2 years of age.

False
On the contrary, we look for a secondary cause in children over 2 years of age.

Acute intussusception occurring in a child under 2 years of age should investigate a secondary cause


Which of the following are risk factors for prosthesis infection?


Which of the following are contraindications to non-invasive ventilation?

True, may worsen an undrained pneumothorax

False, it is precisely one of the formally validated indications of NIV

Acute lung oedema with respiratory distress

False, it may be an indication of NIV. (Table evoking pneumocystosis!)

Hypoxemic acute respiratory failure of the immunocompromised


Which of the following proposals are plasmodial species pathogenic to humans?

True, responsible for 90% of severe malaria attacks

There are more than 130 different plasmodial species. Only 5 are pathogenic for humans: falciparum, knowlesi, oval, vivax, malariae


Which of the following are transudative ascites etiologies?


Which of the following are complications of cataract surgery?


What is the treatment for post-treatment eczematization?


Which of the following propositions are true concerning the anterior luxaion of the humerus?

Possible damage to the nerves of the hand (via brachial plexus injury)

We never find hypoaesthesia of the fingers


Which of the following are differential diagnoses of autism spectrum disorder (ASD)?

Children with intellectual disabilities frequently experience symptoms of ASD (in all 2 clinical areas). A psychometric assessment makes it possible to estimate the patient's IQ and to identify an intellectual disability and its level of severity.

The realization of an audiogram or auditory evoked potentials make it possible to eliminate this differential diagnosis

Children have difficulties with verbal communication, but the difference with ASD is that children are able to compensate for this deficiency through non-verbal communication and maintained relational skills.

Patients with ADHD frequently have difficulties in social interactions (mainly related to symptoms of hyperactivity and impulsivity) but no deficit in social or emotional reciprocity, nor in steteotyped or restricted behaviors.

Patients with schizophrenia frequently have difficulty in social interactions.


Which of the following are vaccines already delivered at 3 months of age?


True, acute (emergency) and chronic hypercalcemia

There are 2 main semiological tables of hypercalcemia that are quite distinct and do not involve the same management

The reference is ionized calcium (active calcium), which is difficult to access. We can still rely on corrected plasma calcium

The reference measure of calcium is plasma calcium

Acute hypercalcemia crisis is defined as a serum calcium threshold > 3.5 mmol/L

The repercussions of hypercalcemia on the ECG include QT prolongation, early T waves, tachycardia, BAV.

In hypercalcemia there is a tendency to extracellular dehydration


Which of the following are the causes of macular pathologies?


Which of the following are causes of intravitreal hemorrhage?


When should diversification be introduced?


Which of the following proposals regarding the pre-hospital management of a polytrauma patient are true?

False, it is necessary to put 2 VVP of good caliber <16G

True, the indications for intubation in the context of a polytrauma are among others a Glasgow ≤8, respiratory or hemodynamic distress

If the patient requires mechanical ventilation, rapid sequence orotracheal intubation should be performed

Vasopressor therapy with dobutamine should be introduced if hypotension persists despite adequate filling

False, the reduction of fracture foci is the first step in analgesic treatment of these and prevents fat embolism. They must also be immobilized afterwards to prevent secondary displacement that may be the cause of vascular and/or nerve damage.

In case of fractures, they should not be reduced in pre-hospital


Regarding the epidemiology of goiter. Which of the following propositions, which one or which are true?

The sex ratio of goiter is 5 women to 1 man

The sex ratio of goiter is 3 women to 1 man

Prevalence decreases with age as there is a decline in TSH synthesis


Which of the following are part of the posterior segment?


Regarding pre-oxygenation before general anesthesia out of emergency. Which of the following are true?

False. At least 3 minutes of pre-oxygenation. The goal is to achieve a FeO2 ≥ 90%.

The patient is preoxygenated for at least 2 minutes

False. 90%. This testifies to the almost complete denitrogenation of the lung (= replacement of nitrogen by O2)

True. It is the act of replacing nitrogen with O2.

The goal of pre-oxygenation is to achieve almost complete "denitrogenation" of the lung

100% FiO2 should be administered during pre-oxygenation

True. This limits the risk of hypoxemia.

The purpose of pre-oxygenation is to saturate the body's oxygen reserves, including the functional residual capacity of the lung, in order to ensure the longest possible safety apnea in case of difficulty accessing the airways during intubation


Which of the following are true for the treatment of mumps parotitis?

