A 32-year-old patient has had renal colic for 3 years. He weighs 75 kg and his blood pressure is 121/76 mmHg. It presents bilateral calculations of 3 to 8 mm visible to the scanner, density 1000 UH.

Its biological balance shows: Na 142 mmol / L, K 4 mmol / L, protein 67 g / L, serum creatinine 70 μmol / L, serum calcium 2.5 mmol / L. Diuresis of 24 hours: 1000 mL.

24-hour urinary lonogram shows natriuresis at 200 mmol/L, kaliuresis at 35 mmol/L and hypercalciuria.

What is (are) the risk factor(s) for lithiasis in this patient?

At least 2 liters per day is recommended.

17 mmol NaCl = 1 g NaCl ingested. 200/17 gives about 200/20 = 10 g of NaCl per day. This is much more than the 6g / D indicated in a patient for secondary prevention of lithiasis.


An 88-year-old patient is referred to the emergency room for confusion during a heat wave. He lives in a nursing home. Its usual treatment is amlodipine, metformin, candesartan, furosemide. Its constants are: blood pressure 100/70 mmHg, heart rate 92/min, temperature 37.2 °C.  Its biological balance shows: Na 152 mmol/L, K 5.7 mmol/L, Chlorine 95 mmol/L, HCO3- 14 mmol/L, protein 88 g/L, urea 20 mmol/L, serum creatinine 170 μmol/L. What is the exact proposal(s)?

The plasma anion hole is 43 mmol/L (potassium not taken into account)

Renal failure explains the decrease in bicarbonates

Renal failure leads to decreased clearance of potassium and protons. The latter are buffered into the plasma by the bicarbonates, whose concentration then decreases.

Candesartan promoted hyperkalaemia and acute renal failure


A 68-year-old patient is referred to the emergency room for acute kidney failure by his general practitioner. He is hypertensive and diabetic. He has asthenia and diffuse myalgia.

Its constants are: blood pressure 150/85 mmHg, heart rate 70/min, temperature 37.7 °C.

Renal ultrasound is normal.

Its biological balance finds:
• haemoglobin 10.5 g/dL
• leukocytes 8 G/L
• Na 141 mmol/L, K 4.2 mmol/L, Cl 100 mmol/L, HCO3- 22 mmol/L, protein 68 g/L
• urea 23 mmol / L, serum creatinine 350 μmol / L
• urine strip: 2+ proteins, 3+ red blood cells, negative leukocytes, negative nitrites;
• urine test: Na 100 mmol/L, K 34 mmol/L, urea 150 mmol/L, creatinine 4 mmol/L, proteinuria 1.5 g/1.
Which proposal(s) is the exact proposal(s) at this stage?

There is a functional part to his acute renal failure

Acute tubular necrosis does not normally regain hematuria or proteinuria.

It may be rapidly progressive glomerulonephritis

It is necessary to evoke a diabetic nephropathy

It is necessary to evoke a myeloma tubulopathy


Which proposal(s) regarding classification bias in analytical (or etiological) epidemiological studies is/are correct?

Ranking biases may be differential between cases and controls

That is, the bias is not as strong between cases and controls. That is a possible situation.

Ranking bias can be controlled for by multivariate analysis

The random selection of controls within a general population avoids ranking bias

Memory bias is a special case of ranking bias

The use of standardized and validated questionnaires makes it possible to limit the risk of ranking bias


A 62-year-old man is seeing positive hepatitis C (HCV) serology. Transaminases are raised to twice normal. Which exam(s) are you asking for as a first line?


Which proposal(s) regarding the informational performance of a test is(are) accurate?

The sensitivity of a test is the conditional probability that the test will be positive if the subject is free of the disease

The specificity of a test is estimated by the proportion of true negatives among subjects free of the disease

The likelihood ratio of a positive test is equal to the ratio of the probability that the test will be positive in a sick subject to the probability that the test will be positive in a subject free of the disease under study

The likelihood ratio of a negative test is equal to the ratio of sensitivity to specificity

Negative predictive value is the conditional probability of being free of the disease if the test is negative


A 62-year-old patient consults you for pain that has been evolving for 5 days. This pain is permanent, intense and upsets the sitting position. On clinical examination, you perceive a left perianal inflammatory swelling. Inspection of the margin shows nothing in particular. Digital rectal examination is impossible because of pain. What etiology(s) do you mention?

The margin is described as normal. The pain has been permanent for five days (it is gradually decreasing in hemorrhoidal thrombosis).


An X-ray of the entire spine is requested as part of an abnormality of spinal statics. What is (are) the exact proposal(s) concerning this spinal deformity?

There is a rotation of the vertebral bodies

It is, until proven otherwise, idiopathic scoliosis

It is associated with a rocker of the pelvis


You are following a 22-year-old patient with a complete block of 21-hydroxylase, with a severe mutation on both alleles. She asks you about the risk of having a child with the same condition with her partner who has no particular history. Knowing that the frequency of heterozygosity in the general population is 1 in 50, what is the exact proposition?

The mother will necessarily transmit her relief. So everything depends on the probability of the father to transmit his. The risk of it being heterozygous is 1 in 50. The risk that it will transmit its allele, if it is heterozygous, is 1/2. 1/50 * 1/2 = 1/100.


In a 68-year-old patient, with which etiology(ies) can this skin lesion be associated?

A syndrome of familial hyperchylomicronemia

Clinical signs of hypertrygliceridemia: eruptive xanthomatosis, hepatosplenomegaly, acute pancreatitis (if > 10g/L), retinal lipemia, abdominal pain.


A 6-year-old boy consults for the sudden appearance of diffuse edema within 10 days of a viral episode. His blood pressure is 100/60 mmHg. The urine strip finds a three-choice proteinuria (+++) without hematuria. Blood urea and creatinine are normal. What is the exact proposal(s)?

Diagnosis of pure nephrotic syndrome is most likely

A renal biopsy is indicated before treatment


In a patient with recent parkinsonism syndrome, what element(s) will make you remember a diagnosis other than Parkinson's disease?


A 25-year-old patient arrives at the emergency room because he has just violently twisted his ankle during a basketball game. His ankle is edematous. What is the exact proposal(s)?

The presence of a sub-lateral malleolar bruise makes the radiographic assessment essential

It is not the bruise but the pain that falls within Ottawa's criteria

The impossibility of taking three steps makes the radiographic assessment essential

Pain of the base of the 5th metatarsal should suggest a tearing of the insertion of the short fibular tendon

An x-ray of the ankle showing a medial malleolar fracture without fracture of the lateral malleolus should be supplemented by an x-ray of the entire leg

A talo-crural effusion is at best visible on the front X-ray


On this X-ray of the pelvis from the front, to which anatomical structures do the numbers correspond? (one or more correct answers)

The number 1 corresponds to the acetabulum

The number 2 corresponds to the major tubercle

The number 3 corresponds to the third left obturator foramen

It's the second (or the first, it depends how you count) 😬

The number 4 corresponds to the first left sacred fora men

The number 5 corresponds to the right iliopubic branch


A quadriplegic patient complains of feeling the two angles of his jaw differently. Do you consider that it is an attack of the following neurological structure(s)?


A patient has ankle pain with swelling following a mild sprain that occurred 3 weeks ago and for which she had not consulted. You suspect complex regional pain syndrome (CRPS) type 1. Which of these proposals concerning the CRPS is the true proposal(s)?

The edema of the SDRC does not take the bucket

CRPS is associated with biological inflammatory syndrome


What are the possible etiologies of eye redness (one or more exact answers)?

Acute glaucoma crisis due to angle closure

Obliteration of the central artery of the retina


Which of the following are suggestive of an allergic etiology in conjunctivitis? (one or more correct answers)

Pruritus strongly evokes an allergy. Pollen-allergic externals (like me) have a distinct advantage here 😅.

Secretions are often abundant in conjunctivitis, whatever their origins.


In case of myopia: (one or more exact answers)

The optical system formed by the eye is too convergent

Distance vision is better than near vision without correction

A divergent lens can be used for correction

The risk of retinal detachment may be increased


What is the exact proposal(s) regarding vaginal infection with Trichomonas vaginalis?

Upper genital infection is frequently associated

"Clue-cells" are visible under a microscope

This is true with Gardenerella vaginalis infections


Which of the following infections is (are) the one that can (can) classically be associated with eosinophilia?


Which of the following proposals on antibiotic treatment for strep throat is, which is (are) accurate:

The main goal of treatment is to reduce the risk of post-strep throat glomerulonephritis

The risk of glomerulonephritis is not diminished by drug treatment (but other complications, such as rheumatic fever, are).

One of the goals is to reduce the duration of symptoms by 3 to 4 days

The duration of symptoms is reduced by a maximum of 48 hours according to studies.

In case of allergy to first-line treatment, one possibility is levofloxacin

It is necessary to detect the contamination of the close entourage by a Rapid Diagnostic Test (RDT)


A young West Indian woman is referred to you by occupational medicine for abnormalities of the blood count. The CBC shows: red blood cells 5.17 T/L, hematocrit 38.9%, Hb 124 g/L, MCV 75 fL, MCDC 32 g/dL, leukocytes 4.0 G/L, platelets 232 G/L. What do you do? (only one answer expected)

Main lure here 👉 but it is first necessary to dose the ferritinemia before thinking of thalassemia 🤭.


A 70-year-old man consults for a diffuse itchy rash that appeared 48 hours ago, initially on the trunk. He has been widowed for 2 years and has an estimated active smoking of 45 packs years. His history includes plaque psoriasis since the age of 40 localized to the elbows, treated with topical corticosteroids and chronic obstructive pulmonary disease since the age of 55. He has been receiving amoxicillin-clavulanic acid treatment for bronchial superinfection for 10 days. The temperature is at 37.8 degrees Celsius, without alteration of the general condition. Examination of the mucous membranes is normal. There is no sign of Nikolsky. There is no peripheral lymphadenopathy or hepatosplenomegaly. The blood count, liver test and renal function are unremarkable. What diagnosis do you mention? (one or more correct answers)

Acute generalized exanthematous pustulosis


A 35-year-old man, with no particular history, has been complaining for 3 months of redness, heat and intense pain such as burns of both feet. Symptoms appear abruptly, often after exposure to heat, and usually disappear about 1 hour later. What diagnosis do you mention?

Acrocholosis is mainly observed during certain neurological pathologies such as peripheral neuropathies. Heat sensitization is observed, without any dermatological expression.


Which pleural effusion(s) should be punctured urgently?

Fluid pleural effusion in a context of suspected pulmonary embolism

Fluid pleural effusion in acute heart failure

Fluid pleural effusion in an infectious context

Fluid pleural effusion suspected of hemothorax

Fluid pleural effusion suspected of neoplasia


What main etiology(ies) may be responsible for chronic cough?

Uncontrolled gastroesophageal reflux disease asthma


About heart failure, what is the exact proposal(s)?

Its prevalence increases with the age of the population

Ejection fraction is the parameter used to characterize the systolic function of heart failure

Heart failure with preserved systolic function is mainly linked to left ventricular filling disorder

Heart failure with preserved systolic function is very often associated with hypertension

HTA 👉 Hypertrophic cardiomyopathy 👉 Heart failure with LVEF preserved.

Heart failure with preserved systolic function is usually associated with


What are the functional or clinical sign(s) of faecal incontinence?

Fecal incontinence = loss of uncontrolled stool.

The impossibility of distinguishing the passage of gases and stool

Not related to faecal incontinence (which is the loss of uncontrolled stool). This proposal refers instead to incontinence, which corresponds to a completely different semiological framework.

The emission of more than three bowel movements per day

This corresponds to the definition of diarrhea, of which fecal incontinence is a differential diagnosis to be aware of.

Loss of the sensation of exonerating need

Tenesmus / Epreinte 👉 they are part of the rectal 💩 syndrome


Regarding protein-energy malnutrition, which proposal(s) is(are) accurate?

It reduces the speed of healing of chronic wounds

It is measured by the evolution of the weight over the last 6 months

It is diagnosed by a MNA score less than 21/30

It is a consequence of physiological aging


Regarding successful ageing, which proposal(s) is/are right

Psychosocial determinants are major factors

It occurs only in individuals with a long life expectancy

It cannot exist in individuals with addiction


A bronchioloalveolar lavage with hyperlymphocytosis is seen when: (one or more responses)


Investors want to estimate the prevalence of diabetes in a French city among subjects aged 18 or older. They draw lots from a representative sample of the subjects registered on the electoral list of that city. Random participants are invited to participate in this study. Which proposal(s) is (are) accurate?

This is a descriptive epidemiology study

The subjects on the voters list of this city constitute the target population

Target population = subjects aged 18 or over living in the French city in question

Subjects refusing to participate may cause ranking bias


Regarding the medical information transmitted to the patient, which is (are) the right proposal(s)?

The transmission of medical information must be mentioned in the medical record

Information must be clear, fair and appropriate

Proof that the medical information has been issued must be provided by the patient

The patient has the right to refuse to be informed

The physician has the right to refuse to inform a patient


A 33-year-old man, driving school instructor, consults for low back pain that has appeared for four months and wakes him up in the morning. You want to eliminate spondyloarthritis. What visible sign(s) on the standard lumbar spine X-ray might be in favor of this diagnosis?

Thin, vertical bone bridges at the periphery of intervertebral discs

A square appearance of the vertebral bodies on profile X-rays


A 55-year-old patient comes to consult for pain of the anterior surface of the right thigh radiating to the knee appeared for 5 months. Its body mass index is measured at 32 kg/m^2. An X-ray of the front pelvis is performed. What diagnosis do you mention on imaging? (only one answer expected)

The x-ray is normal, so you evoke cruralgia


A 57-year-old patient suffered trauma to her right ankle following a fall. She was unable to regain support on her lower limb when she stood up. She complains of elective pain in the posterior part of the fibula. You have had x-rays of your right ankle. What is the real proposal(s)?

There is a trans-syndesmotic fibular fracture line

There is a fracture of the distal 1/3 of the tibial diaphysis

There is a fracture of the neck of the talus


A 45-year-old woman consults you following a skiing accident 3 days after the trauma. She complains of pain in the inner side of the left knee during flexion/extension. You do not find patellar shock. You cause this pain on palpation visualized in this photo, as well as in valgus. There is no previous laxity. What is your diagnosis(s)?

A sprain of the anteroexternal cruciate ligament

This is the right place and this is the right clinic 😉 Elective pain on flexion/extension eliminates the fracture. The lack of laxity makes a sprain of the cruciate ligaments unlikely. As for CRPS, we are only 3 days away from trauma and there are no clinical arguments in favor.

A fracture of the medial edge of the patella


A 35-year-old man consults you for a foot falling to the right. He explains that he was crouched for a long time for work. Achilles and quadricipital reflexes are preserved. The manual test finds a right hip abduction at 5/5, a right leg extension at 5/5, right foot lifters at 3/5. The sensitivity of the back of the foot is impaired, while the cutaneous areas of the sole of the foot are respected. The lumbosacral and right hip mobilities are free. What is your most likely diagnosis?

A tendon rupture of a levator muscle in the right foot

This would not explain the sensory impairment.

This is the right territory 😉: affecting the lifters of the foot (at the motor level) and the back of the foot (at the sensory level).

The numerous branches of the tibial nerve mainly innervate the muscles and skin of the calf (thus the posterior part of the leg), as well as the sole of the foot. This is not the right semiology!

The right obturator nerve essentially innervates the thigh, at the motor and sensory level.

Root involvement is made very unlikely by the highly targeted involvement of a single nervous territory (that of the right fibular).


You see a 63-year-old patient in consultation. A former English teacher, he is being treated for hypertension by an ACE inhibitor. He complains of stage 1 dyspnea of MRD. It has no other functional signs. He weighs 82 kg and is 171 cm tall. In terms of chest examination, palpation and percussion are normal. Auscultation finds bilateral but predominant crackles in the right base. The clinical examination is also strictly normal. He benefited from EFR. You do not yet have imaging tests that will of course be important.
In the light of these initial results, which diagnosis do you think is most likely? (only one answer expected)

This is the main distractor here, but is made less likely by the absence of signs of right heart failure, the lack of correlation between stage 1 dyspnea and the presence of crackling at rest (i.e. crackling is therefore not related to OAP, since the patient is dyspneic only with sustained effort),  the absence of a clear etiology to heart failure (no ACS, no alcohol consumption, etc.). All these arguments make REIT more likely.


What are the indications for the implementation of oral corticosteroid therapy when a diagnosis of sarcoidosis is highlighted? (one or more correct answers)

The presence of mediastinal lymphadenopathy exceeding 2 cm in diameter

The lymphadenopathy of sarcoidosis is not compressive. So OSEF frankly 😂.

The presence of non-disabling arthralgia

The occurrence of central facial paralysis

The occurrence of hepatic cholestasis with gammaGT and alkaline phosphatases > 2N


AL amyloidosis can be revealed as: (one or more possible responses)


In a 40-year-old patient who has had deep vein thrombosis, what risk factors for venous thrombosis are you looking for? (one or more possible answers)

It is a risk factor for arterial damage (venous thrombosis is an attack of the veins).


You see in consultation a patient of 34 years, without particular history for the discovery of a splenomegaly exceeding the costal rim of 3 cm. What abnormalities of the blood count could point you to a particular etiology? (one or more possible answers)

Splenic sequestration of red blood cells and platelets is a consequence of splenomegaly (i.e. any splenomegaly, whatever its cause, is accompanied by anemia and thrombocytopenia distribution) and does not point us towards etiology.

The presence of 2% myelocytes and 3% metamyelocytes


In case of exophthalmos, what are the clinical elements that would direct you to a Basedowian origin? (one or more correct answers)

Diplopia by involvement of the inferior rectus muscle


What pathology can result in myodesopsia? (only one exact answer)

Macular edema can give metamorphopsis (for example, in diabetic retinopathy or in AMD) but not myodesopsia.


Your 66-year-old patient recently received BCG therapy and surgery for a vegetative tumour of the bladder underground, whose histology had concluded that there was high-grade urothelial carcinoma that deeply infiltrated the chorion (T1bG3). You have not yet applied to the health insurance fund for a long-term illness. He was a worker in a dye factory his entire career, until his retirement at age 60. Several of his former colleagues have been recognized as having an occupational disease for the same pathology. He wondered what recognition as an occupational disease would currently bring him, to know whether it was worthwhile to apply for it. What do you say to him? (one or more possible answers)

A priori, he is not on sick leave 🤷 ♂ If he were in AT, he would have an increase in daily allowances.

A pension, depending on the degree of disability

A conviction of the employer for inexcusable fault

Compensation from the Asbestos Victims Compensation Fund (FIVA)


Mrs. D., aged 27, gave birth vaginally 6 weeks ago to a girl weighing 3120 g who is doing well. She describes difficulties in caring for her child. Which of the following symptoms suggest postpartum depression?


A 67-year-old woman with autosomal dominant polycystic kidney disease has reached the stage of end-stage renal disease and wants to be transplanted from a cadaveric donor. What is the exact proposal(s)?

She is past the age limit for kidney transplantation

There is a low risk of recurrence of polycystic disease on the transplant

The donor will necessarily be of the same sex

His risk of cancer will increase after transplantation

Its cardiovascular risk will decrease after transplantation

The cardiovascular risk is increased after transplantation, especially because of immunosuppressants. It is one of the leading causes of mortality in chronic transplant patients.


As part of the law of 2 February 2022 known as the Leonetti-Claeys law<<>>, the legislator has given the right to a patient with a serious and incurable condition to benefit from deep and continuous sedation until death if he decides to stop treatment with the consequence of a short-term commitment of his vital prognosis and unbearable suffering. What deadline has been adopted by the High Authority for Health to define this << short term >>?


Regarding the physiology of the larynx, what are the exact proposals? (one or more expected answers)

The vibration of the vocal folds is carried out thanks to the pressure under glottigue

The intrinsic muscles are innervated by the inferior laryngeal nerve

Laryngeal dystonia is a common cause of unilateral laryngeal immobility

Unilateral laryngeal immobility may be related to cricoarytenoid dislocation

Multiple sclerosis can lead to unilateral laryngeal immobility


Regarding the functional assessment of hearing, what are the exact proposals? (one or more correct answers)

In the presence of sensorineural hearing loss, the Weber is lateralized on the deaf side

The Rinne test compares the transmission of sounds in air and bone conduction

Tonal audiometry is sufficient to analyze hearing acuity

In the presence of sensorineural hearing loss, the air and bone curves are superimposed

Impedancemetry is used to analyze the function of the tympano-ossicular system


A 59-year-old man has dysuria with an indurated nodule, painless occupying less than half of the right prostate lobe on digital rectal examination. The PSA value is 7 ng/ml What is the evolutionary risk of this disease entity according to the D'Amico classification? (only one answer expected)

It is probably not a cancer and the d'Amico classification does not apply

This question cannot be answered with the elements of the statement alone.