Amoxicillin - Clavulanic acid for 7 days

3rd Generation cephalosporin alone for 10 days

3rd Generation cephalosporin for 10 days plus Amikacin in single dose

True, and especially primary prevention through MMR vaccination!


Which of the following are true for trochlear IV nerve palsy?

The trochlear IV nerve is the smallest of the cranial nerves

True, the healthy eye can go, the affected eye can not

Diplopia is maximum at the bottom and inside

It is very embarrassing: climbing stairs, reading, ...

The chin is lowered, the head is tilted to the healthy side

The compensatory position includes a raised chin


True, in nephrotic syndrome there is secondary hyperlipidemia to compensate for the loss of osmole.

False, proteinuria of small proteins is physiological in small amounts

True, if proteinuria is suspected at orthostatism, especially in 12-16 year olds, proteinuria should be measured after 2 hours of clinostatism.

Proteinuria can be promoted by infection, fever or orthostatism, etc.

True, urinary protein electrophoresis will determine the content of urinated proteins: mostly albumin or mostly low molecular weight proteins

To analyze the content of proteinuria an electrophoresis of urinary proteins is performed


Which of the following proposals can cause eye strain?


Which of the following proposals are suggestive of a malignant lesion on imagery?

True, these are spiculated multilamellar periosteal appositions


With regard to acute diarrhoea in children, what are the right proposals?

False, rotavirus viral diarrhea is the most common but vaccination is not part of the schedule (nb: withdrawn for increased risk of intussusception)

The most common etiology is rotavirus, which is subject to mandatory vaccination in children under 6 months of age.

True, however it must be remembered that it is contraindicated for children under 2 years of age and contraindicated in general for bloody invasive diarrhea or with high fever

True, it is necessary to evaluate the child to estimate his degree of dehydration.

Symptomatic treatment is mainly aimed at dehydration

False, there must be liquid stools several times a day (>3/d in general).

Diarrhea is defined by the occurrence of watery stool


Insulin resistance during pregnancy is a physiological phenomenon

The prevalence of prior diabetes associated with pregnancy is <5%

Classically in the second half of pregnancy

Gestational diabetes typically appears from implantation

The main risk of gestational diabetes is intrauterine growth restriction (IUGR)

On risk factor: age >= 35 years, family history of diabetes, history of gestational diabetes, history of macrosome children, BMI >= 25 kg/m2

Screening for gestational diabetes is routine


The facial nerve emerges from the bulboprotuberantial sulcus to the medial part of the lateral dimple of the medulla elongata

They penetrate the rock at the level of the internal acoustic meatus

The motor fibers of the facial nerve circulate in the pontocerebellar angle and penetrate the rock at the level of the middle acoustic meatus

They accompany the VI nerve abducens in the rock

In the rock, the facial nerve is contained in the Fallop canal

It comes out at the level of the stylomastoid foramen. The foramen ovale of the base of the skull (because the interatrial communication of the fetus is also called foramen ovale, be careful not to confuse) allows the mandibular nerve (branch 3 of the trigeminal nerve), the small fearful nerve (branch of the glossopharyngeal nerve IX) and the accesory meningeal artery to pass through.

The facial nerve exits the rock at the foramen ovale


How long are the initial medical certificates (C0) valid?

True, medical certificates for TDPS, SSPI and SPDRE must be less than 15 days old


Regarding diabetic ketoacidosis, what are the true proposals?

True, abdominal pain, nausea and vomiting are typical of ketoacidosis. Fever can be explained by an infection that would be the trigger for ketoacidosis.

It can manifest as febrile abdominal pain

False, it is first necessary to rehydrate because prolonged hyperglycemia and osmotic polyuria dehydrate. It will be rehydrated with NaCl then NaCl + Glucose to avoid hypoglycemia of insulin. Do not forget also potassium supplementation after checking hypokalemia due to renal leakage of potassium but also insulin therapy

Treatment is simply the administration of rapid-acting insulin, as this is an insulin deficiency.