We are missing the Gleason. If it is 3+3 👉 the risk is low. Note that the Gleason has recently been replaced by the ISUP score. This IQ therefore loses some of its interest 😬.


A young woman aged 35, practicing the profession of hairdresser consults you for increased lower limb pain at the end of the day and in the pre-menstrual period. These pains are type of heaviness of both legs. On clinical examination, there are no varicose veins but simple telangectasias and vesper edema. You remember the diagnosis of functional venous insufficiency.

What measure(s) do you propose for this patient?

Echosclerorosis of the great saphenous veins


A 56-year-old patient consults with the results of an abdominopelvic CT scan with injection performed to explore left abdominal pain. The CT scan finds a left renal cyst of 2.9 cm, hyperdense not raising after injection of contrast medium, with thin partitions and fine parietal calcifications. What is your treatment option?

It is an incidentaloma that requires no treatment or supervision.


What is(are) the correct statement(s) regarding permanent tubal sterilization?

It can be performed on a minor woman if both parents (or legal guardians) sign the authorization to operate

It can be performed in a woman who has never had an intrauterine device

It must be carried out after a reflection period of 3 months

The cooling-off period is... 🌟 4 months ⭐ (do not rage, life is too short).

It can be performed in a woman who has never had a child


A 65-year-old man consults you for a congenital thoracic nevus that has recently changed, with the appearance of pigment strengthening on two distinct areas. This hyperpigmentation would have started 2 years ago on the lateral edge and, since this summer, the patient has noticed the appearance of a central strengthening of the pigmentation that has become nodular. You suspect a degeneration of this pigment lesion which measures 4 x 3 cm. What is your attitude in the first intention towards this lesion? (only one answer expected)

Prescription of a right axillary ultrasound

This attitude is possible in the face 😊.

Excision of the entire lesion with a margin of 1 cm

Suspicion of melanoma 👉 excision then histopathological study. The narrowest margins are chosen. A rework may be carried out depending on the histopathological 🔬 study.

Excision of the entire lesion with a margin of 2 cm


You see in consultation M. P., 35 years old, 3 months from a head trauma. He was hit on a bicycle by a car. He suffered a brief loss of consciousness. The brain CT imaging assessment was without abnormalities. Since then, he complains of concentration difficulties that hinder him in his daily professional life, in particular, and his wife evokes a very marked irritability. What is the exact proposal(s)?

These symptoms correspond to a subjective syndrome of head trauma

Irritability can be part of dysexecutive semiology

No brain MRI in the absence of clinical signs of calling.

This proposition is too definitive to be true.

A thorough neuropsychological evaluation is recommended

This assessment will be able to objectify the disorders as well as quantify them. It will make it possible to offer appropriate care.


A patient describes very severe pain in the right hemiface accompanied by rubefaction of the face and tearing. You mention cluster headache. Which proposal(s) concerning this diagnosis is (are) accurate?

A mnemonic means: "AVF is rare, you will not see a thousand (verapamil)." 😍

It affects alternately the right and left hemiface

It is treated by thermocoagulation of the Gasser lymph node


Which of the following parasitosis is transmitted through skin contact (walking barefoot, swimming)?


In the following list of bacterial infections, which one or are the ones that do not usually cause hyperleucytosis?


What element(s) is (are) part of the diagnosis of conversion disorder?

Patients do not simulate. Their symptoms are sincere.


You receive in the emergency room a 22-year-old patient brought by paramedics, who intervened at home at 9:30 p.m. on a call from her boyfriend. He found his girlfriend in a stuporous and confused state, two hours after an argument that took him out of the house. He doesn't know what happened during those two hours. You find a patient agitated. She aggressively answers your questions and yells that she wants to leave the hospital, struggling violently. You objectify reactive intermediate pupils and phlebotomies on both anterior surfaces of the wrists, the depth of which you cannot determine because of agitation. Which of the following proposals for the management of this patient is:

The clinical picture makes you reject the hypothesis of benzodiazepine poisoning

You must respect the patient's wishes and let her out

You must physically restrain the patient without chemical restraint

You mention possible alcohol consumption

The patient must be seen immediately by psychiatrists


A 25-year-old patient is hospitalized in hematology in the context of induction chemotherapy for acute lymphoblastic leukemia. On call, you are called at 8 p.m. because she "does not breathe well". You find a patient lying in bed, restless, polypneic with a supraclavicular pull and a thoraco-abdominal, cyanotic and marbled swing. Vital parameters are: heart rate at 125/min, blood pressure at 95/60 mmHg, respiratory rate at 38/min, SpO2 at 87% under 2 L/min of oxygen to the nasal glasses. What are you doing while waiting for the mobile resuscitation team? (one or more correct answers)

You increase the O2 to 5 L/min with glasses

You increase the O2 to 10 L/min with glasses

You change the nasal glasses for a high-concentration face mask

You place the patient in the Trendelenburg position

You place the patient in a semi-seated position


Regarding immunohistochemistry during an histopathological examination, it is true that: (one or more exact answers)

Either directly under the microscope (manual counting) or via flow cytometry techniques.


A 22-year-old patient is referred for consultation by her general practitioner because of an abnormal blood count, which is presented to you below. The patient is asymptomatic, has no fever or other symptoms suggestive of an infectious episode, significant cutaneous or joint signs. The physical examination is normal, and finds no palpable lymphadenopathy or organomegaly.
Which of the following explorations do you carry out in 1st intention in this patient?

The systematic first-line assessment in front of isolated thrombocytopenia reminiscent of ITP is: CBC on citrated tube (if suspected of false thrombocytopenia with EDTA), a blood smear, a PPE, HIV HBV HCV serologies, a liver test, NAAs, a renal assessment (creatinine, hematuria), a hemostasis assessment (TP, TCA, fibrinogen), grouping and RAI (in severe forms). According to the PNDS of the HAS: https://www.has-sante.fr/upload/docs/application/pdf/2017-06/dir36/pnds-_purpura_thrombopenique_immunologique.pdf


Which of the following proposals can (may) constitute a criminal offence that can be charged against a doctor?

Lack of information provided to the patient

Ordinal and civil offense, but not criminal.


A 15-year-old woman consults for heavy menstruation for 10 to 15 days a month since menarche. Which additional exam(s) do you prescribe as a first-line treatment?

Really no longer done at the ECN (especially in the first line) 😅

Plasma determination of Willebrand factor


You welcome to the emergency room Mrs. X. aged 75, referred by her doctor because of a picture of acute anuric renal failure in a context of diarrhea. Blood sugar levels measured in the city 3 hours earlier were 6.9 mmol/L. At the time of the transfer to her bed in a cubicle, she suddenly loses consciousness. His pulse is no longer perceived. The scope is not yet plugged in. Which of the following proposals regarding its management is (are) accurate?

You start by ventilating it with a balloon

You immediately inject 1 mg of adrenaline

You have the external defibrillator brought in immediately

Calcium gluconate has a cardioprotective function in hyperkalemia. In case of taking digitalis, magnesium chloride should rather be prescribed.


A 73-year-old man presents for dermatology for itchy skin lesions evolving for 2 years having started in the groin and pubis, with recent extension to the upper limbs, face and neck, despite treatment with antihistamines and very strong local dermocorticosteroids (clobetasol). The history includes untreated hypertension, prostatectomy for adenoma he was 3 years old and left total nephrectomy for kidney cancer he was 5 years old. Which test will be most cost-effective to confirm the diagnosis you suspect?

Bullous dermatosis is not suspected in front of this table.

Dermatophytosis is suspected here. The most cost-effective examination is therefore a mycological sample to find out what we are ⚔ fighting against.


A 45-year-old man consults you for dyspnea of effort. On cardiac auscultation, you find a proto-meso-diastolic murmur better perceived when sitting. Blood pressure is 120/40 mmHg in both arms. Neck inspection finds synchronous pulse beats. What is your diagnosis?


As a general practitioner, you detect an HIV infection in a 27-year-old butcher. Several butchers work in his butcher shop and they share knives. Which prevention measure should you propose first (only one expected response)?

Prescription of sick leave until an undetectable viral load is obtained

Tell the patient to inform other butchers of their HIV status

Recommend the use of strictly personal knives

Primary prevention measures are more urgent to put in place than secondary prevention measures (telling colleagues that they should be tested).

Inform other butchers yourself of this HIV status

Request the patient's invalidity from the medical officer


A 4-year-old boy is brought to the emergency room for a hematemesis that occurred in a context of rheumatoid purpura started 3 days earlier. Upon diagnosis, he complained of abdominal pain that was treated symptomatically. His heart rate is 120 beats per minute, his systolic blood pressure is 110 mmHg, his temperature is 37.1°C.  Abdominal palpation is painful, defenseless. What is the most likely diagnosis?

This potit patient has no reason to have a duodenal 🤷 ♂ ulcer

The college reminds us several times: a swallowed epistaxis is not a cause of hematemesis but a differential diagnosis!

This potit patient has no reason to have esophagitis 🤷 ♂


A 68-year-old man consults his GP for a recent onset resting tremor. The clinical examination shows a slowdown at the initiation of movements and a phenomenon of << cogwheel >> at the wrists. What medication(s) should you look for before making a definitive diagnosis?

Selective 5-hydroxytryptamine-1D receptor agonists (triptans)

Triptans are not a classic cause of iatrogenic parkinsonism syndrome.

Certain intestinal motor stimulants, such as metoclopramide

Some antihistamines for systemic use, such as alimemazine


A young man consults the emergency room following an assault. His attacker stabbed him in the face. It has a transfixing jugal wound of 5 cm, above the lateral canthus (see diagram). What anatomical elements can be damaged by this wound? (one or more expected answers)


A 79-year-old man with Parkinson's disease has intense and continuous suprapubic pain. He has not been able to urinate for several hours. Palpation shows a rounded suprapubic mass, matte to percussion. It is treated with dopaminergics (levodopa-benserazide), sympathomimetic (midodrine) for orthostatic hypotension and alpha-blocker (tamsulosin). After bladder probing, what modification(s) of the drug treatment do you propose?

Decrease in the dosage of levodopa-benserazide


A 34-year-old woman was diagnosed with pulmonary tuberculosis. A triple antibiotic therapy (rifampicin, isoniazid, pyrazinamide) is implemented. Its only usual treatment is oral contraception (levonorgestrel, ethinyl estradiol). What advice(s) do you have?

Use a mechanical contraceptive method for the duration of rifampicin treatment

Replace current contraception with a progestin

Rifampicin is an enzyme inducer that reduces the effectiveness of oral contraception.