True, it is necessary to do an ECG, check the renal function with the ionogram

Possible complications of ketoacidosis are hypokalemia, renal failure but also cerebral edema

True, note among others (for the rest of the "others" cf College) that arterial blood gas is not necessary

The diagnosis is confirmed by a combination of hyperglycemia >2.5 g / L, venous pH <7.3 or bicarbonate <18mM and ketone >3mM or ketonuria of +++


Any suspicion of malaria is a diagnostic and therapeutic emergency

The HCSP publishes annual health recommendations for travellers for health professionals

Public Health France publishes annual health recommendations for travellers for health professionals

Artesunate IV is the standard treatment for severe malaria, with quinine used only if artesunate is not immediately available

The anophele is a mosquito does not make noise and its bite is painless

The anophele is a mosquito that does not make noise and whose bite is very painful

P. Falciparum is the plasmodial species responsible for severe forms of malaria. P. Knowlesi can give exceptionally.

P. Malariae is the plasmodial species responsible for severe forms of malaria


Which of the following are possible causes of cataracts?


Which of the following are Ottawa criteria?

Pain on palpation of the internal malleolus over 6 cm

Pain on palpation of the medial malleolus over 6 cm


What is the first-line paraclinical examination to diagnose endometriosis?

False. 3rd intention exam. This is the gold standard for diagnosis because histological samples can be taken

True. This is the first-line paraclinical examination recommended by the CNGOF

False. It is not a paraclinical examination. On the other hand, it is a crucial examination for the diagnosis


At what size is a canker sore << giant >>? (College of FJA, page 295)


Regarding the treatment of type 1 diabetes, what are the right proposals?

True, optimizing glycemic control tends to make lean mass gain weight. (This side effect is no longer mentioned in the new 2019 edition)

Weight gain is one of the side effects of insulin

False, it is necessary to maintain aerobic physical activities despite the risk of hypoglycemia

In addition to insulin, aerobic physical activities that promote hypoglycemia should be avoided

False, it is rather capillary blood glucose, 3 to 4 times a day, mainly before meals but also upon waking, bedtime, before and after physical activities (College of Endoc + Pediatrics)

Self-monitoring relies mainly on venous blood glucose

True, strengthen glycemic monitoring but also do a dosage of ketonuria or ketonemia if prolonged hyperglycemia, abdominal signs or during pregnancy

Blood glucose monitoring should be strengthened in case of intercurrent events such as infections, surgery, stress etc.


False. There are 3 parts to the checklist. - Patient identity verification - Type of intervention - Patient's side

The course of anesthesia depends on a checklist of the HAS which includes 4 parts

False. These drugs may be administered, but first a hypnotic must be used, then an analgesic and then a curare to facilitate orotracheal intubation.

During the induction phase, 3 classes of drugs can be administered: first a curare, then a hypnotic, then an analgesic

False. An opioid analgesic should be added to reduce pain through endotracheal intubation and the surgical or interventional procedure. Opioids control the neurovegetative response of pain-induced stress (tachycardia, hypertension, vagal shock) that may exist in an artificially sleeping patient.

There is no need to administer opioid analgesia during general anesthesia because the patient is unconscious and does not feel pain.

During the induction phase, 3 drug classes can be used: hypnotics, opioid analgesics and curare.

True. It is an IV hypnotic antagonist of glutamate NMDA receptors (unlike other hypnotics which are rather GABA A agonists)


What is the treatment of choice for a methicillin-resistant Staphylococcus aureus?

True, no enteral absorption
(= always by way
parenteral except treatment
, C. difficile colitis). Bactericide. Dependent time activity. FYI, the only beta-lactamine acting on SARMs is ceftaroline.

Resistance to all beta-lactam (except ceftaroline)

No, the reference is vancomycin. SARMs are frequently resistant to fluoroquinolones.


By what is the anterior chamber, forward, delimited?

True. The aqueous humor fills the anterior chamber, bounded by
the cornea in front and the iris in the back

In the anterior chamber but does not delimit it


Ivermectin taken once, twice, 7 days apart

True, body brushing, leave to act for 24 hours. To be carried out a second time at 2 or 7 days interval.


What is the treatment of choice for a methicillin-sensitive Staphylococcus aureus?

Poor oral bioavailability (oxacillin, 40%; cloxacillin,
70%), saturable digestive absorption. Became obsolete in France!!

True, it is the smallest 👌 spectrum And the one that acts the fastest. Important in severe situations, e.g. endocarditis!

All these antibiotics have SAMS in their spectrum, but oxacillin IV has the smallest spectrum and is therefore indicated as a first-line treatment. The possible alternative is cefazolin (C1G).

Works but is not the ATB of choice. Can be used in relay of oxa IV in combination with another PO antibiotic.


Which of the following are risk factors for poor adaptation to ectopic life?


What is the overall mortality rate from acute pancreatitis?

Overall mortality rate, it can reach 20% for the necrotizing form


True or False: In acute pancreatitis, there is a linear correlation between the rate of lipasemia and the severity of pancreatitis

There is no correlation between the rate of lipasemia and the severity of pancreatitis.


Regarding the epidemiology of infertility. Which of the following propositions, which one or which are true?

At least 50% of infertility has a male origin

True. 1/5 in the College of Gynecology, 1/7 in the College of Endocrinology


Which of the following are true for congenital adrenal hyperplasia?

She is screened at 48 hours of life by the Guthrie test

The main deficient enzyme is 21-hydroxylase

Increased secretion of pituitary ACTH is observed

50 births per year in France. It is very rare. Reminder: the threshold of rare disease is 1/2000


What CRP threshold directs to severe pancreatitis?


Which of the following proposals is/are germ(s) with a secretory mechanism?

False it has an entero-invasive mechanism, it is E. coli enteroaggregative and E. coli enterotoxigenic which have a secretory mechanism. They are at the origin of TIAC and traveler's diarrhea, turista!

True, especially aureus which is a toxi infection. Secretory ➡ mechanism fluid diarrhea without fever


Which of the following are true about Candida albicans infections?

Candida albicans is never found on healthy skin

Candida may cause sepsis in immunocompromised patients


Which of the following proposals are validated for the treatment of early forms of AMD? (AREDS-2 study, 2013)

True, with zeaxantin, lutein, vitamin E and C

No studies showed a difference in outcome versus placebo


Renal failure is observed in ....... of cases

Renal failure is observed in about 20% of cases, it is a pejorative prognostic factor


At what ages is the dTP vaccine injected?

No vaccine is recommended at 6 months (5 months = Meningococcal C)


Which of the following are causes of brutal white eye and painless BAV?

True, attention MS. NORB is painless in 20% of cases.

Retrobulbar optic neuritis (NORB) in 20% of cases

Red and painful eye (on intraocular hypertension)

Acute anterior ischemic optic neuropathy (AIO-A)


Which of the following are cataract etiologies?

True, especially posterior uveitis requiring prolonged corticosteroid therapy


Which of the following are bilateral etiologies of decreased visual acuity most often?

Acute anterior ischemic optic neuropathy


What is the first-line treatment for urinary colonization of pregnancy in case of germ sensitivity?

3rd line treatment. Avoid during the first two months of pregnancy (embryonic phase)


Which of the following are recommended supplements for pregnant women?

True. Folic acid 0.4 mg/day in all women (increased dosage in case of history of spina bifida or epilepsy)

Only in late pregnancy, if taking medication that interferes with vitamin K metabolism

False, unless there is a risk of deficiency


Ultrasound in mode B conventionally allows to show:


True, centro-medullary nailing for example


Which of the following are recommended vitamins for any woman in periconception and during pregnancy?

Only in case of treatment interfering with vitamin K metabolism


Which of the following propositions are true regarding prosthesis wear?

It can accompany/cause a loosening of prosthesis


Beta-blocker eye drops decrease the secretion of aqueous humor

Prostaglandin eye drops decrease aqueous humor secretion

Alpha 2-adrenergic agonist eye drops decrease aqueous humor secretion

COPD contraindicates subcutaneous beta-blockers only

True. 2nd intention = laser trabeculoplasty (modest effect). 3rd line = filtering surgery

Medical treatment is offered as a first-line treatment


True. And this bone age corresponds to the appearance of sesamoid on X-rays of the hand and wrist.

Puberty occurs at a bone age of 11 years in girls and 13 years in boys.

Impubertism is pathological if the X-ray of the child's hand and wrist shows a sesamoid bone.

False. This is for peripheral pubertal delays because we look for ++ the Klinefelter in boys and the Turner in girls which are causes of peripheral pubertal delay.

The karyotype is to be done in case of suspicion of peripheral precocious puberty as well as peripheral pubertal delay.

Undernutrition can be the cause of delayed puberty.

The association of delayed puberty and bilateral cryptorchidism excludes the diagnosis of simple pubertal delay.


Which of the following is used to measure visual acuity from afar?

Classification of mitral leakage mechanisms


What pathogens can cause acute pancreatitis?


Which of the following are possible indications for laser surgery?


Which of the following are transudative ascites etiologies?