Inform about the risk of reducing the contraceptive effectiveness of an estrogen-progestin


A vestibular schwannoma can be diagnosed before: (one or more expected responses)

Unilateral conductive hearing loss of slowly progressive evolution

Vestibular 👉 involvement Ataxia with light walking (= frustrated).

It's a bit far from the external 😉 ear canal


A 75-year-old patient complains of a cough, with colored sputum, in a context of fever evolving for 72 hours. Her doctor did not notice any signs of seriousness and prescribed probabilistic clarithromycin antibiotics. Its usual treatment is limited to ezetimibe-simvastatin and low-dose acetylsalicylic acid. What advice(s) could you make?

Discontinuation of simvastatin for the duration of clarithromycin treatment

Macrolides are enzyme inhibitors. There is no risk in stopping statins for a few days.

Discontinuation of acetylsalicylic acid for the duration of treatment with clarithromycin

Decrease in ezetimibe dosage during treatment with clarithromycin

Replacement of clarithromycin with erythromycin


Speech therapy sessions may be prescribed in case of: (one or more expected responses)


Jules, 7, is scheduled to have surgery for phimosis. The preoperative hemostasis assessment shows: Quick time (TQ) = 12.5 s; control= 11.5 s; ratio: 1.08; cephalin time with activator (TCA) = 59 s; control= 32 s; ratio: 1.84; fibrinogen 2.8 g/L (standards: 2-4 g/L); blisters 290 G/L.

What are the diagnostic hypotheses to be formulated in Jules in front of this hemostasis assessment? (one or more correct answers)

TCA: factor VIII (hemophilia A, Willebrand disease because this factor is protected by Willebrand factor), factor IX (hemophilia B), factor XI and factor XII.


A woman of Martinican origin has just given birth. The child's father is also of Martinican origin. The child has a cleft lip and palate. With regard to regulatory newborn screening of this child, what is the exact proposal(s)?

Phenylketonuria is the only disease of amino acid and organic acid metabolism currently being screened for newborn in France

General screening test can detect hypothyroidism of pituitary origin

This couple can refuse the screening after information

Completion before 48 h of life decreases the sensitivity and/or specificity of the screening test

Targeted screening for sickle cell disease is not indicated in this child


You receive a 3-month-old infant for a systematic visit. He was born at term after a normal pregnancy. You saw him at the age of 2 months for his vaccinations, his examination was normal. He is very awake but moves spontaneously very little. What proposal(s) is (are) in favor of peripheral neurological involvement?


You organize the care pathway of a 90-year-old patient, previously autonomous and living at home, admitted following a fracture of the upper end of the femur operated the day before with the placement of an intermediate prosthesis without surgical complications. Which proposal(s) are (are) part of your care?

Preventive anticoagulation for a period of 45 days

Routine prescription of oral nutritional supplements

Prescribing benzodiazepines to ensure restful sleep

Prescription of bisphosphonates in case of femoral T-score ≤ -1


Which symptom(s) is part of the clinical picture of a hypomanic episode?

Disorganization of thought is classically not found in bipolarity (rather a symptom of schizophrenia).

The presence of suicidal ideation classifies the clinical picture in the manic phase.


In front of a twelve-month-old child, what proposal(s) do you remember as a warning sign of a neurodevelopmental disorder?

An absence of nycthemeral periodicity of sleep


A 34-year-old patient complains of excessive anxiety. Which of the following symptoms specifically points to a diagnosis of generalized anxiety disorder?

A delay in falling asleep of more than 1 hour

Significant anxiety when speaking in public

A sad mood for two weeks following an emotional breakdown

This proposal refers to the characterized depressive episode.


The mother of a 17-year-old patient smoking cannabis asks you about the risks associated with this use, acute or chronic. What information(s) is(are) accurate about this?

Possible occurrence of a withdrawal syndrome

Increased risk of bronchopulmonary disease

Risk of precipitating entry into schizo p hrenia in vulnerable individuals


You are the general practitioner of Mr. M., 75 years old, who has been suffering for 3 years from small cell lung cancer. He is also followed by a mobile palliative care team for the management of very disabling pain related to bone metastases. The patient lives at home with his wife. With your agreement, the mobile team doctor came to see the patient at home because of an increase in the pain picture. He decided to modify the analgesic treatment by introducing corticosteroids and increasing the opioid treatment. 48 hours later, during her visit to her home, the liberal nurse calls you because she suspects an overdose with opioids. What is the most important question to ask?


In consultation with his parents, you will see a 16-year-old teenager who has been suffering from generalized tonic-clonic seizures since the age of 12. Her epilepsy is poorly balanced by treatment (valproate). They ask you about his academic orientation, because he must choose a professionalizing path. They considered several possibilities. Among those they mention to you, which one (which) do you advise against (one or more expected proposals)?


Regarding AA amyloidosis, what is (are) the exact proposal(s)?

the peripheral nerve is frequently affected

Diagnosis can be made on a salivary gland biopsy


Regarding mutations in the APC gene in familial adenomatous polyposis syndrome, which proposals are correct? (one or more proposals expected)

Pathogenic mutations in this gene are expressed in the heterozygous state

Genetic exploration must be offered to relatives

Upper gastrointestinal involvement is possible and warrants gastroscopy

Mutations in this gene predispose to breast cancer


Regarding cadaveric lividities, which is (are) the exact proposal(s):

They are dependent on the type of insects present on the corpse

They are less marked in case of internal bleeding at the time of death

They are non-existent in melanoderma individuals

They are one of the indicators of the post-mortem time

They are due to a passive phenomenon of blood sweating after death


A 42-year-old patient has cervical angioedema. The blood laboratory test shows a deficiency of C1 esterase inhibitor. Which drug(s) is (are) likely to be involved?

Selective competitive bradykinin receptor antagonist type 2


Mr. C., 60 years old, is followed by his general practitioner whom he declared as a general practitioner. The latter has just diagnosed him with chronic obstructive pulmonary disease. The patient presents an active smoking quantified at 45 pack-years. He has just been admitted to long-term illness. He has no other pathology and is totally autonomous. Which proposal(s) is (are) accurate?

It is exempt from the flat-rate contribution of € 1 per consultation

He is exempt from the co-payment for all medical examinations that he will have to carry out

It benefits from a management of nicotine substitutes

He benefits from 100% coverage of his ambulance transport for all his consultations

In case of hospitalization, the hospital package may be reimbursed, in part or in full, by its complementary health


You receive a 70-year-old patient with a history of myocardial infarction, who has uncontrolled epistaxis. What will be the elements of your care? (one or more expected answers)

You request a CT scan of the facial mass

embolization will be the first-line treatment


Here is an X-ray of the elbow in profile made in the context of a trauma. What is (are) the exact element(s) of radioanatomy?


A 45-year-old patient has weakness of the left hemibody predominant in the arm. His entourage tells you that he hit his left side several times when crossing the doors of his home. The bilateral and simultaneous tactile stimulation of the 2 upper limbs is not perceived on the left while the right and left stimulations are perfectly identified when the stimulation is done only on one side. By asking the patient to stare at your nose and alternately mobilizing your hands, he cannot discern the movements of your right hand while your left hand is perfectly perceived. The osteotendinous reflexes are more vivid on the left than on the right. The plantar skin reflex is extended to the left. Which clinical sign(s) should be mentioned?


One patient is being followed for minimal corticosteroid-dependent glomerular lesions syndrome. He suddenly relapses to the decline of corticosteroids. He gained 10 kg in 1 week. Its biology is as follows: albuminemia 12g / l, urea 25 mmol / l, serum creatinine 160 micromol / l, natriuresis 12 mmol / l, kaliuresis 35 mmol / l. ECBU: red blood cells <1000 / ml, leukocytes <1000 / ml, sterile in 24h. What is the most likely cause of acute renal failure in this patient?

functional renal impairment by relative (or effective) hypovolemia

Functional renal impairment by true hypovolemia


Which of the following symptoms is (are) part of the diagnosis of obsessive-compulsive disorder?

fear of committing a reprehensible act in spite of oneself


You suspect multiple myeloma in a 58-year-old patient who comes to see you for impaired general condition and bone pain. It has a peak of monoclonal appearance at electrophoresis. Which exams do you think are relevant to perform? (one or more correct answers)

Determination of beta2 microglobulinemia


Regarding small cell lung cancers, what is (are) the exact answer(s)?

They represent 35% of all bronchial cancers

These are willingly cancers with proximal localization on the airways

They are readily accompanied by superior cava syndrome

Paraneoplastic syndromes are exceptional in this histological form

Treatment is more often surgical in locally advanced forms


Mrs. F, 22, has a microcytic iron deficiency anemia of gynecological origin. You prescribe a martial treatment per os. What do you say to him? (one or more possible answers)

An oral treatment of 1 month is usually sufficient to correct the iron deficiency

Martial supplementation will be continued until serum iron normalizes

Treatment can lead to digestive disorders

vitamin C increases oral iron absorption


With regard to thyroid goiters, which proposition(s) is(are) true?

Iodine deficiency is a risk factor for simple goiter

Tobacco promotes the occurrence of goiters

A scintigraphy is the first-line examination in front of a goiter

The cervico-thoracic CT scan is used to diagnose plunging goiters

the blood test of TSH is essential in the goiter assessment


Which of the following proposals regarding indications for bariatric surgery is (are) true?

BMI should be greater than 40 kg/m2 or 35 kg/m2 if there is associated co-morbidity

The indication for bariatric surgery should be taken in a multidisciplinary consultation meeting for all patients

Surgery can only be offered after failure of well-conducted medical care for at least 6 months

the patient must be over 21 years of age

the patient must agree to be followed for life


With regard to liver tumours, which is (are) the true proposition(s)?