Which of the following are true in the event of unexpected infant death?

There is a systematic assessment to be carried out (HAS 2009)

A suspicious death must lead the doctor to notify the judicial authorities

The examination of the child should look for suspicious lesions

If the parents object to the transfer of the body to a referral centre, the doctor must tick the box "medico-legal obstacle"


Which of the following are white precancerous lesions?


Which of the following are risk factors for prosthesis infection?

Long delay between fracture and operation


What does the very high elevation of lipase in pleural or peritoneal fluids mean to you?


Screening for deafness in infants is done by:


Which of the following are true for angioedema?


Which of the following are causes of pruritus sine materia?

True, cutaneous T-cell lymphoma in >50 years


True. = Recovery room. Part of the legal obligations with the pre-anesthetic consultation (if scheduled) and the visit.

After surgery, there is a mandatory passage in SSPI (post-interventional monitoring room)

False. The only exception is the course of a morphine titration: it takes 1 hour of minimum monitoring after the last bolus

No minimum monitoring time in IPPS is recommended

During morphine titration, there is a monitoring of one hour after the last bolus

False. 30 minutes BEFORE the incision. As a reminder, antibiotic prophylaxis is administered according to the Altemeier classification.

If there is an indication of antibiotic prophylaxis to cover the surgical procedure, it will be administered 30 minutes after the incision

A curare is always essential during the maintenance phase of general anesthesia


Which of the following are signs of CRVO at the fundus?


The amount of topical corticosteroids on the phalangette of the index finger may cover:

True, the phalangette unit of an adult is enough cream to treat the surface of both palms.


Which of the following are etiologies of brutal white-eyed and painless BAV?


Which of the following are spherical ametropias?


The amount of topical corticosteroids on the phalangette of the index finger corresponds to:


At 3 months, which vaccines are mandatory?


Which of the following are atopic diseases?

The so-called atopic diseases are: atopic dermatitis, allergic asthma, IgE-mediated food allergy and allergic rhinoconjunctivitis. (College of Pediatrics 2021)


Which of the following are common etiologies of ascites?

Rather straight (we are in the frequent causes)

Hepatorenal syndrome may be a consequence of ascites


Vascular tumors, most often capillaries, are characterized by proliferation of endothelial cells and mainly represented by hemangiomas of the infant

In vascular malformations, endothelial cells are quiescent and may involve blood capillaries, veins, arteriovenous communications or lymphatic vessels.

Hemangiomas are benign endothelial cell proliferations that are more common in girls, premature infants and low birth weight infants

True, superficial forms are willingly more nipple, and in relief than deep hemangiomas

The deep forms of the hemangioma are more elastic in consistency than the superficial forms

False, these are hemangiomas and AVMs that are fast flowing. Vascular malformations such as venous angiomas, lymphangiomas or planar angiomas are slow flow

All vascular malformation Doppler ultrasounds show a richly vascularized fast-flow lesion


What vaccinations are mandatory at 2 months?


Which of the following proposals are part of the previous segment?


Which of the following are causes of tonsillar ulcer?

Diphtheria is responsible for pseudomembranous angina


Which of the following proposals are parasitosis found in metropolitan France?

It is present in tropical and subtropical areas: in Africa, South America, Asia and the Mediterranean basin. (Wikipedia) Corsican!!

They are present in Africa, Asia, and the Pacific, in tropical areas (more rarely in America)


From what date is a prosthesis infection considered chronic?


What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with RDT positive, in case of true allergy to beta-lactams?

Allergy to amoxicillin. No indication of this association in tonsillitis (SBHA sensitive to amoxicillin alone)

True. 3rd intention, if allergy to beta-lactam (<10% resistance)


Which of the following proposals are fundus abnormalities in CAPM?

Cup/disc ratio less than 0.2 between the 2 eyes


Which of the following propositions are true regarding urinary colonization?

In the general population, screening for urinary colonization of pregnancy is performed by BU.

If the BU is positive (leukocytes or nitrites positive), confirmation by ECBU is required.

Not in women for atypical enterobacteriaceae (other than E. coli or enterococci) according to Pilly 2020

ECBU is always positive when bacteuria is greater than 10^3 CFU

ECBU and susceptibility testing are not treated

In case of positive BU, treated with 1g of Amoxicillin three times a day for 7 days without ECBU

In case of positive BU, treated with 3g in a single dose of Fosfomycin-Trometamol without ECBU