Hepatic adenoma has a hypodense, heterogeneous appearance with fleeting arterial enhancement on injected CT

focal nodular hyperplasia is characterized by the presence of a hypo-intense central scar on T1 MRI

On CT scan, the hemangioma is characterized by a << >> clod enhancement after injection of contrast medium

In the context of chronic liver disease, the first diagnosis to evoke in front of an isolated nodule on CT scan is hepatocellular carcinoma

MRI is used to characterize liver tumours


A patient, whom you have been following for a long time for her active non-progressive multiple sclerosis (MS) and who does not tolerate her treatment, consults you with a scientific article talking about a new treatment that has just been put on the market and that allows good control of flare-ups. She would like to hear from you. You see that this is a non-inferiority trial conducted in patients with non-progressive active MS compared to a reference treatment currently available to this patient. The authors of the study considered that a 10% increase in relapses compared to the standard of care was acceptable as long as there was also a decrease in adverse events. This is a sufficiently powered test with no obvious bias. The relative risk (RR) of relapse is 1.03 (95% confidence interval [1.01-1.06]), and the RR of adverse event is 0.95 (95% confidence interval [0.87-1.02]). The authors conclude that their treatment is interesting because it is non-inferior and without over-risk of adverse events. What can you tell your patient based on these results? (one or more proposals expected)

New treatment controls flare-ups in an acceptable way

New treatment puts less risk of adverse events

The new treatment may be interesting for your patient

Only a superiority trial would make it possible to evaluate the interest of this new treatment

A statistical test of non-inferiority is missing to conclude that the treatment is worthwhile


A colleague wants to set up a study on a new preventive treatment for flare-ups in Crohn's disease. It is a known molecule, already used in other inflammatory diseases and without known serious adverse effects. The study sponsor has sent them documents to fill out and your colleague is asking for your opinion on the regulatory procedures. What do you say to this colleague? (one or more proposals expected)

This is a minimal-risk interventional study

The favourable opinion of a Committee for the Protection of Persons (CPP) is necessary

The authorization of the National Agency for the Safety of Medicines and Health Products (ANSM) is necessary

An information sheet for the patient on the risks involved is necessary


A patient consults for the renewal of his glasses. Your clinical examination reveals acuity at 10/10 th Parinaud 2 in both eyes with the following correction: - 8 (-1 to 150 °) in the right eye and -9 (-1.25 to 135 °) in the left eye. What are the risks associated with its ametropia? (one or more expected answers)


You are called to the home of a 10-year-old child who has acute hives 4 days after a booster vaccine. The lesions are diffuse in the chest and limbs, and rapidly migratory, which impresses the mother of the child. Pulmonary auscultation is free. Blood pressure is at 105/70 mm Hg. What do you offer? (one or more correct answers)

Oral corticosteroid therapy oral solution

H1 antihistamine oral solution once daily

Transfer to emergency department for a few hours of monitoring

Dermocorticoid class 2 for the duration of symptoms

Remote allergological investigation of the current acute episode


You take care of a patient in intensive care. He is married and has 3 children, one of whom is a minor. He designated his only brother as a trusted person. He did not write advance directives. Unfortunately, its clinical situation becomes extremely pejorative with an almost non-existent recovery capacity. You decide to initiate a reflection on a possibility of limitation of processing, in order to avoid unreasonable obstinacy. As part of this reflection, you initiate a collegial procedure as provided for by law. Which person should be consulted in the context of this collegial procedure to seek the wishes expressed by the patient?


A 25-year-old woman, hairdresser, has erythematous and pruritic dermatitis of the hands, located in particular between the fingers, reminiscent of allergic contact dermatitis. What element(s) reinforces the hypothesis of work-related allergic contact dermatitis?

regular use of products containing allergens in the workplace

the presence of positive skin prick tests

the appearance of lesions from the first days of her apprenticeship as a hairdresser


In the context of palliative care, the High Authority for Health defines a concept of vital prognosis << in the short term >>. Which of the following best fits this definition?


A young man of 23 years comes to your office in a painting of asthenia and myalgia; it has no history. On examination, you notice erythematous angina, cervical and axillary lymphadenopathy of one or two centimeters, soft, mobile and painless. What are the biological arguments in favor of infectious mononucleosis? (one or more possible answers)

>10% hyperbasophilic polymorphic lymphocyte cells

> 50% lymphocytes in the leukocyte formula


During the clinical examination of a 62-year-old patient treated for high blood pressure and who consults you for the occurrence of pain in the lower right limb when walking, you have measured humeral pressure in both arms as well as distal pressures and established the value of systolic ankle pressure indexes:  humeral pressures at 162/72 mmHg on the right and 158/70 mmHg on the left arm; left ankle pressure at 148 mmHg (systolic left ankle pressure index at 0.93); right ankle pressures at 120 mmHg (systolic left ankle pressure index at 0.75). What can you say from these results? (one or more expected answers)

the treatment of hypertension is not suitable

This patient is a carrier of arterial disease of the lower limbs

This limping patient is in the stage of exercise ischemia

This patient has significant anisotension

This patient is suspected of aortic dissection


You have been following Mr. X in consultation for 2 years. This 62-year-old patient has a subrenal abdominal aortic aneurysm. The last ultrasound assessment carried out 6 months ago did not show any evolution of the aneurysm which had been measured at 41 mm anteroposterior diameter. He presents today in emergency for the occurrence for more than an hour of a dull and continuous abdomino-lumbar pain. Gentle abdominal palpation is difficult. You find all the peripheral pulses. Blood pressure is measured at 140/70 mmHg in both arms and heart rate is steady at 76 beats per minute. What management strategy do you propose to this patient? (only one answer expected)


You see in the early afternoon at your office a young man of 17 years who has a fever at 39 ° C since this morning. He is brought by his mother who prefers to come to your house because she lives next door, while the hospital is 1 kilometer away. He tells you that he has had a headache for several hours despite taking paracetamol. He vomited recently when he didn't eat anything at noon. The temperature is 39.2°C.  He has trouble bringing his chin back to the sternum, can't help but bend his lower limbs and says he is bothered by street noise. There are no skin abnormalities. What do you do very quickly? (one or more correct answers)

Administration of one gram of ceftriaxone intramuscularly

Administration of oral or intravenous dexamethasone


A 25-year-old woman consults with her 27-year-old husband for a desire for pregnancy. It reports regular cycles of 28 days and periods lasting 4 days. They have been in a relationship for five years and have been trying unsuccessfully to get pregnant for two years (stopping the pill and regular sex). This man has no history and he does not smoke. This woman has never smoked and was operated on for appendicular peritonitis at the age of 16, by laparoscopy. The clinical examination of this man shows normal hair and genitals (testicles and penis) of normal appearance and volume. He is 1m80 tall and weighs 74 kg. The clinical examination of this woman objectifies the scars of laparoscopy, normal breasts and normal external genitalia; She is 1m67 tall and weighs 59 kg. The examination of the cervix under speculum is normal, as is the vaginal examination which does not objectify any abnormality. Among all the examinations that you could prescribe for this interfility assessment, and taking into account your observation (interrogation and clinical examination of this couple), what are the two most important examinations to prescribe to determine the continuation of the care?

Antral follicle count by pelvic ultrasound

Hormonal plasma assays of the woman (FSH, LH, E2, AMH) on the third day of the cycle

Bacteriological, mycological and parasitological vaginal samples


A 40-year-old patient presents to the emergency room. He is known to be diabetic but adherence to treatment is poor. His left foot is deformed. The patient does not complain of pain. At the opening of the dressing, there is purulent discharge and a foul odor. On inspection, the patient is marbled. Blood pressure is at 80/40mmHg. On palpation of the leg, you find a crackling and the local aspect is as follows. Which of the following proposals do you think is appropriate to the situation?

The absence of pain is an element of good prognosis

Mottling and general signs indicate a therapeutic emergency

The functional prognosis of the leg is exceeded

The introduction of antibiotic therapy will be done after deep samples are taken in the operating room


A 42-year-old woman consults for difficulty falling asleep that has lasted for years. She feels very tense and constantly worries "about everything and nothing," she says. This makes her irritable and tiresome. What is the most likely diagnosis?

Depressive episode characterized with anxious characteristics


You see a 25-year-old patient in the emergency room who has a traumatic wound on the lateral side of the knee. A photograph of the lesion is attached. On clinical examination, the patient has a motor deficit of dorsal flexion of the ankle and foot. There is also hypoaesthesia of the back of the foot. Given the location of the wound, which lesion do you suspect in the first place?

Proximal insertion of the long fibular muscle


A 45-year-old woman consults for pelvic heaviness associated with moderate and intermittent left lower back pain. In her history, you note two vaginal deliveries, a cholecystectomy and a pollen allergy without associated asthma. His last cervical smear was two years ago and he was normal. She has contraception by copper intrauterine device. Clinical examination by abdominal palpation and objective vaginal examination a mobile pelvic mass of 10 cm, without ascites clinically identifiable with abdominal palpation. Vaginal secretions are normal in appearance. She weighs 62 kg for 1m59. The urine strip does not objectify leukocytes, red blood cells or nitrites and the search for beta-hCG is negative. What are the two most likely diagnoses?


An 85-year-old woman with a history of breast neoplasia consults for right thigh pain. These pains are permanent. X-rays of the right femur were performed. Which proposal(s) is (are) accurate?

There is weakening of the right proximal femur

There are multiple areas of disappearance of cortical


Regarding the osteology of the facial massif: (one or more expected answers)


You receive a young woman victim of a sports accident, she has a periorbital hematoma. What clinical elements point you to a fracture of the floor of the orbit? (one or more expected answers)


A 5-year-old child fell on his chin, he has a 1 cm wound, you want to eliminate a fracture of the mandibular condyle. What are you looking for at the clinical examination? (one or more expected answers)


An 18-year-old patient is transferred from orthopaedic surgery to follow-up care and orthopaedic rehabilitation. He was operated on 5 days before a major exostosis of the tibiotal joint as part of Bessel Hagen disease (multiple exostosis disease). He wears a resin immobilization for 6 weeks. The pain is localized throughout the leg but predominates at the ankle. The rating on the numerical scale is 6/10. The pain is not relieved by level 1 analgesics at an effective dose. Which of the following proposals should you mention?


A chronic low back pain patient enters a physical medicine and rehabilitation department for a multi-professional rehabilitation programme. He has been suffering from low back pain for 5 years. These continued after acute low back pain at his workplace. Which of the following applies(s) to the management of this patient?

The physiotherapist can work on isometric strengthening of the abdominal strap muscles

Ergotherapy has a role in the management of

The realization of plantar orthotics by an orthopaedic technician is indicated

CBT (cognitive behavioural therapies) can be used to better manage pain

You can apply to the social security fund to apply for recognition of disabled workers.


A 25-year-old patient presents for consultation for inflammatory arthralgia evolving for 6 months. She has Hashimoto's thyroiditis currently substituted with levothyroxine. She has no other symptoms to report and the clinical examination is poor, showing no synovitis. An immunological assessment was performed: - negative anti-CCP antibodies - rheumatoid factor positive >3N - anti-positive anti-nuclear antibodies - anti-SSA and anti-SSB positive >3N - negative native anti-DNA The search for antiphospholipids is positive anti-cardiolipin type (IgG and IgM positive >3N) without anti-b2GPI or circulating anticoagulant. The diagnosis of rheumatoid arthritis can be made

The diagnosis of Sjögren's syndrome can be affirmed

Antiaggregant therapy should be introduced

It will be necessary to recontrol the anti-phospholipids at 3 months


Which of the following proposals characterizes COPD?

The constant association with chronic bronchitis

An incompletely reversible obstructive syndrome

Often accelerated decline in respiratory function


In a 40-year-old man complaining of a tendency to doze off during the day, what symptom(s) correspond to the diagnosis of narcolepsy?

continuous and increasing sleepiness during the day

repeated bouts of abrupt abolition of muscle tone without altered consciousness

transient complete paralysis occurring at the beginning of the night


A ten-year-old has been repeating regularly for more than two years that he has << stomach ache >>. These abdominal complaints, without identified triggering factor, have been the subject of numerous assessments that have shown no cause of injury. Which of the following diagnostic proposals is the most likely?

excessive fear of having a disease (hypochondria)

disorder with functional neurological symptomatology (conversion disorder)

somatic symptomatological disorder (somatoform pain disorder)


What type(s) of event(s) experienced can (can) lead to the development of post-traumatic stress disorder?

Receiving a letter of dismissal without having been prepared

verbal abuse and insults on the phone by an unhappy customer

Serious car accident without physical injury

Direct witness to the sudden death of a loved one by heart attack


You see a 23-year-old patient who complains of nocturnal dyspnea episodes 2 to 3 times a week. These episodes almost always occur around 5 a.m. She sometimes uses a salbutamol spray, which relieves her within minutes. She lives in a seemingly healthy apartment and has no pets at home. It is also sometimes hampered by a shortness of breath in its activities. She does not complain of any other symptoms. She has no other history and does not smoke. When you see her in consultation, her auscultation is normal. Which proposal(s) is (are) accurate?

A nocturnal ventilatory polygraph recording should be performed

An allergy assessment including prick-tests to the main pneumallergens is necessary

an oral corticosteroid test should be undertaken


Regarding confusion in subjects over 75 years of age, which proposal(s) is (are) accurate?

It can be seen in case of meningoencephalitis

An organic etiology is rarely objectified

It is indicative of a decrease in cognitive reserves

It can be complicated by transient urinary incontinence


You see a 9-month-old infant due to contact with his uncle who was hospitalized 15 days ago for tuberculosis with a cave. Her uncle spent 8 days at the child's home 2 months ago. The child was vaccinated with BCG at one month of age. The child's chest x-ray is normal. Regarding the care of the child, which proposal(s) is (are) accurate?

Performing an in vitro interferon gamma release test

realization of gastric tubing in search of BAAR

Prescription for prophylactic treatment with isoniazid and rifampicin


In anticipation of a caesarean section, a hemostasis assessment reveals a PT at 110%, a TCA ratio of 1.4 (42 seconds for a control at 30 seconds) and a fibrinogen at 3.5 g / l. Counts and platelets are normal. The patient has no history or clinical signs. What analysis would you ask for in the first line? (only one answer expected)

TCA correction test (sick TCA + control)

Determination of endogenous pathway factors


A 5-year-old child has febrile exanthema and vomiting. There are large, uniform bright red congestive tablecloths with no healthy skin gaps that predominate at the bending folds. Examination of the mouth and throat shows a partially depapillated saburral tongue and swollen and inflammatory tonsils. The temperature is 39.5°C.  The rapid diagnostic test for streptococcus A is positive. Which proposal(s) is (are) accurate regarding care?

amoxicillin antibiotic therapy for 6 days

search for group A streptococcus in the patient's siblings

search for proteinuria at a distance from infection

Oral antibiotic prophylaxis in the 80-year-old grandmother


When monitoring a patient's pregnancy, intestinal hyperechogenicity was detected on the second morphological ultrasound of the fetus. The assessment of suspicion of cystic fibrosis led to demonstrate in the fetus the presence in the homozygous state of the p.Phe508del mutation at the CFTR locus. Which proposal(s) is (are) the exact proposal(s)?

Full information about cystic fibrosis should be offered to this woman

Recourse to medical termination of pregnancy is possible

A possible negative opinion of a CPDPN (Multidisciplinary Center for Prenatal Diagnosis) cannot be appealed

The patient can apply to the CPDPN (Multidisciplinary Center for Prenatal Diagnosis) through her gynecologist


A 15-day-old newborn is brought in for discomfort. On examination, there is mucocutaneous jaundice and the stool has been discolored for several days according to the parents. He has not regained his birth weight and has difficulty sucking. His capillary blood glucose is 0.3 g / L. What is (are) the possible diagnosis (s) in front of this whole table?


An 11-month-old infant is brought to the emergency room for functional impotence of the right lower limb without any notion of trauma. On examination the mobilization of the right lower limb is very painful and the joint amplitudes impossible to evaluate, there is a bruise on the right cheek The X-ray shows a fracture of the right femur. You suspect abuse. The child is kept at home by his paternal grandmother. What do you do? (one or more exact propositions)

referral to the Brigade for the Protection of Minors


An infant born prematurely at 36 SA is brought to the emergency room at 4 months of age for bronchiolitis. His respiratory rate is 55 per minute, his heart rate is 140 beats per minute, his temperature is 38.2°C.  On clinical examination, there is intercostal pulling, cyanosis and intense cough. Parents report that he drinks about 120 mL of milk out of the 180 mL he used to drink. What is the main criterion of severity in this child? (only one answer expected)


Mrs. T. 57 years old, diabetic, consults you for her annual ophthalmological check-up. The diagnosis of diabetic retinopathy is based on the examination of the fundus, we can find: (one or more exact proposals)


In ophthalmology, about macular edema: (one or more exact answers)

There is an increase in macular thickness in optical coherence tomography

The decrease in visual acuity is usually brutal

It can occur during diabetic retinopathy

It is visible after occlusion of the central artery of the retina


Ms. R., 42, is being treated for multiple sclerosis. It is sent to the ophthalmologist for assessment. Multiple sclerosis can cause: (one or more exact propositions)

An occlusion of the central artery of the retina

Increased retro-ocular pain during eye movements


A 70-year-old woman presents to the emergency room for a rash (see photograph) that appeared a week ago. She has been complaining of pruritus for 3 months. She is a widow, mother of 5 children and lives alone at home. She has no medical follow-up or background treatment. Which of the following tests will be most useful in confirming the diagnosis you suspect?

Direct immunofluorescence on skin biopsy

Indirect immunofluorescence on blood sample

Parasitological skin sampling for sarcoptes


A patient is accompanied by her roommate to the emergency room at 2:00 a.m. Clinical examination suggests meningitis. The results of the lumbar puncture are: leukocytes 10,000 / ml; proteinorachy 2.8 g / l; glycorachia 0.8 mmol / l (blood glucose at 6 mmol / l); Gram-negative cocci in diplococci on direct examination. Which proposal(s) is (are) accurate?

You will report this case as soon as confirmed by the microbiological culture

One of the objectives of mandatory disease reporting is epidemiological surveillance

One of the objectives of reporting is to initiate preventive measures

you prescribe precautions such as << Air>>

you initiate antibiotic prophylaxis for the patient's roommate


A 28-year-old patient comes to the emergency room with a very painful erection that has been going on for 9 hours now. What are the main possible causes of such a state? (one or more correct answers)

Intracavernous injection of prostaglandins


What is (are) the true proposal(s) concerning the urodynamic balance?

It gives information about bladder sensitivity

It includes a measurement of the post-voiding residue

It gives information on bladder compliance


An 80-year-old patient is admitted for a hip fracture. He is being treated for ischemic heart disease with aspirin (75 mg/day) combined with beta-blocker therapy. He has no other antecedent. His consciousness is normal and he is not confused. Its vital parameters are normal. Regarding the intensity of his pain, what is or are the scale(s) usable in this clinical context?


You receive Mrs. V., 67 years old, for a table of alteration of the general condition associated with the following rash, which has been evolving for 4 weeks: Which of the following diagnoses seems compatible with the above clinical presentation?

vasculitis with anti-glomerular basement membrane antibodies


On an anatomo-pathological account of bronchoalveolar lavage, it is specified that the Golde score is equal to 5. Regarding Golde's score, check the exact proposal(s):

It is based on a count of red blood cells

The result indicates intraalveolar hemorrhage in this patient


What is (are) the true proposal(s) concerning spinal anesthesia?

the anesthetic is given directly into the cerebrospinal fluid

It can be performed at the thoracic level

Respiratory complications are among the risks associated with this technique


A 30-year-old patient underwent a scheduled cholecystectomy surgery. He goes to the emergency room 72 hours after the procedure because he is not feeling well. The HR is at 115/min, the BP is at 85/35 mmHg, the FR is at 30/min, the SpO2 is at 94% in ambient air. The patient is stuporous and the diuresis of the last hours is zero. What type of shock seems most likely to you? (only one answer expected)


What biological abnormality(s) usually accompanies moderate vitamin D deficiency in adults?


What clinical element(s) does (make) refute the diagnosis of Parkinson's disease at the beginning of the disease?


Regarding meningiomas, what is (are) the exact answer(s)?

they can develop as part of neurofibromatosis type 1


Which proposal(s) for cotrimoxazole is (are) correct?

Cotrimoxazole is a combination of 2 anti-infective agents

It is naturally active on staphylococci and Escherichia coli

Cotrimoxazole may have an anti-parasitic action


An 85-year-old diabetic, hypertensive patient is hospitalized in front of the sudden appearance of a predominant rash with large folds of flexion and which gradually generalizes. The patient is dehydrated, her temperature is 38.5 ° C.  She has neutrophil hyperleukocytosis (8500/mm3). The biological balance is also normal. The entourage tells you that she presented a picture of acute bronchitis 3 weeks ago. In the face of a persistent cough, treatment with amoxicillin combined with codeine and prednisolone was introduced 48 hours ago. His son tells you that his mother has already had many allergic reactions to antibiotics.

acute generalized exanthematous pustulosis


A 38-year-old patient underwent surgery for a non-functional pituitary macroadenoma, expressing beta-LH to immunohistochemistry, without markers of tumor aggressiveness. The postoperative period was marked by the occurrence of corticotropic insufficiency. Which proposal(s) is (are) accurate?

treatment should include fludrocortisone

The dosage of the treatment is adjusted according to the results of the cortisolemia at 8h

The return to normal of corticotropic function should be controlled by the 24-hour cortisolurie assay

Substitution of this deficiency renders annual influenza vaccination ineffective


Regarding the characteristics of carcinoma in situ, which is (are) the exact proposition(s)?

It can interest the entire height of the epithelium

He has an excellent prognosis after treatment


Regarding the prefixes/suffixes used in TNM classifications, which proposal(s) is (are) accurate?

gives it stage after neoadjuvant treatment


Which of the following recommended treatment options for impaired ejection fraction heart failure, in addition to certain beta-blockers, has (have) demonstrated a decrease in mortality?

angiotensin-converting enzyme II inhibitors


A 58-year-old patient, a former carpenter, is referred for unilateral nasal obstruction and you mention the diagnosis of adenocarcinoma of the ethmoid. Which proposals are correct? (one or more expected answers)

there may be repeated epistaxis homolateral to obstruction

It is a disease entered in the schedule of occupational diseases

Cervical lymphadenopathy is common at the time of diagnosis

the tumour may be masked by a reactive polyp

the presence of exophthalmos would be a sign of an advanced tumor


One patient had a brief loss of consciousness. You question him and the witnesses. What are the arguments in favor of syncope? (one or more correct answers)

Brief, low-amplitude muscle twitching of the shoulders 20 seconds after loss of consciousness

inability to get up on one's own after returning to consciousness

prolonged drowsiness after return to consciousness

feeling strange before loss of consciousness

palpitations before loss of consciousness


A couple consults you because of a pregnancy project. The woman is 32 years old and the man is on chronic hemodialysis due to X-linked Alport syndrome. What are the exact proposals? (one or more correct answers)

Man cannot transmit the disease if they have a son

the child will necessarily carry a trait of the disease

It is better to resort to postnatal diagnosis if it is a son

It is better to resort to prenatal diagnosis if it is a girl

Hemodialysis of the husband contraindicates the plan of pregnancy


What is the main reason for chronic kidney disease to shorten life expectancy? (only one answer expected)

increased risk of cardiac conduction disorder


A 42-year-old man was admitted to intensive care 48 hours ago for shock complicating acute pneumococcal pneumonia. Despite the correction of hemodynamic failure, it remains oliguric, and serum creatinine has increased from 78 μmol/L at intake to 134 μmol/L. What is (are) the exact proposal(s)?

Acute tubular necrosis should be mentioned

It is necessary to evoke a cortical necrosis

It is necessary to evoke a secondary renal localization of the infection


In what situations is anemia of central origin? (one or more correct answers)


Your 55-year-old patient has been a cashier in a supermarket chain for 30 years. He has incomplete paraplegia following a road accident that occurred during his vacation 8 months ago. He is currently still on sick leave. What accompanying measures do you recommend? (one or more proposals expected)

apply for recognition of the status of disabled worker

request a pre-resumption visit with your occupational physician

Request recognition in a commuting accident


A 25-year-old patient, smoker (10 cigarettes a day since the age of 15), is referred for consultation for symmetrical polyarthritis affecting the wrists, proximal interphalangeal, and metacarpophalangeal, present for 2 months. She has a history of pericarditis 6 months before your consultation, which has improved on nonsteroidal anti-inflammatory drugs. However, she retains a persistent deep inspiration discomfort. She tells you that she has been sensitive to cold since the age of 15 (with fingers that turn white), and also sensitivity to the sun since she took the last summer of significant "sunburn" on the face and décolleté, while she had little exposure. She does not have a feeling of dry eye or dry mouth. The biological analyses are as follows:

The whole is in favor of inflammatory myopathy

the diagnosis of lupus can be affirmed even in the absence of native anti-DNA antibodies

The whole is in favor of rheumatoid arthritis

there is probably a secondary Sjögren's syndrome


What biological abnormality(s) may be related to an inflammatory syndrome?


A 48-year-old woman consults for paresthesias of the anterior surface of the thigh. You suspect cruralgia. What is (are) the true statement(s)?

It can be caused by a foraminal disc herniation L5-S1

It can be caused by a paramedian disc herniation L4-L5

A motor deficit of the quadriceps can be observed

The pain may radiate to the anterior surface of the tibia

It can be caused by reducing the size of an osteoarthritic conjugation foramen


Regarding the judicial report, which is (are) the exact proposal(s)?

It can only be performed by a health professional

It is one of the authorized derogations from professional secrecy

It is done orally during a telephone communication to the public prosecutor

If written by a doctor, it increases the punishment of the perpetrator

It makes it possible to warn the judicial authorities of suspected violence in a minor


Regarding the autopsy, which proposal(s) is (are) accurate?

A medical autopsy may be requested by the doctor in order to investigate the causes of death

The family of the deceased may refuse to have a forensic autopsy of the body performed

The family of the deceased is the recipient of the conclusions of a medico-legal autopsy

Medical autopsy is governed by the same laws as organ harvesting

Family cannot see body before medical autopsy


In case of metastatic pulmonary adenocarcinoma, the search for therapeutic molecular targets: (one or more exact answers)

can be made from formalin-fixed biopsy material and included in paraffin

determines the therapeutic choice of first-line treatment

requires prior morphological pathological examination


For osteosarcoma of the lower end of the femur, check the exact proposal(s):

It consists of a proliferation of osteoblasts

The most frequent metastases are pulmonary

Its diagnosis requires a histo-radiological confrontation

Its diagnosis requires molecular confirmation

Surgical treatment from the outset is recommended


An 89-year-old patient comes to consultation for a fall. He has had three falls in the past year. What factor(s) will you look for at the interrogation and clinical examination as a risk factor for osteoporosis in the elderly?


A patient has a fracture of the third thoracic vertebra and a fracture of the first lumbar vertebra. What are the elements in favor of vertebral fractures due to bone failure? (one or more correct answers)

Disappearance of the anterior cortical of the vertebral body

Respect for the pedicles of the fractured vertebra


Which first-line examination(s) for etiological purposes should be requested in the face of hyperferritinemia? (one or more expected answers)


Which semiological element(s) of imagery enter into the definition of a fluid pleural effusion?

In radiography, it is a declivated opacity, basi-thoracic if the patient is standing

In radiography, in case of partitioned effusion, the internal limit of opacity can become convex

In radiography, there is an airy bronchogram within the abnormal opacity

There is an erasure of the diaphragm in radiography

Pleural ultrasound is the technique of choice for the diagnosis of fluid effusion in a lying patient


Among the following proposals, what is the main clinical manifestation of an infection of the gastric mucosa by Helicobacter pylori? (only one answer expected)


A 48-year-old non-diabetic patient experienced multiple episodes of hypoglycemia. What proposals are in favour of hypoglycaemia by hidden injections of rapid insulin? (one or more correct answers)

Pro-insulin increased during hypoglycemia

No sign of neuroglucopenia during episodes


A 6-year-old boy is brought to a dermatology consultation by his mother. He lives in rural areas and attends school. He has been presenting for 1 month alopecic plaques that continue to spread despite the prescription of topical corticosteroids. What diagnosis(s) do you mention?


Which bacterium(s) are the main responsible bacteria(s) for acute purulent otitis media?


Which of the following infectious agents is usually associated with a biological mononucleosis syndrome?


You receive the result of the first toxoplasmosis screening serology of a patient who is 12 weeks pregnant with amenorrhea (AS). This is positive with the presence of IgM and IgG. Which proposals are correct? (one or more correct answers)

an IgG avidity test should be prescribed

It may be a primary infection in early pregnancy

it may be an old infection prior to the period of conception

amniocentesis with toxoplasma testing should be performed

the risk of mother-to-child transmission is high


You are caring for a patient who opens their eyes to verbal stimulation, has an appropriate motor response to a painful stimulus, and responds confusedly. Regarding its Glasgow score, which proposal(s) is (are) accurate?

It takes into account brainstem reflexes


When faced with this type of lesion in a child, what is the main diagnostic hyothesis? (only one exact answer)


What are the possible side effects of strong opioids? (one or more correct answers)


Regarding Takayasu's disease, what are the exact proposals? (one or more correct answers)

It can be revealed by high blood pressure

It belongs to the group of vasculitis of medium-sized vessels


About bacterial endocarditis, which is (are) the exact proposal(s)?

It occurs more frequently on an injured valve than on a healthy valve

It occurs more frequently in valvular heart disease of the right heart than of the left heart

The elemental lesion is composed of fibrinoplatelet debris

It occurs preferentially on an atrial septal defect

Patients with prosthetic valves are at higher risk of endocarditis


The diagnosis of brain death requires: (one or more exact answers)

Check the absence of spontaneous breathing by extubating the patient

Check for the absence of brain activity by a brain MRI with injection

To be ascertained by a doctor practicing outside the establishment where the patient is hospitalized

To verify clinical or paraclinical criteria established by decree


About sickle cell disease, which is (are) the exact proposal(s)?

It is a disease of membrane origin of the red blood cell

It is the most common genetic pathology of red blood cells in the world

Sick subjects are heterozygous for the causal mutation

Sickle cell screening is offered to all children born in France

A sick person who unites with a spouse from northern Europe has a high risk of having a sick child


In case of sarcoidosis, what are the exact answers regarding the granuloma? (one or more correct answers)

It can be seen on skin samples of erythema nodosum

It can be seen on accessory salivary gland samples


A 30-year-old woman consults following an episode of spontaneous deep vein thrombosis. At the interrogation, you find a history of pulmonary embolism at age 50 in the mother. You suspect constitutional thrombophilia. Which analysis(s) do you think are relevant?

The determination of protein Ce of protein S

The search for a mutation of the II factor


Mr. R., 54 years old, comes to consult for the discovery of a lump in the groin. On examination, you palpate a left inguinal lymphadenopathy 2.5 cm in diameter. What should your clinical examination include? (one or more possible answers)

Inspection of the skin of the entire left lower limb

Inspection and palpation of the external genitalia


A 45-year-old man consults the emergency room for severe pain in his right wrist that woke him up this morning. You find hyperthermia at 38.5 ° C.  The wrist is red, warm and very swollen. You suspect septic arthritis. Which of the following proposition(s) is (are) correct?

Standard radiography should be performed

Joint puncture is useful and easy to perform in emergency

MRI is part of the systematic assessment

The scintigraphy may be indicated in a second step to look for osteitis


A young student wakes up the day after a party with toxic abuse and notices a deficit in her right arm. You mention paralysis of the right radial nerve by compression at the tricipital gutter. Which of the following proposals corresponds to this diagnosis?

A sensory deficit of the entire posterior surface of the forearm

An abolition of the cubito-pronator reflex


The diagnosis of childhood autism spectrum disorder is based on:


An 8-year-old child comes to your consultation for swallowing pain, earache and fever. Examination of the objective throat of inflammatory tonsils. What is your attitude?

You have a sample for streptococcus and rhinovirus PCR taken at the laboratory

You perform a strep rapid diagnostic test in the office

You prescribe symptomatic treatment with Ketoprofen

You prescribe amoxicillin + clavulanic acid as a first line

You prescribe in-the-ear antibiotic therapy


Among the following proposals concerning the entourage of a patient with meningococcal meningitis, indicate which one(s) is/are right.

Ciprofloxacin is a second-line antibiotic prophylaxis

Antibiotic prophylaxis aims to eradicate pharyngeal carriage in contact subjects

Antibiotic prophylaxis is offered up to 1 month after last contact with the index case

Antibiotic prophylaxis is based primarily on rifampicin

Vaccination may be offered in combination with antibiotic prophylaxis


A 92-year-old patient has seen this tumor develop on the left nasal wing for a few months. The tumor is nodular, with bleeding ulceration on the surface. The patient is in good general condition, with no notable history. She worked as a farmer for 50 years. What is your diagnosis?


A 64-year-old man has this chronic rash reaching 45% of the body surface area, evolving for about ten years. He has a history of hypertension treated with losartan, hydrochlorothiazide and atenolol, and smoking valued at 25 pack-years, as well as daily alcohol consumption. Which of the following measures do you think is appropriate for the management of this patient?

There are relatively few situations where this proposal is not checked off at EDN

Replacement of sartan with a calcium channel blocker

Very strong local dermocorticotherapy with clobetasol 30 grams per day


You receive a feverish 16-month-old infant in the emergency room, whose mother is worried because she finds him tired. Which of the following is(are) in favor of a serious infection?


An 80-year-old patient consults his general practitioner at the request of his wife for an annual check-up. What symptom(s) could you link to age-related androgen deficiency?


A 67-year-old patient consults a urologist because his father and brother have prostate cancer. What symptom(s) would be in favor of prostate cancer?


What advantage(s) does permanent implant brachytherapy offer in prostate cancer compared to conventional irradiation?

Lower risk of sequelae erectile dysfunction


Ms. M., 35 years old, presents for a dull pain in her right calf that has existed since the previous evening. During the interrogation, you find the existence of arterial disease of the lower limbs in the father of this patient, which led to a leg amputation at the age of 78. Despite this hereditary history, Ms. M. reports smoking quantified at half a pack of cigarettes a day since the age of 18. You also find Raynaud's syndrome in the patient's mother. Ms. M. has no treatment and has just presented a spontaneous miscarriage for which she remained hospitalized 24 hours. Clinical examination reveals an increase in the circumference of the edema of the right calf by 1 cm compared to the contralateral calf. There is also an increase in skin heat in the right lower limb as well as an increase in the visibility of the superficial veins and pain on deep palpation of the calf. In this patient, what element(s) should be taken into account to establish the clinical probability score?

Increased right calf circumference by 1 cm

Increased visibility of superficial veins


A 45-year-old woman consults for a right parotid mass. Which of the following criteria is (are) that directs you towards the diagnosis of pleomorphic adenoma?

Spontaneous hyper signal in T2 sequence on MRI


What element(s) contraindicate(s) the organization of palliative care care at home?

Lack of consent and consent of the patient

The fact that the patient lives in a building without an elevator

The fact that the patient has more than 2 electric syringes

The fact that the patient lives alone at home


On what argument(s) do you assess the seriousness of an epistaxis?


In order to avoid any << unreasonable obstinacy>> and in accordance with the terms of the law of 2 February 2022 known as the Leonetti-Claeys <<>> law, a treatment may be suspended or not undertaken, in accordance with the patient's will if the following condition(s) is (are) respected.

It has no other effect than the only artificial maintenance of life


A 44-year-old man's bank check revealed hypokalemia at 3.2 mmol / L. What is the exact proposal(s)?

The patient must be hospitalized in an emergency

A urine ionogram on a sample should be requested

Hypokalaemia poses a risk of complete arrhythmia by atrial fibrillation

In case of associated high blood pressure, it is necessary to look for a chronic intake of licorice

In case of associated high blood pressure, it is necessary to seek a cocaine intake


What advice(s) can you give to a 78-year-old man with hypertension effectively treated with a low-salt diet and ACE inhibitor, and who is worried about the announcement in the media of an impending heat wave?

To suspend your salt-free diet during the heat wave

Quantify your diuresis during the heat wave

Bring urine strips to measure daily urine density


What is(are) the characteristic(s) of therapeutic part-time?

It can be prescribed by the general practitioner

It may be prescribed by the occupational physician

It can correspond to a recovery of 80 percent of a full-time equivalent.


A 38-year-old woman is hospitalized after an emergency caesarean section at 36 weeks of amenorrhea for severe pre-eclampsia with HELLP syndrome. She is anuric upon admission. Which additional examination is a priority?


A 45-year-old woman has been consulting for persistent pelvic pain for a few weeks. She tells you that her last period was 3 weeks ago and she reports a few episodes of bleeding between periods, but very few. An endovaginal pelvic ultrasound was performed. This objective a moderate fluid effusion in the Douglas cul-de-sac and a heterogeneous right adnexal swelling measuring 3 cm of major axis, painful at the passage of the ultrasound probe. The objective clinical examination a flexible, slightly sensitive abdomen in the iliac fossa, defenseless. Blood pressure is 120/60 mmHg. The temperature is 37.3°C.  The heart rate is 65 bpm. What plasma dosage(s) do you prescribe as a first-line treatment?


You receive a patient suffering for 2 weeks from a depressive syndrome. He tells you that he has been working more than 50 hours a week for months, regularly bringing home work and feeling << drained >>. In addition, he tells you that his executive reproaches him daily and unjustified since he refused his advances. He wishes to apply for recognition as an occupational disease. Which element(s) do you indicate on the initial medical certificate?

Burnout is not, today, a recognized pathology

Reactive anxio-depressive syndrome following sexual insistence

The precise date of the advances of its executive


At 25 years old, you have just passed your passage in the 38th cycle and you arrive in a new city as a first-semester intern, in the adult emergency room of the CHU. You had never been seen in school medicine or occupational medicine before, and you lost your health record a long time ago. You have no notable history, other than atopy in childhood, and two unreported blood-exposure accidents during your surgical rotations. You are summoned for an occupational medicine consultation. What should the occupational physician do (one or more exact proposals)?

Look for latex irritation dermatitis due to a history of atopy

Performs an anti-Hbs antibody test to check for immunization against hepatitis B virus

Require you to be vaccinated with the dTP vaccine

Flu vaccine is highly recommended but not mandatory


You are seeing a 40-year-old patient with non-calcifying rotator cuff tendinopathy in the right shoulder. She is right-handed and works as an oyster worker. She explains that she has to handle bags of oysters weighing 20 kg to unload the barge, which leads her to have to abduct her shoulders. In her history, she is followed for well-balanced insulin-dependent diabetes. She quit smoking 3 months ago and started learning tennis. Which element(s) is (are) in favor of a potential occupational origin of his pathology?

Pathology is lateralized on the dominant limb

You noticed the pathology while it was active

The gestures performed are at risk for the rotator cuff


A 75-year-old woman has been consulting for bleeding externalized through the vagina for two months. She weighs 89 kg for 1 m 50. In her history, there are two vaginal deliveries and high blood pressure. She does not smoke and has no allergy. What is the most likely diagnosis?


A 27-year-old pregnant woman is seeking urination burns that have been ongoing for 24 hours. She is at 23 weeks of amenorrhea. This is her first pregnancy. She has no allergies and no history. The objective clinical examination a pain at the shaking of the right lumbar fossa. On vaginal touch, the cervix is long, posterior and closed. Blood pressure is 125/65 mmHg. His heart rate is 78 bpm. Its temperature is 38.1 °C.  The urine strip objectifies the presence of proteins, leukocytes, blood and nitrites. A cytobacteriological examination of urine was prescribed. Direct examination shows 10,000/mL leukocytes and gram-negative bacilli. Which antibiotic treatment is most relevant at this stage?


Which of the following pathologies can (may) promote the appearance of cataracts?


A 72-year-old patient has bilateral primary open-angle glaucoma treated with eye drops based on prostaglandin analogues and beta-blockers (fixed combination). Which of the following tests may have been used for the diagnosis of his glaucoma (one or more exact proposals)?


You are following Mrs. F., aged 32, for chronic thrombocytopenic purpura progressing by flare-ups. Her platelet count remains around 20 G/L. What advice(s) do you give to this patient?


A 67-year-old patient arrives at the emergency department with fever at 39°C with chills of sudden onset. He is very asthenic. His wife who accompanied him found him pale and tired for several days. The first results on the hospital server show hemoglobin: 8.2 g / dL, leukocytes 2.8 G / L, polynuclear 0.41 G / L, platelets 36 G / L, reticulocytes 20 G / L. The automaton has not returned a formula and the smear has not yet been read. Which diagnosis(s) is compatible? (one or more exact propositions)


A 19-year-old patient is referred to you for consultation because of repeated episodes of upper airway infection (ear infections, sinusitis) and bronchitis, with multiple antibiotic therapies (5 to 10 per year) in the last five years. A serum protein electrophoresis performed in the city shows the following results albumin 44 g / L - alpha1-globulins 2.61 g / L - alpha2-globulins 4.7 g / L - beta1-globulins 3.8 g / L - gamma globulins 3 g / L. blood lymphocyte immunophenotyping finds a decrease in switched memory B lymphocytes, without associated T-cell deficiency. To which of the following microorganism(s) does your patient have an increased susceptibility?


A 62-year-old patient is referred by her general practitioner to the emergency department for pallor. The blood count is below.
 Reticulocytes are at 40 G/L. You mention: (one or more expected answers)


A 37-year-old patient suffered a sprained right ankle 4 months ago. She complains of pain in the lower right limb when walking with allodynia of the upper surface of the right foot, equine varus of the right foot when walking, and edema of the foot. You mention a complex regional pain syndrome. What technique(s) can (s) be used by the physiotherapist?


About the decision on medical termination of pregnancy (IMG), which is (are) the exact proposal(s)?

The couple can make the IMG decision on their own if the disease is particularly severe

Serious and incurable diseases are listed in a list giving entitlement to an IMG

IMG is only allowed if it is certain that the unborn child has the disease

The IMG is authorized by law with no term limit

The particular severity of a disease meets certain objective criteria such as the risk of premature death or cognitive impairment.


A young man of 25 years old consults you for acute low back pain occurred when getting up from his bed, radiating above 2 knees. He is addicted to the hard drugs he injects. All mobility of the spine is limited, pain in standing position is evaluated with an EN (numerical scale) of 7/10. You find on the general examination a systolic heart murmur. He tells you that he has been coughing for several days. What do you suspect in this patient? (one or more possible answers)